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Bush's Parting Gift

A Report on Pregnant Teenagers, Mutilated Mothers and Fewer Jobs

In an IM interview with Jessica Yates, a student of Nursing at Radford University in Roanoke Virginia, Mainstream Idea was afforded a small glimpse into the abominable US health care system, and how it affects the working poor. For the past year Jessica has worked in several places, but has taken special interest in her work at the Child Health Investment Program (CHIP) of Roanoke, the Pediatric Mental Rehab Center in Salem, and the Mother Baby Health Unit in Roanoke. There she works with new-born infants, pregnant teenagers and poor women up to 25 years of age.

In her short time as a student nurse, Jessica has seen first-hand how health care is handled in poorer parts of the country, with pregnant teenagers being withheld vital information about birth control and STDs, students being allowed to perform surgery in order to cut costs, and heads of households opting for unemployment because their incomes are too small to provide health care for their families.

Roanoke's health clinics, which see many poor and rural patients, have been hit especially hard by outgoing President George Bush's health care policies, including his stance on birth control. These policies, combined with a stagnating economy and high rates of unemployment, have left hospitals and health clinics unable to cope with the large numbers of sick people, much less being able to provide the preventative health care that poorer families desperately need.

To make matters worse, in December President Bush, according to the Planned Parenthood Federation of America, enacted into law "a rule that will allow individual health care providers to redefine abortion to include the most common forms of birth control--and then refuse to provide these basic services. A woman's ability to manage her own health care is at risk of being compromised by politics and ideology."

In a video on their website, President of PPFA Cecil Richards says, "Under this new rule, doctors, physicians and health care workers of all kinds could deny patients vital health care information and services, without the patient even knowing. For example, we believe now that health care workers in emergency rooms could deny sexual assault victims information about emergency contraception that could prevent an unintended pregnancy."

"With more than 45 million Americans currently uninsured, this is no time to make access to health care even more difficult," says the video's accompanying press release. "In addition, this rule could potentially create total chaos in an already stressed health care system, particularly for low-income women and families whose options are already limited."

Jessica confirmed Richards' and the PPFA's concerns: "[It has] made our job that much more difficult, because the expense [of birth control information in the health care clinic] will be on the state now." Furthermore, "the new policy does not allow organizations to discriminate in hiring those who have adverse beliefs about [the] procedures their facility performs."

"So if I didn't agree with giving an unmarried person birth control, I don't have to mention it. If they ask me directly, I can refuse information, and may refer them to someone else."

Asked about social situation was in her area, whether there are many pregnant teenagers, Jessica replied, "Yes, and [in] spite what my grandparents think, black or white, [it] doesn't matter when it comes to the issue. It is just the poor, and in this area we have plenty of that."

"My last girl was nineteen and she had four kids already, and when I asked her what birth control she wanted, she said, 'What's that?'"

"And now with Bush's midnight ruling the free clinics don't have to provide sexual health information." "'His parting gift' they call it."

"I hate that I was the first to tell this girl about birth control."

I asked whether the girl had had a high school education. "Yeah, [but] that's about it," she replied. The girl's high school had not been allowed to teach her about birth control. She learned "abstinence only." The policy had failed this particular student, "but the hospital [had] failed her too; after her first child she needed education and no one had given it to her." She was fifteen years old when she had her first child.

Teen pregnancy is not uncommon. Virginia ranked 19 according The National Campaign to Prevent Teen Pregnancy's Teen Birth Rates in the United States, which ranks teen pregnancy rates by state. The 2006 data shows that, in Virginia, 72 out of every 1,000 girls aged 15-19 polled had been pregnant or had already given birth at the time of the polling. New Hampshire ranked first in the country, with a teen pregnancy rate of 18.7, and Mississippi ranked last, with 68.4. The national average is 41.9.

Teen pregnancy rates have actually declined significantly since Bush took office. In 2000, Virginia ranked 19 with a teen pregnancy rate of 72, and the national average was 84. However, this decline follows a trend that began in the 1990s, well before Bush took office.

"Despite a one-third decline in the teen birth rate since the early 1990s," says The National Campaign in an October 2006 press release, "teen childbearing in the United States cost taxpayers (federal, state, and local) at least $9.1 billion in 2004.... The estimated cumulative public costs of teen childbearing between 1991 and 2004 totals $161 billion.."

According to National Campaign Youth Risk Behavior Survey data between 1991 and 2007, the percentage of teens who have ever had sex in the United States had declined sharply, by 15.7%, between 1991 and 2001, but had risen by 4.8% between 2001 and 2007. The 15.7% decrease in the 1990s is considered statistically significant--that is, there is strong statistical evidence that the result is accurate. The 4.8% increase is not statistically significant, meaning that it could be only an apparent increase, and not a real one. However, it does tell us that the percentage of teens who have had sex has leveled off since 2001, instead of decreasing sharply as it did in the 1990s. Between 1991 and 2007 there has been an overall decline of 11.6%, but this number is also not statistically significant.

Another statistically significant number is the 25.3% increase in condom use among teens between 1991 and 2001. The 6.2% increase between 2001 and 2007 is not statistically significant, again marking only a leveling off as compared to the 1990s data. These numbers reflect the percentage of teens who had used a condom the last time they had sex. Use of birth control pills among teens at last sex had decreased by 23.1% between 1991 and 2007, with -12.5% between 1991 and 2001, and -12.1% between 2001 and 2007. However, the decrease may be due to concerns about possible adverse side-effects of birth control pills.

These surveys suggest that decreased teen pregnancy rates are due to policies during the 1990s that encouraged both abstinence and the use of birth control, as well as to the efforts by organizations such as The National Campaign and Planned Parenthood to raise sex education standards and sex awareness. The results are fewer teens having sex and fewer sexually active teens having sex without using birth control. Yet while Bush's policies have not reversed the momentum that began in the 90s, that momentum has been slowed. The National Campaign is concerned about the lost momentum, and about the fact that, according to its data, the teen pregnancy rate in 2007 increased for the first time in fourteen years.

Jessica has seen the lowered sexual education standards first-hand: "I went with one of my professors to a school when she taught a sex-ed class, and they gave us a list of things we were not allowed to say and questions we couldn't answer. One of the words was 'masturbate' for fucks sake!"

Professors don't normally teach sex-ed class, and the job is usually handled by gym teachers. "I hate that it's left up to gym teachers to educate about that sorta thing.... [T]hey have a school nurse, and up until the 80s it was the nurse who taught [sexual education], but [the school systems] found that it was cheaper to let the gym teachers do it."

Concerning pregnant teenagers, I asked Jessica if she saw many poor families, as opposed to well-to-do families, when she was on duty in her clinics. She said, "Very much so; this area is pretty poor. The families I've worked with are usually on Medicaid, and have jobs like coal miner, truck driver, factory worker at our local munitions plant, and many have simply been laid off. Most have high school degrees and less. I think we see more of these sort of patients because they lack the means for preventative care, and [they only] come in during emergencies."

Then I asked about how many people she saw that didn't currently have health care, or have never had health care. "Well, it depends," she replied. "[W]ith CHIP and other public programs, all my clients of course, but in the hospital you may get a few that have private insurance[;] but the majority of my younger children and all of my pregnant teenagers are on Medicaid."

"I think it says something that all of my pregnant women under 20 are on public insurance."

Asked how effective she thought public insurance is at preventative care, and whether people with public health insurance have the option to get regular checkups, Jessica said, "Well, it could be great, except that if you can't get to your appointments it doesn't matter." "They do offer some check-up for the pregnant, but not specifically for teenage girls unless they approach the health department, which wouldn't matter soon," due to Bush's recent ruling on birth control and free health care.

"Bushes parting gift... I mean there are a ton of great programs for the poor in my area to help them get where they need to go, food and drug cost coverage, and some education when they approach the health department, but if you don't have a phone or a computer and are up in the mountains, as many are, it is very difficult, and that is if you qualify [for public health insurance]."

There are several obstacles to qualification, and one common one is also the strangest: "Some people make too much money. It's usually [the case that] someone [who] brings in $32 thousand a year for a family of four is considered poor. So [qualification for public health insurance] encourages them to be out of work, and when you do qualify it doesn't mean you can just go see a doctor. Often doctors will not take patients with public insurance, because they wouldn't get reimbursed the way they would like [to be]."

"[D]octors have to pay over-head to the hospital and [to] their own, very expensive insurance. They will sometimes refuse certain patients because they [wouldn't] get reimbursed by Medicare or Medicaid the way they would like."

And the patients with public health insurance don't receive the same treatment as privately insured patients: "In the hospital, when a client was on Medicaid during her delivery, she would be attended by student doctors and one practitioner, instead of certified doctors. I was in with a woman who was a "clinc" (or Medicaid patient) when she had a C-section. The head surgeon cut her open and then allowed the student to work on her. She was cut so badly, I almost threw up."

I asked if the practice was typical of all procedures, and not just deliveries. "In other settings its a little different," she said. "The student may observe or be under the direct supervision of the doctor, but it is usually determined by hospital policy, and each one will differ. Most hospitals allow students, because they are a free work source, with liability [only] to [their] professors."

As the state of the economy falls in a downward spiral, Jessica reflect and her collegues reflect on the uncertain fate of health care in Roanoke and in Virginia: "The nurse that I see at the health department says [that] she sees their funding coming to a state vote."

I asked Jessica what she expected from the upcoming Obama administration. She said, regarding Bush's ruling on birth control, "I don't really see it as a priority [among voters] right now, and many people don't know about it."

"Also, it seems that the ruling looks very difficult to undo. They may leave it up to a state vote, [and other factors such as] the economy. Unemployment went up 1.5 percent--doesn't help my cause."

by Andrew Fassett

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