Where Birth Control Is Scarce, Young Women Create Sex Education Outside the Classroom

A Kentucky program trains women to advocate for their reproductive health.

Over the course of an eight-week paid fellowship, young women interview other women about their reproductive health experiences, specifically focusing on birth control, and create short educational films. 

Photo by Hero Images/Getty Images

There have been times in Hannah Adams’ life when she’d been confused about her body and birth control. Sex education in middle and high school in mountainous eastern Kentucky was severely lacking, she says.

Then she was asked to join a new fellowship program, All Access EKY, that she says changed her life.

All Access began in 2016 as a collaboration between the Kentucky Health Justice Network, the national nonprofit Power to Decide, and Appalshop, the local media and arts organization in Whitesburg where the project is housed. It started as a reimagining of a previous Appalshop program, the East Kentucky Reproductive Health Project, but is specifically focused on increasing access to full-spectrum birth control in the region.

All Access hires young women ages 17 to 22 from Appalachian counties to create media campaigns around reproductive health. Over the course of an eight-week paid fellowship, young women interview other women about their reproductive health experiences, specifically focusing on birth control, and create short educational films. They have also produced social media campaigns, set up tables at local festivals, and distributed printed materials through clinics and local businesses.

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“I knew I wanted to be a part of this program,” Adams says, “not only to help people like me who feel lost in those situations, but to also educate myself at the same time.”

The barriers a young woman encounters if she wants to obtain birth control can be profound in eastern Kentucky.

First, she has to find transportation to the local clinic. There is no public transit in the region, so however she gets there, it has to be reliable because she might need to go back a second time, depending on which type of birth control she gets. That’s if the clinic has that form of birth control in stock, and that no one who works at the clinic knows or goes to church with her parents, and that her doctor will take her concerns seriously. She has to be as discreet as possible about it, lest anyone at her high school or in her community find out and shame her.

This is all assuming she knows anything about her birth control options in the first place. Many young women in eastern Kentucky must battle abstinence-only sex education in their schools and a cultural veil of secrecy about their bodies in order to fully understand their options.

“It’s community-centric rather than focusing on just the media side of it.”

Access to birth control in the region is “hard” and “bleak,” says All Access EKY Project Director Stacie Sexton. Out of all the pregnancies in Kentucky, 47 percent are unplanned. However, only six of the 19 health departments and federally qualified health clinics in the eastern Kentucky counties where All Access operates offer the full range of birth control options, and there are just four nurse practitioners at public health clinics in the seven-county area served by All Access who are qualified to insert IUDs. This landscape is something the program hopes to change.

The program’s approach to accomplishing that goal is multifaceted and somewhat unique, Sexton says. She works with publicly funded health care providers and community members to identify ways in which they feel disconnected from one another, and then tries to find ways to help bridge those divides.

“Health care providers understand there is a huge divide between the services they provide and the folks who are actually coming to get them,” Sexton says. She also helps clinics educate their providers about birth control so they can better disseminate that information to their patients and out into their communities.

But Sexton doesn’t educate providers and community members with third-party materials; the fellows in the program create those materials.

“That’s what makes this project unique,” Sexton says. “It’s community-centric rather than focusing on just the media side of it, or just the institutional side of it.”

One social media campaign was launched on a Friday the 13th and focused on making birth control less scary. One fellow made models of several forms of birth control, and other fellows posed for pictures with them. The pictures were posted with facts about each form of birth control. Most of the media campaigns happen through social media, and the films are shown at local screenings.

“They all need to be working together to give young people a better opportunity.”

The fellows range in age from 17 to 22. So far, All Access has completed two eight-week fellowships, hired 13 fellows, and produced 20 media pieces. Seven interns this summer will complete a six-week media workshop in partnership with Appalshop’s long-time youth media program, Appalachian Media Institute.

“We’re trying to build some of these bridges in our communities so it’s not just teenage girls on an island and health care providers on an island and educators on an island,” says All Access Media Director Willa Johnson. “They all need to be working together to give young people a better opportunity.”

The overall goal of All Access is to increase access to the full range of birth control in eastern Kentucky, but it quickly became apparent to program leaders that the young women entering the program needed much more education about birth control options than anticipated before they could begin to produce media about it.

“We were asking them to create these really smart, educational videos about something they’ve never been talked to about,” Johnson says. This prompted her to provide frank, nonjudgmental sex education and space for the fellows to talk with other women about their reproductive health care experiences at the start of each fellowship semester.

All Access has also been an important place for young eastern Kentucky women to explore their passions, something Johnson says they aren’t often allowed or encouraged to do in their communities.

“I know how hard it is for young women from this region to pursue a career that’s not nursing or education—it’s so difficult,” Johnson says. Over the years, she’s seen young women who are very talented media makers from AMI choose to pursue health care professions like physical therapy because they see no other career options for themselves in eastern Kentucky. “If you are passionate about physical therapy, that’s great, but you shouldn’t have to do it.”

“I feel a lot closer to the women in my community, which is something I’ve never really felt before.”

Just three semesters in, the program is already having an impact. Fellows sometimes bring their friends to All Access workshops with them, doubling or tripling the size of attendance. Three of the eight fellows from the first class gave presentations about birth control to their college classes completely on their own initiatives. One fellow designed and implemented a birth control public education campaign, also independent of All Access, while another brought all the men from her family—including her father—to a screening of her fellowship class’s short films.

“These young women had this opportunity to do this project, and they took it even further because they ended up being really passionate about it,” Johnson says. She says the pieces they make should speak to everyone, so barriers can be broken down, and young women won’t continue to be shamed for their choices. “It is not a shameful thing to protect yourself or to plan your family when you want it.”

Hannah Adams, who was a fellow from 2017-2018, worked with other fellows to create films for the program about teen pregnancy and discrimination against birth control. In one film, a young woman tells her story about a time when she asked her family doctor for birth control but was denied access because the doctor said it was against his religious views to prescribe it. Adams says the program made her more confident about her own body and birth control options. She recently got a birth control implant because of what she’s learned about it in the program.

“If you had told me two years ago that I would be getting that, I would have told you you were crazy, because I always thought it was something really scary,” Adams says.

All Access has changed her perspective in other ways. “I feel a lot closer to the women in my community, which is something I’ve never really felt before,” Adams says. “I feel like I have a lot more people that I’m willing to talk to about these issues when I need to. I’m not scared, and I don’t feel ashamed.”

All Access also has worked with policymakers to try to pass legislation that would make access to birth control easier. State Rep. Chris Harris from Pikeville sponsored a bill that would allow women to keep birth control prescriptions filled for 12 months without having to see their doctors for a new prescription. The bill did not pass, but Sexton counts her work with Harris on the bill to be a success.

She’s also spoken with other legislators about ways they can work together, including state Sen. Brandon Smith from Hazard. Smith made headlines in 2017 for sponsoring a state bill that would make abortion illegal after 20 weeks, despite vocal opposition from several local and national advocacy groups, including the ACLU and members of the public who shared their personal stories during a committee hearing about the bill. His political views do not deter Sexton from reaching out to him. She says it would be a disservice to eastern Kentucky not to work with as many people as possible to increase access to birth control.

“At the end of the day, if [Smith] wants to increase access [to birth control] to reduce abortions, we have a common goal,” Sexton says. “We come from different places, but I think we both have our hearts in the right place based on our personal value systems. He’s doing what he thinks is right; I’m doing what I think is right, but we do have a shared interest in increasing access to birth control. I can work with that.”

She says past efforts to increase access to birth control or provide education about reproductive health justice have not been very successful because those driving those initiatives either didn’t listen to the community or took more of a top-down approach. Sexton wants to make sure All Access is different, and, therefore, more successful.

“I never want to be that person who preaches to the choir,” Sexton says. “This project is by the people, for the people, literally. It shouldn’t be any other way.”

This article was funded in part by a grant from the One Foundation.