Trail Markers in the Wilderness

Looking Back on my Career Path to Public Health

Middle school is full of mortifying moments. At least one of mine, though, was prophetic. We were boarding the school bus home from a field trip to the Robert Crown Center for Health Education, rowdy after spending the better part of the day immersed in serious lectures and cringe-worthy videos about reproductive health and the dangers of drugs and alcohol. Each year’s class visit to Robert Crown prompted a hormone-driven blend of dread, eye rolls, dramatic sighs, and incessant giggles.

I sat down on the bus with my three best friends, and we started a game of “Most likely to…”. After going several rounds, we landed on the killer question: “Who’s most likely to work at the Robert Crown Center when they grow up?”

The mere thought that any of us could work at a place like that — the source of so much embarrassment among Chicagoland tweens — was horrifying.

“Liz!” “Liz!” “Oh yeah. Definitely Liz!”

My face burned. Everyone around us was laughing, nodding in agreement. At least half the bus had overheard this mortifying prediction of my future, and I squirmed under the crushing weight of their easy and unanimous decision. What was it about me that made them think I’d end up talking about reproductive health for a living?

A young Catholic married couple led the youth group my parents forced me to attend throughout high school. The name of the program was Godparents, and the idea was that George and Kelly* played the role of Godparents, or trusted adult confidantes, to us. At 27, they had two young children and a third on the way.

Every Sunday night, we would gather at their modest suburban home to discuss issues of faith, religion, and teen life in general. Sex would occasionally come up in conversation. Each time it did, George and Kelly would gravely caution us that anyone who had premarital sex would go to hell (unless, of course, we confessed our sin and asked for forgiveness, which seemed easy enough). That was the extent of our conversations on the matter. And that was more than most of us had heard about sex in our Catholic homes from our parents.

Junior year, one of the girls in our group, Margaret, gave birth to a baby girl.

Senior year, a second group member, Anna, got pregnant.

By the time I graduated, quite a few of my classmates had gotten pregnant, and I had seen friends through pregnancy tests, abortions, miscarriages, adoptions, baby showers, and births.

For some of us (my high school boyfriend and I included), watching our peers try to navigate these grown-up situations at 15 or 16 years old was very effective birth control. But for others, the feeling that everyone else was having sex magnified the pressure to follow suit.

I remember attending a birthday party my sophomore year for two seniors who were dating. As a gift, their friends were sending them to Sybaris, a suburban “couple’s retreat” that boasted pool suites and rooms for rent by the hour. My boyfriend and I gave our friends a big box of condoms with a bow on top. It was the first time we had ever bought condoms, and I still remember the terror I felt as the pharmacist asked how he could assist us. At the party, though, we were cool and nonchalant, as if we were simply sharing our stash with them. I’d be tempted to believe that many of us had been less sexually active than we let on, except for the memory of watching nine of my friends’ bellies grow and grow that year until they left school to have their babies.

What I didn’t see was the actual parenthood that followed. I went away to college and then further away to the Peace Corps and so on. Now while I’m chasing around my preschool-age daughters, a fair number of my high school classmates have adult children. I’m willing to bet that at least one or two people from my graduating class are 36-year old grandparents.

The final youth group meeting before graduation is stuck firmly in my memory. We sat in a circle in the living room as George and Kelly shared their impressions of us, and their hopes for our future.

When it was my turn, George said, “Liz, you’re the intellectual of the bunch. We love that you ask questions and seek deep answers. But we worry that your intellect puts you at risk because it might allow you to choose reason over faith and rationalize things like contraception.”

I thought it was such a strange choice to use contraception as an example of the “danger” of my intellect when we had two teen mothers in our midst.

Two teen mothers who, however hard they worked and however smart and strong they were — and they were — would likely never have the same educational and economic opportunities in their young lives that I would have.

It turns out my Godparents’ cautionary advice was prophetic, too. Sometimes I smile and think, “If they could see me now…”

On September 11, 2001, I was just two weeks into my teaching career in suburban Chicago. I spent the morning planning period in the school’s audio-visual room, watching in horror as the Twin Towers fell and the Pentagon smoldered.

At the end of the last period of the day, one of my quieter 9th grade students, Mae, gave me a handwritten note on a folded piece of notebook paper. “Don’t read it until after I leave, okay, Miss Ward?” And she darted out of the classroom.

The long note described, in bubbly 14-year-old-girl writing, how Mae’s stepfather’s 37-year old friend had been having sex with her. It was clear in her note that she had felt during the relationship that it was consensual and romantic. But someone had found out and told her parents, and the gravity of the situation was dawning on her. Now Mae would have to face her predator in court and testify against him, and she was terrified. She didn’t trust any of the adults in her life to keep her safe. And so, on a torn piece of notebook paper, she begged me to help her.

When I took the note to the school’s administration, I was grateful for their compassionate and proactive response. They set Mae and me up in an official mentoring program for students dealing with trauma and abuse. We were able to spend time alone together and talk. She needed a grownup to listen to her. To help her define her limits, her expectations, and herself.

Several years later, I began teaching at a new high school in North Carolina. The scant teacher orientation included the strict directive that we were not, under any circumstances, to discuss sex or other sensitive subjects with our students. Thinking back to my mentoring experience in Illinois, this blanket policy seemed shortsighted.

My 4th period class of 9th graders that year was troubled and challenging. Once I assigned them narrative essays about an experience that had shaped their perspective on life. They wrote about things like seeing a friend gunned down in a drive-by shooting, attempting suicide, losing their virginity, and pregnancy scares. And I wasn’t supposed to discuss any of it with them. When I was a student, I never would have dreamed about telling my teachers this stuff. But many of these kids had little support or structure at home, and they were desperate for someone, whether a person or an institution, to care about their reality, to expect something of them, and to establish boundaries for them.

I was new to the South and didn’t know if the policy of sweeping sensitive matters under the rug was unique to this particular school or whether it was typical. But it was one of my first glimpses, through adult eyes, of what happens when the institutions that are supposed to equip youth to thrive in this world willfully ignore their needs.

I was ready to change careers. After spending a couple of years teaching overseas, I found it hard to readjust to the American educational system. I wanted to do more international work and to focus on public health, an interest that had been sparked in college by volunteer work I did with people living with HIV and AIDS. While I tried to figure out a new career path, I took a corporate administrative job and signed up to volunteer as a financial literacy mentor for a local program that aimed to help low-income women gain financial independence.

I was paired with a woman named Shania who was recovering from addiction. At age 34, she had six children and one grandchild. She’d had her first child at age 12. He was in prison. She had her second child at 16. She didn’t know where he was. Her four youngest children lived with her, having survived sexual abuse by her ex-husband, who was now in prison. Shania’s daughter DeeDee, now 14, had given birth to a daughter at age 12.

Every three months, Shania would take DeeDee on the long bus ride to the clinic to get a Depo Provera shot, something they started just after she had her baby. I asked Shania if she also got a Depo shot. (One condition of participation in our program was that the women could not be pregnant.) “Nah,” she said. “It’s not for me.”

I began spending more time at Shania’s apartment, which was provided by the mentoring program. I helped her create a budget and prepare to take her driver’s test. Her kids sat around us, jumping in with answers, excited that their mother might be able to procure a license and a car with the money she was saving from her new job at a dry cleaner. As I watched Shania interact with her kids, I saw that they watched and worried over her, and not the other way around.

Before long, things started to go downhill. I took an afternoon off of work to take Shania for her driver’s test. She failed. We practiced more and returned to the DMV. She failed again. Her kids had learned the material inside and out, but she struggled. She never got her license, but she had nevertheless taken the small amount of money she had saved up from her job and used it to buy a barely-functional minivan. Then she lost her job at the dry cleaners. The program helped her get another job at a thrift store, but to get there, she had to take several buses, making for a two-hour commute each way. Another woman in the program who worked at the thrift store told me that things weren’t good there. She thought the store manager was dealing crack.

Shania’s belly began to grow. The program supervisors grilled her about whether she was pregnant and made me do the same. “Hell no,” she said, “And thanks for making me feel fat!”

Shania lost her job at the thrift store. Though she adamantly denied it, she was struggling again with her crack addiction. And she was, in fact, pregnant — with twins. Because pregnancy was a program violation, she was expelled. This meant she lost her transitional housing.

She and her four children and her one grandchild and her two unborn children were going to be homeless.

After that crash and burn, I decided not to mentor anyone else. Someone from the program called me a few months later to let me know that Shania’s babies had been born. They were one pound each.

There were so many moments in my adolescence and early career that illuminated the life-altering power of contraception and reproductive health. Certainly it had allowed me to chart the course of my own life. If I hadn’t been able to obtain a prescription for the pill at my university’s campus health center as a college student; if I hadn’t been able to access the morning after pill just out of college when I was making less than stellar choices while I rebounded from a bad breakup; if I hadn’t been able to rely on Planned Parenthood for routine exams and contraception in my low- income days as a newly returned Peace Corps Volunteer and an underpaid North Carolina teacher — I, too, might have been a young mom. And if I had, I probably wouldn’t have gotten to spend my twenties in North Africa and Asia and graduate school and other venues for education and exploration. I certainly wouldn’t have the professional or economic opportunities I have now.

When kids think about what they want to be when they grow up, they’re only aware of a small fraction of the careers that exist. Teacher. Nurse. Firefighter. Baker. But, since I knew I didn’t have the stomach to be a doctor or a nurse, it never occurred to me that I could work in family planning and reproductive health — that I could take the ability to empower people with knowledge, which I had honed as a teacher, and apply it to public health.

I lucked into the field through an internship during graduate school and eventually landed at the Johns Hopkins Center for Communication Programs working on the Knowledge for Health (K4Health) Project, which aims to ensure that family planning program managers and service providers in low- and middle-income countries have access to the most up-to-date guidance and tools to help them serve their clients effectively.

The past year has been perhaps the most professionally satisfying of my life, because my colleagues and I proposed an activity that combines many of the things I care about — people, storytelling, reproductive health, teaching. The idea has blossomed into Family Planning Voices, a global storytelling initiative led by K4Health and Family Planning 2020 (FP2020). My work on the initiative includes interviewing fascinating people all over the world who care about family planning about the work they do and why they do it, curating their stories, and co-leading workshops to teach others essential storytelling techniques.

Photo by David Alexander, Johns Hopkins Center for Communication Programs

Many of the people I’ve interviewed tell harrowing stories of the difference between life and death that access to reproductive health services like contraception can make, especially in low-resource settings. Though I’ve lived and worked in several countries, I haven’t seen firsthand the dire circumstances many of my colleagues have faced regularly: women dying in childbirth under the strain of being too young to give birth or having given birth too many times; frightened girls bleeding to death after unsafe abortions; undernourished babies and children. But sitting down with diverse people from around the world, from midwives to high-level donors to young advocates, makes me realize that each of us has a compelling story, a path that led us to this work.

For some of us, it is only in hindsight that we’re able to see we were on a path at all.

*All names have been changed to protect the privacy of the subjects in this story.

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The Exchange is a K4Health publication. The Knowledge for Health (K4Health) Project is supported by the United States Agency for International Development (USAID) Office of Population and Reproductive Health, Bureau for Global Health, under Cooperative Agreement #AID-OAA-A-13–00068 with the Johns Hopkins University.
The contents are the responsibility of the authors and do not necessarily reflect the views of USAID or the U.S. Government.