Crow Wing County Board: Board votes down condom distribution

After hearing from nearly 30 community members Tuesday, the Crow Wing County Board voted down a motion to reinstitute the practice of distributing condoms through its family home visit program.

The issue was on the agenda Tuesday at the request of Commissioner Rachel Reabe Nystrom, who said she wanted the board to clear up confusion arising from a recent action to halt condom distribution.

In January, Crow Wing County Community Services was ordered to cease inclusion of condoms in packets provided to new mothers, who were clients of the family home visiting program. County Administrator Tim Houle said the practice was not supported by board-approved policy, because it was not included in the county's community health services plan.

Stats, history presented

Before comments from the public were accepted, representatives of community services provided background information on the county's history in family planning and the current rates of pregnancy and sexually transmitted diseases.

Kara Terry, community services director, said Crow Wing County has never played a huge role in family planning services. Beyond the condom distribution, the county did pregnancy testing through 2013, when that was discontinued.

Terry spent several minutes outlining federal and state guidelines for public health services, including the 10 essential public health services as identified by the Centers for Disease Control and Prevention and state statutes governing community human services boards and duties under the Local Public Health Act. She said these policies covered the broad strokes, while language in grant agreements was where much of the specificity of expectations was included.

Chairman Doug Houge asked how Crow Wing County compared to other counties in terms of pregnancies and STDs.

Michelle Moritz, program coordinator of public health in community services, said while overall births in the state have decreased, the rate of pregnancies among 18- to 19-year-olds in Crow Wing County is twice the state average. Statewide, that population recorded a birth rate of 28.4 per 1,000, but in Crow Wing County, the rate was 66.1 per 1,000.

"So while many other counties have improved, we have regressed in Crow Wing County," said Kara Griffin, community services program manager.

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Video from Crow Wing County Board of Commissioners Meeting
03/28/2017 10:00 AM

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Moritz added the county has a "significant problem" with STDs as well. She pointed to the county's 137 reported cases of chlamydia in 2015, compared to the state's total reported cases of 4,097. While Crow Wing County accounts for 1.2 percent of the state's population, its share of chlamydia cases was disproportionate-3.3 percent of chlamydia cases were in Crow Wing.

Nystrom asked what the county's public health department was doing about these statistics.

The condoms the county was distributing were acquired through the Minnesota Department of Health's Condom Distribution Project, a program of the STD/HIV/Tuberculosis Section. The state's condom distribution program cost $19,453 to operate in 2016. Distribution of free condoms is a requirement from the CDC for the state agency to receive federal funding for HIV prevention.

Terry said Crow Wing County was one of 47 in the state receiving free condoms and lubricant through the program in 2016, and it received about 11,000 condoms. Of those, about 600 were distributed each year to families in the home visiting program.

The purpose of including the condoms in the family home visiting packets, said Griffin, was as part of education about pregnancy spacing. Moritz said spacing births is important to the health of both the mother and baby, adding pregnancies too close together can lead to low birth weight or premature birth.

Houge asked whether the county's numbers could increase if "this program went away."

Terry replied the outcome was uncertain, but speculating based on other data showed the potential for a negative impact.

"There was a Planned Parenthood clinic in the Brainerd area, and then there was a clinic after that," Terry said. "We have seen increases in the rates of disease and pregnancy since those community resources have closed."

Terry said of the 14 counties in the central region, eight provide family planning services through providers at least monthly. The closest of these is in Pine River.

"While we promote folks being associated with a primary care provider obviously as the number one, we have given the information about these different clinics in the different areas," Terry said.

Commissioner Paul Thiede asked whether it was clear the clinic closures were the direct cause of the increase in the county's numbers.

"What I hear staff saying is there is correlation," Houle added. "We don't know if there's causation."

Nystrom asked whether the county should be offering family planning services. Terry said she couldn't answer that question, and as a staff member, she looked to the board for that policy direction.

"The condom piece is one tool in our toolbox to be able to influence that, but it's not the be-all, end-all that this will be the answer to our prayers," Terry said.

Thiede said since no one else was rising to the occasion, he wanted to address what he felt was the "heart of the question."

"Are we condoning, are we encouraging an activity if you give them a device (condom) that is supposedly going to solve their potential problem with pregnancy or prevent an STD?" Thiede said. "I would certainly hope it isn't just a question of health, and a question of controlling passions. It isn't just a question of health, and that's the be-all and end-all. ... I think there's two views here, and coming to the conclusion of what the right policy is is a pretty important thing. But I think it has to respect, not judge, and that's a real interesting thing."

Passionate public weighs in

In all, 27 members of the public shared their views on family planning. Among the speakers were pastors, teen mothers, doctors, activists on both sides of the issue, a retired public health nurse, executive directors of family planning organizations and concerned residents. Of those who spoke, 13 expressed support for condom distribution by Crow Wing County, 11 stated they were against it and three did not express an explicit opinion one way or the other.

Two teen mothers spoke-one who became a mother 21 years ago, and another who held her baby while testifying to the board.

Collette Cordingly of Staples said she became pregnant at 16. She said she felt the use of condoms was "pushed down (her) throat" as being safe, but she got pregnant and dropped out of school. She married her husband of 20 years at age 17, she said.

"I believe parents need to take responsibility for their own actions," Cordingly said. "They need to take responsibility for their children. They need to teach their children the right way to live, how to grow up."

Andrea Hines of Brainerd choked out that it was hard being a teen mom, before she began loudly crying.

"I feel like I don't have the help," Hines said. "I did know how to prevent getting pregnant, but at the time, I didn't know where to go. You never really learn about it in school, so you always think it won't happen to you."

Speaking in favor

Those in favor of the county reinstating condom distribution urged the county to focus on fact-based data, and not be swayed by emotion and opinion.

Becky Twamley, executive director of WeARE Advocates for Reproductive Education, said not only is distributing condoms good public health policy, it results in savings in public assistance-she said for every $1 spent on family planning, it averted $5 in spending on assisting families in need once a birth has occurred.

"We invite the county board to join us in a public health effort," Twamley said. "We are on the right side of this issue, we stand with the community and we ask the county board to allow public health employees to do their jobs."

Also speaking in favor was Rev. Leslie Moughty of the First Congregational United Church of Christ in Brainerd. Moughty said abstinence was a legitimate and viable choice, but sexuality was a God-given gift.

"When people choose to engage in sex, safer sexual practices such as using condoms, is more loving and more responsible than unprotected sex," Moughty said.

Dr. Becky Holcomb, an emergency care physician at Essentia Health-St. Joseph's Medical Center in Brainerd, said despite serving a Michigan community seven to eight times larger than Crow Wing County during her residency, she witnessed more teen and unplanned pregnancies in Brainerd. She offered the example of a 19-year-old she saw in the emergency room Monday night, who was experiencing her third unplanned pregnancy and had a history of STDs. STDs meant a risk increased by five times for potentially fatal conditions such as an ectopic pregnancy, Holcomb said.

"When I asked her if she was utilizing anything for birth control, she was not," Holcomb said. "She didn't have access, she didn't have health care, she didn't have a regular doctor, she didn't have gas for her car to drive to a clinic. These are the people we're talking about helping. We have an opportunity to provide her and others like her with better opportunities and options and it's our job to do so. I know that that's what I want and that you want our community to have a better future."

Mary Holbrook of Nisswa said she was appearing on behalf of her grandsons, who she hoped would have access to needed family planning services.

"I'm not even thinking about condoms, I'm thinking about the larger health question," Holbrook said. "I would like a place for them to go if they needed or if their friends needed to be tested for STDs. When you're a teenager, you're not always really fond of having those explanation of benefits coming home to your parents that say, 'Hey, I was in being tested.'"

Speaking against

Those speaking against the county's condom distribution focused on personal responsibility, the degradation of the family unit and government intervention.

Dr. Ed Rosenbaum, family practice physician at Cuyuna Regional Medical Center, responded to Holcomb's comments. He said the woman Holcomb used as an example had education after every delivery and probably before her deliveries, too.

"On TV, kids are bombarded with all the sexuality and that's what people are listening to," Rosenbaum said. "We talk family planning. What family? Families are going away. Wake up and smell the coffee. ... Bastard children are promoting bastard children. Not a dirty word, it's factual. It's in the dictionary and we need families that are more put together."

Rosenbaum later approached the microphone to apologize for using the word "bastard," but reiterated his feelings about families.

Keri Heintzeman-wife of Rep. Josh Heintzeman, R-Nisswa-said she was upset family planning was on the county board's agenda.

"It is not the place of our county to enter into our bedrooms or our children's bedrooms by accepting condoms and lubrication and distributing it throughout our community," Heintzeman said.

She said condoms offered a false sense of security, and even the CDC said abstinence or monogamous sex with an uninfected partner were the most reliable ways to prevent STDs. She said the issue was whether or not commissioners would support taxpayer-funded contraception.

"Commissioners, I urge you to listen to Crow Wing County and don't vote for condoms coming into our community," Heintzeman said.

Dan Willett, deputy chair of the Crow Wing County GOP, said he did not accept the premise the county should be distributing condoms because they were free from the state.

"That promotes promiscuity, it does not promote good health," Willett said. "Good health comes, I also believe, totally in abstinence. That's the best way to go. It's not always the way that people will go. I understand that. Yet, we need to get back to strong families. That's where our breakdown is in our community. ... Just because something is coming to us without a cost, does not mean it does not have a social cost."

Doug Kern, former chair of the Crow Wing County GOP, told the board he was an unintended pregnancy, and said his mother suffered postpartum depression that was "worse than death, it was like dying."

His mother went on to have seven more children for a total of 14, Kern said.

He questioned some of the statistics and said he wondered whether there was data to support the distribution of condoms had any impact on pregnancy rates.

"I can't picture Jesus distributing condoms," Kern said. "For the folks that don't know how to get a condom, at the Holiday gas station they are 75 cents in the bathroom."

Ginny Rogers, executive director of the Lakes Area Pregnancy Support Center, did not speak for or against the condom distribution. She noted, however, the organization once offered STD testing but discontinued it for lack of use.

"That may be because we're a local nonprofit and we don't receive government funding, we don't have a huge advertising budget," Rogers said. "We're not opposed to having that conversation again, and we just want you to know we're here to do whatever it is we can do to help."

Board debates, decides

After closing the public hearing, Houge thanked the speakers for remaining civil.

"It's one of the most polite groups of people I've seen for an audience so large," Houge said.

Nystrom made a motion to reinstate the condom distribution by the public health department after thanking those in attendance for being a part of the conversation. Houge seconded the motion after passing the gavel to Commissioner Rosemary Franzen, vice chair of the board.

"Crow Wing County loves to be number one in the state of Minnesota or at least ranked as high as we possibly can, but this is one area that we're not proud of," Houge said. "I think everybody here said stuff today that we're all on the same page here, we all want the same result, we just have to figure out how to get there. ... We have to figure out how to put an end to some of these numbers. Whether we believe these numbers or not, that's what we have to work off of."

Thiede said he disagreed with Houge that everyone was on the same page.

"Some of us have strongly held beliefs in a different direction than others," Thiede said.

Thiede went on to respond to Kern's observation about postpartum depression, and his words were met by the most boisterous response from the crowd throughout the meeting.

"I've gotten myself in trouble at this desk before for saying something meant to be said facetiously, and it isn't taken facetiously," Thiede said. "I'm going to say this not facetiously, but to show the absurdity that one answer is the best of all. Mr. Kern got up and shared about postpartum (depression). I'm the father of eight children. I can tell you I've experienced postpartum depression in my life, too. The good doctor is over there shaking her head, and I wish the public could see that, too. I'm making a point. One of the ways we can solve postpartum is to give them a great dinner out with their husband, their spouse."

As the crowd reacted, Thiede went on: "You see how, gosh, isn't that amazing. Isn't that amazing? Did I not preface this by saying there are other solutions? That's one of the solutions, is being able to give people a freedom to have other options there. I'm not going to support the motion."

Koering made a motion to table Nystrom's motion, although the motion to table failed 2-3. In a roll call vote, Nystrom and Houge supported reinstating the distribution, while Franzen, Koering and Thiede voted against.

Koering said during a recess he asked for the tabling so he could further discuss the issue with his own constituents in the southern part of the county.