Teens, sex and public health obfuscation

I am sorry to do this to you, but like your high school sex education teacher, I have the uncomfortable duty to… address a… well… subject that can be a bit awkward. By that I mean (gulp) “S. E. X.”

Worse yet, I need to discuss teenagers and sex and birth control and porn and hickies and well, you get the point. But bear with me. That was probably the most uncomfortable part of this post.

The inspiration for my dive into this weird and adult-torturing world of teen sex came when I recently attempted to help a young girl get birth control in rural Eastern Oregon. The girl had very recently become obsessed with sex, told me about her boyfriend in detail, showed me her hickies, alternately expressed fear and disgust about sex, said in no uncertain terms that she isn’t ready “to have babies,” as well as accidentally downloaded—and in fascinated shock—read several viciously manipulative pornographic pamphlets designed to groom girls for being sex-trafficked (specifically about mob bosses forcing extremely explicit sex on their young daughters to “protect” them from the other mob bosses, free on Amazon Kindle and anywhere child pornography and middle-school comic books are sold next to each other).

Knowing the girl and her situation, I was aware that she lives with limited supervision and she has a developmental disability that makes impulsivity and difficulty foreseeing consequences very challenging for her. Has there ever been a case where birth control was more clearly indicated?

I made an appointment at a local public health agency for a consultation. I was told even during the scheduling that the girl “has to agree on her own,” despite being both well underage and developmentally disabled, which combine to deny her any reasonable ability to give informed consent. I figured I could talk her through it.

While both parents were enthusiastic about getting birth control for her, the agency insisted they had no say in the matter.

The day of the consultation arrived and the girl was nervous and uncomfortable. She was immediately handed a stack of 30-plus pages of dense forms to fill out and I was ordered to stay out of it. Due to her disability, she scribbled on the signature lines without understanding what it was for. After 45 grueling minutes and a bureaucrat who eventually relented and “helped” her fill out the forms by misspelling her name multiple times, we got into the actual consultation.

amateur Actors playing the roles of teenage lovers in the lion king - image by Arie Farnam

I had promised the girl that this would be quick and easy, because I’d been told it was just a brief consultation ahead of a procedure. And her tolerance for long paperwork and confusing, boring adult conversation is very limited, yet she held up admirably.

Then, we were shown in to see the nurse, who immediately began to talk about sex in graphic and uncomfortable detail. When the girl cringed in loathing and anxiety, the nurse stopped abruptly and asked if this was really something she wanted to do. The girl said, “Well, no. I don't want to do it. They want me to!” indicating me and apparently family members not present at the moment.

The nurse immediately started to end the interview and stated that there was no way birth control would be offered in this case. And some god came down from Asgard and created a miracle, because the girl, who is normally timid and diffident when it comes to unknown adults, faced the nurse again and said she had changed her mind and did want it. She was forced to rehash that consent at least five times over the next 45 minutes of explicit sex consultation, and bless her, she did.

The next day, before the date when the birth control device was to be implanted, I got a phone call from the agency demanding documents showing the parents’ guardianship, despite the fact that “they have no say in the matter.” I provided the documentation and pretended I was not livid with outrage at these two-faced guardians of male access to the reproductive capacities of teenage girls.

I fantasized about the conversation I’d have after she was safely protected, asking them if they thought there was anything else they could do to make birth control harder or more uncomfortable for a young disabled girl to access. But when the time came, my entire focus was on comforting the young girl, who was terrified of the Lidocaine numbing injection and awed by all the sterile preparations. So, I didn’t say anything except “Thank you!” as we walked out.

But the whole incident illustrated how far we are from a society that truly protects the choices of the most vulnerable women and girls. Do I think underage girls should have choices about their bodies. Definitely, I do. Do I think that they should be considered “consenting adults” when it comes to being manipulated, tricked or forced to become pregnant and have babies. No, I vigorously disagree. Should an underage girl who demonstrates understanding of the issues and who can make informed decisions of a complex nature be allowed to refuse birth control? Well, yes. I guess I agree with the spirit of the law on this.

But should a developmentally disabled child be forced to endure lengthy explicit discussions of sex and give repeated rote recitations of a consent she doesn’t understand in order to be protected from pregnancy, which she does clearly state that she does not want? No. This made no sense and it was in several respects both irresponsible on the part of health care providers and unnecessarily shaming to the girl.

The long and the short of it should be that at this age birth control is health care. It’s no different than a vaccination, and parents give consent for vaccinations. Children often vehemently disagree because they don’t like being poked with needles and they get vaccinated anyway, if they have responsible parents.

The young girl I helped get birth control is still confused about what it is for, despite having it explained a dozen times or more. She’s asked several times if it will keep her from being kidnapped. We told her it wouldn’t do that and that it is only to keep her from having babies before she is old enough. But the truth is that there are all sorts of ways such a vulnerable young woman could end up needing birth control. She may break up with her boyfriend tomorrow. But she is a vibrant young person with a healthy body, which includes natural sexuality.

And there are plenty of predators out there, some of whom would be delighted at the rural “public health” response to making birth control particularly uncomfortable for a teenage girl to obtain.