Category: Family Planning

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Family Planning Population

Watch East Los High

There was an omission in my last article about the effectiveness of the media on teen pregnancy rates. Bill Ryerson, one of the world’s most effective population activists, kindly reminded me of my mistake in leaving out an important example of the use of modern media.
“East Los High” is an online TV series aimed at Hispanic teens. All the episodes of the 2013 season and several episodes for 2014 are available at www.hulu.com. Be prepared for an advertising blitz, and for an introduction to a very different lifestyle.
When I was in high school I knew that guns, shootings, teen pregnancies and drugs all existed, but I had no personal experience. Times have changed. I watched several episodes of “ELH” with real apprehension because of the problems these adolescents endure—and the excellent quality of the acting.
In between the violence and sex are some sweet but instructive scenes. Jacob is a football hero who discusses with his dad whether he should join the military or not. His father recommends that he take advantage of a sports scholarship and be the first in his family to go to college.
Jessie is a very good student who doesn’t date and belongs to the “Virgin Club”. She is a junior and so is amazed when Jacob, a senior, asks if she will help him study chemistry. The study session turns out to be more when he becomes amorous. She protests, pushes him away and says that she is still a virgin and needs more time.
“I totally understand if you think I’m lame and you don’t want to hang out no more,” she says.
“Hey, I don’t think your lame” Jacob replies.
In another episode a dancer announces to the dance team’s head that she is pregnant. “I thought that you were on the pill” was the angry reply.
“I am. Unless I forgot to take it.”
“Stupid, the pill won’t work if you don’t take it every day. Why didn’t you take the Plan B pills I gave you?”
“Do you have any on you?”
“It’s too late, pendeja. You have to take the pill within 3 days of having sex.”
Then comes reality testing about the future of the dancer—and of the pregnancy. Her boyfriend seems happy to become a dad, and invites the young woman to stay at his house after her aunt kicked her out. When he introduces the mother-to-be to his mother, the older woman tells him to throw her out.
“I can’t. She’s going to move in. She’s having my baby.”
“Again?” was the baby’s grandmother’s reply. Apparently this older man had caused more than the one unplanned pregnancy.
Has this program lowered teen pregnancy rates, reduced drug use or caused any other improvements? it is too soon to tell. However, ELH is under the watchful eyes of two communication professors, Drs. Arvind Singhal (University of Texas, El Paso) and Helen Wang (University of Buffalo). They have been using several techniques to measure the program’s impact. The results are very encouraging.
As expected, ELH is most popular in areas with the most Hispanics. Many people watched the show more than once because of the high appeal of the stories. This appeal has spread to Facebook, whose interactive properties engaged the audience even more. Furthermore, over 25,000 people have linked from one the show’s sites to reproductive health service providers in Los Angeles alone.
Closer to home, the teen pregnancy rate in Colorado has taken a nosedive. It has shot down 40% from what it was just 5 years ago. This decrease is important because, on the average, children born to teen moms don’t succeed as well in life. Furthermore, a teen mother’s chances of completing education are lessened and adolescent pregnancies are expensive to society. From a financial standpoint, every dollar spent on family planning saves $3.74 in Medicaid costs for maternal and newborn care. The human savings are much greater, of course.
Title X (ten) is a government program that works. It provides reproductive health services to women of any age who otherwise would have difficulty affording them. Here in La Plata and Archuleta Counties clinics offer women disease screening and their choice of family planning.
One of the reasons for the recent success of Title X clinics is that they are able to provide Long Acting Reversible Contraception (LARC), such as IUDs and Nexplanon®. Do you remember when you were a teen, how forgetful you were? LARCs remove the risk of forgetting to take “the pill”—the problem of the dancer in East Los High.

© Richard Grossman MD, 2014

Categories
Contraception Family Planning Population Reproductive Health

Reject these Old Memes—2-2014

Recently a friend introduced me to the word “meme”. Now I run across this concept frequently.
The word “meme” is analogous to “gene”, but it is information in our culture rather than in our DNA. A meme is a building block upon which our way of life is built. One definition is: “an idea, belief or belief system, or pattern of behavior that spreads throughout a culture”.
An old example is the Pythagorean theorem—the square of the hypotenuse of a right triangle is equal to the sum of the squares of the other two sides. This meme is ancient.
One accidental meme is changing lives in Brazil. The average family size has dropped rapidly. In 1954, when I visited as a child, women had an average of over 6 children. Now the average is 1.8—less than replacement. This big change is largely because of TV telenovelas, where middle class families are all small.
Some memes are harmful. An example is a tradition in Nigeria that leads to the death of many children. For eons Traditional Birth Attendants used mud or other unclean substances to dress newborn babies’ umbilical cord stumps. If tetanus spores are present, the baby can die a horrible death from tetanus. This improved when TBAs were taught the advantages of cleanliness and sterile instruments. Now pregnant women getting prenatal care are immunized against tetanus and there are many fewer deaths.
Galileo, who was born 450 years ago this month, suffered because of a religious meme. This meme slowed the development of knowledge for centuries.
Ancient Egyptians thought that the sun rotated around them—the geocentric model of the solar system. A Greek may have first proposed that Earth revolved around the sun 2500 years ago—the heliocentric model. For centuries people believed that the earth was the center of the universe, supported by theology that interpreted the Bible thusly. One verse that supports this meme is found in Psalms 104:5: “(God) built the earth on its foundations, so it can never be moved”. There are still people who hold that the sun goes around the earth—including 26% of US citizens, according to a recent National Science Foundation survey!
In the early 17th century Galileo defended the heliocentric theory, for which he was accused of heresy and placed under house arrest for the rest of his life. The Inquisition’s ban on reprinting his works was only lifted a century later. It was not until the 19th century that the Roman Catholic Church removed books advocating heliocentrism from its Index of Prohibited Books. Pius XII was the first Pope to acknowledge the many important contributions of Galileo—in 1939. Yet there are people who believe that heliocentrism is a conspiracy (http://www.johnthebaptist.us/jbw_english/default.htm). It is amazing how long this meme has persisted!
Years ago I sold “green umbrellas” at a public health meeting. From a campaign in Bangladesh (where it rains a lot), these umbrellas carry slogans such as “stay well” and “take health services” in Bengali. A doctor from Bangladesh bought one, then a few minutes later returned and wanted his money back. I asked him what was wrong. He replied that one of the sayings is “small families”, and we should have as many children as Allah gives us. This is another case of a religious meme that has outlived its usefulness, since Bangladesh is very crowded.
I find it amazing that some religions have not yet recognized the benefits of contraception to individuals, to families and to the world. The official doctrine of the Roman Catholic Church is that only periodic abstinence (the “rhythm” method) is acceptable. This policy is ignored by many of the 1.2 billion Roman Catholics worldwide—and many women I have talked with have left the Church because of this policy.
In many Catholic countries, such as Brazil and in Western Europe, couples use modern contraception resulting in average family size less than two. There are places, including some of the poorest countries in the world where this prohibition against effective contraception is followed. They will continue to be stuck in poverty so long as people are prohibited from using modern family planning. Rwanda is an example; its rapid population growth was one factor leading to its genocide 20 years ago.
Memes can outlive their usefulness to society. It is time for women to have the same status and rights as men, and for all people to have the access to the means to manage their fertility.

© Richard Grossman MD, 2014