Living in a state of freedom

You may wonder why I’m always blogging about emergency contraception (EC) and birth control. What does it have to do with domestic violence? Why would an advocate need to talk about this with a survivor of abuse? And why should domestic violence programs have EC, pregnancy tests, and condoms available on site?

If you have never experienced it, it might be hard to understand how birth control sabotage, or reproductive or sexual coercion, is an incredibly powerful way to exert power and control over someone. Imagine someone flushing your pills down the toilet or poking holes in a condom. What about stopping you from getting to the clinic to get your Depo shot? Or forcibly pulling out your IUD by the strings? If you’re in an abusive relationship, negotiations around birth control and whether to have—or not have—children might happen without your opinion being respected or even considered. The harm of this may be invisible to an outsider, but when survivors of abuse are not allowed to make their own decisions about pregnancy, they lose control over the trajectory of their life and their connection to the abuser. And they have to constantly weigh the risks of any act of resistance, any attempt at independence.

Domestic violence advocates know that survivors coming to their programs are experiencing a range of abusive behaviors. But even if they are experiencing reproductive or sexual coercion, it is usually not something they bring up. If we want long-term solutions for survivors and their children, then we need to bring it up. Offering EC and birth control information, and having it available on site, is a liberatory act.

We need to offer it because Plan B or Levonorgestrel (emergency contraception) is effective within five days after unprotected intercourse and is available to anyone, no matter age or gender, without a prescription. We need to offer it so that survivors know we are comfortable talking about sex, birth control (especially forms that are less likely to be felt by a partner), and reproductive health. We need to offer it because access to timely information and practical help can change the circumstances of someone’s life. And we need to offer it because advocacy is about supporting someone to determine their own life—to live in a state of freedom.

A flock of birds and the words "I'm Free"

What does it take to believe a woman?

We bring you this post from the Executive Director of a domestic violence program in rural Washington.

The domestic violence agency I work at often buys supplies that our clients need but can’t always afford, like diapers, toiletries, and contraceptives. Easy access to birth control supports a survivor’s control over their body, and promotes their safety and independence. Recently, I walked into our community’s only pharmacy to buy some Plan B. The young woman behind the counter asked me for ID and went into the back room.

planb2Her: Here you go, all set.

Me: What did you do with my ID?

Her: Checked to see if you are over 18.  (I think this is funny – I’m 39.)

Me: There are no restrictions on buying Plan B, so you don’t need to know my age. I work at the local domestic violence agency and for my clients, being asked to show ID can be scary if their abuser monitors what they are doing and checks public records. It is also scary for people who are worried about their immigration status.

Now the pharmacist comes out and joins the conversation.

Pharmacist: That’s not true. On the Plan B package it says “For Women Over 17 Years of Age.”

Me: It’s old packaging (wondering just how old the packaging is). The law has changed. Plan B should be able to be purchased as over-the-counter medication. I don’t have to show identification.

Pharmacist: That’s not true and it is my choice how to dispense it.

This same conversation continued over a few more visits. I brought in articles and the new federal regulations—none of it seemed to matter to the pharmacist. Then my town gathered a small team of community members interested in women’s reproductive health services that were available locally. One community member went back to the pharmacy, and while the same “it’s just not true” argument ensued, another visiting pharmacist broke into the conversation and said we were right. He confirmed the changes in law we had already shown the local pharmacist.

This pharmacy—the only place in town to buy Plan B—is now in compliance with the law. And while I’m very happy about that, I still find it frustrating that my local pharmacist would not listen to what we were saying (read: what we women were saying) and would not change the pharmacy’s practice until a man said our information was correct. How many laws that affect women’s health are ignored when women are telling the truth?

Teens want to talk

“It might be easier if you talk to my teenagers and I talk to yours.” That’s where a chat with a good friend went when we realized our teenagers no longer wanted to discuss sex with us or their dads. Even though I have had pretty frank conversations with them in the past about emergency contraception, responses to street harassment, and grinding at dances, I understand that I’m not their only source of information. Most teenagers I know think that conversations at home, school health class, and with their friends are all they need. Maybe so, but I know my daughters forget things and don’t always have the most current information. Sometimes they are just plain wrong. And I’m sure they’ve never practiced telling someone they care about “No, I don’t feel comfortable doing that.” Whatever that is—sex acts, drugs, drinking, or anything else.

Some of the complicated conversations I want someone to have with my kids:

  1. Medically accurate information about all available forms of birth control
  2. Knowing how to respond when a friend or potential partner oversteps their boundaries
  3. Deciding when is the right time to have sex
  4. Knowing how to freely say yes or no to anything involving your sexuality
  5. What to do or say if a friend has difficult questions or secrets they don’t feel comfortable keeping
  6. Knowing where to get good information and help—online or in-person
  7. Strategies for stepping in to help someone else
  8. Knowing the qualities of a healthy relationship and believing they deserve it
  9. Knowing how to talk to a friend about his or her relationship

teens-talkingI think teenagers want lots of chances to talk about these things. As a parent, your best bet may be to find the right person to initiate those conversations. Think about a terrific woman or man that you trust who could engage your teenager. It might be a relative, friend, or an educator from Planned Parenthood. You could set up one or several conversations with this trusted adult, add some food, a couple of your teenager’s close friends and leave for a few hours. I did this with my daughters. I know it was a success because one of my daughters said to me “we talked about a lot of things that I wouldn’t want to talk about with you.” I understood what she meant. With me, she has to worry about my judgment or if I’ll ask too many follow-up questions. This way, we can pick up the conversation whenever they want and I sleep a little better at night.

News you can relate to

Some news stories that caught our eye this week:

Emergency contraception is especially important for women in abusive relationships, which is why we’ve been paying close attention to the stories about Plan B (and equivalent medications) being ineffective for women over 176 lbs. Healthline has a brief clear explanation of what other options are available.

Forbes takes a characteristically financial viewpoint on domestic violence, pointing out that it costs us $8.3 billion annually in medical expenses and lost productivity.

Victim-blaming is a common response in our culture to stories of sexual assault and domestic violence, so it’s not surprising that sometimes victims blame themselves. Jenny Kutner’s complicated exploration of her own culpability is captivating and Amanda Hess’s response is thought-provoking.

Why aren’t they restricting condoms?

Not exactly on point, but I got what my teenager was asking. Even she gets the double-standard of the Obama administration’s position on emergency contraception. She asked, “If they think that making it easy for girls to get emergency contraception means that they are going to have more sex, then why do boys get to buy condoms without any problems?” This is mind-boggling coming after President Obama’s speech at the Planned Parenthood Conference: “When it comes to a woman’s health, no politician should get to decide what’s best for you.”condoms

Why do I have a problem with the government policy? Because of all the barriers: you must be 15, you must have a government-issued or photo id (not something all schools provide), you must purchase it in a store that has a stand-alone pharmacy (rare in rural and remote communities), and it is expensive—even though Medicaid covers other over-the-counter medicines like condoms.

We have plenty of evidence-based scientific studies proving that emergency contraception is safe, prevents ovulation, and cannot terminate an existing pregnancy. We have research that shows the dramatic decline in unintended teen pregnancy and abortion rates when teens learn how to use contraception more effectively.

We also know that teens who are abused experience birth control sabotage, pressure to get pregnant, and significantly higher rates of unintended pregnancy. Emergency contraception is important because negotiating birth control methods is awkward in any relationship, but it’s nearly impossible if you’ve got an abusive partner who wants control.

News you can relate to

Some news stories that caught our eye this week:

  • The FDA lowered the age limit this week (to 15) for emergency contraception and gave Plan B the green light  to sit on drugstore shelves (instead of behind the pharmacist’s counter).
  • An incredibly powerful story from a domestic violence survivor in our state. The full segment will air on NBC’s Rock Center with Brian Williams tonight and talks about the escalated risk when domestic violence abusers have access to guns.
  • Saudi Arabia just launched its first major ad campaign against domestic violence. Check it out!

Emergency Contraception is the breakfast rush conversation

Eggs, toast, and a side of emergency contraception. Not exactly like that but pretty close. My girls and I were listening to a morning radio story about a pharmacist who refused to sell EC to a man whose condom broke while having sex with his girlfriend (who happened to be a law student). The pharmacist said “I can’t sell it to men. Who knows what they could be doing with it?” The law student girlfriend told the pharmacist that her boyfriend waspharmacist allowed to purchase EC under the law—actually, any male or female 17 or older can purchase it without a prescription.

My girls were confused. “Isn’t that the pill you take right after sex if you don’t want to get pregnant?” (How do they know about this??) My exterior demeanor was calm but my insides were sweaty. Try giving clear and simple information in 5 minutes while flipping eggs over easy. The girls asked why the pharmacist would not give the boyfriend medicine that was legal? I explained that some people think that taking emergency contraception was like having an abortion.

The truth is that the  EC pill slows down ovulation and prevents the egg and sperm from fertilizing. If you wait too long to take it and fertilization happens, it can’t undo the pregnancy and it won’t hurt the person taking it.

After my mini-medical lecture, it turned out what the girls really wanted to know was, why was I so upset about the pharmacist’s response? I tell them (with just a little passion) that I want them to have control over their bodies and be able to make their own decisions without any additional barriers—like a pharmacist who won’t follow the law. I say that I want them to have accurate information (which I hope they will share with their friends).

“Yeah,” they say, “I bet that boyfriend felt weird.” Okay, don’t forget your lunch bag, give me a kiss. Hustle, you’re gonna be late to school.