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By Peggy Ann Bliss
Of the Daily Sun staff
The new national birth control regulations to go into effect in January 2013 may help prevent unwanted babies and abortions, but in Puerto Rico money is not the only deterrent to preventing conception. The decision by Health and Human Services Secretary Kathleen Sebelius to make contraception available free to anyone for the asking startled and delighted almost every woman and women’s groups when it was announced Tuesday, but most agree that it is not a panacea to the high rate of unplanned births.
Although most Puerto Ricans support making birth control available at no cost — because it will prevent millions of unwanted pregnancies — many teenage pregnancies will continue to happen, because the women want them to.
For some women, the 18-month wait for the new protocol to go into effect will be too long to prevent unplanned children, but the main consideration for the decision is the alarming statistic that four out of every 10 babies born in the United States are unwanted.
In Puerto Rico, it is the fashion to say that all children — especially babies— are a blessing from God, and that none could be unwanted, there are many good reasons for planning maternity with more help from health providers and the government.
According to the specialists in the area, young Puerto Rican women continue to have babies, because of peer pressure, a belief that pregnancy will hasten marriage, a lack of other goals, the need for someone to love, and a yearning for a strong nuclear family. Many of these beliefs come from a heritage of troubled family life and the lack of a clear focus, say the experts, but both they and the Puerto Rican women in the streets and clinics and homes also see the recent U.S. Health Department decision as a breakthrough. “I hope [other young girls] don’t make the same mistakes that I did [with this new opportunity,]” said Elizabeth Roldán, 30, who was visiting the HealthproMed Clinic with her infant and 14-year-old son. She has a 7-year-old daughter at home. “This new policy will be a total success.
“I am already teaching them to make the right decisions when they are old enough,” she said, having been only 15 when she became pregnant with her first child.
Jenny Colón, 32, agrees with her, having had her 16-year-old daughter when she was the same age. She also has two other children, including a 9-month old infant.
“These children are all loved, and live in a happy home,” she said. “Most people are clueless when they have their children. They just think it’s a great big game.”
She echoed the sentiment of many women interviewed at public clinics, all of whom said they were encouraged by the new policy. While not always a money issue, it goes hand in hand with the democratic belief that pregnancy is a public health issue and as such should be treated with as much of an open-door policy as possible.
The Pill usually costs between $15 and $60 a month in Puerto Rico, depending on the type. Many health and family planning clinics sell birth control pills for less and many health insurance plans cover them. Making the right choice
Puerto Rico, with a population of 3,927,776, has 1,887,087 men and 2,040,689 women, with one of the lowest population growths in the world, 0.47 percent. Nevertheless, when children are born to a woman who can not take care of them, they risk all kinds of illness and a shortened life span. One of the main obstacles to protected sex in Puerto Rico is the penal code related to the age of consent, which allows unmarried women to legally consent to sexual intercourse when they reach age 14. Younger girls do not have legal permission to have sex, and therefore cannot be prescribed birth-control pills.
The legal age of consent, which is lower in Puerto Rico than all states except Hawaii, Idaho and South Carolina, has been controversial here for many years. It is also lower than most countries, except for Zimbabawe, where the age is 12, and Burma and South Korea, where it is 13. Several countries, including Italy and Ecuador have a legal age of consent of 14, equal to Puerto Rico.
“We must counsel [girls from 12 to 16] about early sexual activity, because obviously the goal of abstinence is not working,” said Dr. Héctor Villanueva, chief medical officer for Health Pro Med, in an interview with the Daily Sun. He said some of the methods discussed are the barrier method—condoms and foam– the pill, the day-after pill, or “Plan B,” as Villanueva called it, the coil or shield and the injection given every three months. Villanueva said the clinic did not deal much with the tried and true diaphragm, but that is another barrier method, using a jelly, to cover the entrance to the uterus. The woman inserts it, herself, before having sexual intercourse and removes it after coition. Although it is quite effective–unless it springs a leak or is damaged by heat or age—it is not so often used because many women say it takes away the spontaneity of the sex act.
The doctor said he believed that the diaphragm should be inserted by a professional, but that has never been considered a practical approach by the people involved.
Many teenagers get pregnant on purpose, despite its being frowned on by many segments of society, said Villanueva, who has 25 years of experience as a pediatrician. Peer pressure, a desire to hasten adulthood, a need for someone to love, a belief that pregnancy will get them a husband and many other socio-biological reasons that trump the economic ones, he said. “The educational element has a long way to go,” said Julia Vélez, Chief Executive Officer of Health Pro Med, a community clinic with 8,000 regular patients at their several offices in Barrio Obrero, San Juan, and one in Culebra.
In the same interview with Villanueva, she said that the new guidelines for birth control “will be good for our patients, because they won’t have to worry about paying for it.”
This is significant for women with low incomes and several children, especially because the price could run as much as $720 a year, and even the lesser charges come to almost $200 a year.
However, she said, there is a caveat: “Most of the women don’t consider until they are pregnant who will pay for it, but they know someone has to pay.”
Villanueva agreed. “There is a lack of knowledge and a lack of access to information,” he said. “Most parents don’t seem to care whether their daughters are having sex, and don’t want to know they are on the pill. Their lifestyles are casual, they get pregnant, and then get a larger apartment. Someone must pay for it, they figure.”
Nevertheless, he said, “the bottom line is that having free access [to birth control] will at least eliminate one reason for not using it to prevent pregnancy.”
The clinic, which serves about 8,000 regular patients, deals with all income levels, and with all kinds of insurance or lack thereof. The clinic, which has been in operation for 24 years, receive most of their money from the federally funded Title X, which for over four decades has helped millions of American women prevent unintended pregnancies and obtain pre-natal health care, according to their website. The bi-partisan supported plan, launched in 1970, makes accessible contraceptive services and is the only national government program to reduce unintended pregnancy, by providing contraceptives to low- income women, says its mission statement. It supports 60 percent of family planning health centers, accounting for 24 percent of the total revenues of most health centers. There are about 4,480 health centers in the program. One analysis showed that of the women served by the program, 43 percent received care at health departments, 33 percent received care at Planned Parenthood health centers, 13 percent received care at other independent community-based clinics, seven percent received care at hospitals, and four percent received care at community or migrant health centers.
Another Title X recipient is the University of Puerto Rico, Medical Sciences Campus Graduate School of Public Health Family Planning Program is an offshoot of the Region II Federal Department of Health and Human Services. A Title X grantee since 1969, it provides complete services to San Juan, Carolina, and Ponce regions. The program sub-contracts the Health Department to offer reproductive health services, giving family planning services to low-income women and teens.
The program has developed educational projects, research activities, counseling, and clinical services to help reduce infant mortality and low birth weight and to lower the number of abortions caused by unwanted pregnancies, a spokeswoman said. “Another goal is to ensure that low-income people plan their pregnancies and engage in responsible sex, by involving the client in all decisions.”
A pioneer in family planning services in Puerto Rico, which does not receive Title X funding, is PRO- FAMILIA. The organization provides medical and educational family-planning services, especially for low- income people, and promotes sex education in public schools. They have agreements with the municipal government to provide information and contraceptive methods through private doctors. A hotline since 1989 helps young people learn about sexuality, contraception, AIDS and unwanted pregnancies PRO- FAMILIA obtains local funding through the sale of educational and medical services and contracts with public and private agencies.Sebelius’s decision that family planning should be considered preventive health care was based on a report from a panel of medical experts. Las week, she announced that new insurance plans must eliminate the copay on a full range of contraception.
Nancy Keenan, president of NARAL Choice America, which lobbied for almost a year, called Sebelius’s decision a major step for American women, one in three of whom struggles with the high cost of birth control at some time in her life.
“The United States has a far higher unintended birth rate than other industrialized countries, said Keenan. “Secretary Sebelius’ decision to follow a science-based recommendation will improve women’s access to affordable basic health care, including contraception. Women will realize the importance of this decision every time they pick up their birth control without a copay. This change in policy will help millions of women prevent unintended pregnancy and thereby reduce the need for abortion.”
NARAL Pro-Choice America also notes that the administration is proposing to allow certain employers to opt out of the requirements, said Keenan, adding that “we believe all women should have access to contraceptive coverage.” And in a message sent widely over the email, she urges everyone who agrees with her: “Thank Secretary Sebelius for following sound science, and let her know that you support no- cost birth control!”