[Friday Wrap Up, Part II!]: 26.5

So I did a new thing this week, which was to write my [Friday Wrap Up] before Friday…gaspI know! But there were so many things already, I felt I had enough for a post.

Then I found a bunch of new things…so I’m back, to share a few more pieces.

Related to the theme of changing narratives around adoption…Reuters has blown it out of the ballpark with this stunning, heartbreaking series that investigates the underground “re-homing” scene. 

Through Yahoo and Facebook groups, parents and others advertise the unwanted children and then pass them to strangers with little or no government scrutiny, sometimes illegally, a Reuters investigation has found. It is a largely lawless marketplace. Often, the children are treated as chattel, and the needs of parents are put ahead of the welfare of the orphans they brought to America.

The practice is called “private re-homing,” a term typically used by owners seeking new homes for their pets. Based on solicitations posted on one of eight similar online bulletin boards, the parallels are striking.

I don’t know which is more sad to me, the fact that this is happening at all…or the fact that it’s been happening for years and only now are people starting to get it. Some people might argue that articles like this will deter “good, well-intentioned” people from considering adoption, increasing the number of children in a broken system. This argument fails to do justice to the fact that it’s a broken system…and the only way we can start changing that system is by shining a strong light on it, exposing the dark side and that has gone unexamined.

The Adoption Policy and Reform Collaborative has issued an official statement in response:

The APRC is acutely aware of the unethical and dangerous “rehoming”* practices that have occurred for more than a decade. We have expressed our concerns with alarm. We look forward to collaborating, from the perspective of adult adopted persons, with other powerful change agents to fully, appropriately, and ethically address adoption disruptions and dissolutions.

*Please note: while the APRC recognizes “disruption,” “dissolution,” “displacement” and “re-homing” as industry terms, APRC members regard these terms as sanitized and rationalizing practices terminating the parent/child relationship. While using industry vernacular in this statement we do not endorse their usage for the reasons indicated.

 The ‘Pullout Generation’ is Here. What Do Sex Educators Think?

In response to this New York Magazine article, RH Reality Check’s Martha Kempner offers this follow-up on the idea of “pulling out”, or coitus interruptus, as a method of birth control. Kempner focuses in on research around efficacy of withdrawal, condoms, and other contraceptives, pointing out the obvious, which is withdrawal, when practiced by someone who really knows their body well and has good self-control, is still better than no contraception at all.  Kempner quotes Deb Hauser, president of Advocates for Youth:

“I believe that young people should be given honest, accurate information. They have the right to all of the information and when empowered with that information are more able to take agency over their sexual health. That means we should teach youth about withdrawal as an option when they don’t have anything else with them. Withdrawal is much more effective at preventing pregnancy than using nothing. To withhold that information is misguided.”

On the theme of health disparities, this is probably not new news…but still, glad to see folks are bringing it up:

‘Baby-Friendly Hospitals’ Bypass Black Communities

A Women’s eNews analysis finds that 45 percent of U.S. Baby-Friendly hospitals are in cities and towns that have African American populations of 3 percent or less.

A full 83 percent of U.S. Baby-Friendly hospitals are in communities where the African American portion of the population is 13 percent or less.

This geographic segregation of breastfeeding care and support may play a significant role in the lower breastfeeding rates among African American mothers, which in turn means the mothers and the infants do not enjoy the health benefits of breastfeeding.

And finally, this infographic on the geography of unintended pregnancy from Huffington Post, which really speaks for itself:

[Friday Wrap Up]: 22

So many interesting items in the news, it’s hard to keep up with it all. Here’s what I’ve been saving:

American Way of Birth, Costliest in the World

When she became pregnant, Ms. Martin called her local hospital inquiring about the price of maternity care; the finance office at first said it did not know, and then gave her a range of $4,000 to $45,000. “It was unreal,” Ms. Martin said. “I was like, How could you not know this? You’re a hospital.”

Like Ms. Martin, plenty of other pregnant women are getting sticker shock in the United States, where charges for delivery have about tripled since 1996, according to an analysis done for The New York Times by Truven Health Analytics. Childbirth in the United States is uniquely expensive, and maternity and newborn care constitute thesingle biggest category of hospital payouts for most commercial insurers and state Medicaid programs. The cumulative costs of approximately four million annual births is well over $50 billion.

How Long Can You Wait to Have a Baby? I’m sure this is somewhere in the minds of many of the midwifery students out there in the world…

The widely cited statistic that one in three women ages 35 to 39 will not be pregnant after a year of trying, for instance, is based on an article published in 2004 in the journal Human Reproduction. Rarely mentioned is the source of the data: French birth records from 1670 to 1830. The chance of remaining childless—30 percent—was also calculated based on historical populations.

In other words, millions of women are being told when to get pregnant based on statistics from a time before electricity, antibiotics, or fertility treatment. Most people assume these numbers are based on large, well-conducted studies of modern women, but they are not. When I mention this to friends and associates, by far the most common reaction is: “No … No way. Really?

Getting Men to Want to Use Condoms I would love to think that some new creative condom will help increase use of contraception…but honestly…I think it’s gonna take more than condoms, no matter how cool.

Profiting from Pain This is mostly a placeholder for me to remember, once we get to opioids in pharmacology.

Disabled People Say They, Too, Want a Sex Life, and Seek Help Attaining It

But many disabled people, including Ms. Rebord, believe that they have a right to sexual assistance, a psychological and physical means to overcome their inhibitions and empower them to find love.

Marcel Nuss, a severely disabled father of two who breathes with an artificial respirator, is the author of “I Want to Make Love.” The book describes his personal fulfillment through love with his former wife and a sex life with escorts. His experiences, he said, persuaded him to support the use of sexual surrogates.

Institute for Healthcare Improvement’s Open School: as if I need more reading…but still!

Contraception

I’ve been participating in a great online course on contraception through Coursera. The 5-week course is taught by Jerusalem Makonnen, a family nurse practitioner and professor at UCSF’s School of Nursing. It features weekly video lectures, readings and some short writing assignments that are peer-assessed. I’m learning a lot of great details about the various forms of contraception, their efficacy and safety, contraindications, as well as getting a better overview of contraception use and barriers globally.

This week we’re discussing long-term methods, which include intrauterine devices and sterilization. It’s been interesting to observe the rise in popularity of IUD’s…providers love them and so do many patients. I use the Paragard myself and have had no complications. However, when this article came out last December in the New York magazine, it definitely caught my attention.

There was something about the use of the words IUD and evangelism in the same sentence that gave me pause. Yes, it’s a wonderful birth control option. But it doesn’t work for everyone. I personally know several women for whom it caused several months of extreme discomfort before they opted for removal. And let’s not even get into the can of worms conversation about access. The fact of the matter is, IUD’s are often not financially feasible for folks without insurance coverage.

I guess what I’m really trying to say is that I think it’s important to find a balance when counseling women about their options. I worry a little that women will start to feel pressure to choose the all-exalted IUD even if it’s not something they feel comfortable with. As a clinician, I can see a lot of benefits to using an IUD…but I think one of the things clinicians can have a harder time grasping is the personal, religious, or philosophical reasons why a woman might not want a device placed in her uterus, even if she is fully committed to not getting pregnant.

As a peer pregnancy options counselor, doula and former patient support advocate at my local Planned Parenthood, I often speak with women who are hesitant to use contraception for a variety of reasons: worry about the effect of hormones in the body for long periods, worry about worse periods, or no periods. Some women I speak with express a hesitation to alter their cycles–they feel a deep spiritual connection to these cycles. Or, the thought of having a plastic device in their uterus…well, it just doesn’t sit right with them.

Ultimately, I think that while we can counsel and educate all we want about the benefits of long-term, reversible methods, it needs to come from a place of deep compassion, understanding, and genuine curiosity. This curiosity keeps us open and humble and prevents us from assuming that just because a contraceptive method is perfect on paper, that every woman will fall in love with it. I do appreciate that this course also covers counseling approaches. I can’t wait to actually be able to talk about this stuff with future clients…

IUD Evangelism: The Birth Control That Converts