Ava, p.5
Ava, page 5
That August, Tennessee’s Human Life Protection Act went into effect, banning all abortions. Exceptions to the law were made only to save the mother’s life or to prevent irreversible impairment of a major bodily function.
Other states had similar “trigger laws” that went into effect immediately after the Dobbs decision. It was rumored that conservative states were considering even more restrictive laws to prevent women from traveling to states where abortion was still legal. Some states were even looking into banning internet searches on abortion.
Larkin’s parents had been shocked that the protection they had grown up with was now gone. Their mothers had marched for a right that they thought would remain in place for their children and grandchildren.
The ramifications made national news less than a month later when it was reported that a ten-year-old girl in Ohio had been raped and impregnated. Under the new law, she was unable to get an abortion in her state because she was six weeks and three days along when she learned she was pregnant, and the “heartbeat law” in her state made it illegal. She had to travel to Indiana to have the procedure.
Larkin had been only three years older than that little girl. She couldn’t imagine suffering a trauma like that. The rape itself would have been horrible enough. Being forced to carry and deliver a baby at that young age sounded scary and awful. She felt so sad for that little girl and mad at the adults who didn’t know her or her family but had decided what was “right” for her.
Early in the fall of seventh grade, Larkin and her classmates attended a “family life” education program. Her parents had always been open with her about sex, contraception, homosexuality, gender identity, and consent. They knew this program was an abstinence-only course, but they agreed to let her attend if they later discussed together what she had learned.
Ten years before Larkin’s class assembled in the auditorium, Senate Bill 3310, also known as the Gateway Law, was passed. It banned Tennessee public schools from discussing behaviors such as oral sex and genital touching—anything that could be considered a “gateway” to sexual intercourse.
Sex education wasn’t taught in any Tennessee public schools, but if a county’s pregnancy rate “exceeded 19.5 pregnancies per 100 females ages 15 to 17,” per the state legislature, then those schools were required to provide a family life course discouraging “non-abstinent behavior” while strictly avoiding the topic of actual sex. Larkin lived in one of those counties in a suburb of Nashville.
The students were asked to fill out an anonymous questionnaire before the speaker began. Two of the questions asked if they’d ever had sexual intercourse, and if they hadn’t, did they plan to wait until marriage to have sex?
Larkin wasn’t planning to get married until she was at least thirty but doubted she would be a virgin until then. She didn’t care if the questions were anonymous or not. She didn’t answer and handed in a blank page. Her best friend, Aubrey, did the same but added a crude drawing of a small penis on the bottom of the form. She showed it to Larkin before turning it in, and they both giggled until their teacher, who stood near the back of the room, shushed them.
The speaker at the podium introduced herself as Mrs. Elizabeth Hawks and stated she was a certified Sexual Risk Avoidance Specialist. She looked to Larkin to be about the same age as her mom. She was dressed in a gray cardigan and a long, navy blue skirt with a small cross necklace and gold stud earrings. The necklace’s serpentine chain was caught on the top button of the sweater, making the cross awkwardly dangle sideways. She wore thick, black eyeliner on the top and bottom of her eyelids, and her hair was dyed so blond it almost looked white, barely contrasting with her pale skin. Larkin thought she looked a bit like a sickly panda bear.
The school had purchased the curriculum from Make the Right Choice, a faith-based organization that taught biblically aligned sex education. Mrs. Hawks’s job was to present that information to Larkin and other students across the state.
Mrs. Hawks began talking about marriage and family and commitment and healthy relationships and two-parent households and the joy of raising biological children or adopted children or both while an assistant tallied the anonymous questionnaires. Several minutes into the course, the assistant handed Mrs. Hawks a summary page with the survey results. Mrs. Hawks was pleased to announce that none of the students said they’d had sexual intercourse and 100 percent of those who’d responded planned to wait until marriage. She assured them all they were making good choices and started to clap. The teachers in attendance, and most of the students, gradually joined in the tepid applause.
Larkin put her head down at that point to keep from laughing. She had been learning about the scientific method in her biology class, along with the appropriate way to gather objective data. This was not the way.
Of course, a bunch of kids lied. Who would tell a stranger anything like that? Larkin thought, We just told her what she wanted to hear so we wouldn’t get a lecture on being a piece of used-up chewing gum or something if we don’t save ourselves until marriage. She’d heard other students had been told things like that in prior years when they’d been honest with their answers.
Mrs. Hawks continued emphasizing how sexual activity affects the whole person, including the physical, social, emotional, psychological, economic, and educational consequences of nonmarital sexual activity. She discussed how teen sexual behavior can lead to other risky behaviors such as drinking, drug use, dating violence, and sexual aggression. She encouraged students to practice refusal skills to help them resist sexual activity and gave tips on how to develop healthy relationships that result in a strong marriage.
At the end of the presentation, Mrs. Hawks asked if there were any questions. She said students could raise their hands, or they could write down their questions if they preferred.
Other than a few murmurs from restless students wanting to catch their buses home or head to after-school practices, there was silence.
Aubrey elbowed Larkin in the ribs until she raised her hand.
“Yes?”
“Hi . . . yeah . . . so . . .” Larkin took in a deep breath. “Since Roe v. Wade was overturned this summer by the Supreme Court, will your organization now consider teaching safe sex and contraception to help prevent unwanted teen pregnancies since abstinence-only teaching has been proven to be ineffective?” Larkin paused and sharply inhaled as she waited for Mrs. Hawks to reply.
The auditorium was quiet other than a few random snickers. “Try-hard!” one boy shouted under a cupped hand, resulting in an outburst of laughter from several others. Aubrey reached for Larkin’s hand and gave it a reassuring squeeze.
Larkin didn’t move, but her face grew hot.
When the laughter stopped, Mrs. Hawks pursed her lips and thanked Larkin for her question. “Rest assured,” she said, “everything that I have discussed today is medically and scientifically sound and designed to help young adults like yourself become responsible leaders and parents in our communities in the future. Until those facts change, the content of this presentation will not change. Thank you all for your attention, and I hope you all continue to make the right choice.”
She gave a quick nod, picked her notes off the podium, and walked off the stage as students began gathering their backpacks and heading out the door.
Larkin mumbled, “That didn’t answer my question at all.”
Aubrey whispered, “Well, I hope she liked the penis I drew for her. It’s probably the only one she’s seen besides her husband’s.”
CHAPTER 9
When Larkin was fifteen, she’d asked her mother to make an appointment with her pediatrician. She was having a lot of cramping and heavy bleeding with her periods and wasn’t sure if it was normal.
At Dr. Mills’s office, Larkin handed the nurse a urine specimen in a plastic cup that had her initials and birthday written on the side. Her mother sat in a chair across the room, and Larkin sat on the exam table with the crinkly white paper. The nurse held Larkin’s hand, palm up, and pricked her finger to take a blood sample. Then she wiped Larkin’s finger and applied a bright yellow bandage with some cartoon characters on it that Larkin didn’t recognize.
A few minutes later, Dr. Mills gave a couple of quick knocks on the door and walked in with a warm smile, her laptop in hand. She talked fast but was always very thorough and kind. Larkin loved the energy packed into Dr. Mills’s petite, four-foot-eleven-inch frame.
“Hi, Larkin! Great to see you again. Tell me why you’re here today.”
“Well . . . I’ve been having a lot of cramping with my periods. It’s so bad that I have to take ibuprofen and use a heating pad. And the bleeding is really heavy. I have to change tampons almost every couple of hours at school, which is hard to do, and when I wake up in the morning, I’ve soaked through the heavy overnight pads. We have to wear white uniforms in soccer sometimes, and I’ve bled through a couple of times, which is gross.”
“Well, let’s see what I can do to help,” Dr. Mills said. “I’m sure we can figure something out.”
After Larkin’s examination, Dr. Mills told her and her mother that Larkin could start a trial of hormone therapy to see if it made her periods lighter and eased her cramping.
“Would that mean shots?” Larkin asked.
“No, it would be a small pill you would take every day. It’s ‘the pill,’ an oral contraceptive. A lot of young women take them to prevent pregnancy, but other women and adolescents take them for irregular periods, heavy periods, ovarian cysts, and dysmenorrhea, which is the medical term for the bad cramping you are having. Other patients are referred to me by dermatologists because the pill helps with acne. There are lots of reasons why patients take it other than to prevent pregnancy.”
Dr. Mills reviewed the side effects and warned them about an increased risk of getting a blood clot, especially in women who smoke or have a family history of clotting disorders. She jokingly told Larkin that if she started on the pill, she would have to give up her cigarette habit. Larkin smiled and promised never to smoke or vape.
Dr. Mills asked Larkin’s mom if she would like for her to write Larkin a prescription. Her mother replied that it was up to Larkin.
“Agreed,” Dr. Mills said. “Let me talk to Larkin in private about some other things, and then I will send her back out to the waiting room with you. If she decides that’s what she would like to do, I’ll send a prescription to your pharmacy. After about four to six months, if she doesn’t see an improvement, let me know. How does that sound?”
After Larkin’s mom thanked Dr. Mills and headed to the waiting room, the doctor asked Larkin if she had any questions so far.
“Why might it take up to six months to see if I get better? That seems like a long time.”
“It might not take that long. It depends on how your body responds. It might be quicker.”
Dr. Mills took a Sharpie from her front pocket and drew something on the exam paper that looked like a longhorn steer. She explained that the uterus (she pointed to the steer’s head) is where the menstrual blood lining builds up. The hormones should help thin this lining, but it may take some time. Dr. Mills said the pill would also stop Larkin from ovulating and pointed to what looked like Christmas ornaments hanging from the tips of the steer’s horns—the ovaries and eggs.
“Did you know women are born with a couple of million eggs, Larkin?”
Larkin nodded; she remembered hearing this in her biology class.
“They are very small. Only about the size of the dot on the letter i,” Dr. Mills continued. “It’s amazing to think about, isn’t it?”
Larkin agreed.
“Now, even though you’ll be taking hormones to regulate your periods, they are very effective at preventing pregnancy. Are you sexually active, Larkin?”
She shook her head.
“If you decide to become sexually active, please talk to me first, okay? It’s your decision, but my job is to keep you as safe and healthy as I can. You can call me if you need to talk. Anything we discuss is private and protected by doctor-patient confidentiality. I can’t tell anyone anything we have discussed, including your parents, unless you are in danger of hurting yourself or someone else.”
“Yes, ma’am.”
“Alright, then. I hope the medicine helps you. If not, let me know.”
Larkin texted Aubrey after the appointment to tell her she was going to be starting the pill.
slut, she texted back.
lmao not taking for that
whatever. i’m coming over slut
haha ok
A few hours later, Aubrey arrived at Larkin’s house. As they were lying on Larkin’s bed and scrolling through videos on their phones, Aubrey asked if she could also get a prescription for the pill from Dr. Mills.
“Sure. Why not?”
“She’s not my doctor.”
“Then see your doctor.”
“I don’t want my mom and dad to know. They’d never let me.”
“They found out you’re having sex, right? Didn’t your mom see some texts?”
“Yeah . . . she and my dad yelled at me and took me to a walk-in clinic for STD testing and a pregnancy test. I can’t go to Brody’s house anymore. They told me we can’t be in my room, especially with the door closed. They make us stay in the den when he comes over. They made me promise to never do it again, so I did.”
“But you’re still having sex, right?”
“Well, yeah, but they think I can be a born-again virgin. They even got me a purity ring.” She held up her left hand and pointed to the silver band with cursive script that said “True Love Waits” and rolled her eyes.
“I guess they think it has retroactive power or something. It’s obviously not working. Brody and I use condoms, but I really want the pill, too.”
“Aubrey, that condom is going to break and you’re going to get pregnant and you’ll be a teen mom with a reality show who lives with her grandmother after being kicked out of her parents’ house. Later, you’ll be struggling to go to college and get into medical school to achieve your dream of being an obstetrician while your deadbeat boyfriend goes off to a Division I school on a full baseball scholarship and you’ll have to constantly fight with him to be a dad and pay child support.”
“You seem to have thought this through.”
“More than you have!”
“I said I want the pill! Can you ask Dr. Mills for me?”
“Okay, since I care about you not being an idiot.”
The next day, Larkin called Dr. Mills’s office and left a message with her nurse. At the end of the workday, the doctor called her back.
“Hi, Larkin. It’s Dr. Mills. Did you have a problem getting your prescription?”
“No, ma’am. I’m calling for a friend of mine. Doctors follow the HIPAA-cratic oath, right? Isn’t that what you told me about keeping things private?”
“Well, there is a Hippocratic Oath where we promise to do our best to take good care of and not harm a patient, but do you mean doctor-patient confidentiality?”
“Yes. That’s it. So, my friend wants to be on the pill like me, but she wants to take it so she won’t get pregnant. But she doesn’t want her parents to find out. Can she see you for that?”
“I would be happy to see her if she would like to be my patient, but sometimes parents don’t allow their teens to speak with the doctor in private. And if we were able to talk in private, I couldn’t tell her parents that she is having sex, but it would be difficult to keep it completely anonymous if she is getting a prescription.”
Dr. Mills proceeded, “I would recommend your friend go to our county health department. They can see patients down to the age of fourteen without parental consent. They can perform STD testing, provide counseling, and prescribe birth control if they determine your friend is mature enough to consent. It’s not far from your school. That would be the best way, I think. But it may not be an option for much longer, so your friend should go soon.”
CHAPTER 10
According to Tennessee Supreme Court case law, minors ages 14–17 years are able to receive medical care in Tennessee without parental consent.
—Michelle Fiscus, MD, FAAP, former medical director of Tennessee Vaccine-Preventable Diseases and Immunization Program
Fired from her position after emailing this information to physicians during the COVID-19 pandemic.
Larkin texted Aubrey the information Dr. Mills had given her about the county health department. They were free to go the following Wednesday after school. Larkin didn’t have soccer practice that day, and Aubrey’s student government meeting was canceled. Aubrey’s parents didn’t know that, though, so they wouldn’t expect her to be home. She texted her brother, Lance, during lunch and asked him to drive her to the health department after school.
Aubrey and Larkin met Lance at his car in the seniors’ parking lot a little after 3 p.m.
“Why do you guys want to go to the health department?” he asked Aubrey as he leaned against the door of his car.
“I’m thinking of doing some volunteer work there for my health sciences requirement. I think it will look good on my college application.”
“And why are you bringing Larkin?” he asked skeptically.
“Same thing.”
“You want to be a doctor someday, too, Larkin?” Lance probed.
“No. I’m going to be a research scientist, but it will still look good on a college application.”
“Sure it will,” he said and raised one eyebrow.
“While you guys are there, can you grab me some more free condoms? That’s where I get all mine.” He smirked.
“Gross. Absolutely not,” Aubrey replied, her face scrunched in disgust.
Larkin bent over and made retching noises.
“Whatever. Get in the car,” he muttered.
When they arrived, he dropped them off at the front door. As Aubrey and Larkin stepped out of the car, Lance said, “It’s good to get on birth control, Sis. You’re smarter than I thought you were.”
