People are still having sex well into their golden years. According to public health data compiled by Bloomberg News, 67 percent of men between the ages of 65 and 74, and 39.5 percent of women in the same age group, have had partner sex within the last 12 months. But at institutions and in organizations that ostensibly cater to seniors’ needs, the matter of older adults’ sexuality is often ignored altogether.
“It’s not like the gift shops in these long-term care facilities are providing condoms,” Melanie Davis, co-president and a founding member of Widener University’s Sexuality and Aging Consortium, told RH Reality Check. The Consortium, which was formed in 2010, works with nursing home administrators around the country on educating their staff about addressing behavioral issues or day-to-day questions about privacy and sex. Though condoms are occasionally distributed at sex education classes at these facilities, Davis says, few even have policies addressing sexual expression, residents’ privacy, or sexual safety and consent, let alone ready accessibility to STI-prevention methods.
Robin Dessel, sexual rights educator at the Hebrew Home in Riverdale, New York, said the lack of resources for sexually active seniors is reflective of narrow public attitudes. “Society at large has not come to terms with older adult sexuality,” she said. The Hebrew Home was the first adult care facility in the country to draft a policy regarding residents’ sexual expression; it’s also created a set of guidelines to help care providers determine whether a person with dementia can consent to sex.
The consequences of failing to address senior sexuality are complicated: While sexually transmitted infection rates among seniors actually haven’t increased dramatically, seniors may not be getting adequate details about prevention or treatment. In addition, one in three seniors dies due to Alzheimer’s or another form of dementia, and the rate of Alzheimer’s diagnosis is projected to climb over the next few decades. Memory loss can change a patient’s sexual expression and complicate matters of consent. And, as Dessel argues, the rights to privacy, sexual expression, and intimate contact are fundamental human rights—ones that seniors can be losing out on due to a lack of good information and clear policies.
More Than STI Prevention
Much recent media coverage of older adults’ sexuality has been pegged to reports that some sexually transmitted infections are up among people older than 65—leading to suggestions from commentators and reporters that aging Baby Boomers are less likely to practice safer sex or to communicate with partners about their sexual history.
The data on seniors’ STIs come from the Centers for Disease Control and Prevention, but CDC officials interpret the data differently. A spokesperson for the agency told RH Reality Check in an emailed statement that the CDC has not performed an analysis of sexually transmitted infection rates among adults older than 65 as a whole, and that the agency does not believe the uptick in chlamydia reports actually represents an increase in cases. For example, comparing 2008 to 2012, the rate of reported chlamydia among those older than 65 increased from 2.1 to 2.7 cases per 100,000 people—a tiny increase that could be attributed to population growth. For other STIs, such as gonorrhea, the rate of change among seniors is in keeping with that among other age groups.
While STI increases may not be as dramatic as sometimes reported, both Davis and her Sexuality and Aging Consortium co-president, Robin Goldberg-Glen, say seniors still often have a hard time accessing good information about how to protect themselves. Sex education classes in care facilities are far from common, for one thing; for another, there are no condoms designed specifically with older adults in mind.
“Physiologically, erections aren’t as firm when people get older,” Davis, who also runs a private practice as a sex educator, said. “They’re less firm, so it’s harder to get a condom to sit right. What are you supposed to do? Take it off, put it back on—it’s often easier just not to use it.” In facilities that do make condoms available during sex ed classes, she adds, seniors may feel shy about mentioning their difficulties using condoms.
Davis often recommends the female condom, FC2, to older clients. But it takes some time and education to learn to use FC2 properly, especially for older women who haven’t used tampons before.
In addition to these and other physiological concerns—such as erectile dysfunction, lubrication or lack thereof, chronic pain, or changes in mobility—caregivers must address issues of privacy, consent, and appropriate sexual expression that can affect older adults uniquely.
Many facilities are “sex-positive on the face of it,” Davis said; one facility that engaged her as a consultant, for instance, told her they have a private room clients can use for conjugal visits. In reality, however, she says available amenities are often lacking. One facility’s “private room,” for example, was actually a conference room, which staff used for meetings.
Federal guidelines don’t require nursing facilities to allow residents a private room. According to Bloomberg, a handful of states give married couples the right to private visits. And only Colorado’s regulatory language explicitly grants residents and their non-married partners the right to consensual sexual visits. In the 2012 textbook Sexuality and Long-Term Care, Kansas State University Center on Aging Director Gayle Doll suggests care facility staff can support a patient’s right to sexual privacy in several ways—such as helping residents rent a hotel room, moving twin beds together, permitting use of a double bed, or hanging do-not-disturb signs when a resident’s sexual partner visits. The Hebrew Home’s policy, for example, requires the facility to ensure residents’ privacy and, when possible, to make arrangements for sexual expression, such as allowing a private room for one member of a couple.
Consent Is Key
The issue of sexuality becomes even more complicated, advocates say, when memory loss or other forms of dementia come into play. Before Dessel developed the Hebrew Home’s sexual expression policy, she worked in memory care at the facility. There, she found a crying need to address sexuality in an appropriate way.
Many forms of dementia will cause patients to make inappropriate comments or act out sexually, Dessel says. She points out that staff need to be trained to address those behaviors appropriately.
Oftentimes, Dessel says, facilities take a “parochial attitude,” as she put it, toward residents’ sexual expression. Davis and Goldberg-Glen, too, say that it’s not uncommon for families or facilities to deny—or offer and then remove—residents’ access to private spaces and visits without fully assessing whether a resident can consent to sex.
“It’s very challenging because it’s not formulaic,” Dessel said of determining whether a person with dementia is able to consent to sex. The Hebrew Home’s guideline sheet for consent among memory patients suggests asking questions like, “What are your wishes for this relationship?” and “Do you enjoy sexual contact?” It also suggests caregivers check residents’ body language while asking these questions. Dessel adds that caregivers should communicate frequently with residents to observe whether their feelings or capacity are changing.
According to Dessel, it’s usually best to involve a “collective of clinicians and family” and to check in with the resident frequently.
The issues of consent and memory have recently resurfaced among advocates, caregivers, and media outlets with last week’s Bloomberg report on the case of Henry V. Rayhons, a Republican Iowa legislator and retired farmer who will be tried in January on charges that he raped his wife, who had Alzheimer’s disease and was in a care facility. The charges refer to an alleged sexual encounter in the shared room of Rayhons’ wife, Donna Lou Young. Young’s roommate made the complaint; Young has since died. Rayhons told investigators he couldn’t remember if he had sex with Young on the day in question, and forensic evidence is so far unclear. Rayhons has said that he had many sexual encounters with Young after the onset of her dementia.
The Hebrew Home’s director, Daniel Reingold, is quoted in the story as saying, “This was not a rape,” contending that Rayhons and his wife had a loving relationship. Dessel, when contacted by RH Reality Check for a comment on the Rayhons case, wrote in an email, “This is a tale with a sad and demoralizing last chapter … where is the humanity when vilifying a gentleman for sharing cherished and final intimate relations with his wife? A fatal error occurs when we presume guilt based on the notion that Alzheimer’s has stolen not just mind but heart.”
She continued, “Consent is a fluid state of awareness in the context of all decision-making, whether in the presence or absence of Alzheimer’s. I am hopeful that the takeaway is one of enlightened understanding and regard for older adults with Alzheimer’s and, in spite of this fate, that we give credibility and honor to their life choices.”
Young’s facility, Concord Care, did not have a policy regarding sexual matters specifically, but after her family raised concerns about visits with Rayhons, a provider gave her a 15-question mental capacity test—the Brief Interview for Mental Status (BIMS), often used to diagnose dementia—to decide whether she could continue to consent to sex.
The assessment is pretty basic: It asks clients to repeat back common words to the tester, like “sock.” A score of 15 on the test indicates high mental capacity, and zero is the lowest score possible. Young scored a zero on the test the second time it was offered, ten days before the assault is said to have occurred. After the second assessment, Concord Care staff moved Young to a room with a roommate and told Rayhons his wife was no longer able to consent to sex. According to Bloomberg, Rayhons said that he understood.
For her part, Doll writes in Sexuality and Long-Term Care that facilities can use several means of determining whether adults with dementia can consent to sexual activity. One path involves using a different cognitive assessment—the Mini-Mental Status Exam—as a first step. On that test, the highest score is 30, and people with Alzheimer’s usually score a 26 or less. Doll’s text describes a “decision tree” where a person with a score 14 or higher on the test goes through further assessment. Someone with a lower score would automatically be deemed unable to consent.
Based on her BIMS score, it’s likely Young would automatically have been disqualified from progressing in the decision tree. But a study published earlier this year does note that although BIMS works well for determining the presence of dementia, it does not consistently assess the severity of impairment.
Doll goes on to say that clinicians and facilities may prefer to use “functional competency” rather than a cut-and-dried test—a model that recognizes that people with dementia may be incapable of making some decisions for themselves and capable of making others.
“No matter how an organization chooses to go about determining consent, there are a few basic things to remember,” the book says. “The capacity to decide to have an intimate relationship should not be based on a one-size-fits-all concept. While some people affected by dementia will not be capable of handling their finances, they might have very clear ideas of what they want in a relationship. Cognitive memory may be affected while emotional memory is not. Feelings remain long after the ‘facts’ have disappeared.”
Doll also notes that literature from the field of developmental disabilities care has addressed consent in ways that could apply to senior care since at least the 1990s. In their various works on the subject, Dr. Thomas-Robert Ames, the now-deceased former president of the Coalition on Sexuality and Disability, and Perry Samowitz, senior director of education and training at the YAI Network, recommend examining relationships based on safety, voluntariness, lack of exploitation and abuse, ability to say no, and ability to choose a socially appropriate time and place for sex.
Beyond Long-Term Care
The fact that Young’s facility, Concord Care, lacked a clear policy on residents’ sexual rights is not unusual. Dessel said she’s regularly contacted by nursing care facilitators all over the country either to consult on specific clients’ cases, or to help them develop a sexual expression policy.
Other than pioneers in the field like Dessel, there are very few resources when it comes to improving attitudes toward sexual education and expression in long-term facilities. Sexuality in Long-Term Care is one of the few textbooks that addresses sex among older adults. Older, Wiser, Sexually Smarter—written for staff at senior centers or long-term care facilities—is another.
In a broader sense, the majority of older adults do not live in facilities—in fact, just 4.1 percent of Americans older than 65 do. So far, few sex ed curricula exist for older adults, and media covering older adults’ lives are often vague on the issues that affect their sexuality, says Davis. With that in mind, she and Goldberg-Glen created a public service announcement urging older adults to use condoms, and a website, Safer Sex for Seniors, intended as a clearinghouse for people looking for information about older adult sexuality.
The site is also there for young adults who may find themselves having to have a variation of “the talk” with their aging parents, and it includes information for grandparents who are caring for their grandchildren and aren’t sure how to talk to them about sex. Davis is also working to develop a sex in long-term care curriculum not geared to adults living in facilities. In addition, the Consortium offers continuing education to family care providers, geriatricians, and sex educators about the best ways to address education for their older clientele.
Independent of the Consortium, other provider organizations are beginning to talk to their members about older adult sexuality as well. Joan Baird, director of pharmacy process and product development for the American Society of Consultant Pharmacists, says that her organization has started holding continuing education sessions for pharmacists on older adult sexuality, because pharmacists play a special role in working with patients on a regular basis.
“More and more clinicians are realizing [seniors’ sexuality] has to be part of the conversation about safer sex,” Baird said.
Davis says her interest in sexuality and aging stems from the fact that she herself is aging, and she has led workshops on, as she said, “age-related sexual privilege—this idea that sexuality, sexual expression is in the realm of younger people.”
“People automatically assume you’re talking about intercourse,” Davis said. In mainstream discussions, she said, “there’s nothing about sexual identity, gender, orientation.” Plus, she pointed out, “There’s intimacy that may or may not be physical. If all you think about of sex is having an erection, once that goes away, you’re done. While the sexual activity may change, your essence may not change.”
Missouri in 2014 led all state legislatures in introducing bills designed to restrict reproductive rights. It appears that lawmakers in the state are working to ensure that Missouri may once again earn that distinction in 2015.
There are seven bills to restrict reproductive rights that have been pre-filed by Missouri lawmakers, as of the publication of this article. The bills were filed by lawmakers with records of introducing and supporting anti-choice legislation.
Every bill to restrict reproductive rights is nearly identical to those introduced by the same lawmakers during the 2014 legislative session. Elizabeth Nash, state issues manager for the Guttmacher Institute, told RH Reality Check that this kind of practice by state lawmakers is not unusual.
“We often see lawmakers introduce the same legislation year after year,” Nash said.
The bills include a variety of restrictions, including changing the laws governing parental consent for minors seeking abortions, increasing the number of inspections the state is required to perform on abortion clinics, and awarding fathers what amounts to veto power if they don’t want an abortion to be performed.
Missouri, a state of more than six million people, has one abortion clinic.
State Sen. Wayne Wallingford (R-Cape Girardeau) pre-filed a bill that would mandate state health officials to conduct annual inspections of abortion clinics. Wallingford introduced a similar bill during the 2014 legislative session.
SB 33 would required the state Department of Health and Senior Services (DHSS) to conduct four annual inspections of all abortion providers, and give the DHSS the power to force the immediate closure of clinics they deem to pose a “serious risk of harm” to patients.
The bill is part of a continued effort by anti-choice lawmakers in the state to target the only abortion clinic in the state. Lawmakers have introduced several bills with regulations targeting the Planned Parenthood facility in St. Louis.
HB 99 was pre-filed by Rep. Rocky Miller (R-Osage Beach), and would amend Missouri’s parental notification law by requiring a consenting parent or guardian of the minor to notify any other custodial parent or guardian in writing at least five days prior to the abortion being performed.
The bill would also change the laws regarding so-called alternatives-to-abortion agencies, commonly known as crisis pregnancy centers (CPC).
Miller’s anti-choice bill would prevent the state or any state agency or municipality from creating an “order, ordinance, rule, regulation, policy” that would regulate CPCs, which are largely operated by anti-choice extremists who regularly distribute misleading information about pregnancy and abortion to women seeking an abortion.
Miller filed an identical bill during the 2013 legislative session, and the bill was passed by the house but died in the senate.
Rep. Sonya Anderson (R-Springfield) pre-filed HB 81, which would change the laws regarding consent for a minor seeking an abortion. The bill would make it illegal for a physician to provide abortion care to a minor “unless such physician first obtains the notarized written consent of both the minor and one of her parents or her legal guardian.” Under current Missouri law, a parent is already required to consent to a minor’s abortion.
Anderson filed an identical bill in 2014.
Both Miller and Anderson co-sponsored several other pieces of anti-choice legislation, including a ban on using telemedicine procedures to administer medication abortions and increasing the number of required state inspections on abortion clinics.
Rep. Rick Brattin (R-Harrisonville) pre-filed HB 131, which would prohibit an abortion from being performed until the father provides written, notarized consent to the abortion. Brattin introduced an identical bill during the 2014 legislative session.
The bill includes an exception for women who are pregnant as the result of rape or incest. However, Brattin says that this exception only applies to women who are the victims of “legitimate rape.”
“Just like any rape, you have to report it, and you have to prove it,” Brattin told Mother Jones. “So you couldn’t just go and say, ‘Oh yeah, I was raped,’ and get an abortion. It has to be a legitimate rape.”
Brattin’s use of the phrase “legitimate rape” harkens back to former Missouri Rep. Todd Akin using the same phrase while a candidate for U.S. Senate. The comment drew a firestorm of controversy and was the beginning of the end for his campaign.
“Those kinds of comments are disappointing—we’ve been through this,” Nash said. “You would think at this point, particular lawmakers in Missouri would understand that women who have been sexually assaulted are carrying a huge emotional burden and attempting to report a rape to the legal authorities can be extremely difficult.”
HB 151, pre-filed by Rep. Jeff Messenger (R-Republic), would prohibit any public funds or governmental economic incentives to be awarded for projects involving abortion services, human cloning, or prohibited human research, which is already prohibited under state and federal law.
Messenger introduced an identical bill during the 2014 legislative session.
Rep. Elijah Haahr (R-Springfield) pre-filed HB 182, which would change the laws regarding custody and visitation rights of a father who “attempted to coerce the mother of his child to obtain an abortion.” Haahr introduced an identical bill this year.
HB 124, pre-filed by Rep. Linda Black (R-Desloge), would require the DHSS to create a video that must be provided to a woman considering an abortion. The video would include information that is already required by state law to be given to women seeking abortion care.
Black introduced an identical bill during the 2014 legislative session. An analysis of the bill by Planned Parenthood said that the video would include medically inaccurate information designed to discourage women from terminating a pregnancy. The information would be repeated three times: in person, in writing, and in the forced viewing of a video.
Black has served in the house since she was elected in 2008, and has served three terms in the state legislature as a Democrat. Just one day after being elected as a Democrat to her fourth term in the house, Black announced that she was switching parties and caucusing with the Republicans.
Black’s decision to switch parties makes her legislative record more aligned with her party. During the 2013 legislative session, Black co-sponsored several anti-choice bills, including a bill that would have forced women to have an ultrasound before having an abortion.
Black, in a statement announcing her decision to switch parties, said that she found it “difficult to square my social and moral beliefs, and, I believe, the social and moral values of voters in my district, with some of the views of the Democratic Party.”
The Missouri legislature convenes on January 7 and lawmakers have until the day before the session begins to pre-file bills.
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Alaska’s newly elected Gov. Bill Walker adamantly campaigned on a platform to expand Medicaid, but whether he’ll be able to meet his promise with a Republican-dominated legislature isn’t so clear.
If Walker, who took office December 1, is able to push Alaska to expand the public health insurance for low-income Americans, it will become the 28th state to do so under the Affordable Care Act. Medicaid expansion is a central reform of the federal health law, and makes millions of Americans newly eligible for free or low-cost health insurance.
“I support expanding Medicaid,” said Walker, an Independent, during his campaign for governor this year. “We achieve three objectives by doing so. First, we cover nearly 40,000 Alaskans who have little or no coverage. Second, we expand job growth in the health care field in Alaska. Third, we counter the impacts that uncovered Alaskans have on the insurance premiums of other Alaskans who must underwrite the costs of hospital and other medical care to the uninsured.”
Walker’s interest in expansion likely won’t be enough to actually push through the policy measure long opposed by Republicans on the state and federal levels. Most states have gotten legislative approval for Medicaid expansion, a feat that may not be so easy in Alaska, where the state government is controlled by conservative Republicans.
“There have been a few states where the governor has acted on his own through executive authority,” Laura Snyder, a spokesperson for the Kaiser Family Foundation, told NPR. “But most states [like Alaska] have generally incorporated it into state budgets, which usually require legislative sign-off.”
A conservative legislature has proven insurmountable for other governors seeking to push Medicaid expansion under the ACA. Florida’s Republican governor, Rick Scott, for example, has recently advocated for Medicaid expansion after initially decrying it. But Scott has been unable to bring his fellow Republicans in line, though critics say he has hardly tried.
Wyoming is among deep-red states that have slowly embraced the popular expansion of Medicaid to cover those who couldn’t obtain affordable health insurance before passage and implementation of the ACA.
Alaska’s current Medicaid system has technical problems that would make expansion difficult, even if Walker were to announce changes today. The state in September filed a complaint against the company it hired to manage Medicaid, due to the number of defects in the system, which last totaled a whopping 870, according to the Associated Press.
Walker recently hired a new state health commissioner, Valerie Davidson, to look over the system and the possibilities of expansion. Davidson told NPR that Alaskans are going to have to compromise on the issue if they want to get anything done.
“It may not be something everyone’s 100 percent happy with,” she said, “but we may be able to find middle ground that we can all live with.”
Image: James Brooks / Wikimedia
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The least productive Congress in modern history concluded Tuesday night with a rare flurry of productivity.
The Senate confirmed 59 Obama nominations, including a dozen judges who will serve lifetime appointments on the federal bench. Controversial anti-choice nominee Michael Boggs was not among them.
Boggs came under fire for a series of anti-choice votes, including a bill that would have published the names of abortion doctors online, and for his support of a same-sex marriage ban and a Confederate symbol on the Georgia state flag.
“Boggs’ defeat is a victory for women, LGBT equality, and racial justice,” NARAL Pro-Choice America president Ilyse Hogue said in a statement. “At a time where our rights are under fire in the courts, Americans will not accept the elevation of a nominee with a clear history of anti-choice bias as the price of a ‘deal’ struck to fill federal judicial vacancies.”
That deal was one struck between the Obama administration and Georgia’s two senators to include Boggs in a package of seven nominees in exchange for the senators not using their veto power against any of the nominations.
The nominees that went through were a victory for diversity in the Obama presidency.
Obama’s nominations have significantly increased the diversity of the courts, and he has already confirmed more women than any other president in the modern era.
Obama has gotten more judges confirmed this year and overall in his presidency than his predecessors, with 89 district and circuit court judges confirmed this year alone, and a total of 305 confirmations in his six years as president.
Obama can thank the Senate’s “nuclear option” filibuster reform for nominations for the high number of confirmations this year.
Oddly enough, he can also thank Sens. Ted Cruz (R-TX) and Mike Lee (R-UT), whose procedure-bucking insistence on anti-immigration votes late Friday night kept the Senate in session over the weekend and provided more time to set up confirmation votes.
This allowed the confirmation of high-profile nominees like Vivek Murthy as the new surgeon general.
Murthy was one of a staggering 69 nominees who were able to be confirmed since Friday night.
“Because of the antics of Ted Cruz and Mike Lee, we were able to end the 113th Congress on a high note,” a senior Democratic leadership aide told RH Reality Check. “Senator Reid and the Democratic caucus showed tremendous unity and perseverance to push through many important nominations before the end of the year.”
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Walmart continues to discriminate against pregnant workers despite changing its employment policies to provide “reasonable accommodations” for the company’s pregnant employees.
Those are the allegations in a new charge filed Tuesday with the Equal Employment Opportunity Commission. The charge was filed by the National Women’s Law Center, A Better Balance, and a private law firm on behalf of Candis Riggins, a former Walmart employee who claims the retail giant discriminated against her when she was pregnant.
Riggins’ job responsibilities at Walmart included cleaning bathrooms with toxic chemicals that were causing her to become ill while she was pregnant, according to the EEOC charge. When Riggins asked Walmart for temporary relief of those duties, she was denied. Without the accommodation, Riggins was left no choice but to call out sick a number of times, and was eventually fired.
“I made it clear to my supervisors that I wanted to keep working and that I could do several other jobs well,” Riggins said in a statement following the filing of the complaint. “I just needed to keep away from the chemicals, but Walmart said, ‘No,’ even though I know they gave light duty to a coworker of mine when he hurt his back. Finally, I was forced to choose between a healthy pregnancy and my paycheck. No pregnant worker should have to make that decision.”
Tuesday’s charge is the most recent accusation against the mega-retailer of abusive labor practices against its pregnant employees. In March, the same legal organizations filed an initial complaint with the EEOC on behalf of a nationwide class of women workers asserting that Walmart has a nationwide policy and practice of pregnancy discrimination based on its failure to accommodate pregnant workers.
Walmart, shortly after the EEOC complaint was filed, revised its written policy, stating that the store will provide reasonable accommodations for temporary disabilities caused by pregnancy.
But according to the compliant filed Tuesday, Walmart denied Riggins her accommodations while she was pregnant, even after the retailer changed its accommodations policy.
“Walmart has made only the bare minimum of accommodations for its pregnant workers,” said Ellen Eardley, partner at Mehri & Skalet, a Washington, D.C.-based law firm and one of the attorneys involved in the matter. “Walmart’s policy accommodates women with disabilities caused by pregnancy, but in practice Walmart does nothing to accommodate the vast majority of pregnant women who are healthy, yet still may need a temporary change in duties.”
The groups allege that Walmart’s written policy providing “reasonable accommodations” for temporary disabilities caused by pregnancy doesn’t go far enough. In order to comply with the Pregnancy Discrimination Act, the superstore must make accommodations available to all pregnant workers, the advocates say.
“The Pregnancy Discrimination Act mandates equal treatment, nothing less, and we will continue to fight until Walmart obeys the law in full,” said Emily Martin, vice president and general counsel at the National Women’s Law Center. “Walmart should heed the part of its slogan that says ‘live better’ by not making life worse for its pregnant employees.”
The EEOC charge on behalf of Riggins comes just two weeks after the Supreme Court heard oral arguments in Young v. United Parcel Service, which addressed the scope of the 1978 Pregnancy Discrimination Act and what legal obligations employers have to accommodate pregnant workers.
The charge also comes on the heels of recent legal defeats for Walmart.
A National Labor Relations Board administrative law judge this month ruled the retailer had illegally intimidated employees in California, while the Pennsylvania Supreme Court just affirmed a $151 million judgment against the retailer for wage theft after workers at Walmart and Sam’s Club stores in Pennsylvania were forced to work off the clock and when they were supposed to be on break.
Walmart is reportedly considering appealing the Pennsylvania decision to the Supreme Court.
Image: ValeStock / Shutterstock.com
The post Lawsuit: Walmart Continues to Discriminate Against Pregnant Workers appeared first on RH Reality Check.
“The Court holds that the Executive Action is unconstitutional because it violates the separation of powers and the Take Care Clause of the Constitution,” wrote U.S. District Judge Arthur J. Schwab, who was appointed to the federal bench by President George W. Bush. In his ruling, Schwab used common GOP talking points meant to criticize and delegitimize Obama’s immigration order that came after Congress repeatedly failed to strike a deal that would reform federal immigration policy.
Obama’s executive actions, which create pathways for three-year work permits for more than 4.4 million people who were brought to the United States as children as well as the undocumented parents of citizens, are illegal because they amount to the president legislating, the task reserved for Congress, according to Schwab’s ruling.
“Congress’s lawmaking power is not subject to Presidential supervision or control,” Schwab wrote. “Perceived or actual Congressional inaction does not endow legislative power with the Executive.”
The ruling came in a case of a Honduran man who was deported, and then unlawfully reentered the country and was arrested and detained by the Department of Homeland Security. In considering how to sentence the defendant, the court sought supplemental briefing from the parties on whether or not the president’s executive actions would apply in this case, and if so, whether these policies would provide the defendant with additional avenues for seeking the deferral of his deportation.
The fact that the court independently ordered supplemental briefing to address the immigration actions suggests Schwab was looking for a way to address the constitutionality of Obama’s orders on his own.
Yet the impact of the ruling is not immediately clear. Noting that the case was “arguably unequal and arbitrary immigration enforcement,” the order declares the president’s actions to be unlawful, but also gives the defendant an opportunity to seek relief from deportation under the recent executive actions.
In other words, Obama’s immigration orders remain in effect despite Schwab ruling them unconstitutional.
Schwab’s ruling also echoed Republican talking points opposing the president’s deferred prosecution order, suggesting that Obama’s executive actions conceivably have no limits and that a future president could instruct the IRS to collect a lower tax rate than established by law and “defer prosecution of any taxpayer” who pays the lower rate, for example.
Tuesday’s ruling is not the only challenge the Obama administration faces on its immigration policy.
A handful of states led by Republican governors, have sued, challenging the orders. Meanwhile, the American Civil Liberties Union filed a nationwide class-action lawsuit this week challenging the administration’s asylum detention policy.
The post Conservative Judge Blasts Obama’s Immigration Orders as Unconstitutional appeared first on RH Reality Check.
This Year in Sex takes a look back at the news and research related to sexual behavior, sexuality education, contraception, sexually transmitted infections, and other topics that captured our attention in 2014.
The HPV Vaccine Works, It Doesn’t Cause Promiscuity, and There’s an Even Better One Coming
HPV and its vaccine made headlines many times this year. The upsetting news is that two new studies came out suggesting that we had been underestimating the number of both HPV cases and cervical cancer, but as far as the vaccine itself was concerned, things were looking pretty good.
First, and most importantly, it appears to be working. A 2013 study found that despite the fact that only half of teen girls had gotten one dose of the vaccine—and fewer than a third had gotten the recommended three doses—the proportion of teen girls infected with the HPV strains that the vaccine addresses has dropped by 56 percent. This year, another study confirmed this success when it found that states with high rates of HPV vaccines have lower rates of cervical cancer, and vice versa.
Additional research this year should (though probably won’t) also put to rest the idea that giving young people the HPV vaccine encourages them to engage in sexual behavior. One study found that young women do not change their attitudes or behaviors toward safer sex if they get the shot, and the other showed that girls with the vaccine are no more likely to get pregnant or be tested positive for a sexually transmitted infection than their unvaccinated peers.
More good news: Last week, the Food and Drug Administration (FDA) approved a new version of Gardasil, one of the two HPV vaccines on the market, which will protect against more strains of the virus. The original vaccine protected against strains 11 and 6, which cause most genital warts, and strains 16 and 18, which cause 70 percent of cervical cancer. The new vaccine, called Gardasil 9, will protect against these four strains in addition to five more cancer-causing strains—31, 33, 45, 52, and 58. Public health experts are hopeful that this added defense can prevent 90 percent of cervical, vulvar, vaginal, and anal cancers.
Wins and Losses for Those Who Want Condoms in Porn
Last year ended with a shutdown of filming—the third of its kind in 2013—in the porn industry after another actor was found to be HIV-positive. So it should be no surprise that this year included numerous rounds in the battle between producers who say no one wants to see condoms on film and public health experts who insist safer sex should start on set.
An effort to get California to pass a statewide law mandating condom use ultimately failed after facing a lot of opposition from porn company representatives, who threatened to take their business to a friendlier state, and porn stars who said it would force their industry underground and make their work more dangerous.
Defenders of the ban, however, did get an end-of-year victory this week when Measure B—a Los Angeles County ordinance requiring condoms on adult industry sets—was upheld by the Ninth Circuit Court of Appeals. A lower court had formerly upheld the measure, though it has yet to be systematically enforced.
The IUD Gains Supporters and Users
The intrauterine device (IUD) was once one of the more popular methods of birth control available. Then one model, the Dalkon Shield, came on the market with numerous design flaws that caused many users to become infertile, even resulting in several deaths. Though the dangers were unique to Dalkon Shield, women and physicians became suspicious of all IUDs; for many years, very few women—and only those who had already had children—would use them for contraception. In the last few years, however, IUDs have started getting more attention as providers and public health experts note the safety of newer models and the unparalleled efficacy rates.
This year, the IUD gained even more supporters, such as the American Academy of Pediatrics, which came out with a recommendation in October suggesting that IUDs be considered a first-line contraception for sexually active young people. Three months prior, research out of Colorado suggested that increasing the number of young women at Title X clinics using long-acting reversible contraceptives (which include both IUDs and implants) had led to lower than expected fertility rates among low-income women ages 15-to-24 in the state.
Other states, even conservative ones, decided this year that fixing the way Medicaid pays for IUDs—to make it possible to obtain one in a single visit, or even while still in the hospital after delivering a baby—could help prevent unintended pregnancies.
All of this support seems to be translating into increased use of the method. The National Survey of Family Growth found that 6.4 percent of contraceptive users were using an IUD in 2011-2013, compared to just 3.5 percent in the 2006-2010 survey.
Lab-Grown Penises and Transplanted Uteri
The future of reproductive health may include penises grown in a lab and babies born from transplanted uteri.
This year, the first baby to grow in a transplanted uterus was born to a 36-year-old Swedish woman whose name is being withheld. The woman, like the nine others who began the trial, had functioning fallopian tubes but was born without a uterus. After she received a donor organ from a friend of the family, doctors put her on anti-rejection drugs immediately. She became pregnant using IVF and had a relatively uncomplicated pregnancy, though the baby was delivered at 32 weeks when she showed signs of preeclampsia.
The medical team who undertook the trial hailed this as great news for assisted reproductive technologies, but others have expressed worry that the procedure is too invasive for both the donor and the recipient. Two of the nine women in the original study had to have their donor uteruses removed.
Meanwhile, no one has yet to be given a lab-grown penis, but new research on rabbits publicized in October suggests that it’s just a few years off. The process starts with a donor organ that is first stripped of its cells, then seeded with two different types from the genitals of the intended recipient. By making the penis out of the recipient’s own cells, scientist say they are reducing the chance of organ rejection. The procedure was tested on 12 rabbits; all successfully tried to mate using their engineered penis, eight were able to ejaculate, and four impregnated their bunny partner.
Truvada Dominates HIV-Prevention Discussion
Truvada is a combination of two antiretroviral drug used to treat individuals who have HIV. When used daily in HIV-negative individuals, these drugs have been shown to prevent transmission of the virus. The FDA approved the use of Truvada as a form of pre-exposure prophylaxis (PREP) in 2011 and it has been gaining popularity ever since.
This year, both the Centers for Disease Control and Prevention and the World Health Organization released guidelines suggesting that those at high risk of HIV infection—including injection users and men who have sex with men who are not in a monogamous relationship—consider using Truvada.
The method is highly effective. Studies have found that men who take it every day can reduce their risk of HIV infection by as much as 92 percent.
Still, some HIV advocates are concerned that those who choose Truvada—which can cost as much as $10,000 a year and needs to be taken every day—will stop using condoms, putting themselves and their partners at increased risk of other STIs, such as gonorrhea or syphilis.
The Dangers of Mixing Sex and Technology
The intersection between technology and sex got a little tricky this year as officials pointed to a dating app, Grindr, as being at least partially responsible for a syphilis outbreak; meanwhile, a jury in California found that an STI dating site called PositiveSingles had been sharing private information.
Grindr uses global positioning technology to help users meet other users nearby who are interested in getting together, presumably for sex. Grindr is marketed to men who have sex with men, but similar apps exist for heterosexual couples and women who have sex with women. This March, the popular app was at the center of an outbreak of syphilis in Onondaga County, New York.
A few months later, research in Los Angeles found that men who have sex with men who met partners on apps like Grindr had a 25 percent greater incidence of chlamydia and a 37 percent greater incidence of gonorrhea than those who met men in person at a bar, club, gym, private sex party, or even an online dating site. There was no difference in HIV rates or syphilis rates based on where men met.
The online dating sites, however, might pose another problem, at least according to a California jury that awarded 16.5 million dollars last month to a man who says the dating website PositiveSingles—which advertises itself as a place where people can meet other people living with STIs—violated consumer law and committed fraud by sharing information among many other niche websites owned by the same company. As the plaintiff’s attorney put it: “[my client] is not Black, gay, Christian or HIV positive and was unaware that [the] defendant was creating websites that focused on such traits that would include his profile, thus indicating that he was all of these things and more.”
Always a New Sex Toy
Finally, lest anyone worry that we will get bored heading into the new year, we take a look at the sex toys that emerged in the public eye in 2014. There’s the Svakom Gaga, a new vibrator introduced by a Chinese company that comes equipped with a camera and a USB port—plug it into your computer and star in your very own vulva video.
Of course, if you’re not ready for your close-up or you live far from your partner, you could instead turned to the OhMiBod, a vibrator that can be controlled from an iPhone via Bluetooth.
And, for the fitness buffs who aren’t satisfied knowing that they took their 10,000 steps a day, there is the kGoal, a U-shaped device that counts kegels. Women put one side of the device inside their vagina and the hook the other to their phones and are able to know exactly how many times they squeezed their pelvic floor muscles. Known as kegels, these exercises have been shown to help during childbirth, prevent or control urinary incontinence, and improve orgasms.
How can pro-choice advocates change the cultural conversation that can help win policy victories? For starters, don’t be afraid to just say “abortion.”
At this year’s Rootscamp, a conference bringing together about 2,000 progressive activists and strategists, NARAL Pro-Choice America President Ilyse Hogue and representatives from the viral content curation site Upworthy talked about their experiments with social media to figure out what would draw the most people into the conversation about reproductive freedom.
Their biggest finding was that phrases like “reproductive freedom” have their limits—if you’re talking about abortion, the presenters said, it’s best to come out and say so.
The staff of Upworthy, which partnered with NARAL to create a pro-reproductive rights vertical called Feminent Domain, ran tests on their content’s headlines, images, share text, and other factors to tease out what would resonate most with readers and inspire them to share with their networks, including people who might not necessarily identify with the pro-choice cause.
“The term ‘abortion’—can we just put it in a headline? Can we come out and say it? How will the Internet respond to that?” said Upworthy’s Patty Carnevale.
As it turned out, she said, “Being very direct with our audience about what we’re talking about really paid off.” Headlines that spoke more indirectly or euphemistically about abortion did much worse in their testing.
That jibes with other recent data showing huge payoffs from canvassers going door to door to directly share their own abortion stories with people, Hogue said.
“Voters, when you engage them at the door one one one, they don’t know what we mean when we don’t say what we mean,” Hogue said. “If I am talking about abortion and I want you to know what I’m talking about, I am going to say ‘abortion.’ It moves people because they feel like we are being direct with them.”
The other big finding was that in stories that hinge on emotion, compassion draws people in—especially people who think differently than the storyteller.
And snarky cleverness, though it may be therapeutic for embattled social justice writers and be a hit with the base, actually turns a lot of people off because it seems too “insidery” and not inclusive.
Other findings included that it’s OK to joke about abortion since humor is a release and a conversation-starter, and that while it’s fine to have political content, political references may not get more initial clicks; a headline referencing “a dude who hates abortions” did better than talking about an anti-choice “politician,” but less-electioneering terms like “conservative” work OK.
The presenters acknowledged that there’s a difference between online and offline activism, but said that they reinforce each other and have lessons for one another. And the online world is an integral part of culture, which has to change first in order to build political power.
“Politics is the most risk-averse sector that we have,” Hogue said. “One of my observations as a new leader was that we were never going to get the political will that we need if we didn’t actually tackle the cultural question.”
12.17.14 - (PRESS RELEASE) The Dominican Republic Chamber of Deputies has agreed to amend the country’s Penal Code to allow abortion in cases of rape or incest, or when the life of the pregnant woman is at risk—a major step toward expanding access to safe and legal abortion.
On November 28, in accordance with international human rights standards, President Danilo Medina sent a letter to the Chamber of Deputies asking Congress to change the Penal Code to allow safe and legal abortion in limited circumstances.
Once this revised code is approved, the Dominican Republic will become the 36th country to decriminalize abortion in the last 20 years, ending the country’s absolute ban on abortion and the harsh penalties associated with it.
Said Nancy Northup, president and CEO of the Center for Reproductive Rights:
“Loosening the most severe and harmful restrictions on safe, legal abortion care is an essential step toward ensuring the fundamental human rights of women.
“The abortion ban in the Dominican Republic has needlessly destroyed the lives of countless women and families, and there is still more that the country must do to prevent further harm and injustice.
“We hope the government works quickly to approve this revised penal code so that more women can get the essential reproductive health care that is their right.”
The Dominican Republic is currently one of only six countries in Latin America that completely bans abortion with no explicit exceptions, which has led to more than 90,000 unsafe abortions occurring in the country each year.
“We commend the President and Chamber for taking this first critical step toward protecting and respecting women’s fundamental human rights to reproductive health care,” said Mónica Arango, regional director for Latin American and the Caribbean at the Center for Reproductive Rights.
According to a recent Center report, 35 countries have amended their laws to expand access to safe and legal abortion services in the last 20 years—a trend that has marked incredible progress toward improving women’s rights and lives, including significantly reducing rates of maternal mortality due to unsafe abortion. The report was released alongside the Center’s updated World’s Abortion Laws map—one of the most comprehensive resources on abortion laws across the globe.Abortion Worldwide: 20 Years of Reform
12.17.14 - (PRESS RELEASE) Last night President Barack Obama signed the Consolidated and Further Continuing Appropriations Act for FY 2015 into law, which includes an historic budgetary fix that will finally allow women serving in the Peace Corps equal health care coverage for abortion services in cases of rape, incest, and life endangerment.
Until this point, Peace Corps Volunteers have been barred from abortion coverage in any circumstance – even in the case of rape or a life-threatening pregnancy. With the signing of this new funding bill, Peace Corps Volunteers will have the same limited coverage available to federal employees, women receiving health care assistance through Medicaid, and most recently, military servicewomen. President Barack Obama included long-denied coverage in his annual budget proposal for FY2015, and this summer appropriations committees in both the Senate and House voted to include the critical fix in their respective funding bills.
Said Nancy Northup, president and CEO of the Center for Reproductive Rights:
“For the first time in more than 30 years, the dedicated women of the Peace Corps will have the same coverage for reproductive health care as all who serve the U.S.”
“Women who have decided to end a pregnancy because of rape, incest, or life-threatening complications will no longer have to wonder how they are going to pay for the health care they need.
“We commend President Obama and the bipartisan supporters of this measure in Congress for their commitment and leadership, which has finally made equal reproductive health care coverage for women in the Peace Corps a reality.”
A recent study documented more than a dozen women’s personal experiences with abortion while serving in the Peace Corps—from the time before the discriminatory federal ban was put in place in the late 1970s through 2013. The study’s authors concluded that “lifting the federal restrictions on abortion coverage in cases of rape, whether through the appropriations process or a stand-alone bill, would be consistent with this overarching effort to respond better to the needs of sexual assault survivors serving in the Peace Corps.”
Peace Corps Volunteers—63 percent of whom are women–are only paid a monthly stipend of $250-$300, typically less than the cost of a first-trimester abortion. Several women interviewed in the study reported serious challenges paying out-of-pocket for the procedure. One participant explained, “I got a comfortable monthly stipend to be living in those local conditions, but there’s no way that the stipend would have been enough for me to obtain a safe abortion.” Over 97 percent of the study’s participants supported efforts to extend health care coverage in cases of life endangerment, rape, and incest.
“It is comforting beyond words that my voice, along with the voices of my fellow returned Peace Corps volunteers affected by this ban, have been heard and acknowledged, and our fight has been fruitful,” said Christine Carcano, a former Peace Corps volunteer who has shared her own story of struggling to pay for an abortion after she was raped during her service in Peru. “This change is about support and compassion for a woman in time of need, and it is an absolute relief that no future Peace Corps volunteer will have to feel the effects of this traumatizing policy. If there is any silver lining to such a situation, this is it.”Senate Committee Passes Appropriations Bill Promoting Equal Health Coverage for Peace Corps Volunteers House Appropriations Committee Approves Abortion Coverage for Peace Corps Volunteers New Study Documents the Human Toll of Unequal Abortion Coverage for Peace Corps Volunteers