At long last, I bring you the full and unexpurgated recounting of my time in Philadelphia. Whee! Wednesday and Thursday were chock full of meetings with all sorts of people working to facilitate women's control over their bodies and their lives.

I started the day off at Choice, an organization dedicated to increasing awareness of and access to reproductive health care, especially among under-served populations who traditionally experience barriers to care. At Choice, I met Jackie, who coordinates their 4(!) hotlines, and walked through the bustling hotline reception room on our way to her office. I'm always interested in the posters and paraphernalia that people choose for their offices. There are a few things that are nearly ubiquitous—the "Just do it" condom stickers, various incarnations of the Rosie the Riveter poster, a rainbow of buttons.

I was particularly interested to visit Choice because in San Francisco I was a Board Member at ACCESS, an organization that does similar work in California. Pennsylvania, it turns out, has some of the most restrictive laws in the area—there is a parental consent law for abortion that is enforced, and state Medicaid funding for abortions is restricted to women who are pregnant as a result of rape of incest or for whom carrying the pregnancy to term would pose a "life risk", defined as threatening her mental or physical health. (In California, for instance, women who are faced with an unplanned pregnancy who aren't able to afford an abortion can get emergency Medicaid to cover the cost of the procedure, although the number of providers who accept Medicaid is decreasing).

Incidentally, Pennsylvania follows federal guidelines which were enacted by the Hyde Amendment in 1977. The Hyde amendment bans state use of federal Medicaid dollars to pay for abortions unless the pregnancy is the result of rape or incest, or the abortion is "necessary to save the life of the woman." States can use their own funds to cover other medically necessary abortions—usually defined by states as those to protect the physical or mental health of the woman—for Medicaid recipients. These restrictions leave thousands of low-income women vulnerable to delayed care, financial burden, and unsafe, illegal abortion by requiring them to come up with the money for their procedures.

Choice advocates for women seeking reproductive health care on a number of levels, including with health care providers. It turns out that the biggest barrier women face to getting Medicaid funding for procedures is the providers themselves. In order to qualify for the funding, doctors have to sign a form stating that a woman meets one of the three requirements set forth by the Hyde Amendment, and many doctors, even at reproductive health clinics, are reluctant to sign the forms. Many women get their initial pregnancy test from their general practice doctor, who would be the logical person to sign form enabling them to get Medicaid funding. Those doctors give a variety of reasons for their reluctance to sign the waiver, from religious objections to abortion to fears of scrutiny from medical boards. Jackie related that one doctor told a woman "We don't deal with women's issues." Can you imagine being faced with an unplanned pregnancy and having a doctor tell you that?

I asked Jackie how they incorporated advocacy into the work they did—certainly a huge part of their mission is dedicated to helping women advocate for themselves personally, but I was curious if they positioned that work in a political context, if they talked to the women they were helping about the need for political advocacy to remove barriers to accessing care. She raised what has been a particularly thorny problem—that many women who are having trouble accessing health care are also dealing with numerous other issues in their lives, and writing a letter to their member of Congress isn't a high priority given everything else they've got going on. Choice does make a concerted effort to educate women about their role within the medical system and what rights they have within that system.

During this conversation Jackie said "you know, some people don't believe in access to some kinds of medical care", which really struck me, not because it's not obvious from all the laws and restrictions they've passed, but because I'd never heard it put in quite that way before. I mean, I get not agreeing with some of the choices people make, but to not BELIEVE in their right to access care is a pretty horrific idea, if you ask me.

My next stop was Planned Parenthood of Southeastern Pennsylvania, a formidable affiliate best known for their role as the plaintiff in Planned Parenthood of Southeastern Pennsylvania v. Casey, in which the Supreme Court ruled that states could impose restrictions on access to abortion like parental consent laws and mandatory waiting periods as long as they don't pose an "undue burden" on a women's ability to access abortion. I met with Karen Fitchette-Gordon, the Vice President for Education and Professional Development.

Karen runs a truly extraordinary Education department—they have nearly a dozen different programs that include Youth First, a year round program in Philadelphia schools that serves over 1700 students each year in sixth and eighth grade. Yup, you heard that right. Year round. Most sex education happens, at best, for a day or two once or twice during middle and high school. These students get one period of sex education a week for their entire sixth and eighth grade years. Oh-la-la. I have long despaired at the brevity of sex education classes, knowing how long it takes to really have conversations about safer sex and positive sexuality, so I was delighted to learn that there were places where the importance of maintaining a conversation about sexuality with youth was acknowledged and encouraged.

And guess what? The students who participate in Youth First in sixth grade are less likely to be sexually active in eighth grade and more likely to have safe sex if they are sexually active. Well, doesn't that just beat all. I'm reminded of the Waxman report, a Congressional inquiry led by Congressman Henry Waxman which found that students who take virginity pledges are less likely to use contraception when they have sex (which 88% of them do, before marriage, according to Columbia University researchers), and are less likely to seek STD testing despite comparable infection rates.

Republished with permission. Read more about Nora's journey at Wanderlust with Rhonda.