Colorado is leading on reproductive rights— and men are among the biggest advocates
Will other states follow their lead?
Dr. Larry Wolk is executive director and chief medical officer of the Colorado Department of Public Health and Environment. Women at the Center spoke with Dr. Wolk in his office in May.
Can you tell me about your connections to family planning issues and the Colorado Family Planning Initiative? How you got involved?
I’m a pediatrician by training. I started my career 20 years ago as somebody who helped start school-based health centers and studied school-based health centers. During that time, I published a study of the condom availability program that Adams County School District 14 [in Colorado] had in place, demonstrating that making condoms available in schools did not encourage sexual promiscuity or behavior, and in fact offered more protection. So, personally I’ve always been involved and had an interest. I even made that the basis for my thesis for my master in public health. Three years ago, I became the executive director of the Colorado Department of Public Health and Environment, which is the home of the Colorado Family Planning Initiative (CFPI). So my role is oversight, management, accountability and responsibility for the CFPI.
The CFPI gets a lot of different funding sources to keep it going. There’s federal funding through Title X, which then gets disseminated to Title X clinics. There’s some state funds, there’s now insurance money available to providers of family planning services through both Medicaid and commercial payers to help pay for these services. This year, we were successful in getting the legislature to include in the state budget a $2.5 million a year line item from the general fund to help support the ongoing success of the CFPI.
Why have you chosen to take a stand on supporting this program and improved reproductive health access?
I’m an evidence-based guy, so I like to make sure that we lead with public health that has the best evidence when it comes to improving the health, and therefore the lives, of people. This particular program has some very strong evidence. We helped reduce the rate of unintended pregnancy, which includes not just children that are born to parents who might not be ready for those children, but we also dramatically reduced terminations or abortions. And as a result of all of that, there’s been a decrease on public assistance spending because many more women and young adults are able to stay in school and are able to work toward getting better paying jobs, so that they can plan their pregnancy and the state of their families when it’s a better time.
What do you see as the role of men around family planning and contraception issues, not just personally but politically?
Interpersonally, it takes two. Men are involved and they have a role. Men need to be advocates because the result in birth or the result in termination are results of both the man and the woman. So the burden should by no way, shape, or form, rest solely on the women involved.
From a policy standpoint, I think that it’s important that men who are in leadership positions use those positions to advocate, not just for themselves but for everyone. We still have a male-dominated culture, more so in certain parts of the state and certain parts of the country. And I think we have to try and use that, then, to help strengthen the message and help garner the support that necessary. It would be nice if we lived in a culture and society where women or minorities or folks who are disadvantaged socio-economically had as loud a voice as people with money, or people who have opportunity or have education or are male, but we’re not quite there yet.
With my role, first as a physician and second working with a regulatory agency, we try to stay out of the political issues and stay in the center of the clinical issue. The law says abortion is legal, the law says people have the right to access family planning and family planning services, and even can expect that their insurance covers that in most if not all cases. So our role as regulators is to make sure the law is followed and that policy supports the law. People might question the analogy but it’s similar to marijuana. When people ask me about marijuana, I say “look, the law says it’s legal,” and so my role is to not question the legality but to regulate and to make sure that people are informed with regards to what are the risks and what are the benefits, and what’s the expected outcome. I think family planning and LARCs [long-active reversible contraceptives] are an example of “look, the law says I’m entitled to this and by the way it doesn’t cause abortion.” Family planning doesn’t cause abortion. Certain political factions might think they could get their viewpoint supported by making that association, but that’s not science and it’s not clinically accurate. It’s incorrect, and the association between abortion and family planning misleads people.
Recently someone tried to bait me into a conversation about pro-life vs. pro-choice and I said “I’m pro-life too, but I’m also pro-choice.” I said, “just because you’re pro-choice doesn’t mean you’re not pro-life.”
Are you a father? And if yes, why is improved access to family planning important to you from that perspective?
I am a father and a stepfather, and family planning is something that I was privileged to work with my wife at the time, to be able to talk about and make sure we were able to do to and plan our family accordingly. And again we were privileged because we had the resources, including insurance and having a good job. Those are definitely challenges to folks trying to access family planning services. So it’s important to me to do whatever I can to reduce those barriers and make family planning available to people who don’t have as many resources as others do.
I think youth need to have all the facts. I think it’s easy to think you have all the facts because you listen to your friends and your relatives. We see that many unintended pregnancies that occur in youth happen as a result of that youth’s parents having the same experience. Some of these are intended, some youth in fact to intend to be pregnant and to have children, but many of them don’t have all the information and education one might need to make an informed decision. So this isn’t about one broad stroke saying we’re going to prevent all pregnancy in all young teenagers and adults. This is about making sure folks are informed and educated and have access to tools, should they decide that they want to wait. And by the way, going back to evidence-based data, youth have a much better chance of having a successful family — and success is defined a lot of different ways — if they plan those pregnancies and those opportunities to have families when they can afford to do so, and when they have the ability and maturity to do so.
When it comes to the role of the father, I think it’s about having honest conversations with your kids. Even though you think your kids, especially when they are becoming ornery teenagers, aren’t listening to you, they are. It’s perfectly naturally for them to think that what you’re telling them is stupid or embarrassing, or they might tell you to stop, but leave information in a place that they can review when they’re ready to and in their own time and space. I think it’s important to have these conversations in the context of “I care about you and I’m not going to stop caring about you, just because you’re an ornery teenager.” And also in the context of their overall health. There are so many things that parents need to be talking to our kids about, whether it’s family planning, whether it’s drinking or tobacco or drugs or social relationships. We don’t have to isolate those into separate conversations. You can keep it all together in the context of “I care about you and I want you to be healthy.”
What do you see as the relevance of this program within the larger national landscape around these issues now? Where does this program fit into the national dialogue, and what kind of support do states like Colorado want from the federal government to help women and men deal with family planning issues?
I think people have taken notice because of the success we’ve had in Colorado, so we’re getting a lot of interest from other states and the federal government on what can we learn from Colorado, and what can Colorado learn from other states, in regards to a successful family planning initiative.
I have a vision that family planning becomes as routine for health care providers as immunizations. In order for it be routine, that means clinics need to have an inventory so they don’t have to worry about whether or not they’re going to be paid by that patient or that patient’s insurance. It means clinics are appropriately trained, so they can write a prescription but just as easily as writing a prescription they can insert an IUD or another LARC. Among the community, I think working on campaigns that target young people so that there’s no stigma around family planning for them. We want young people to know that there is nothing scary about family planning, that there’s nothing irreversible about this, there’s nothing that hasn’t been tried or tested, and there are plenty of options to find out what works best for you, from abstinence all the way to having an IUD put in. That’s why it’s important to have information to learn what works best for you.
Do you believe this is a model the global or international community can learn from? Are there any plans to show the success of this program to national or international sustainable development groups?
We have had some interest from abroad and there’s a lot of interest around IUDs, especially if the price of an IUD can be lowered. There’s a new IUD coming into the market that’s a tenth the cost of what an IUD costs now. IUDs are very expensive, ranging from $500 to $900. But when you consider the money saved by preventing an unintended pregnancy, that is a reasonable price to pay. The new IUD, the Liletta, is supposed to be around $55. If I can now have 10 IUDs for the price of one, I can help a lot whole lot more people, and now I can start looking at developing countries and doing a larger population-wide access movement, and not having to worry about the expense as much.
Domestically, I think a lot of states have taken an easier path because there is a secondary prevention when you’re talking about family planning where you offer options in the hospital when a young woman or a couple has just had their baby. And that’s fine, I mean you have a captive audience and this is successful in preventing another unintended pregnancy. But I think we should challenge ourselves to start right at the beginning, and try to prevent that first unintended pregnancy.
I think a lot of people in developing countries look to the U.S. as a leader for these kind of things. The U.S. voice amongst the international community is a strong voice, and I think we have a responsibility to be a leader with that voice. For some countries, improving family planning services is not economically feasible, so again we need to be leaders in removing those barriers and making family planning tools more economically accessible.
When you and your colleagues were discussing this program, were there any conversations around the connections between environmental health and access to family planning?
For sure. It’s all tied together and here, we’re all about health. I think climate change is another issue that tends to make people polarized and so I try to opt out of the fuss on whether or not our climate is changing as a result of a natural evolution vs. man-made emissions. I say, “for whatever reason, we can help reduce the effects of climate change if we reduce man-made emissions going forward.” So it doesn’t really matter how we got here, we’re here and it could be getting worse, so we need to be doing our part to lower the man-made emissions. When we have climate change, it does impact people’s health, more so people who are living in poverty, and so addressing climate change really does help strengthen resiliency, especially amongst folks who are living in disadvantaged circumstances. It’s all tied together. Mental health is another part of it too. Here in Colorado we have a pretty high suicide rate among youth, so the more we can do to better people’s lives and make them happier, whether it’s through how we address environmental health or whether it’s how we address family planning, I think we have a real shot at lowering that rate.
We also talk about environmental justice, which is about people who are in disadvantaged situations who don’t get the ability to not have to live near a power plant that might be spewing emissions, or near an industrial area that might be leaking pollution into the soil or water. So again, if you’re in a disadvantaged situation and if you want to plan your pregnancy so you can finish school, go to college, or get a good job and move away from industrialized area to a healthier environment, then all the more reason to offer family planning services targeted specifically to folks who maybe are suffering environmental injustice.