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Feminist Majority Foundation Chat Series of 2003

Dr. Vanessa Cullins, VP for Medical Affairs
Planned Parenthood Federation of America

CULLINSDr. Vanessa Cullins is vice president for medical affairs at Planned Parenthood Federation of America (PPFA®), and is responsible for leadership and administration of the Medical Affairs Division. Prior to joining Planned Parenthood Federation of America, she served as vice president and medical director of EngenderHealth, where she provided oversight and direction of technical teams responsible for providing technical support for reproductive health service delivery in over 25 countries.

In the 1990s, Dr. Cullins worked simultaneously as an attending physician in the Ob/Gyn Department of The Johns Hopkins Bayview Medical Center, as an assistant professor of medicine at Johns Hopkins School of Medicine, and as acting director of the Bureau of Adolescent Reproductive and Women’s Health for the city of Baltimore. Dr. Cullins serves on a number of subcommittees and advisory boards, including the Obstetrics Subcommittee of the New York State Department of Health, and is chair of the International Subcommittee, American Medical Women’s Association, Reproductive Health Initiative.

Moderator: Dr. Cullins, thank you for joining us tonight. To start off, can you tell us a bit about the work that you're doing with Planned Parenthood Federation of America?

Vanessa Cullins: My work with PPFA is very exciting. PPFA has visioned out to 2025 and the PPFA promise is creating hope for humanity, the freedom to dream, make choices, and to live in peace with our planet. The vision was adopted by the entire Federation, which includes 125 affiliates that operate over 870 clinics across the country and the national offices. There are 10 goals to the vision for 2025 and 13 beliefs. It's very exciting to be part of this federation-wide effort. From the standpoint of medical care and healthy sexuality, some of the more exciting goals include: the PPFA will ensure that sexuality is understood as an essential, lifelong aspect of being human and that it is celebrated with respect, openness and mutuality; in addition, PPFA will ensure access to reproductive and sexual healthcare for all and will secure passage of laws and policies, including state and federal constitutional amendments that guarantee reproductive freedom for all. Medical Affairs is closely involved in all of these goals, of which I have only mentioned 3. As part of the Medical Affairs division, I have the opportunity of working very closely on the strategy around ensuring that PPFA will be a significant catalyst for the development and universal dissemination of new reproductive technologies.

Diana: Dr. Cullins, What type of projects are you currently working on?

Vanessa Cullins: With affiliates within the federation, other divisions in the national office, Medial Affairs is currently working on a number of different projects, including: development of a multi-center network that will be able to conduct research for the development of microbicides which are sorely needed in the fight against HIV-AIDS, improvement of diagnosis and treatment of various sexually-transmitted infections, improved service delivery for abortion, and increased access and improved techniques for cervical cancer screening, and more convenient forms of contraception with less side-effects. We are also working with communications and public policy to create a strategy for development of a group of PPFA medical professionals, who are more involved in advocacy that advances both the PPFA mission and vision. We are very excited to be working with affiliates to fully investigate and implement service delivery models such as services online and express clinics. All of these things that move the United States towards improved access to reproductive and sexual healthcare for all reproductive aged people within the US.

Vicky: In practically all fields, minority women, particularly Latinos and African-Americans are disadvantaged, especially in terms of access and education. How does PPFA address inequalities suffered by such groups in it's programs?

Vanessa Cullins: Traditionally PPFA has had as part of its mission, provision of comprehensive reproductive healthcare for all individuals in need of that healthcare. Traditionally have provided services to low-income, uninsured and underinsured women. The care that we provide is quality care and is appropriate for all women regardless of socioeconomic status.

Vicky: What's your take on the dangers, if any, of using regular tampons (vs. unbleached ones)?

Vanessa Cullins: Tampons are extremely safe. As long as they are changed frequently. Tampons should be changed every 2-4 hours, depending on the heaviness of the flow and the size of the tampon used. As long as these rules are adhered to, it doesn't matter whether the tampon is bleached or unbleached.

Diane: Do you think there will be a Supreme Court retirement this year? What can I do to ensure that if there is we will not see the overturning of Roe?

Vanessa Cullins: Unfortunately there is a good chance that at least 1 of the Supreme Court justices will retire this year. This is a very ominous situation for reproductive freedom and choice because Roe v. Wade more than likely will be overturned if Right Wing conservatives have their way. It is extremely important that you educate your friends and colleagues as to this dire situation. State and federal advocacy, which can be done through the local PP affiliate, and importantly, voting to ensure that only public officials that are sensitive to reproductive freedom and will vote for legislation to ensure reproductive freedom, are some of the ways that you can help ensure that either reproductive freedom continues unchanged, or if it is changed because of a SC retirement, that reproductive freedoms are reinstituted - and made more accessible to all segments of the population.

Diane: Has the contraceptive pill that you can take so you avoid a period for a few months been approved by the FDA? When will it be accessible? Do you think insurance companies will cover it?

Vanessa Cullins: The bleeding that occurs when taking the pill is because of a withdrawal of hormones. This means that when you get the placebo pills, or hormone free pills of the pack, you should have a bleeding episode - usually within 2-3 days of starting the last 7 pills of a 28 day pack. The decision to place 7 hormone-free pills at the end of the pack, or to have 1 week of no pills if you use a 21 day pack, was not based on health. It is okay to take birth control pills continuously for several weeks to months before having a bleeding episode, or period. Some healthcare providers and women already know this and some women have extended the taking of the pills that contain hormone by skipping the hormone-free pills and going directly into a new package of pills, thereby continuously taking pills that contain hormone and delaying the bleed. This can be done with an ordinary packs of birth-control pills. The product that is soon to be approved by the FDA is simply a repackaging of pills, so that all the pills contain hormones and they are taken every single day for approximately 3 months. At the end of that 3 month packaging of pills, there are hormone free pills - and anytime someone takes the hormone free pills, the period will occur. Delaying the period is very safe and is just another option for women to have control of their sexuality. Hopefully insurance companies will cover this additional, and for many women, more convenient form of oral contraception. It is unconscionable that some insurance companies do not cover the full range of contraceptives. It is important that women advocate that their insurance coverage definitely covers all FDA approved contraceptives as part of the prescription plan. PPFA has been at the forefront of legislative advocacy at both the state and federal levels to help ensure passage of laws requiring that insurers that provide prescription plans cover contraception. There is still much work to be done and each of you can be part of this advocacy work through your local PPFA affiliate. Fore more information, log on to www.plannedparenthood.org and click on "cover my pills" or go to www.covermypills.org.

Gloria Regal: An anti-abortion protestor told me the other say when I was leaving a clinic that my fetus' heart was beating before I missed my first period. I ignored it and kept walking, but I've been thinking about it a lot. Is it true?

Vanessa Cullins: Prior to missing the first period, the growing, developing embryo does not have full development of the heart. The information you received is erroneous.

Karlee Rockey: I don't know exactly how two ask this question but I believe there would be less abused children and less children in foster care and the streets if abortion was more readily available. How do you feel about this? and I want to start a campaign in my state for a pro-choice license plate. I am in NC Do you know how I can do this? I really like it to be something like the hanger poster? What are your thoughts on this. I am a lesbian and a mother of two and believe totally that its a woman's choice.

Vanessa Cullins: At PPFA, we believe that all children should be wanted, nurtured, and cared for. We also believe in the right to sexual and reproductive self-determination that is non-coercive, non-exploitative, and responsible. We believe that the decision around an abortion is a personal decision and may vary between women and within the same woman at different points in her life. So the important issue here is having the ability to make that choice and to have access to safe services when the choice is made - whether the choice is carry the pregnancy to term and raise the child, to carry the pregnancy to term and place the child for adoption, or to have an abortion. I encourage you to become more involved in advocacy around choice, maintaining reproductive freedom, and maintaining the right to have an abortion. Please contact your local PP affiliate to see how you can become more involved. Ask for the public policy department or advocacy department. Also, visit the PPFA web site to find out more opportunities for advocacy: www.plannedparenthood.org.

Sarah: What are the most pressing sexual and reproductive health issues today?

Vanessa Cullins: The most pressing sexual and reproductive health issues in this country are: the recognition that sexuality is an important part of being human and should be talked about among individuals, celebrated, and should not be looked upon as something dirty. We have cultural attitudes within this country and some sexual mores that prevent us as a society from openly discussing sex and sexuality and because of this we are unable to tackle sexually transmitted infections and pregnancy prevention head on. Because of our inabilities to talk candidly about sex and sexuality, we are unable to talk openly about how to prevent sexually transmitted infections such as HIV/AIDS, gonorrhea, herpes, chlamydia, trichomoniasis, and cervical cancer. In addition, because of our cultural prudishness around sexual issues, we are unable to candidly talk about how to prevent pregnancy and thus avoid abortion. For us in this country, we must get over thinking that abstinence is going to work for everyone. Even though most individuals go through time periods of abstinence, the majority of us also have time periods of sexual activity. In order to know how to live a healthy lifestyle during both abstinent time periods and during sexually active time periods, we need to incorporate medically accurate and comprehensive sexuality and contraceptive education for all individuals in this country. Clearly, school curricula should only include comprehensive, medically accurate sexuality education, which includes abstinence + contraception + how to negotiate decisions during a relationship + conflict resolution + info about the full range of relationships that one may be involved in throughout ones life.

Nora: What do you think has been the most damaging policy of the Bush administration?

Vanessa Cullins: There have been a multitude of policies, executive decisions, and regulation changes that have constituted a "war on women". It is clear that the Bush administration is intent on removal of most, if not all, of the civil and reproductive liberties that women in this country enjoy. The very fact that this administration is only increasing funding for abstinence based education, that this administration is trying to give the embryo and fetus legal rights through the giving of insurance to the fetus instead of the pregnant woman, are examples of how this administration values the unborn over women who are born citizens of this country. The administration's judicial appointments and appointments to various advisory boards and panels are all designed to strip women of their reproductive and civil rights. This administration is also attempting to reverse the US endorsement of the 1994 Cairo program of action that over 180 countries endorsed, and which affirms the right of all couples and individuals to determine freely and responsibly the number and spacing of their children and to have the information and means to do so. Additionally, the administration is censoring scientific information and is placing ideological propaganda on the CDC and NCI web sites. Specifically, in Nov 2002, NCI web site revised its fact sheet about abortion and breast cancer to indicate that there was a connection even though the scientific evidence is that there is no connection. Luckily, a recent advisory panel was convened that re-reviewed the data around whether or not there is a link between abortion and breast cancer and this panel said unequivocally there was no link. Another example of ideological propaganda instead of evidence being posted on an important government web site occurred in Dec 2002, when the CDC (center for disease control and prevention) posted changes to its fact sheet on condoms, to cast doubt on condom effectiveness. All data indicates that aside from abstinence, the condom is the best possible protection against sexually transmitted diseases. For sexually active individuals who are not involved in a life-long monogamous relationship, the condom is the best protection against sexually transmitted diseases. The Bush administrations tactics are insidious and dangerous.

Moderator: Thanks for joining us today, Dr. Cullins!

Vanessa Cullins: It is so important to become politically involved at both the preservation and expansion of reproductive freedom in this country and throughout the world. We cannot be complacent about the gains that have occurred over the past 30 years. At the very least, vote in all local and federal elections for reproductive choice and reproductive freedom, vote for all citizens in this country - both women and men - to reach their personal aspirations. Throughout the ages, time and time again, there is evidence that it is critical for women to have control of their fertility in order to reach their aspirations for themselves and for their families. Throughout the ages, women have often resorted to drastic methods to control their fertility when safe medical methods were either illegal or not accessible. We all need to work together to ensure that safe reproductive healthcare is legal, accessible and available to all members of society.