Plan B on a drugstore shelf in Canada. Photo / Cory Doctorow

What a frustrating week in the ongoing battle over evidence-based health policy.

To the surprise and disappointment of women’s health advocates, the U.S. Justice Department on Wednesday filed an appeal to prevent girls under age 15 from gaining over-the-counter access to emergency contraception.

Approaching the date U.S. District Judge Edward Korman’s order making levonorgestrel-based emergency contraceptive pills (such as Plan B and Next Choice) available without restrictions would go into effect, the Obama administration also requested a stay pending appeal, meaning the judge’s order would not be implemented according to schedule.

The judge’s ruling last month was in response to the Center for Reproductive Rights’ renewed lawsuit seeking over-the-counter access to the morning-after pill.

Responding to the appeal, Nancy Northrup, CRR president and CEO, said in a statement:

Women who urgently need emergency contraception have been delayed in getting it or denied access entirely for more than a decade because of the political maneuverings of the last two presidential administrations. The federal court has made clear that these stalling tactics were based purely on politics, not science.

We are deeply disappointed that just days after President Obama proclaimed his commitment to women’s reproductive rights, his administration has decided once again to deprive women of their right to obtain emergency contraception without unjustified and burdensome restrictions.

In the appeal documents, the administration argues that the court overstepped its authority and improperly interfered with the rulemaking process; the judge should have instead sent the issue back to the FDA for further action.

“We aren’t focused in this appeal on the merits of the secretary’s decision,” a Justice Department official, who spoke on condition of anonymity, told The New York Times. “What we’re focused on is that the remedies that the judge ordered were beyond his authority.”

Ironically, overstepping is what many would argue the administration did in 2011 when HHS Secretary Kathleen Sebelius overturned a decision by FDA scientists to make the contraceptive pills available without restriction.

The administration also argues that since the actual plaintiffs in the case are all over age 15, and it’s not a class action suit, that no harm is done to the plaintiffs by granting the stay (see below). By making this argument, the administration avoids addressing the potential harm to girls who are prevented from accessing a drug both FDA scientists, and the judge, said should be available.

The administration claims that the public would suffer irreparable harm if the stay is not granted; if the ruling is allowed to go forward and later overturned, it would create confusion for women, who might “mistakenly believe that they can obtain the drug without a prescription or at certain locations where it used to be available, but is no longer.”

We’re also supposed to believe the appeal has nothing to do with politics. A Justice Department official told The New York Times: “This is a decision that the Justice Department is making in representing our client: FDA. This is not a political decision. It’s not had White House intervention or involvement. This in our judgment is the right legal step to take in this case.”

Meanwhile, FDA Approves Making Plan B Available to Teens Age 15 and Up
The decision to appeal came just one day after the FDA announced its approval of Plan B One-Step emergency contraception pills without a prescription for teens age 15 and older. The drug was previously only available without a prescription to women 17 and older.

It’s a great step forward; however, younger women, for whom access to a healthcare provider may be most difficult, are still left without prescription-free access to the drug, which must be used within a limited window.

The FDA adds to the burden by specifically requiring proof of age. From the FDA’s press release:

The product will now be labeled “not for sale to those under 15 years of age *proof of age required* not for sale where age cannot be verified.” Plan B One-Step will be packaged with a product code prompting a cashier to request and verify the customer’s age. A customer who cannot provide age verification will not be able to purchase the product. In addition, Teva has arranged to have a security tag placed on all product cartons to prevent theft.

In addition, Teva will make the product available in retail outlets with an onsite pharmacy, where it generally, will be available in the family planning or female health aisles. The product will be available for sale during the retailer’s normal operating hours whether the pharmacy is open or not.

The ID/proof of age requirement is a big hurdle for many teens. Many states set an age requirement of 16 for a driver’s license or learner’s permit. Obtaining a state ID (related to driving or not) costs money, and hours for doing so are often limited. And undocumented teenagers are unable to obtain a legal ID at any age.

“While welcomed by some as an acceptable compromise,” said Nancy Stanwood, Physicians for Reproductive Health board chair-elect, the “FDA decision to approve the sale of emergency contraceptive Plan B One-Step to those 15 years and older with government-issued identification does little to improve real access for already-vulnerable women and young teens. Plan B has a time limit, and too many women in the U.S. have gone without it because of unfair, unnecessary, and medically unjustified barriers to access.”

Writing at ThinkProgress, Tara Culp-Ressler explains other reasons why the policy shift is still problematic, noting in part that it simply isn’t based on science, and the high cost remains a barrier.

The FDA’s ruling was in response to an amended application request by Teva Women’s Health, the company that makes Plan B One-Step, to make the drug available without a prescription to women age 15 and older. The FDA in 2011 denied Teva’s application to make Plan B One-Step available for all females of reproductive age. And still the debate goes on.

Although there is a fair amount of information and research available on postpartum depression in general, very little of it seems to focus specifically on the needs or care of teen mothers.

A pilot study published in the American Journal of Obstetrics and Gynecology in March attempts to fill in this gap — and it shows some promising results.

First, the authors explain why the risks of PPD in teens are important:

PPD puts adolescent mothers and their children at risk during an already challenging time in their lives, and this hardship may be a major determinant of poor outcomes for these young mothers and their children. Untreated, depression is associated with school dropout, suicide, and substance use. Among adolescent mothers, evidence suggests that depression may prevent them from engaging in health-promoting behaviors for their infants and themselves.

The study is based on a randomized controlled trial of the REACH program (Relax, Encourage, Appreciate, Communicate, Help), which is designed to help expectant mothers develop stress management and other skills. The program was offered as structured therapy during pregnancy, followed by a postpartum “booster” session.

Participants in the therapy group used interpersonal therapy to work on effective communication skills, conflict management, improving their social support systems and building healthy relationships, and goal setting. They, as well as the control group, received a handbook of typical pregnancy and postpartum/newborn health information. A total of 106 teens age 17 or younger and without pre-existing mental health issues were randomized to the therapy or control groups.

The researchers looked for major depressive episodes within the six months after birth. Although only 12.5 percent of the REACH teens developed postpartum depression, compared with 25 percent of the control teens, the results were not statistically significant, as the study was fairly small and very few teens (19) overall developed postpartum depression. A larger study may be needed to better determine the utility of the program.

Despite a lack of clear effect, the study highlights a need for further investigation into the postpartum mental health needs of teens. As the authors explain:

Although validated treatments for adolescent depression exist and include interpersonal therapy, cognitive behavioral therapy, and antidepressant medication, teen mothers with mental health problems are mostly under treated. To date, only one published report of 2 small open-trial pilot studies addressed treatment for depression in pregnant adolescents. Despite the potentially high burden of depression to young women and their families, studies on the prevention of PPD in pregnant adolescents are virtually nonexistent.

Another lesson learned in this study was that teens preferred individual therapy sessions over the planned group sessions, so sessions were adjusted to be one-on-one. The researchers also took care to specifically design the REACH program to be culturally appropriate for a diverse group of racial and ethnic backgrounds.

Intrauterine devices (IUDs) are a fairly safe, long-acting form of contraception, but many myths about the devices persist. For example, it’s somewhat common to hear that women who haven’t already had a baby, and especially teenagers, are not good candidates for IUDs; neither of these is true.

For a new study published in the journal Obstetrics & Gynecology, researchers reviewed data from health insurance records of more than 90,000 women who had IUDs inserted (including both hormonal and copper IUDs). They looked specifically at how many records indicated a IUD-related complication, discontinuation, or pregnancy.

When the researchers looked at the data by age group, they found that women ages 15-19 did not discontinue using IUDs any more frequently than older women. Teens were slightly more likely than older women to experience dysmenorrhea (menstrual cramps) or absence of menstruation within one year of insertion, or failure of the IUD to prevent a normal pregnancy, but rates for both of these were very low. Only 1.8 percent of teens using a levonestrogel-releasing IUD experienced a pregnancy (3.6 percent for copper), and 2.4 percent experienced cramping (6.2 percent for copper).

Pelvic inflammatory disease occurred in less than half a percent of teens. Women of all ages using a copper IUD were much more likely to stop using it than women using the hormone-releasing IUD, and this was most true for teens, although it’s not completely clear why. Rates of removal within 30 days for any complication were estimated to be very low for teens (2.9 percent for hormone IUD, 5.2 percent for copper) as well as older women.

The researchers conclude:

Overall, these data indicate that the IUD is an appropriate contraceptive for younger women and is not likely to cause serious side effects among teenagers. Physician recommendations play an important role in their patients’ decision-making, and their recommendation of the IUD could increase the use of this cost-effective and safe method of birth control among teenagers. Thus, physicians should include information about this highly effective method when they counsel young patients on their contraceptive options to help reduce the unintended pregnancy rate among teenagers in the United States.

The authors cite evidence that teens may indeed face clinician education barriers when seeking an IUD. One survey found that “only 19% of obstetrician–gynecologists surveyed in a 2010 study stated that they would offer an IUD to an unmarried 17 year old who had never been pregnant.”

With more evidence like the current study on hand, we hope it will become easier for teens to access this long-acting, effective form of contraception.

Related: Revisiting the IUD for Contraception – Pros and Cons for Women looks at the rise in IUD use and the safety record.

by Hanna Pennington 

No one ever really wants to take health class; it’s a required course, something people try to get out of the way so they aren’t that about-to-graduate senior who still has to take health. And that’s because at most high schools, health class doesn’t offer much — and everyone knows it.

I spent 80 minutes every other morning in health class during the second semester of my sophomore year, and when faced with an end-of-the-year survey about the class, I realized that the time had not been “spent,” but wasted.

We had not discussed birth control; condoms were the only form of contraception mentioned, and they came up only in the context of preventing STIs. A significant number of high school students are already taking hormonal birth control, like the pill, for a variety of reasons, whether to regulate hormone imbalances that can cause acne, reduce the pain of bad menstrual cramping, or because they are having sex, but the pros and cons of the pill were never addressed.

Through reading “Our Bodies, Ourselves” and other feminist websites and books, I have learned about many types of birth control. But this is because I care about this kind of thing. Most people don’t know what they should have been taught until it’s too late.

Another way in which my health class was insufficient, and also offensive, was that LGBTQ people were only mentioned in the context of HIV/AIDS, which we learned about by watching the film “And The Band Played On.” There was no other discussion.

As a bisexual person, I felt shortchanged. I sought out resources online, much the way I did with birth control, but again, this didn’t make up for the lack of class information. The majority of high school students are straight, but it is important to provide for those who aren’t, or who might be questioning. It is important to learn about how to have safe gay sex, not only safe straight sex; that information is a lot harder to find, unless you know where to look.

Related: A “Real” Sex Ed Story: A Teenager Recalls Lessons From “Our Whole Lives”

Another issue we did not discuss is consent. People need to learn not only that it’s OK to say no, but that enthusiastic consent is the key to happy, healthy sex (in fact, there’s a petition to make consent a mandatory part of sex-ed in public schools).

Abuse, both physical and sexual, should also be discussed. And resources should be provided for everything: where to get help if you’re being abused, where to purchase prescription contraception at a discount, where to get tested for STIs, and the number for the closest Planned Parenthood, for starters.

Finally, we never discussed masturbation. It is important for students to know that instead of it being something unholy or disgusting, masturbation is a perfectly healthy and important way to explore one’s own body and sexuality.

According to research by the Sexuality Information and Education Council of the United States (SIECUS), comprehensive sex education is more effective in preventing teen pregnancy than abstinence-only education. In her 2008 New Yorker article “Rex Sex, Blue Sex,” Margaret Talbot analyzed the differences in sexual patterns of teenagers living in different parts of the country, including the prevalence of teen pregnancies and STIs and use of contraception.

In conservative red states, where abstinence-only education is the norm and religion dictates much of the discourse, teenagers have sex earlier, usually without protection. In more liberal blue states, where there is often (but not always) more comprehensive sex education, teenagers wait longer to have sex and use protection more often when they do.

Although I live in blue-state New York, my health class was not all that. It is possible to acknowledge teenagers being sexual without encouraging it, but our teachers didn’t acknowledge any part of it. It is irresponsible to teach the class assuming that everyone is and will remain abstinent until marriage.

The 2009 documentary “Let’s Talk About Sex” examines young people’s attitudes toward and knowledge of sex and sexuality, comparing America’s largely insufficient programs to those of places like the Netherlands, where parents and children talk openly about sex (and which have lower rates of teen pregnancy and STIs).

Although I was briefly tempted to move overseas, there are comprehensive sex-ed curriculums in the United States, even if they can be hard to find.

One of my friends attends Rye Country Day School in Rye, N.Y. A program there encourages underclassmen to ask upperclassmen leaders whatever they want about sex, relationships, and so on. I was really impressed when I first heard about this, as it fosters an environment that removes shame from asking questions, which is how people get the answers they need.

At Manhattan Country School, there is a sex-ed curriculum, designed by Dr. Cydelle Berlin, that involves theater arts and peer education. Trained actors answer questions while in character. There is a box in every classroom in which students can leave anonymous questions.

The Unitarian Universalist Church, instead of strictly discouraging or not discussing sex as other churches often do, teaches a K-12 sex ed curriculum called “Our Whole Lives.” As stated on the website, the program “not only provides facts about anatomy and human development, but also helps participants clarify their values, build interpersonal skills, and understand the spiritual, emotional, and social aspects of sexuality.”

This curriculum is based on SIECUS’ “Guidelines for Comprehensive Sexuality Education,” which spans the same age range and includes such important topics as body image, gender identity, masturbation, abortion, and sexuality and society.

When reading this curriculum, I was pleasantly surprised how enlightened, inclusive, and accurate it was. But this should not be surprising; accurate language should be the norm.

It is bad enough that decisions about women’s health are made mostly by male politicians, but it is even more disheartening when you realize that some of them have no idea what they’re talking about. High school students aren’t the only ones who need basic education about reproduction, but it’s a good place to start.

Hanna Pennington is a high school senior in New York whose first foray into feminist activism was at age 7, when she wrote a letter to a children’s magazine protesting the omission of Sacagawea in an article about the Lewis and Clark Expedition. 

Hey, it’s Valentine’s Day! Seems like a good time to revisit the topic of safer sex and sexually transmitted infections!

The CDC just released a new fact sheet on STIs, indicating that there are about 20 million new infections each year, and that young people (ages 15-24) account for about half of these.

In its report, CDC provided the following recommendations for women for STI screening:

• All adults and adolescents should be tested at least once for HIV.
• Annual chlamydia screening for all sexually active women age 25 and under, as well as older women with risk factors such as new or multiple sex partners.
• Yearly gonorrhea screening for at-risk sexually active women (e.g., those with new or multiple sex partners, and women who live in communities with a high burden of disease).
• Syphilis, HIV, chlamydia, and hepatitis B screening for all pregnant women, and gonorrhea screening for at-risk pregnant women at the first prenatal visit, to protect the health of mothers and their infants.
• Trichomoniasis screening should be conducted at least annually for all HIV-infected women.

Have questions about sex, sexuality, STIs or related topics? Beloved sex-ed site Scarleteen has just launched a new live help feature, providing anonymous live chats with Scarleteen staff and volunteers. The full website, which tackles all kinds of questions about sex, is an amazing resource for young people.

Though it won’t be as accessible as condoms, health experts are proposing to make the birth control pill available without a prescription. Photo / Jenny Lee Silver

This month, the American College of Obstetricians and Gynecologists released a statement calling for oral contraceptives to be sold over-the-counter, no longer requiring a doctor’s prescription.

ACOG considered a host of issues, including the safety of birth control pills; whether pharmacists could screen for who shouldn’t get them, or if women could self-screen; adherence to taking the pill; whether women would skip other preventive care if they didn’t visit a health care provider for a prescription; and cost.

Notably, ACOG addresses frequent objections to OTC oral contraceptives by concluding that “several studies have shown that women can self-screen for contraindications,” and “cervical cancer screening or sexually transmitted infection (STI) screening is not required for initiating OC use and should not be used as barriers to access.”

As Kevin Drum points out at Mother Jones, most countries outside of North America and Europe do not require a prescription for these drugs.

ACOG notes, though, that making the pill non-prescription might increase the cost for women who have health insurance — especially since under health care reform, contraception can be purchased without a co-pay. Over-the-counter costs might end up being anything from the $4 deals many pharmacies offer to more than $100. Dr. Kent Sepkowitz also explores this concern at The Daily Beast:

Yes, your life is easier because you will be able to get the pill right this second, without calling my office. No, you don’t need to fill out forms and show insurance cards and wrangle over copay. But guess who is paying for the whole shabang? You. Yes, you.

Another concern is that if the pill were dispensed by pharmacists, we might see the more of same kinds of refusals as have happened with emergency contraception.

However, many patients may experience increased access with an OTC model. The National Latina Institute for Reproductive Health issued this response:

The recommendation that birth control be available over-the-counter supports what we know about Latinas and contraception: over-the-counter access will greatly reduce the systemic barriers, like poverty, immigration status and language, that currently prevent Latinas from regularly accessing birth control and results in higher rates of unintended pregnancy.

Pre-Prescribing Emergency Contraception to Teens
Another professional medical organization, the American Academy of Pediatrics, issued a statement recognizing high teen birth rates in the United States and barriers to access to emergency contraception for adolescents 17  and younger. The AAP strongly admonishes pediatricians who refuse to discuss or provide contraception to teens based on their own beliefs, stating:

Pediatricians have a duty to inform their patients about relevant, legally available treatment options to which they object and have a moral obligation to refer patients to other physicians who will provide and educate about those services. Failure to inform/educate about availability and access to emergency-contraception services violates this duty to their adolescent and young adult patients.

The AAP recommends that physicians provide prescriptions to emergency contraception like Plan B in advance, so teens have it ready if and when the need arises. They also urge physicians to provide accurate information to teens on this topic, and, “At the policy level, pediatricians should advocate for increased nonprescription access to emergency contraception for teenagers regardless of age and for insurance coverage of emergency contraception to reduce cost barriers.”

Nice job, AAP!

HHS Urged to Remove Restrictions on Emergency Contraception
Finally, a petition is circulating urging the U.S. Department of Health and Human Services to remove restrictions on emergency contraception and make it available to women of all ages without a prescription. To learn more, see RH Reality Check’s audio news conference and related links and commentary from Kristin Moore. Our previous posts provide background on why EC is not *already* available OTC to all women:

• Evidence Trampled By Politics: HHS Secretary Sebelius Overrides FDA Decision on OTC Emergency Contraception
• Susan Wood Issues Response to Sebelius’s Overruling of Emergency Contraception Access

In 2006, when the FDA approved the first HPV vaccine for girls and women ages 9 to 26, one of the concerns opponents expressed was that it might make young girls think it’s OK to have sex.

That’s because the HPV vaccine protects against a virus that is contracted during sexual contact; specifically, four strains of the human papillomavirus, or HPV, which can cause cervical cancer and some vaginal, vulvar, penile and throat cancers.

In Nashville, where I live, one religious leader claimed, “What we are encouraging is abstinence and sexual purity. If they have a relationship with the Lord, they will recognize that they don’t need that vaccine.”

Others made claims along the same lines — that girls who “come from good homes” don’t need the vaccine, or that it would otherwise somehow promote promiscuity.

We’ve heard a lot less of this rhetoric lately, now that the novelty of the vaccine has worn off and the initial controversy has subsided. It always seemed like a bit of a ridiculous objection, since girls who become sexually active are probably not weighing the risk of some far-off consequence like cervical cancer. 

Heck, even the notoriously conservative Family Research Council has come around to acknowledging that either through abuse or by marrying someone who is a carrier of the virus, “it is possible that even someone practicing abstinence and fidelity could benefit” from the vaccine.

Still, opponents should be pleased with this news: The journal Pediatrics published a new study this week that shows the HPV vaccination is not associated with increased sexual activity among girls.

The researchers looked back at records for almost 500 girls who received the vaccine at ages 11 or 12 compared to about 900 girls who did not get the vaccine. Then they looked at whether the girls, over the next several years, had any record of being counseled about birth control, received contraception (specifically for birth control, not for acne or irregular periods), or had a diagnosis of pregnancy or certain STIs — all markers that imply sexual activity.

The researchers found no significant difference between girls who did and did not receive the vaccine.

Of course there are some limitations to the study, such as that some girls considered unvaccinated could have been vaccinated elsewhere, and girls could have received reproductive health care at places that weren’t counted in the study. A more conclusive set of results could come from following girls in real time over the years and collecting more detail about their health care and behavior.

However, this study provides important initial information that refutes concerns about HPV leading to increased sexual activity. Future research on concerns about the vaccine, then, might be better focused on learning more about long-term safety and effectiveness questions, rather than behavioral concerns.

Now we’ll just have to wait to see if there’s equal worry over whether boys who get the HPV vaccine are more likely to be more sexually active. I wouldn’t count on it.

Last week, we wrote about a controversial decision by HHS Secretary Kathleen Sebelius, who overruled the FDA’s decision that emergency contraception should be made available over the counter to women of all ages.

On Friday, former FDA official Susan Wood issued her response to the move in the Washington Post, rejecting Sebelius’s claim that more data is needed on safety and label comprehension for the youngest of possible emergency contraception users:

…this type of age restriction, and worries about the use of medicines by teenagers, have not been applied to other products…Indeed, for no other over-the-counter medication has the FDA ever required extra data for a particular age group. (This extra data on younger teenagers was provided to the FDA in the latest application by the company.)

But somehow, the prescription requirement for Plan B — which is very safe and impossible to overdose on — remains in place for those younger teens who are in the unfortunate situation of being at risk of pregnancy and who need emergency contraception immediately.

Wood also notes that because the age restriction remains, access for older women remains restricted – emergency contraception is available without a prescription for those over 17, but is still behind a pharmacy counter.

Wood previously served as assistant FDA commissioner for women’s health and director of the Office of Women’s Health. She resigned in 2005 because of past politically motivated delays in emergency contraception approval, stating at that time:

I can no longer serve as staff when scientific and clinical evidence, fully evaluated and recommended for approval by the professional staff here, has been overruled.

Now, Wood calls out Obama for breaking his promise to the American people by allowing this overruling:

In his scientific integrity memo, the president stated: “When scientific or technological information is considered in policy decisions, the information should be subject to well-established scientific processes, including peer review where appropriate, and each agency should appropriately and accurately reflect that information in complying with and applying relevant statutory standards.”

In overturning the well-considered, scientifically based decision of the FDA, Sebelius and the Department of Health and Human Services certainly did not “appropriately and accurately reflect” the available scientific information…The president should stand by the principles of scientific integrity and restore science to its rightful place. He should support the FDA commissioner and direct the secretary to allow the agency to do its job. By doing so he will fulfill the promise of that beautiful day in March 2009 when he pledged that science would trump politics, not the other way around.

If you would like to write President Obama to object to Sebelius’s action and remind him to remember his promise about scientific integrity, you can contact the White House directly via this online form.

If you have ever wished you had a little black book that answered your questions about sexual health and insurance, your wish has come true.

My Little Black Book for Sexual Health — LittleBlackBookHealth.org – is available online to help you navigate the maze. This resource offers information on various topics, including how to obtain low cost insurance and rules that might govern whether birth control is covered by your insurance.

Described as “a guide for getting the health insurance you need to prevent pregnancy until you’re ready,” My Little Black Book is aimed at young people between the ages of 18 and 26; this group is most likely to be uninsured and faces a high rate of unintended pregnancy.

The interactive website is easy to use (or download the PDF version). You can flip through the virtual pages, blow the text up for easy reading, follow the tabs, or click through the table of contents. I found all sorts of helpful information — who is eligible for a school’s student health plan, how to get prescription drug coverage, and what kinds of sexual and reproductive services are covered. It is very user friendly and easy to understand.

My Little Black Book for Sexual Health was developed as part of the Reproductive Empowerment and Decision Making for Young Adults (REaDY) Initiative, a unique statewide public-private partnership led by NARAL Pro-Choice Massachusetts and Ibis Reproductive Health, to prevent unplanned pregnancy and promote sexual health for young adults in the wake of Massachusetts health care reform. A Spanish language version will be available soon.

Nekose Wills is the OBOS program assistant.

When discussing how sports benefits girls — which many of us are doing today as part of the National Women’s Law Center Rally for Girls’ Sports Day — I keep coming back to the idea of community.

While sports certainly has many individual health and social benefits for girls, it also gives girls a space to develop relationships based on teamwork and respect. Bolstered by their team, girls are able to step in front of their larger school community and exude confidence and pride that might be missing in other parts of their lives.

Girls’ relationships with that larger community, however, are often complicated when schools in underserved neighborhoods have trouble providing girls (and all athletes, for that matter) with a safe space in which to perform.

Here in Chicago where I live, Chicago Public Schools are struggling with many inequity issues. CPS is at the top of the list of schools against which NWLC has filed administrative complaints for Title IX violations. The district has a whopping 33 percent sports participation gap between girls and boys (the next closest complaint is for the Sioux Falls School District with a 15.6 percent gap). See the NWLC’s briefing paper (pdf) for more vivid detail.

But poverty and the constant threat of violence also play a big role in forming sports communities. A recent story by Lisa Pevtzow in the Chicago Tribune highlights the struggle of the girls basketball team of the Rowe-Clark Math and Science Academy in Humboldt Park, a neighborhood on the west side of the city. Because of lack of facilities, the team — along with other boys’ and girls’ teams at the school — have had to walk to a nearby YMCA to practice:

Keeping close together, the players make their way past boarded-up buildings, crumbling sidewalks and a gantlet of drug pushers and users who tug on their coats, grab at their equipment and hurl abuse.

“If we don’t respond, they call us names. It can be very scary,” said team member Ronye Scott, a junior at the Humboldt Park high school.

Thankfully, the school has just broke ground on a new gym of their own that should be ready for next year. But the past experiences of the students will most certainly linger — and act as a reminder of how a safe athletic environment needs to be a right for girls and all athletes.

Marlon Tobin, athletic director and assistant principal at the school, told Pevtzow some of those telling stories:

“We have to beg, borrow and steal space for our programs,” Tobin said. “We’ve already tapped out everything in the neighborhood that’ll let us in.”

Beyond causing inconvenience, the lack of gym facilities has created a significant safety problem, he said. A year ago, a group of Rowe-Clarke students were jumped on their way to play soccer. More recently, Tobin said, the school learned the hard way not to let the girls soccer team walk down the street in their shorts and jerseys, because they were harassed when they did.

“We tell kids to do the right thing and play sports, and now we have to tell them it’s not safe,” Tobin said.

Plus: For more reading about the importance of girls in sports, check out these posts compiled by the NWLC.

by Nekose Wills | OBOS program assistant

The challenges girls face today are unlike the challenges many of us faced growing up. I’m 32, and I remember not caring about my Oscar the Grouch eyebrows, who designed my clothes, or how sexy I looked in them. Girls growing up today don’t have such freedom — they’re sexualized everywhere they look.

The SPARK Summit, held Oct. 21 at Hunter College in New York City, was an alarm, waking us up to the role we can play in bucking the status quo and giving us the tools to take on this fight. SPARK stands for Sexualization Protest: Action, Resistance, Knowledge.

The day started with opening remarks from Hunter College President Jennifer Raaband and MTV’s Amber Madison, summit host and author of “Hooking Up: A Girl’s All-Out Guide to Sex And Sexuality,” a book aimed at young women about sexual health, sexuality and relationships.

Feminist media critic Jean Kilbourne, creator of the groundbreaking “Killing Us Softly: Advertising’s Image of Women” film series, also spoke, followed by a keynote address from the actor Geena Davis. Perhaps best known for her role in the film “Thelma and Louise, ” Davis has long advocated for increasing and diversifying the presence of female characters in media aimed at children. Her presence was a welcomed reminder that not everyone in Hollywood accepts business as usual.

The SPARK Summit encouraged young women to find their voices. There were a number of workshops specifically geared toward self-expression, such as Street Theater, FlipCam Journalism, and Blogs Rock. Throughout the day, it was clear that girls are very cognizant about being sold images of who they should be, but they lack resources to actively combat those images.

Media literacy is the first step. Melissa Campbell who works on media literacy in San Francisco and founded the Manfattan Project (“real fashion, large bodies”), led the Hard-Core Media Literacy workshop. In other workshops, girls created radio spots, photography and art, and shared personal stories. They discussed topics such as street harassment and legislation that would fund media literacy and youth empowerment programs (H.R. 4925).

My favorite part of the day was the Numbers Don’t Lie panel, during which researchers presented findings on how media images and messages influence girls. Among them:

• Even in video games where women are strong, central characters, their sexualized appearance negates the effect of the character’s power — “Video Game Vixens: The Sexualization of Women and Girls in Video Games,” Elizabeth Behm-Morawitz (University of Missouri-Columbia)

• Black women are the most sexualized group in music videos. — “Sexualization in Popular Female Artists’ Music Videos: An Analysis of Race and Genre,” Jennifer Stevens Aubrey (University of Missouri-Columbia)

• Black youth consume more media than their white peers, but they are less affected by the body image ideals perpetuated — “A Woman’s Worth: How Media Use Shapes Black and White Teens’ Views of the Feminine Ideal,” L. Monique Ward (University of Michigan)

• When the media sexualizes female athletes, it negatively affects girls’ perceptions of themselves and of female athletes — “‘You Can Score With Me’: What Girls Think of Sexed-Up Media Images of Female Athletes,” Elizabeth Daniels (University of Oregon)

• Low grades can spur girls to participate more in their own sexualization — “High Heels, Low Grades? The Costs Associated With Sexualization,” Rebecca Bigler & Sarah McKenney (University of Texas, Austin)

• The attire of women and girls in G-rated movies is no different than portrayals in higher-rated movies — “General Audience or G-Porn? A Look at the Prevalence and Sexualization of Females in Film and Children’s Television programming,” Stacy Smith (University of Southern California)

I also learned that Barbie is still evil. One study — “‘I can be … Anything?’: Playing with Barbie Reduces Girls’ Career Aspirations,” by Aurora Sherman and Eileen Zurbriggen (Oregon State University and University of California, Santa Cruz) — found that playing with Barbie lessened girls’ perceptions of attainable occupations. It didn’t matter if girls played with Doctor Barbie — they still thought they could not achieve as much as when they played with Mrs. Potato Head.

The panel made me realize the extent to which girls are encouraged to see themselves as sexual objects — even girls as young as 3 can still be the toddler in a tiara.

We are told that if we just buy enough products, go on enough diets, and work hard to emulate airbrushed and Photoshopped images of girls and women, we might achieve perfection — and there’s something inherently wrong with us if we don’t dedicate ourselves to this quest. It’s time to take our sexy back.

There is nothing wrong with sexy as long as it is not forced on girls and as long as women get to define it on their own terms, not through the lens of a voyeuristic, paternalistic society.

My favorite quotes from the conference were “I am whole, not a ho!” “I am a quirky black girl and proud of it!” and, finally, “Freedom is never really won, you have to earn it in every generation.” We are trying to earn freedom for the well-being of today’s girls.

Years ago, I learned to disconnect from the constant onslaught of negative media images by consuming less. When I stopped watching music videos, especially the ones on BET, and stopped buying women’s magazines, I was much happier. There were less false images for me to compare myself with.

Those images were replaced by the women I saw on the train and on the street, who were in my life as three-dimensional people, with non-airbrushed photos and presences, with blemishes on their faces and extra fat rolls on their sides; real women, beautiful as the reality of an honest life.

The SPARK Summit was the reminder I needed that we can be who we are, with no apologies. We can replace the constant drumbeat of fake “perfection” with action, resistance and knowledge. And, most importantly, we need to have this dialogue on a continuing basis.

From the moment we put girls in front of a television, turn on the radio, drive past a billboard, or let them look at a magazine, we need to reinforce what it means to be beautiful, media literate, and critical of the world around us. I have a few young ladies I need to call.

by Karin Ringheim | Population Reference Bureau

A recent NPR story on the biological basis for the sometimes confrontational, erratic and seemingly irrational behavior of adolescents reminded me of my own experiences in raising adolescents (and gratitude that this particular stage of life is now behind me).

As Garrison Keillor recently reminded us, to be a parent is to live a life of constant silent prayer — prayer that everything will turn out all right. We know that adolescents don’t always exercise the best judgment, and now, at least, we have a better sense of why this is the case.

The Teen Brain – A Work In Progress

The physical evidence gathered from Magnetic Resonance Imaging (MRI), according to Harvard researchers Frances Jensen and David Urion, shows that the adolescent brain is only about 80 percent as developed as an adult brain.

In adolescence, the brain’s frontal lobe, responsible for such important functions as reasoning, planning and judgment, is not as well-connected to the rest of the brain by myelin, or “white matter,” as it is in an older individual. Because of the immaturity of their brains, adolescents are less capable than adults of rational thought processes.

White matter grows substantially over the course of adolescence, providing insulation that increasingly enables nerve signals to flow freely from one part of the brain to another. When the frontal lobe is fully connected to the rest of the brain, around age 25, the brain is more capable of “connecting the dots,” processing complex notions — such as that actions have consequences.

Brain development from age 5 to 20 / Source: Paul Thompson, professor of neurology, UCLA School of Medicine

Death and Disability Rates Double During Adolescence

If parents did not already intuit this, the difficulties that adolescents have in controlling their emotions and behaviors lead to a doubling in rates of death and disability during adolescence as compared to rates among younger children.

According to Ronald Dahl, Staunton Professor of Psychiatry and Pediatrics at the University of Pittsburgh Medical Center, increased risk-taking, sensation-seeking and reckless behavior lead adolescents to higher rates of traffic and other accidents, substance abuse, suicide, eating disorders, depression, violence and risky sexual behaviors.

Although Dahl does not promote a mechanistic view of biology as destiny, he does note that the life trajectories established in youth can have a major impact on later life, and it is best to alter these trajectories in a positive direction while one can.

Youth Reproductive Health: A Politically Charged Issue

Adolescents who become unintentionally pregnant or become infected with HIV are certainly in for a life-altering experience, and usually not one that will be advantageous.

For at least 15 years, reproductive health advocates have called for “youth friendly services” to enable youth who are, or intend to become sexually active, to obtain the information and services they need to remain healthy.

The concept of reproductive health services for adolescents has been, and remains politically controversial. In 2004, ideologues charged that the Global Health Conference [pdf], an international gathering of health professionals held annually in Washington D.C., would be a platform that year to advocate for youth reproductive health services, instigating a last-minute withdrawal of federal funding for the conference from the U.S. Department of Health and Human Services, the Centers for Disease Control (CDC) and the U.S. Agency for International Development (USAID).

While the conference proceeded with funding from other donors, the action had a chilling effect on some federal grantees, who swept their websites clean of any potentially damaging information. U.S. programs for youth in developing countries supported under the President’s Emergency Plan for AIDS Relief, PEPFAR, were firmly grounded in the “ABCs” — Abstain, Be faithful, use Condoms, even as domestic research showed that abstinence-only programs had no long-term health benefits.

Meanwhile, in some African countries, one in five young women is HIV positive and as many as one in two has been pregnant. In South Africa, 22 percent of young women attending antenatal care are both pregnant and HIV positive. These astounding statistics have largely been unmoved by the infusion of PEPFAR and other funding for proscriptive youth reproductive health information and services. And politically shaped policies in the United States help maintain pregnancy, birth and abortion rates among adolescents that are the highest in the developed world.

An Evidence-Based Practice

How should societies respond to the knowledge that adolescents may not be capable of obeying our pleas to “just say no,” “abstain until marriage,” or “always use a condom”?

Adolescents are capable of understanding, if not fully controlling, their own immature thought processes. They need realistic, truly “youth-friendly” tools and resources to help them make better decisions and remain healthy and safe.

If, based on brain research, adults come to view adolescence less as a period of self-centered disobedience and more as a period of innate vulnerability, we will do a better job of providing youth with comprehensive, compassionate services and education. We will do whatever we can to help them navigate this vulnerable period without becoming pregnant or HIV-positive, or undergoing an unsafely performed abortion, and if such outcomes occur, we will aim to minimize the harmful life-altering consequences.

Our obligation is to protect as best we can, those who by virtue of their not-fully-realized intellectual capacity, are less able than we previously assumed to look out for themselves.

Karin Ringheim, Ph.D., M.P.H., is a senior policy adviser at the Population Reference Bureau

Back in 2007, we reported on the release of a devastating report from the American Psychological Association’s Task Force on the Sexualization of Girls. Its findings about the impact of sexualized images on young women weren’t necessarily revelatory for long-time activists, but the thoroughness and precision with which it outlined the cultural crisis provided a renewed foundation of evidence and authority.

Inspired by the report, a coalition of organizations — Hardy Girls Healthy Women, TrueChild, Women’s Media Center, Hunter College and the Ms. Foundation for Women — is convening the SPARK Summit: Challenging the Sexualization of Girls and Women, on Oct. 22 at Hunter College in New York City.

The event will include “girls and media professionals, thought leaders and funders, researchers and activists” and “serve as a national call to action and campaign for change.”

You can follow the build-up to the summit on Facebook and on Twitter (@SPARKsummit). You can even help decide on the meaning of the SPARK acronym by voting on the Hardy Girls blog.

A recent collection of essays out of Australia, “Getting Real: Challenging the Sexualisation of Girls,” edited by Melinda Tankard Reist, also strikes a tone of urgency in its insistence that the problem is only increasing and activism must rise to meet it.

Noni Hazlehurst writes in the preface:

The insistent and ubiquitious presentation of this unbalanced view of the world is nothing less than a form of child abuse. Why is it we kick up such a fuss about junk food and obesity, but are unwilling or unable to tackle the lack of quality sustenance for child’s minds and spirits? [...]

In my view our children’s imaginations are dying. Their sense of themselves as worthy, strong individuals who are valued because they are unique is constantly being undermined. Only a few can withstand that sort of pressure. And very few will be in a position to be encouraged to be different, as many of today’s young parents don’t remember when there were alternative ways of looking at the world and other ways to value an individual’s noteworthiness.

Media critic Jean Kilbourne, among others, provides a rousing endorsement of “Getting Real” — and Kilbourne has just updated her landmark film series, “Killing Us Softly,” on the same subject. “Killing Us Softly 4″ can be previewed and purchased at Media Education Foundation. From the film’s description:

The film marshals a range of new print and television advertisements to lay bare a stunning pattern of damaging gender stereotypes — images and messages that too often reinforce unrealistic, and unhealthy, perceptions of beauty, perfection, and sexuality. By bringing Kilbourne’s groundbreaking analysis up to date, Killing Us Softly 4 stands to challenge a new generation of students to take advertising seriously, and to think critically about popular culture and its relationship to sexism, eating disorders, and gender violence.

Kilbourne also continually updates her definitive list of “Resources for Change” — which provides an exhaustive, clearly categorized set of links to useful reports, websites and allied organizations.

Despite the availability of all these resources and the continual, varied calls to action, however, many young women on the frontlines of this cultural crisis remain conflicted and confused, caught in an impersonal media machine. Possibly the most prominent example of this struggle is, yes, Miley Cyrus.

In his review of her latest album, “Can’t Be Tamed,” Jon Caramanica of The New York Times discusses the difficulty 17-year-old Cyrus has coming of age as a woman and an artist, negotiating her well-established Disney “Hannah Montana” identity and her need to assert her adulthood.

In her now infamous 2008 Vanity Fair photo shoot (remember the outcry — and response to the outcry?), and in the literally wild video for the title track of her new album, the seemingly inevitable sexualization of her image is well underway.

But Caramanica sees a much more hesitant and haphazard construction of identity. Instead of solidifying a new sexualized Miley, the album as a whole reveals the “frayed seams of her identity”:

Ms. Cyrus’s metamorphosis isn’t nearly as radical as “Can’t Be Tamed” — the title track, the video, the title — would suggest. Rather, she’s evolving into something far less controversial: a pop star, confused like all the rest of them.

This confusion is most clearly evident in one of the later songs:

On “Permanent December,” written with Claude Kelly — who also helped write “Party in the U.S.A.” — Ms. Cyrus tries out a sneering type of sing-rapping, à la Fergie: “Don’t call me a Lolita/’Cause I don’t let ’em through.”

On a more coherent album, that idea would be explored further. But the fact that Ms. Cyrus feels little need to assert her sexuality, or lack thereof, is consistent with her rejection of a single new identity in favor of a cluster of experiments. Perhaps she hasn’t had time to think it through, or maybe she’s realized that evading the subject for now is a more flexible strategy than tackling it head-on.

Of course, presuming that Miley’s original Disney identity didn’t involve its own form of sexualization would be naive. And I’m not just talking about the crazy Mickey Mouse underwear ads that debuted in China a couple of years ago, or the “dive in” underwear for girls that Disney wrote off as an “oversight.”

Last month, according to the Orange County Register (more here), the YWCA of Australia sought “a PG rating for tween magazines Disney Girl, Barbie Magazine and Total Girl, saying that the publications teach young girls that their bodies need to be improved upon.”

UPDATE: The New York Times reports that young fans of Miley Cyrus aren’t super thrilled with her new path. Also, see the comments for great information about the Healthy Media for Youth Act, H.R. 4925. The Girl Scouts is a strong supporter.

Publicado por Christine / del orginial en inglés Sept 15, 2009:

OBOS is committed to expanding our audience and in this spirit we’ve asked former board member Moises Russo to translate into Spanish several of our blog entries. We hope to translate more entries in the coming year.

En OBOS estamos comprometidos a expandir nuestra audiencia de lector@s  y en este espíritu le hemos solicitado a Moisés Russo, ex-miembro de la Junta de OBOS, que traduzca al español varios de los blogs que tenemos en la página electrónica. Esperamos continuar con dichas traducciones durante este año.

Una segunda vacuna diseñada para proteger contra el cáncer cervicouterino estará disponible pronto en Estados Unidos.

La semana pasada, un panel de la de Food and Drug Administración (FDA) dio su aprobación a la vacuna Cervarix de GlaxoSmithKline PLC*, esencialmente recomendando que la FDA apruebe la vacuna para el uso en mujeres de 10 a 25 años de edad. La recomendación no es obligatoria; la FDA puede rechazar la decisión, pero ésta generalmente acepta la opinión de paneles externos de expertos.

La vacuna protege contra dos tipos de virus papiloma humano (VPH), asociados al 70% de los cánceres cervicouterinos.

Escribiendo en el Wall Street Journal, Jennifer Corbett Dooren resumió las preocupaciones con respecto a la seguridad que la FDA levantó acerca de Cervarix, incluyendo “una mayor tasa de abortos entre las mujeres que recibieron Cervarix”. La FDA refirió además “no se puede excluir un ‘pequeño efecto’ sobre los embarazos”. (La vacuna no está aprobada para su uso en mujeres embarazadas).

GlaxoSmithKline intentó por primera vez conseguir la aprobación el año 2007, pero la FDA solicitó más información luego de que algunos reportes sugirieron una tasa más alta de abortos en mujeres embarazadas. Dooren escribe:

La agencia dijo que se requeriría de un estudio de seguridad post- marketing para monitorizar los resultados de embarazos en mujeres que pudiesen recibir Cervarix, junto con otras potenciales preocupaciones sobre su seguridad incluyendo el desarrollo de enfermedades autoinmunes como Artritis Reumatoide y Esclerosis Múltiple. En su revisión del año 2007 de Cervarix, la FDA indicó que tenía preocupaciones sobre un “desequilibrio” en posibles desordenes autoinmunes visto en algunos estudios clínicos. Sin embargo, la agencia ha dicho que revisiones adicionales de los datos realizadas por sus propios equipos y por un reumatólogo externo concluyeron que las diferencias no eran estadísticamente significativas.

Oficiales de Glaxo dijeron que estaban planeando un estudio de post-marketing que enrolaría a 100.000 mujeres en los EEUU, el cual incluiría un registro de embarazos. La compañía también se encuentra realizando otro estudio de post-marketing de grandes proporciones en Finlandia.

Gardasil, la popular vacuna contra el VPH fabricada por Merck y & CO. Fue aprobada por la FDA el 2006. Uno de los principales investigadores para la vacuna recientemente ha comenzado a denunciar preocupaciones con respecto a sus riesgos, beneficios y agresivas estrategias de marketing – principalmente que la protección puede no durar más allá de los 5 años, por lo que las niñas que sean vacunadas a una edad temprana pudiesen en el futuro aún encontrarse en riesgo.

El mes pasado, Rachel apuntó a una editorial del Journal de la Asociación Médica Americana sobre los riesgos y beneficios de la vacunación contra el VPH y analizó un comentario en la misma edición de JAMA (sólo resumen) sobre el marketing de Gardasil. Describiendo los hallazgos de los autores, Rachel escribió: “ La táctica de la compañía fue fomentar que todas las mujeres dentro de un cierto grupo de edad se vacunaran como una medida para evitar el cáncer, en vez de trabajar con oficiales de la salud pública para enfocarse en aquellas niñas que tienen un riesgo más elevado”.

Los Centros para el Control y Prevención de las Enfermedades (CDC por sus siglas en inglés) recomienda la vacuna para niñas de 11 y 12 años, y niñas y mujeres entre las edades de 13 y 26 años que aún no hayan sido vacunadas. Esa recomendación sin embargo se convierte en un mandato para las mujeres inmigrantes entre 11 y 26 años que buscan la ciudadanía Estadounidense. Gardasil fue agregada a la lista de vacunas requeridas el año 2008.

Simona Davis, una niña de 17 años en Florida que nació en el Reino Unido está buscando la ciudadanía Estadounidense pero se rehúsa a vacunarse. El noticiario ABC News tiene un reportaje completo sobre su rechazo a la vacuna. Davis, que es una cristiana devota que dice no tener intención de iniciar relaciones sexuales en el futuro cercano (menciona su promesa de virginidad como una prueba), está buscando una exención por razones morales y religiosas. Los Servicios de Ciudadanía e Inmigración de los EEUU han rechazado su solicitud.

“La decisión de incluir el VPH como una vacuna requerida fue hecha por el CDC”, ha dicho la vocera de los Servicios de Ciudadanía e Inmigración de los EEUU Chris Rhatigan a ABC News. “Nosotros seguimos la ley….La objeción a una exención debiese ser a todas las vacunas, no solamente a Gardasil”.

Un vocero del CDC ha dicho que se espera que el CDC publique nuevos criterios dentro de aproximadamente un mes para determinar que vacunas debiesen ser recomendadas a inmigrantes a los EEUU.

I recently learned of a new documentary film that may be of interest to readers. In “Subjectified: Nine Young Women Talk About Sex,” director Melissa Tapper Goldman interviews nine U.S. women from different backgrounds and locations about their sexuality and experiences.

The film attempts to overcome stereotypes and assumptions using women’s own words, “to overwrite some of these associations, with something more real, more nuanced, deeper and more heartfelt.”

Goldman writes:

This project began as a simple question and a simple frustration. I thought I understood the motivations and pressures regarding girls’ sexuality within the community where I grew up, but I had no clue what sexuality meant for other women around the country… The stories were both more sophisticated and more powerful than what I had anticipated.

Two trailers for the film are available online; view one below.

Readers in and around the Boston area can attend a free film screening, followed by a Q&A with the director and one of the women featured in the film. The event will take place at MIT in Cambridge on Thursday, Feb. 4, at 7 p.m.  The screening is part of the “Chicks Make Flicks” series.

Others who are interested can keep up with the film at the blog and on Facebook and Twitter.