please read carefully

4/18/2017 She’s 17 and Needs Birth Control. Do We Turn Our Backs? ­ The New York Times

https://www.nytimes.com/2017/03/04/opinion/sunday/shes­17­and­needs­birth­control­do­we­turn­our­backs.html 1/4

SundayReview  |  OP­ED COLUMNIST

She’s 17 and Needs Birth Control. Do We
Turn Our Backs?
Nicholas Kristof  MARCH 4, 2017

LEWISTON, Me. — She is 17 years old, has an alarming itch “down there” and has
come to the family planning clinic because she doesn’t know where else to go.

Sara Hayes, a nurse practitioner, breezes into the examining room and soothes
the teenager. Hayes takes a swab and quickly diagnoses a mild yeast infection —
perhaps from scented tampons — while setting aside samples to test later for
gonorrhea and chlamydia. Then Hayes explains birth control options, and the girl
brightens at the idea of an invisible implant in her arm, fully covered by insurance. It
will last at least three years and be more than 99 percent effective at preventing
pregnancy.

Finally, Hayes arranges to give the teenager condoms and fixes her in the eye
and tells her to protect herself from infections. Always!

“If you’re having sex with someone, use a condom,” says Hayes, half sweet and
half stern, the bluntest grandmother you ever met. “If he doesn’t want to use a
condom” — she pauses dramatically — “then he’s not worth it!”

http://www.nytimes.com/

https://www.nytimes.com/pages/opinion/index.html#sundayreview

https://www.nytimes.com/column/nicholas-kristof

4/18/2017 She’s 17 and Needs Birth Control. Do We Turn Our Backs? ­ The New York Times

https://www.nytimes.com/2017/03/04/opinion/sunday/shes­17­and­needs­birth­control­do­we­turn­our­backs.html 2/4

This is health care at its best, preventing diseases and averting teenage
pregnancies, all while saving public money. Yet clinics like these across America are
in peril because of myopic Washington politics.

Vice President Mike Pence and congressional Republicans have long tried to cut off
federal funds for clinics that have ties to abortion, even tangential ones, and this
year, with President Trump’s help, they may succeed.

Let’s be clear: This isn’t about the government paying for abortions. That’s
already mostly banned. This is about paying for birth control and cancer screenings
when the provider has some connection, even a remote one, to abortions.

This clinic in Lewiston is threatened because it is operated by Maine Family
Planning, a nonprofit that provides some abortions. Health experts expect a G.O.P.
push to defund such women’s health clinics, by barring Medicaid reimbursements or
other federal funds from going to them, and by cutting or redirecting the Title X
family planning program.

“We’re afraid we’re going to lose a critical part of the public health
infrastructure,” says George Hill, the president of Maine Family Planning.

Patients are anxious. Clinic staff members say that some women have asked to
get their IUDs replaced early, so that they don’t expire a couple of years from now
when there might be less coverage.

Although the arguments in Washington about these women’s health clinics
mostly involve abortion, what I saw in the three Maine Family Planning clinics I
visited was that a vast majority of the care provided is pretty uncontroversial. It’s
about ensuring women’s health, treating sexually transmitted diseases, testing for
pregnancy or providing cancer screenings.

Meredith Batley says she has been coming to the clinic in Rockland for a dozen
years, and for most of that time didn’t have health insurance or a primary care
provider. In one routine screening, a cervical irregularity was found that could have
led to cancer, but it was removed and she has had no problems since. She has also
received birth control pills.

http://www.mainefamilyplanning.org/

4/18/2017 She’s 17 and Needs Birth Control. Do We Turn Our Backs? ­ The New York Times

https://www.nytimes.com/2017/03/04/opinion/sunday/shes­17­and­needs­birth­control­do­we­turn­our­backs.html 3/4

“If I hadn’t had that access, I’m not saying I would have had an abortion, but my
life would have been different,” she muses. When Batley was ready for a baby, she
came in for a consultation and received prenatal vitamins to avoid birth defects. Five
months ago, she gave birth to a healthy baby girl.

That’s the kind of health care relationship that doesn’t happen often enough in
America for young women. One woman dies in America of cervical cancer every two
hours, and almost all these deaths are preventable. More will likely die if these
clinics close.

Pence and his Republican colleagues in Congress are, I think, well­intentioned
politicians driven by a revulsion for abortion. But the truth is that these clinics do
more to reduce abortion rates than any army of anti­abortion demonstrators.

Later in the afternoon back in Lewiston, Hayes coaxes a 19­year­old named
Destiny Burnell, who had already had one baby after an unplanned pregnancy, to
consider long­acting contraception. After discussing several options, Destiny makes
an appointment for an implant in her arm.

To those who think we can’t afford family planning services, remember: An IUD
or implant like Destiny’s costs about $1,000, while a single Medicaid birth costs the
public about $13,000. Each dollar invested in family planning yields $7 in savings
for the public later on.

There are 2.8 million unintended pregnancies a year in the U.S.; among people
living in poverty, 60 percent of pregnancies are unplanned. One study found that
when Texas cut funding for Planned Parenthood and similar clinics, Medicaid births
rose by 27 percent in one group of affected women.

The Guttmacher Institute, a research organization that supports abortion rights,
estimates that without Title X funding for family planning clinics, there would be, in
a year, an additional 900,000 unplanned pregnancies — and 325,000 more
abortions.

About two­thirds of the women and girls who come to these clinics don’t have
any other health care provider. They’re people like Amanda Bowden, 33, who comes

https://www.guttmacher.org/gpr/2014/12/beyond-preventing-unplanned-pregnancy-broader-benefits-publicly-funded-family-planning

http://www.nejm.org/doi/full/10.1056/NEJMsa1511902#t=article

https://www.guttmacher.org/gpr/2017/01/why-we-cannot-afford-undercut-title-x-national-family-planning-program

4/18/2017 She’s 17 and Needs Birth Control. Do We Turn Our Backs? ­ The New York Times

https://www.nytimes.com/2017/03/04/opinion/sunday/shes­17­and­needs­birth­control­do­we­turn­our­backs.html 4/4

annually to the Maine Family Planning clinic in Augusta to get birth control pills and
a checkup.

I asked her about the effort to cut funding for clinics like these, and she said:
“You’re not taking away abortion services. You’re taking away my health care.”

I invite you to sign up for my free, twice­weekly email newsletter. Please also join me
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(@NickKristof).

A version of this op­ed appears in print on March 5, 2017, on Page SR13 of the New York edition with the
headline: She’s 17 and Needs Birth Control. What Now?.

© 2017 The New York Times Company

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Reflection Scoring Guide

An “reflection” is

A

description of a learning experience, what I
H

ave learned,

and
A
ction steps (what I could do with my new insight). AHA!

A A description of a learning experience	In your introductory paragraph, describe to your reader the learning experience that will be the subject of your reflection. Describe it as if your reader has no familiarity with the assignment. (Hint: This can sometimes be done, in part, by simply putting the directions for the assignment into your own words.) Avoid saying things like, “My assignment is to…” or “Ms. Blomberg is making us…” Instead, try to take ownership of the experience by saying something like, “In an attempt to better understand _X_, I ___…”
INC – The reflection either does not include a description of the learning experience, or it is extremely unclear/ inadequate. It is very difficult for the reader to understand what the writer is reflection on.	C – The reflection provides a brief account of the learning experience, but enough details are missing that the reader may have difficulty understanding what exactly the writing is reflecting on and/or its relevance.	A – The reflection begins with a clear and thorough description of the learning experience (ie: the who, what, where, when, why, and how, as applicable). It is clear to the reader what learning experience the writing is reflecting on and its relevance.
H What I H ave learned, or what was reinforced	In your body paragraph, share your “AHAs!” These may be new pieces of information, ideas that crossed your mind during the experience, connections that you made, or simply things that you already knew but were reinforced through the learning experience. Provide evidence/examples as you are able.
INC – The reflection either does not include a review of what was learned or reinforced from the learning experience, connections made, etc., or it is extremely unclear/inadequate.	C – The reflection includes a review of what was learned or reinforced from this learning experience, connections made, etc., but is brief and/or limited in breadth and depth.	A – The reflection includes a thoughtful review of what was learned or reinforced from the learning activity (or the outcome, if applicable), connections made, etc. Clear and detailed information about growth and new knowledge/understating gained from the experience is included. Evidence/examples are provided as appropriate.
A Action Steps	In your final paragraph, share what you could do with your new insight. (Not necessarily what you will do, but what you could do to promote future growth.) Use and cite additional resources as appropriate.
INC – The reflection does not include action steps, they are extremely unclear, or they are otherwise inadequate.	C – The reflection includes some details about how this experience could guide next steps, but they are limited and/or unclear. … or the reflection is missing either a personal or professional application. (This is for A&P/HS1 students only.)	A – The reflection includes “next steps” describing what the writer could do with their new/reinforced insight. … both personally (ex: as a health care consumer) and professionally (as a future health care provider). (This is for A&P/HS1 students only.)