The other day, a quiet 17-year-old, let’s call her Angie, walked into the only abortion clinic in Mississippi. A wiry teen with coffee-colored skin and delicate features, Angie had recently screwed up the courage to tell her mother she was pregnant. The pregnancy had blindsided her. (Sure, she had been nauseated and had thrown up a few times, but she figured it was just the stomach bug going around.)
But the real shock hit her inside the unassuming stucco clinic in Jackson. An ultrasound revealed that Angie was not eight or 10 weeks along, as she and her mother had assumed, but 14 weeks into her pregnancy. Then, as they were absorbing the news, a staff member informed them that at that stage of pregnancy, Angie wouldn’t be able to get an abortion anywhere in the state.
One year ago, Mississippi became the only state in the country where abortion is limited to the first 12 weeks of pregnancy. If the lone doctor, Joseph Booker, at the lone Mississippi clinic, the Jackson Women’s Health Organization, were to perform any abortions after the first day of that week, he could face jail time. Angie and her mother aren’t the only ones in the dark about the change, though; most patients who come to the clinic have no idea of the 12-week cutoff — fully four weeks earlier than the 16-week limit the clinic had observed for the previous decade and at least 10 weeks earlier than federal law allows. Several other states have also shortened the window in which abortions are available, though not as drastically. In South Carolina, Indiana, Alaska and South Dakota, for instance, abortions are only available up to the 6th day of the 13th week of pregnancy.
Along with the ban on so-called partial birth abortions, which was upheld by the Supreme Court in April, the new limit in Mississippi has been a way for abortion opponents to target relatively advanced pregnancies. While the vast majority of abortions take place in the first 12 weeks (also known as the first trimester) of pregnancy, some 11 percent take place after that point.
Problems with the fetus are sometimes the reasons for later abortions — and are often the examples pro-choice advocates bring up to illustrate the need for them — but the majority of relatively late abortions have more to do with the nitty-gritty realities of everyday life. And here, in the poorest state of the country, all too often the reasons for delaying the procedure have to do with the struggle to come up with the money to pay for it.
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The state law passed in January 2006 requires that any Mississippi facility where abortions are performed after the 12th week of pregnancy be approved to do so by the Mississippi Department of Health after complying with a new set of regulations. So while the only Mississippi clinic already had met rigorous rules determining the width of its hallways and the size of its parking lot, for example, it now had to spend almost $100,000 to meet the new standards, which require costly changes like hiring another full-time nurse and expanding the hours of the ultrasonographer.
The exacting letter of the law is in keeping with the kinds of restrictions the state has already placed on abortion — which include a mandatory 24-hour waiting period after counseling and a requirement that minors inform both parents before having an abortion — but the way this law is being enforced in itself amounts to “a form of harassment,” according to Susan Hill, president of the National Women’s Health Organization, which oversees abortion clinics in five states, including Mississippi.
Hill says the Jackson clinic complied with most of the regulations almost a year ago. By late July 2006, the only outstanding requirement, she says, was that the clinic’s doctor have admitting privileges at a nearby hospital. Though Dr. Booker applied to several hospitals, including Women’s Hospital in Jackson, none would grant him the status. “Some wouldn’t even send an application,” says Hill. “They said they didn’t allow abortions in their hospital, even though the arrangement isn’t so he can do abortions there, it’s for treating complications.”
On Dec. 14, 2006, the Mississippi State Board of Health, which is responsible for enforcing the law, recommended that the clinic’s existing transfer agreement with a nearby hospital should suffice. But, in the six-and-a-half months since then, the clinic has still not received a definitive response from the health department about its status.
Liz Sharlot, director of communications for the Mississippi Department of Health, says that the clinic must apply yet again before it can be granted the go-ahead to perform abortions after the 12th week. According to Sharlot, the delay thus far is due in part to the fact that the Board of Health, which can make the final decision about the clinic’s fate, was disbanded in late March. Sharlot says a new board is expected to meet July 2 and may reconsider the issue.
In the meantime, the holdup — be it due to bureaucratic snafus or intentional defiance — translates into serious hassles, and perhaps worse, for young women like Angie. After having already driven more than an hour west to get to Jackson, Angie and her mother must now go back east into Alabama to a Montgomery abortion clinic. The nearly four-hour trip will cost them gas money they don’t have to spare, and the extra day of travel could cost both of them their jobs in the cafeteria of a military base.
A 2005 study found that 21 percent of women getting abortions after the 13th week cited fetal health problems as the reason. (In fact, most genetic problems are detected by testing that happens after the first trimester, such as amniocentesis.) Another 10 percent referred to their own health issues. But perhaps even more common are scenarios like Angie’s, in which delay is caused by some combination of obliviousness and denial. Even two or three missed periods can be chalked up to irregularity. And who doesn’t get tired and gain weight sometimes? Plenty of women, particularly younger ones, don’t let themselves think about what might be going on in their bodies. Others take the deer-in-the-headlights approach: be still, do nothing, and hope the oncoming truck of pregnancy will miraculously go away.
There are probably as many situations giving rise to these later abortions as there are women who have them. I once spoke with a woman whose husband of a few weeks, a seemingly reasonable and gentle man she had known for less than a year, had thrown her into a wall when she was three months pregnant. One month later, as she was weighing her options, she found legal documents that included photos of a bruised and battered woman and discovered he had spent time in jail for attacking an ex-girlfriend. A few weeks after that, her husband threatened to kill her and her 11-year-old daughter — and the woman decided to have an abortion in her 22nd week of pregnancy.
(Except to protect the life or health of the mother, abortion is generally illegal in the third trimester, which starts at the 26th week of pregnancy and is where the Roe v. Wade decision put the beginning of viability in 1973. But because of medical advances since then, there is now general agreement that a baby can often survive outside the womb at an even earlier point, which doctors have the legal authority to determine on a case-by-case basis.)
In Mississippi and elsewhere, poverty plays a huge role. Federal legislation known as the Hyde Amendment forbids the use of federal funding for most abortions. So many women scrounge for the $380 price of a first-trimester abortion. The Jackson Women’s Health Organization decreases the fees by up to $75 for the poorest women, but, according to clinic staff, even that is sometimes not enough.
The time women spend trying to scrape together that money can easily push them past the now-crucial 12th week, and into the second trimester, when abortions are both riskier and more expensive. “Sometimes, they’re so close on the edge, by the time they come in and they let the light bill go or whatever, it’s too late,” says Betty Thompson, who worked as counselor and then director of the Jackson Women’s Health Organization for years and is now a consultant to the clinic. Thompson, a stately grandmother who had her first child at 16, always encourages resourcefulness in the women she counsels who are struggling to pay for abortions. “I ask them, ‘Have you sold your jewelry yet? Have you asked to borrow from everyone you know?’”
As Thompson knows — and as many women seeking abortions in Jackson do not — the stakes in the money scramble are now higher, since too much dallying can push women who want abortions past the 12th week of pregnancy. “They might let one period go. And then the next period doesn’t come again — so we’re talking eight weeks,” says Thompson, ticking off the weeks on her fingers. “Let’s say you get paid once a month — nine, 10, 11, 12 — then there you are.”
Research backs Thompson’s anecdotal evidence. Sixty-seven percent of poor women having an abortion say they would have preferred to have had it earlier, according to a 2004 study published in the journal Contraception. Specifically, researchers have determined that poor women take both additional time in confirming a pregnancy and several more days between making the decision to have an abortion and actually obtaining one. In Mississippi, where 98 percent of counties don’t have an abortion provider, the logistics of getting the procedure can be particularly daunting: First there is the long drive to Jackson, then the phalanx of protesters surrounding the clinic, followed by the two-day ordeal that begins with the informational session and ends, finally, with the abortion.
No one knows for sure what now happens to the women with unwanted pregnancies in Mississippi who have progressed beyond 12 weeks. In the year since the law went into effect, the clinic has performed 458 fewer abortions than the previous year. Many would-have-been patients, like Angie, were referred to a Montgomery clinic, New Woman All Women Health Care, which allows women who have attended informational sessions in Jackson to get abortions without having to repeat the session in Alabama. The Montgomery clinic (which was firebombed in 1998) hasn’t tracked how many of its patients have come from Mississippi, but according to a staff member, several women who have passed Jackson’s 12-week limit call seeking abortions each week, though many of them don’t show up for their appointments.
Those missed appointments are, no doubt, exactly what the authors of the Mississippi legislation wanted. The abortion rate here is low, despite the fact that the state has the third-highest teen pregnancy rate in the U.S. The state’s many restrictions clearly help depress the numbers. There were only six abortions for every thousand women of reproductive age in 2000 in Mississippi, compared to 21.3 in the U.S. In the six years following the enactment of the law requiring a 24-hour waiting period after counseling in 1992, the rate dropped from 11.3 per thousand to 9.9, according to a study published in Family Planning Perspectives in 2000.
It’s unclear how long the standoff between the Mississippi health department and the Jackson clinic will last. Hill says she has not filed suit against the state yet because she is “so tired of being in court.” Indeed, battle fatigue has meant that several antiabortion laws that haven’t survived in other states have gone unchallenged in Mississippi. By law, clinic doctors there must give the scientifically unfounded warning that having an abortion might increase the risk of breast cancer, for instance. And the state issues “Choose Life” license plates, despite the fact that the practice has been found unconstitutional elsewhere.
Still, Hill and other abortion rights advocates have taken on some legal battles in Mississippi. Most recently, the Center for Reproductive Rights successfully challenged a state law that, like the 2006 one, created a special category for facilities that perform abortions after 12 weeks, but, unlike the more recent law, gave the Jackson clinic no way to apply to become such a facility. Hill says she’s working up to fighting the current situation, but fears it will be difficult because the state hasn’t officially refused to certify the clinic to do second-trimester abortions — just repeatedly delayed doing so.
So young women like Angie continue to risk jobs and borrow money in order to make it out of state to get abortions. Others, like a young Mississippi woman named Tammy, forgo the procedure entirely. Tammy first came into the clinic last October, when she was in her 14th week of pregnancy. She hadn’t known the law had changed and had assumed she would be able to get an abortion. Instead she was told she’d have to make a trip to Alabama. A single mother, she would have had to arrange for childcare to go out of state, and she was struggling to raise the money for travel, according to Cheryl McGee, a staff member at Jackson Women’s Health Organization. “She had just started her job and she couldn’t get no time off and she couldn’t get nobody to take her,” explains McGee. “She doesn’t have a car to get there and she didn’t have the money to get a bus.”
It’s hard to imagine someone who can’t afford a bus trip taking responsibility for a new life — especially when she doesn’t want to. Yet Tammy, who reportedly had her baby a few weeks ago, will no doubt find a way. Anti-choice activists can now chalk one more victory up to the passage and enforcement of Mississippi’s latest abortion restriction — even if, for Tammy, it means defeat.
It was hard not to squirm, listening to Leslie Bennetts defend her book, “The Feminine Mistake: Are We Giving Up Too Much?” on WNYC Radio’s “Brian Lehrer Show.” The stay-at-home moms who called in seemed affronted by her argument that working mothers are both more secure and more fulfilled. And Bennetts sounded even angrier and more defensive, chastising listeners for not having read her book. But it wasn’t until she whipped out her “very happy home life” credentials that the author sounded truly desperate. A Vanity Fair writer who points to her own ability to balance work and motherhood in her book, Bennetts felt the need to dispel nasty rumors that she was — gasp! — single and childless. On the contrary, she told listeners indignantly, she has two children and a husband, for whom she cooks dinner every night. The lowest blow having been blown — questioning whether she is a mommy — Bennetts momentarily gave up on trying to sell books to set the record straight: She is a mommy, and a damn good one.
Bennetts’ publicity tour yielded so much hostility, I had to hope she was winding up and heading home soon to a nice, home-cooked meal with the family. And I hope the end is near for the extremely tiring battle over the so-called opt-out revolution. After all, how many times can we argue over whether highly educated women should stay in their corporate law or marketing or investment banking jobs after they have children? While we might be intrigued by tales of the corner office set texting their nannies on their way to a business trip in Hong Kong, most of us don’t have their particular problems — or options.
Despite Bennetts’ protestations to the contrary, “The Feminine Mistake” focuses on a privileged group of women, as have many of the big motherhood books of recent years, including Naomi Wolf’s “Misconceptions,” Ann Crittenden’s “The Price of Motherhood” and even Betty Friedan‘s “The Feminine Mystique,” which arguably launched the whole conversation in 1963. What’s more, the focus on individual choices obscures the public policies that make rearing children while earning a living so difficult for all mothers. If the “choice” is between working 80 hours a week or staying home full time, then it’s not really a choice. Yet, as Joan Williams of the Hastings Center for WorkLife Law has pointed out, media coverage of the “opt-out revolution” has done much to contort the concept of individual choice to mask structural unfairness — i.e., we end up attacking one another instead of fighting for paid maternity leave.
And then there’s the nasty tenor of the whole discussion. It’s not just Bennetts but everyone who argues that choices made by individual mothers are categorically right or wrong. The mommy wars are, of course, quite personal. Even if they feel they’ve chosen their path — rather than been drawn down it by a special-needs child, an unexpected pregnancy or an unemployed husband — most women don’t feel totally confident they’re doing it just right. And just as Bennetts doesn’t want anyone casting aspersions on her personal life, it turns out that most mothers don’t want to hear that they’re doing something wrong. Nor do most want constant reminders of the unhappy but obvious fact that their husbands could die or leave them at any moment, which Bennetts repeats in her book.
To this unpleasant back-and-forth over women and work, Pamela Stone’s “Opting Out? Why Women Really Quit Careers and Head Home” adds some much-needed substance. Rather than arguing that mothers should or should not stay home, Stone, a sociologist at the City University of New York, describes the complex reasons that 54 women left their high-powered positions after having children and how their lives proceeded from that decision. “Opting Out?” shows how a mix of forces conspired to nudge women out of their careers, despite the fact that most originally intended to stay in them. While her academic and decidedly not strident tone will probably not do a lot for book sales, it’s refreshing to read a balanced take on the upsides and downsides to staying home with kids.
Among Stone’s surprising findings is that most of the women she interviewed ditched their jobs not right after having babies, as you might expect, but when their first children were between 6 and 15 years old. How did they make it so long in the executive office only to slide back to the minivan after all? Stone details a pattern of attempting to adjust their workload or hours to be able to meet some family need — whether school drop-offs or tending to a sick child — and not only failing to get the flexibility they sought but also often getting punished for asking for it. Despite the notion that the pull of children brings mothers home, a series of discouraging pushes from the workplace were often the greater force in their decisions.
Stone also gives evidence of the depressing “yellow light” phenomenon in her subjects’ marriages, in which women wind down their careers as their husbands simultaneously rev up theirs. (The name comes from the notion that women are more likely to slow down at a yellow light, while men tend to floor it.) Thus, wives who start out as their husbands’ peers — often meeting through their jobs — end up deferring to the men’s career needs, picking up the slack the men leave in domestic work and sliding into relationships that are unequal both financially and emotionally — something Bennetts warns against.
The tendency among these high-powered women was to amp up domestic responsibilities to resemble their old professional ones. Many kicked into the kind of intensive mothering that Judith Warner described in “Perfect Madness: Motherhood in the Age of Anxiety,” carting children to fencing practice and Mandarin lessons with the efficiency and stamina of, well, corporate executives. A good number also did high-level volunteer work, serving on the boards of local schools and civic institutions.
Yet even most of those who transformed motherhood into a high-powered job of its own eventually wanted to get back to paid work at some point. And it’s at this juncture that many stay-at-home moms encountered the unexpected. Some hoped to reenter the corporate world but felt unable to. In what Stone calls “another Ophelia moment,” women tended to lose confidence in their professional abilities after a spending time at home. And judging from the response many of the women got when they applied for jobs in their old fields, the work world seemed to reflect that low esteem back at them.
While Bennetts sees not leaving the workforce as the solution to the difficulties of reentry, Sylvia Ann Hewlett argues that the corporate world should accommodate the interruptions in women’s work lives, each of which, she calculates, costs a woman 18 percent of her earning power. Hewlett, whose past books have tackled baby lust and the societal devaluing of parents, profiles the efforts of 11 huge companies to keep women in their ranks in her latest book, “Off-Ramps and On-Ramps: Keeping Talented Women on the Road to Success.” Such “on-ramps” include allowing employees flexible schedules, compressed workweeks, job sharing, part-time options and the opportunity to return after extended leaves.
These innovations clearly make life more livable for women in corporate America, especially those in the extreme jobs Hewlett describes, who work upward of 60 hours a week and do things like get up in the middle of the night to have conference calls with clients in Asia. Some of the huge conglomerates that were part of a task force Hewlett chaired have already managed to retain more women in their ranks. A few female employees have even wrangled much-needed vacations. (I was particularly happy for one female executive Hewlett holds up for her apparently groundbreaking insistence on taking two weeks off every summer.) And — according to Hewlett, anyway — offering women flexibility has also been good for business.
But while Hewlett seems thrilled with the progress of corporate America, the exemplary programs she profiles are often available only to the cream of the already elite corporate crop. The very first example of a worthy workplace innovation, offered in the foreword by Carolyn Buck Luce, for instance, is available only to “high performing individuals” who work at American Express, and who apply to and are accepted by the program. Hewlett repeatedly refers to “top talent” and “highly qualified women,” a privileged and apparently tiny lot. One outreach event she describes held by Lehman Bros. in London, for instance, resulted in the hiring of only four women.
Presumably, these are the lucky few — the “talented women” of Hewlett’s subtitle. But one has to wonder why we spend so much time talking about this privileged group of women when they are already vastly more likely to get flextime, paid vacation, paid maternity leave and sick days than are women with lower-paying jobs. Stone defends her narrow focus on efforts to save high-level women’s jobs by arguing that “the larger cultural and organizational changes they bring about can trickle down (and up) to benefit women at every level of the organization.”
But motherhood in this country isn’t a trickle-down proposition. It’s hard to see what benefit these incremental, voluntary efforts hold for the vast majority of women. Hewlett notes that men have hung onto the “male competitive model” for as long as they have because it benefits them and disadvantages women. They’re fighting for themselves — which is the corporate way, isn’t it? Programs that give a high-heeled leg up only to the corporate elite seem similarly limited, especially when they’re spun as a benefit to the company’s bottom line. What if a humane work policy isn’t going to mean a net gain? Perhaps more important, why do we insist on treating policies that make work livable like gold stars, handed out only to the best in the class? Why doesn’t everyone get a livable life?
The question is enough to make a woman rethink the whole male competitive model, which, it turns out, many mothers do when they “opt out” of it for long enough. Intriguingly, in Stone’s sample, many lost their taste for the fast-paced, big-money world after raising children and decided to become schoolteachers. In exchange for the whopping pay cut, they cited the flexibility of teaching as well as its ability to satisfy values that had been changed — softened, even — by stay-at-home parenting.
No doubt corporate America stands to gain from the infusion of these values when they employ women at the top, as Hewlett argues. But sadly, women in the rest of the country — the vast “untalented” or, perhaps, just unlucky majority of mothers who not only work and take care of their kids but also are stuck watching the seemingly endless media sideshow that is the mommy wars — probably won’t gain a thing.
Melissa Figueroa, the 26-year-old sexual abstinence instructor presiding over this roomful of Bronx high school students, brings out a bag of trinkets and tosses each to the kid who guesses its price. For a minute or two, the air is filled with a stream of cheap gifts: Yankees socks ($5.99), a key chain (59 cents), a water bottle (99 cents), a Frisbee ($1.99). But then Figueroa yanks out a piece of cardboard with “You” scrawled across it in marker. The kids get the point: “We are priceless,” they answer, almost in unison.
Three years after the passage of the Welfare Reform Act, Figueroa’s workshop, held after class in public high schools, is one of a crop of just-say-no-to-sex programs springing up across the country. Through a little-noticed provision in the 1996 welfare law, almost $500 million of government money (a mix of federal and state) is now being used to bring such classes into public and private schools across the country. The funding has also afforded social conservatives the opportunity to present a variety of morality-laced activities in the curriculum.
Community groups in Nebraska, for instance, are using abstinence money for canoe trips, picnics and — a real trick for a landlocked state — an abstinence beach party. Held during a snowy week in February, the party involved motivational speakers, calypso music and a “beach” simulated by decorating a gym with sand, fake tropical birds and patio furniture.
In Ohio, a group that discourages women from having abortions has used its funding to train public school teachers about abstinence. One of the suggested lesson plans has students signing a pledge to remain celibate until marriage.
In Illinois, Kathleen Sullivan, a mother of 12 who runs that state’s abstinence-only programs, put some of the state’s funds toward a secondary virginity rally at which “educators” led kids in the chant: “Sex-free is the way to be!” And Arizona is using some abstinence money to target adults. The state has allocated $67,000 to the Arizona State University Community Health Services Clinic for the Healthy Relationships program, which encourages recovering alcoholics and drug addicts — some of whom used to be prostitutes — to remain free of romantic attachments during their recovery processes.
Back in New York, Figueroa, who works for a local nonprofit called the Bronx Perinatal Consortium, asks students to think about their goals — and about how having premarital sex might interfere with them. She also has kids work on their own feelings of self-worth by passing around a mirror and asking each one to say two good things about themselves. “I like my hair and my ears,” says a 16-year-old girl, wearing a miniskirt and platform sandals. The next girl likes “my hair and my teeth, even though my braces have pizza in them.”
And what, asks Figueroa, might these feelings about themselves have to do with the decision to have sex? Seventeen-year-old Elizabeth has a ready answer: “You notice that the girls that have sex, or the people that have it, they’re usually the ones with lower self-esteem, the ones that care about how they look on the outside,” she says, pausing to flick her hair over her shoulder. “When in reality, what they’re looking for is the feeling of acceptance.”
Whether such game playing and pat positive-image talk will actually affect how these students think about sex, or when and how safely they have it, is an open question. Elizabeth, for instance, says that even before the workshop she had planned to remain abstinent, since having premarital sex may interfere with her plans to hold public office. “I could get pregnant, even if I use protection,” she says. “Or I could get a disease, so I might not be around.” Yet, after the workshop, even she — who describes herself as coming from “a strict Latin family” — says she would consider having sex with the right guy.
Indeed, no one knows what the effect of this giant experiment in sex education will be. Scientifically speaking, there is little reason to believe the almost 700 grants awarded for abstinence-only education so far will make even a dent in the teen-pregnancy or STD rates. A 1997 study from the University of Nebraska-Lincoln that analyzed the evaluation of more than two dozen non-government-funded abstinence-only education programs from 1985 to 1995 found that the vast majority had no effect on the timing or amount of sexual activity. And the largest study to date of an abstinence-only program found that the Education Now, Babies Later program, which involved 187,000 teens in California, had no impact on the age at which teenagers began to have sex.
According to the author of the California study, Douglas Kirby, the results don’t mean that all abstinence programs are necessarily ineffective. “We just don’t know whether any do work,” he says. “The jury is still out.”
Despite its dubious value, abstinence-only-until-marriage education has become the law of the land. Back in 1996, during the final days of hashing out the Welfare Reform Act, conservative Republican Sens. Lauch Faircloth and John Ashcroft added a provision calling for $250 million a year in federal money — the only federal money allotted for sex education — as well as almost as much in matching state funds to exclusively teach about the benefits of abstaining from sex. Under the benign heading Section 510, Title V, the language went directly into the final version of the bill, usually reserved for corrections and technical revisions, without public comment.
Had voters — or even other senators — been afforded the chance to debate it, the abstinence provision probably would never have made it beyond the Senate chambers. More than 80 percent of Americans think that young people should be given information about contraception and how to protect themselves from sexually transmitted diseases, according to a recent nationwide poll conducted by SIECUS, the Sexuality Information and Education Council of the United States. (The questionnaire asked about opinions on sexuality education after mentioning that 70 percent of 18-year-olds and nearly 90 percent of 20-year-olds have had intercourse at least once.)
Yet Title V of the Welfare Reform Act forbids its recipients to teach about contraception beyond providing various methods’ failure rates when asked. The provision also requires grantees to promote the message that “a mutually faithful monogamous relationship in the context of marriage is the expected standard of human activity” and “that sexual activity outside the context of marriage is likely to have harmful psychological and physical effects.”
Abstinence programs have supplanted more comprehensive school-based sex education programs in only two states, according to a report by SIECUS, which tracks — and critiques — the abstinence-only process. In most cases, already existing sex education programs have remained intact. (Schools can conduct both abstinence-only programs and sex-education classes that teach about birth control, as long as their budgets, instructors and sites are kept separate.) But the plentiful Title V money has brought many religiously based sexual abstinence programs into public schools, even as they remain true to their ideological roots.
Consider Teen Aid, for instance, a group that runs an anti-abortion crisis pregnancy center in addition to publishing an abstinence-only education curriculum taught in both public and private schools. The curriculum, “Me, My World, My Future,” states that “the unborn child is alive and human at all stages of intrauterine growth.” A 1994 case brought by the local Planned Parenthood affiliate in Duval County, Fla., where Teen Aid was taught in local public schools, charged that, because of the program’s religious bias and medical misinformation, it violated the state’s requirement for comprehensive sexuality education. The local school board has since voted to implement a curriculum that also includes teaching about contraception.
“Sex Respect,” another popular abstinence-only curriculum that has been put to use in many a Title V-funded program, describes abortion as “killing the baby.” The curriculum, written by Colleen Mast — who also authored “Love and Life: A Christian Sexual Morality Guide for Teens” — teaches kids that premarital sexual behavior can lead to anything from selfishness to death. “Even the practice of petting before marriage can develop negative habits that carry over into marriage,” according to the curriculum, which also refers to AIDS as nature’s way of “making some kind of a comment on sexual behavior.” Sex Respect — which has been the subject of two lawsuits that charged it provided medical misinformation and religious teaching — also refers to homosexuality only in the context of AIDS.
Abstinence supporters are up front about their crusade being morality-based — and unpopular. Congressional staffers involved in drafting the legislation wrote, “That both the practices and standards in many communities across the country clash with the standard required by the law is precisely the point.” Which explains why much pro-abstinence literature aims to convince the reader of the social need for abstinence. Log on to the pro-abstinence Web site of the National Abstinence Clearinghouse, and you can read (under the heading of “research”) articles that show that the “majority of Americans disapprove of sex before marriage,” that “most think saving sex for marriage is a good idea,” and that “saving sex for marriage reduces the risk of divorce.”
Abstinence proponents also tend to focus on the failure of condoms, which they use to illustrate the futility of teaching about contraception. According to the pro-abstinence National Coalition on Abstinence Education, the “condom crowd,” (as NCAE likes to refer to educators who promote contraception) expose kids to danger, since every birth-control method has some risk of failure. NCAE also believes that providing contraception necessarily promotes sexuality itself. “Supplying teenagers with condoms inevitably produces a marked increase in their sexual activity,” the group explains in one of its many tracts on abstinence. To suggest that there is an alternative to abstinence, it argues, ignores basic human nature: “Given the option between two alternatives, some people will choose the worst alternative.”
Ironically, across the ideological divide, the “condom crowd” bases its own approach on a similar assumption: that some kids are going to have sex. Both sides also agree that the American teen pregnancy rate — higher than that of virtually any other industrialized country — represents a national crisis. But, while abstinence-only supporters would try to talk kids out of sex, those supporting broader sex education programs think that the kids who are likely to have sex need to know how to do it without catching diseases or making babies.
“I don’t think a lack of information ever improves any situation,” says Dan Daly, director of public policy for SIECUS. Daly worries that the abundance of funding for abstinence programs cuts into support for education about both contraception and abstinence. “The large sums for abstinence may tempt policy makers because the money’s available and it seems politically less divisive,” says Daly. “The money tail will wag the dog.”
And while some groups are using Title V money to pay for mental-health services and career planning that make only the vaguest references to sexual activity, the conservative forces behind the law have also tried to make sure that those programs that do receive money toe the abstinence line. One of the provision’s authors, Rep. Thomas Bliley, R-Va., wrote to the Department of Health and Human Services in late 1997, requesting that the office evaluate grant applications to make sure they are “consistent with the letter and spirit of the legislation.” And NCAE has issued “compliance report cards” on states’ abstinence performance, giving failing grades to states that manipulate congressional intent “to remove the spirit of the abstinence-until-marriage message.”
State by state, the fight over what Title V programs should say — and what local kids will hear about sex — hasn’t been pretty. In Louisiana, Gov. Mike Foster took the state’s abstinence-only program away from the jurisdiction of the state’s Office of Public Health, after the office had already issued its own request for funding based on grant applications, and placed the process under the control of a Christian Coalition activist in his office, a move described by Julie Redman, president of Planned Parenthood of Louisiana, as a “real tragedy.” “The Office of Public Health had a very good plan; it was based on good research and credible public health practice. And then it was taken away,” says Redman. “Public-health folks feel this was political. The Christian Coalition wanted that money — and they got it.”
In Alaska, a similar takeover ensued after the department of health used their abstinence funds to create a book about generally getting ahead in life. “Helping Kids Succeed — Alaskan Style” was extremely well received, according to the state’s adolescent-health coordinator, Becky Judd. But, because it only obliquely referred to sexual abstinence (the section on the importance of not being sexually active, for instance, suggests helping “people explore the sacred writings for guidance in the area of restraint” and helping “your children learn their Native language [so] they can talk with Elders”), more literal interpreters of Title V put an end to the project on the grounds that it didn’t comply with the law. Judd was heartbroken.
In the midst of this tug of war, Republican favorite, George W. Bush, has made his enthusiasm for abstinence education clear. This past June, while visiting an abstinence program in South Carolina that he called “cool,” Bush promised to up the current $50 million per year in federal funding toward just-say-no education to $135 million if elected. He also made much of his emphasis on abstinence as governor of Texas, where, with his approval, the state Legislature passed a law requiring all state school districts to have “abstinence-based” human sexuality curricula. During his term, Texas also used more state funds for abstinence than required by the law.
Bush’s official Web site even has an entire section devoted to abstinence, where he decrees: “We must stress that abstinence isn’t just about saying no to sex; it’s about saying yes to a happier, healthier future.” Interestingly, while stumping for his own happier future, the presidential hopeful has attempted to gloss over his past. He’s repeatedly bragged of being faithful to his wife, Laura. But Bush has been about as clear about his sexual history pre-Laura as he’s been on his cocaine use. Presumably, his vague, that-was-then explanation — that “what the baby boomers have got to say is not ‘did we make mistakes,’ but if we learned from our mistakes and are willing to share the wisdom” — can be taken to apply to his premarital love life as well.
Not that anyone really wants to hear the details. It’s enough to know he had the tools he needed to stay alive and make it into office. As for Elizabeth, who’s now beginning her senior year, the path to public life is less clear. “You can never know for sure what’s going to happen,” she said recently. “I’m just going to try to keep to my goals.”
If you’d prefer that last night’s crhme br{lei end up in the toilet
instead of on your hips, you might take orlestat. The new drug, which
came on the market less than two months ago, arranges it so that one-third
of ingested fat goes right through you, so to speak.
Orlistat, sold under the brand name Xenical, has only been FDA approved
for — and tested in — those who are officially obese. One of these,
Cindy Smith, could be the Xenical poster child. The new fat-blocking drug
helped her take off hated pounds she had been unable to lose any other way. At 5 feet 4 inches tall, she weighed 220 pounds when she entered clinical trials of the drug
two years ago. Now the 34-year-old bank worker in Houston is a
satisfied 150.
To qualify for the trials, you had to be, like Smith, officially fat. At 6 feet tall, for example, participants had to weigh at least 220 pounds, or no less than 200 if they had fat-related health problems. After two years of testing, it appeared that overweight people who took the drug lost an average of seven to 10 pounds more than those who didn’t. Xenical also lowered levels of problem cholesterol beyond what could be explained by the weight loss.
For the desperate to reduce, such benefits may justify the fact that Xenical is chemically addressing what is essentially a social problem. In a rational world, one might suggest not eating whatever you don’t want
to digest. But in our culture, at once obsessed with both food and
thinness, the blue capsules are being embraced as a way of tempering the
consequences of excess. And not just by the truly overweight.
More than 210,000 Xenical prescriptions have been sold in the drug’s first seven weeks on the U.S. market. Apparently the appeal of the fat-be-gone pill trumps any memory of the recent recall of fenfluramine, another diet drug that was shown to cause heart damage after being pounced on by eager dieters. It also overshadows Xenical’s own hazards, which are many and troubling.
In fact, the FDA panel considering Xenical was at first split on whether to
approve it, with nay-voters stuck on distressing medical points, such as
the fact that the drug leaches vitamins from the body and disrupts the
normal digestion process. Perhaps most alarming, one study the panel
reviewed found that drug takers had a higher rate of breast cancer than
those not on it. New data that the breast cancer cases didn’t
appear to be linked to the drug eased panel members’ concerns enough for
them to approve Xenical in May. But even after approval, Jules Hirsch, an
internist and nutrition expert who served on the panel, says “there is a
residual worry” over the breast cancer question.
And, since Xenical has been only tested for two years, its long-term effects add up to a big question mark. “We don’t know what this drug does over long periods of time to gastrointestinal function,” says Hirsch. “It’s coating the intestine with a thin layer of fat. We just don’t know
what this will do to intestinal function over years.”
Those interested in taking the drug seem less concerned with such medically
weighty matters than with the drug’s embarrassment-potential. As one dieter
encountered in the weight-loss chat room at
href="http://www.thriveonline.com">thriveonline.com delicately put it: “I heard it makes you mess your pants.” The rumor was confirmed by another chatter, whose daughter is taking Xenical.
According to the Roche product information, such “adverse events” –
including anal seepage, oily spotting, orange stool and something
disturbingly described as “fecal incontinence” — occur in about a quarter
of drug takers, but can be minimized by scaling back fat intake. That
side effects increase according to the amount of fat a person consumes is
helpful, at least when it comes to defending Xenical against charges of
fueling an unhealthy compulsion to overeat. Like antabuse, a drug that
makes alcoholics violently ill if they drink, Xenical could theoretically
hem in behavior. But, even when eating light, the potential for oily
spotting and emergency trips to the bathroom remain.
One might be willing to withstand such symptoms in the name of extending
life or avoiding serious disease. Maybe. But would anyone risk such
humiliation for the sake of obsessive vanity? Apparently so. Ben Krentzman,
a weight loss specialist in Venice, Calif., reports that 18 of the 20
or so patients who have asked Krentzman about taking Xenical so far were
not fat enough to meet the criteria. “People who want to lose five pounds
can suffer the same torment as people trying to lose 500,” Krentzman muses,
by way of explaining the generalized lust for Xenical. (At 400 pounds,
Krentzman says he is considering taking Xenical himself, but “wants to see
how it all works out.”) Krentzman will only prescribe the drug to patients
who fit the official guidelines. But less scrupulous doctors can legally
approve it “off-label” for just about anyone.
And those who can’t get Xenical from a real doctor can get it from someone who plays one over the Internet. At least a dozen sites, most of which also
sell Viagra, offer the diet drug “without a prescription,” “in six easy
steps,” or “with complete privacy and confidentiality!” In lieu of a
prescription, the buyer is usually asked to have an online consult, which
involves answering questions about height and weight.
There is no way of verifying the information, of course, which means that
the drug is available to pretty much anyone who has the roughly $120 it
costs per month. (Insurance pays in only a minority of instances.) That
worries some eating disorder specialists. “Bulimics quite consciously
engage in the consumption of large amounts of calories followed by a
behavior to avoid the consequences,” says Tim Walsh, director of the eating
disorders research unit at the New York Psychiatric Institute. As Walsh
sees it, Xenical has the potential to be yet another consequence-avoiding
tool, along with self-induced vomiting
No one makes any money off vomiting, however. So while marketing rights to the finger remain, for the moment, unclaimed, analysts project that
Hoffman-La Roche will make some $3 billion from the drug. Roche, a
pharmaceutical giant known for selling Valium, can’t be held responsible
for the abuse of its product, which it warns bulimics against using.
(Bulimia, remember, is a medical condition, Xenical is a treatment.) But
even while drug materials clearly state that Xenical is for the obese, the
launch campaign seems to extend a extremely friendly hello to most everyone concerned about weight. The promotional information announces: “First and only in a new class for weight loss, weight maintenance, and reduced risk of regain.”
And, to muddy matters more, Roche is promoting something called the “taste
of healthy living campaign” in conjunction with Xenical. The PR
extravaganza — which extends to 18 cities and has employed everyone from
high-end chefs to former New York mayor Ed Koch — doesn’t directly
plug Xenical. But it does use the same shiny, blue folders and lettering as
the Xenical materials to reach out to the population at large. That
includes “Laura,” a woman the promotional brochure describes as wanting “to maintain her weight of 128 pounds.” “You’ll see that you don’t have to
deprive yourself of foods you love to eat,” assures the “healthy living”
dieting guide, which, at the bottom of every page, says “Brought to you by
Hoffman-La Roch Inc., maker of Xenical.”
There is nothing wrong with the eat-light message of the campaign, in which
high-end restaurants are paid to put “healthy living” icons near low-fat
menu options. (So far, no chefs have accepted Roche’s offer to directly
promote the drug itself.) And there was nothing wrong with the
“healthy-living” fare at Sonora, a New York Latin-fusion restaurant
participating in the promotion. The lobster mango ceviche was tasty and the
baked red snapper — which comes in at a startlingly lean 117 calories –
were perfectly good. But what of the fact that the little healthy living icon on the menu will be associated with Xenical?
And, perhaps more to the point, what of the Dulce de Leche cheesecake
listed on the menu just inches from the sensible fish dish? Surrounded by
the constant celebration of richness, how could anyone not consider that
Xenical would help them repel calories from cheesecake as well as from
lighter fare? By reducing their calorie intake, wouldn’t Xenical make people already partial to heavy foods more likely to indulge?
Desperation may dwarf such questions. Obesity contributes to some 300,000
deaths per year. It’s hard to fault the ideal of making any dent in that
number. And there’s also the emotional relief to consider. Smith, the bank
worker who participated in the clinical trials, for instance, says she was
profoundly changed by her weight loss. “I enjoy life a lot more now,”
gushes Smith. “I feel so much better about myself.”
Who wouldn’t want that for our entire nation? Yet, given our ever-mounting desire for consequence-free excess, Xenical seems more likely to nudge us in the direction of even greater consumption, stretching our stomachs to
accommodate bigger sundaes and whetting our appetites for the next big
nutrient-blocking pharmaceutical. Something to think about as we pass a
little oily wind and run like hell to the bathroom.
