Dacey Stratton was surprised when a young Latina woman seeking prenatal care at a South Philadelphia clinic said she had an IUD implanted months earlier. As medical director of Puentes de Salud, Stratton knows IUDs are 99 percent effective at preventing pregnancy. But then the young woman explained.
She had the IUD inserted by another medical provider, who'd given her the typical instructions: it's rare for an IUD to fall out, but feel for the strings at the end of the device once a month to make sure it's in place.
The woman followed directions. A few months later when she checked, she couldn't feel the strings in her vagina. She went to her mother, concerned. But her mother got angry and chastised her for touching her genitals — which she considered taboo, the young woman explained to Stratton.
So the woman dropped the issue, not seeking further care. A few months later, she was pregnant.
Young women can struggle to access health information that is stigmatized in their families or communities, and doctors, too often unaware of these issues, don't provide the type of information the women need. Although the exact stigmas vary by community and household, they often concern women's health topics — from menstruation to sexual health and pregnancy. Now women in cultural communities across Philadelphia are changing that. They're starting conversations, engaging in activism, and working with the medical system to overcome traditional taboos and increase access to women's health information.
For Stratton, it's about learning from her patients. Hearing from the young woman with the IUD helped her understand why birth control implants, which go into the arm, might be a more popular option. Since learning many Latina patients believe not getting a period means blood builds up inside the body, she has started taking time to explain how certain types of birth control prevent the monthly cycle.
Melinda Son, 25, grew up in a Cambodian household in North Philadelphia. "The only time we discussed my body was when I got pregnant," she said. In fact, she was "terrified" to talk to her mother when she got her period, so her uncle's girlfriend taught her to use pads and tampons instead. "It just made you feel like you were dirty if you talked about it," Son said.
As a mother of two now, Son wants things to be different with her kids. "I'm going to tell them everything," she said. "They're going to hate me and say, 'Mom stop,' but they have to hear it all."
She already talks to young girls through her role as program coordinator of Cambodian American Girls Empowering, a group that connects Cambodian Americans with their heritage through arts and activism. "We ask young girls if they're on birth control," Son said. "They say no one else is asking them."
At a recent dance workshop, a blue box of tampons sat beside traditional golden Cambodian jewelry on a vibrant purple fabric. Son breastfed her 7-month-old son while running through the workshop's agenda. It's the type of setting Lanica Angpak, founder of CAGE, envisioned for women to discuss what might be considered shameful at home.
The idea was inspired in part by her own experiences. Growing up, the only sexual health advice she received came during car rides with her cousin, who gave her advice such as, always go the bathroom after sex to avoid getting a urinary tract infection. "If she hadn't said it, I wouldn't have known until I got a UTI," said Angpak, 26.
Now she hopes to be that resource for other young girls.
Jishava Patel sees activism as a way to create the type of open community she craved as a child. As Philadelphia organizer for the National Asian Pacific American Women's Forum, Patel, 24, organizes rallies and campaigns on topics ranging from misinformation around abortion to equal pay.
As a middle-schooler, she was scared to ask her parents about sex for fear they'd think she was sexually active. She was equally worried about asking non-Asian friends who might see her as a prude. Instead, she turned to Urban Dictionary, a website that explains slang, to look up unfamiliar phrases overheard in the hallway and read blogs online to learn about different perspectives on virginity.
"Often the anxiety in talking to our families or communities is that we think we're alone and no one will have our back if we get outcasted," she said.
In her work now, Patel organizes bubble tea socials and political postcard writing campaigns to bring together those who want to speak up. "It gives people courage, so those who would not normally have those conversations can," she said.
Sometimes language barriers add to the cultural stigma, preventing young women from accessing health information, said Nga Vu, health coordinator with VietLead, a Philadelphia and South Jersey nonprofit that serves the Vietnamese community.
Many American-born kids don't know the Vietnamese word for sex, she said, and parents may not have the English proficiency to respond to detailed questions. According to a recent Pew report, 68,000 immigrants in Philadelphia have limited English proficiency; many of them primarily speak an East Asian language.
That's where ethnic media can fill in the gaps, said Vu, 36. Many Vietnamese TV channels and radio stations host health talk shows featuring young doctors fluent in English and Vietnamese and familiar with both cultures. Each week, they explore a different topic, from HIV and sexual orientation to diet and exercise.
"Inside the family, if you talk about these topics, it becomes a situation where the mom might suspect the daughter is doing something inappropriate," Vu said through a translator. But if you just keep a TV channel or radio station on in the background, the information can flow easily.
When community health workers from the African Family Health Organization in West Philadelphia bring up the topic of birth control, they use the term "family spacing," said executive director Oni Richards.
It's a small change from "family planning," but it acknowledges a cultural stigma, she said. Many of the organization's clients are immigrants from countries where birth control was pushed by foreign nonprofits. "So some think family planning is being used as population control for African families," Richards said. Even for family members born in this country, knowing the historical treatment of black people in America adds to the sense of distrust.
Instead of focusing discussions on limiting family size, the community health workers emphasize the health benefits for women of spacing out pregnancies.
It would be great if more American doctors knew to do this, Richards said, but it's unrealistic. "The country is becoming so much more diverse," she said. "There's no way any one doctor can understand all of the cultures of the people who are walking through the door."
Organizations such as hers are eager to help doctors close the gap.
At Temple University's Lewis Katz School of Medicine, the training starts early with students spending time in neighborhoods around North Philadelphia, where they meet with community members and learn how historical and social factors have shaped residents' health. The goal is to help them understand what they might not know about future patients, said Kathleen Reeves, senior associate dean for health equity, diversity and inclusion.
It's not about memorizing facts, she said. "It's about knowing even if you don't know these facts, you need the skills to ask," she said.