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 V.19 No.39 | September 30 - October 6, 2010 

Miss Diagnosis

Robbins Burns Rubbers

Will APS roll out a new sexual health policy?

[Names and details have been changed to protect confidentiality.]

Sarah was already looking forward to the eighth grade dance, even though it was several months away. Her mother couldn’t afford to buy her a dress, but Sarah’s cousin offered up an old homecoming gown. Unfortunately, it was just a hair too small. So Sarah asked her friends about losing weight, and, in their infinite eighth grade wisdom, her friends recommended a fat-free diet.

Sarah began diligently cutting the fat out of her diet. She quit the candy bars and chips. Her mother honored her request to trade whole milk for skim milk. And Sarah studied herself every morning in the mirror, patiently waiting for the weight to come off.

After a few months, Sarah decided her diet wasn’t working. She wasn’t losing weight. In fact, she seemed bigger than ever. And she was sick all the time. Apparently, fruits and vegetables didn’t agree with her stomach.

So Sarah quit her diet. But the nausea and weight gain didn’t stop. Soon her pants weren’t fitting. By the time the nausea finally subsided, she’d begun hiding her stomach beneath baggy shirts.

During my conversations with these young women, however, I discovered one common thread among them. None had used a condom.

The day before the dance, Sarah approached her mother, Denise, with tears in her eyes, begging to know why she was still gaining weight. Denise affectionately smoothed her daughter’s hair and kissed her forehead, assuring Sarah that she was a beautiful young lady. “What are you talking about?” Sarah’s mother protested.

Sarah cried, lifting up her shirt to expose what she called her “chubby” belly. Denise stared at her daughter for a moment before realizing what she was seeing. She gasped in disbelief. How had she failed to notice that her 13-year-old daughter was pregnant? She asked herself, over and over again, Am I blind?

Denise, a hardworking single mother, had been a teen mom herself. With heaviness in her heart, she called a midwife to schedule a prenatal visit for her daughter.

Less than four months later, Sarah delivered a healthy, 7-pound baby girl. Sarah needed stitches and antibiotics following delivery, because her young body, not quite fully grown, had suffered some birth trauma.

Sarah told me her story when she was my patient on the mother-baby unit, animatedly recalling her genuine shock at her pregnancy and the mind-boggling pain of the delivery. I was a brand-new nurse, and Sarah was the first 13-year-old mother I’d ever encountered. But she wasn’t the last. I cared for countless other teen moms during my tenure as a maternal-newborn nurse. Some of these young women were sweet and eager like Sarah. Others were distraught or withdrawn. Some held their babies lovingly, meeting every challenge of new motherhood like a pro. Others giggled and texted with friends while their babies hungrily wailed from their bassinets.

With half of all high school students in the state reporting sexual activity, and nearly as many reporting that they didn’t use a condom, it’s flabbergasting that policies prohibiting reproductive health services still exist.

Although it’s all too easy to stereotype teen moms, young mothers are as individually unique as their adult counterparts. During my conversations with these young women, however, I discovered one common thread among them. None had used a condom. Many of them believed condoms didn’t work. Others didn’t know where to get them. The majority believed in certain birth control myths, like you can’t get pregnant if the guy pulls out or the girl is on her period. Some of the younger teens, like Sarah, had never even heard of condoms and didn’t know you could become pregnant from losing your virginity.

Sadly, these young women aren’t alone in their beliefs. Research shows that adolescents across the nation often fall victim to the same misinformation I found among my patients.

Sarah’s poignant naivety left its mark on me. Here was a girl who hadn’t been able to recognize the signs of pregnancy, who hadn’t heard of condoms before having sex, and who, at the age of 13, tenderly held her newborn and learned how to breast-feed, despite the tears streaming down her face. How could this happen? Would Sarah have chosen a different path if she knew about pregnancy and prevention? Would something as simple as a thin layer of latex have preserved the wide-open horizons of Sarah’s future, or at least given her a few extra years before becoming a mother?

According to Sarah, yes.

“I didn’t know you had to use anything the first time you tried sex,” she told me, looking to her own mother for reassurance. “I didn’t know what to use, anyways.” She was scared of being the only high school freshman with a baby. She knew she needed to get a job now.

Teen pregnancy is a complicated issue. You can’t just point to one thing and say, There, I’ve isolated the cause of teen pregnancy. Now where’s my Nobel Prize? However, research shows us that social and economic disadvantages (such as poverty) make teens more vulnerable to unintended pregnancy. Research also shows that information is often the critical difference between girls who become pregnant and their sexually active peers who don’t. Numerous studies tell us that we should arm our young people with as much accurate knowledge and as many contraceptive tools as possible. This strategy won’t make teens have sex. It will, however, help prevent pregnancy and disease in those who do. It’s a much more feasible policy option than, say, eradicating poverty or legislating sweeping ideological and cultural changes.

Unfortunately, comments like Albuquerque Public Schools board member David Robbins’ Sept. 15 assertion that condoms aren’t effective only add to the misinformation that fuels unintended pregnancy. These comments were made during a board meeting amid a debate over whether the district should tweak its policy prohibiting school-based clinics from handing out condoms and birth control. The amended policy would clarify that, while APS employees are not allowed to distribute condoms, the district will not interfere with the provider-patient relationship.

The clarification would bring the school system in line with state law, which prohibits any interference with the provider-patient relationship. It would also support the state’s Department of Health and the New Mexico Teen Pregnancy Coalition’s recommendation to provide teens with comprehensive, confidential reproductive services without barriers. But the amendment has not yet been approved.

APS is not the only district in need of policy changes. Of the 80 school-based clinics in the state, only 26 offer any reproductive health services at all. With half of all high school students in the state reporting sexual activity, and nearly as many reporting that they didn’t use a condom, it’s flabbergasting that policies prohibiting reproductive health services still exist.

Yet there are those who would rather eliminate these clinics altogether than allow a condom on school property. David Robbins said if APS is not allowed to interfere with the provider-patient relationships, we shouldn't have clinics at all.

Studies show that they provide vital services to children and teens, many of whom have no health insurance and no other source of health care. These services range from asthma and diabetes care to mental health services. Eliminating school-based clinics out of fear of condoms would deny health care to the state's most vulnerable citizens.

When it comes to information about pregnancy prevention and access to birth control, Sarah fell through the cracks. Let’s not allow the same thing to happen to her daughter.

Despite its brilliant name, this column is not intended to prevent, diagnose or treat herpes. Or any other diseases, for that matter.

Whitny Doyle is a family nurse practitioner grad student.

The opinions expressed are solely those of the author.
 
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