I have noticed that sex education has been a common topic that has arose in class whether we are talking about birth and politics, abortion, or public policy and services. I came across this article written by a journalist, Jemimah Steinfield, who talks about sex education, or the lack there of, in China. Sex discussion and education was strictly forbidden in China until around the time of the cultural revolution when the Ministry of Education allowed some sex education, but mainly to teach children about the differences between men and women. They were to be taught mainly about the anatomical differences only. Even in recent years in China, schools are discussing these same topics and including  nothing about contraception, sexually transmitted diseases, or sexual abuse. The problem is that since no one learns about it, no one grows up to be able to teach about it and the vicious cycle continues. Unfortunately, even though there is no education, this doesn’t mean that people are not engaging in sexual activity. The article states that a survey done in 2012 “showed that 70% of Chinese have engaged in pre-marital sex, up from just 15% of those surveyed in 1989” (Steinfield). So its clear that the population is sexually active and without proper protection and education of risk comes the potential unwanted infections and pregnancies. “Sexually transmitted infections (STIs) are on the ascent and China has particularly high rates of syphilis, while sexual transmission now accounts for 81.7% of all new HIV infections” (Steinfield). As well, the article reports that in 2013, 13 million annual abortions were performed with one patient who reportedly had already had 13 abortions throughout her lifetime.

I found this article especially interesting based on the facts. You’d think figures like this would be making a more profound impact on a population. I found it particularly interesting in comparison to discussions we had had in class and different sexual educations experiences each student has had. The article ends stating that there has been more focus on sexual education in China in the past year, but mostly focused on protection against sexual abuse as the cases of child abuse have drastically rise throughout the past decade.

Steinfield, J. (2014, June). Do Chinese Classrooms Need to Talk About Sex? CNN. Retrieved from CNN website http://www.cnn.com/2014/06/19/world/asia/china-sex-education/index.html?iref=allsearch

I’m not sure how it came up but a few of my friends and I were talking about something and one told us the story of how she was born and I thought it fitting to share with you all.

She writes,”I was born in the beautiful city of Khartoum, Sudan in Soba hospital at 4AM, upside down and with no electricity. There was only one doctor around and he was sleeping. They woke him a little while before it was time for my mother to push. He had to start the generator and others lit candles as there was no electricity.”

She’s almost 21 years old and born in 1994. I compared her birth to what I assume mine was like in Staten Island, New York. I had electricity and my mother received an epidural, but we both made it and so did our mothers. I was amazed by her story not in an, “Oh my goodness how did you make it” kind of way, but in a “the pure power of nature kind of way”.

After multiple presentations on abortion, I became interested in learning more about abortion laws in Georgia. According to the Guttmacher Institute, there are several restrictions on abortion in Georgia that are in effect as of November 1, 2014. These restrictions include:

• A woman must receive state-directed counseling that includes information designed to discourage her from having an abortion and then wait 24 hours before the procedure is provided.
• Health plans that will be offered in the state’s health exchange under the Affordable Care Act can only cover abortion when the woman’s life is endangered or her health is severely compromised.
• Abortion is covered in insurance policies for public employees only in cases of life endangerment.
• The parent of a minor must be notified before an abortion is provided.
• Public funding is available for abortion only in cases of life endangerment, rape or incest.

These restrictions are severely muddled especially the phrase, “counseling that includes information to discourage her from having an abortion.” I am interested in the exact verbiage of this counseling and if the counseling takes into consideration the situation in which the woman became pregnant, e.g. rape. I am also interested why rape is not a reason for abortion under health plans offered by the Affordable Care Act.

Abortions in Georgia as well as in the United States, have been steadily declining since 1991. In 1991, there were 24 legal abortions per 1,000 women aged 15-24. In 2011, there were 16.8 legal abortions per 1,000 women aged 15-24. During this time, there were 28 abortion providers in Georgia, with 19 of those being clinics. Also, 96% of counties in Georgia had no abortion clinic and 58% of Georgia women lived in these counties.

For those of you from other states, I am interested in knowing more about the abortion laws in your states. Please chime in.

References

“State Facts About Abortion: Georgia.” Guttmacher Institute. Web. 13 Nov. 2014. <http://www.guttmacher.org/pubs/sfaa/georgia.html>.

I’m reading a very interesting/shocking book called Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men, written by Mara Hvistendahl. Just as the title says, the book focuses on how sex selection abortions came to be, and the effect they have on populations and the societies that are affected by an overabundance of boys. A team of French demographers place gender imbalance on par with the HIV/AIDS epidemic. In 2008 it was estimated that AIDS had claimed 25 million lives in the history of its epidemic. This is a fraction of the estimated 100-160 million girls that have been lost to sex selective abortion practices. As the first generation touched by sex ratios imbalance grows up, the silent biological discrimination that is sex selection has been exacerbated by visible threats to women, including sex trafficking, bride buying, and forced marriages. This only exacerbates the problem, and only further impedes progress in reproductive health for women.

From the 1950’s through the 1970’s UNFPA, The Rockefeller Foundation, The Ford Foundation, and The World Bank sent $1.5 billion in aid to India to support implementation of “any necessary population control measures: including abortion, sterilization, and birth control. Quite interestingly, many of the main players pushing for the implementation of these programs in India, China, and a few other Asian countries were fighting extension of the same rights in the US. The argument was that over population in these areas was impeding development. Chinese officials felt that boosting per capita GDP was a long and difficult process that would take many years to accomplish. With the support of these aforementioned western organizations, China implemented the one-child policy in 1980. Cutting the birth rate and reducing the number of people who would share in the wealth (or lack there of) in the nation seemed a quick and attainable way to push development. Economic development, along with the urbanization, education, and new job opportunities has been shown to lead to lower birth rates in families. But because development is accompanied by plummeting birth rates, it raises the stakes for each birth, increasing the chances parents will abort a female fetus, creating an alarming triangle of development, falling fertility, and sex selection.

In 1982, two years after the one child policy was enacted in China, ultrasounds were widely distributed. Though sex determination was technically illegal in China, there was little incentive to crack down on it, so a small bribe could go a long way. The fine for sex selection was also ten times less than the fine for having a second child. This drove many parents to choose to “beat the odds” and ensure that they had a son on the first try.  I thought this was a striking example of the different effect that certain technologies can have in culturally distinct environments. In the political and cultural climate of China and India at the time, ultrasound technologies served as an inexpensive gateway for working the system and helping families to ensure that they had a boy, at the expense of unborn girls.

Reading this book has made me stop and think about how the implementation of certain technologies often has dangerous and unintended results. I don’t think technology should be withheld, but the implementation has to be careful and sensitive to the political and social climates they are being introduced to. So what can be done? How do you check that what is supposed to be a helpful technology is not promoting gender inequality and obstructing maternal health? As sex selection cannot happen without abortion, this issue obviously opens up conversation on access to abortions and what should be done in that respect.

Japan and Sweden have some of the lowest rates of maternal and infant mortality in the world, and yet, their cultural practices and behaviors vary widely between the countries. While both nations encourage mothers to stay at home with their families after giving birth, there seems to be a lack of choice for mothers in Japan compared to Sweden. As Ugochi mentioned in her presentation, only 3% of mothers take pain relieving medications and are told that it is not appropriate to scream out during labor. I feel like telling mothers that they have little choice in reliving their pain, whether through medication or screaming, is not a healthy cultural behavior. While it seems that Japan is beginning to incorporate more paternal involvement in the birth process, their inclusion of fathers doesn’t seem to compare to the Swedish model.

How then are both countries so successful in maternal outcomes when their practices seem to vary widely? Do you think encouraging mothers to not take any pain reliving medication is a healthy practice?

Hi everyone! I felt a bit rushed at the end of my presentation yesterday, but I wanted to talk a little bit more about Kangaroo Care because I think it provides a great alternative to expensive care for premature infants. For example, I’ve been reading a lot about the use of Kangaroo Care in Malawi. Malawi has approximately 15,000 neonatal deaths a year and 60-90% of those deaths are attributed to LBW babies who are mostly preterm. I’ve attached a video and some resources in hopes that it might be interesting to you all since we have seen through reading Monique and the Mango Rains how important (yet lacking) good maternal care is in Malawi.

Here is the link for the video:

http://www.healthynewbornnetwork.org/multimedia/video/kangaroo-mother-care-living-proof-malawi

And here are a couple (short) articles that you all might find interesting:

http://www.unicef.org/malawi/reallives_13345.html

http://www.who.int/pmnch/events/2007/20071113_malawi_kangaroo.pdf

I’m also wondering how you all think that various disciplines (nursing, public health, politics, etc.) can contribute to promoting programs such as Kangaroo Care.

In light of the fact that the US has the highest rates of STDs and teen pregnancy or any industrialized country, the debate surrounding sexual education in schools is incredibly important. My home state of NM has no requirement for teaching sex ed in schools, and when it is taught, there are no requirements on what should be included. NM also has the second highest teen pregnancy rate in the US. My high school did not teach sex ed, and teen pregnancy was common place with a daycare on school grounds to help moms who wanted to continue going to school. Growing up in this climate it became obvious to me that simply not talking about sex did not stop kids from having sex. For this reason I adamantly support comprehensive sexual education in public middle schools and high schools. Education is power, and teaching young adults about their bodies and safe ways to express their sexuality is important and will help protect against unwanted pregnancies and the transmission of disease.

My high school was also 85% Hispanic with 50% of those students being first generation Americans and 15% newly immigrated. This is important in this conversation because sex was a taboo subject in within this group. Strong catholic families celebrated when their daughters became pregnant, but shamefully swept the action that caused the pregnancy under the rug never to be talked about. Breaching the subject of sex in this community was uncomfortable and considered highly inappropriate especially in school. These cultural differences are incredibly important to consider when approaching the subject of teaching sex ed in public schools. The US has an incredibly diverse cultural heritage, and for many people, talking about sex is incredibly uncomfortable and for some can be terrifying. When discussing the implementation of sex ed in schools, we have to be sensitive to these needs. I work at an HIV/STD clinic in Atlanta and I have seen in support groups we have with HIV positive women from many different backgrounds that forcing someone who is uncomfortable talking about sex because of cultural or religious beliefs doesn’t work. They shut off and are not receptive to the information. The conversation has to become relevant to them, and be presented way that is respectful and approachable to them. In our support groups we have found that breaking women up into smaller groups with a peer navigator that understands cultural or religious hesitations helps to create a more comfortable and relaxed environment where the women feel safe to open up. Once this is established they usually become very engage and ask a lot of questions. I think something similar could be applied to schools. Small culturally sensitive groups could maybe be used to help students feel safer in discussion, and help mediate the cultural barriers between families.

Does this solution seem like it would be feasible?

We all know that educating students about their bodies and sex is important for future health outcomes, so what other solutions are there that still provide the necessary information but make the environment safer and sensitive to cultural differences?