Sex Education and HPV: How Alabama is Failing Its Young People

Currently in Alabama, the state does not have a mandate on teaching sexual education. Most of the information taught in schools is abstinence-only-based, medically inaccurate, and stigmatizing to LGBTQ+ students. There are also much higher rates of cervical cancer (a highly treatable and preventable disease) in Alabama, with Black women twice as likely to die of the disease as white women. Annerieke Smaak Daniel, a fellow in the Women’s Rights Division of Human Rights Watch, joins us to talk with us about the status of comprehensive sex education in a state that is failing its young people.

Not only are abstinence-only programs ineffective, they’re harmful. They withhold information that young people need and have a right to obtain, create a climate of fear around sexual and reproductive health by presenting incredibly harmful metaphors, and make young people ashamed of openly discussing health concerns. This is especially impactful on LGBTQ+ youth in particular, as Alabama is one of six states in the U.S. with “no-promo homo laws,” or laws that restrict the discussion or promotion of same-sex sexual activity. Research by the Human Rights Watch has previously indicated that LGBTQ+ students that attend schools bound by these laws experience increased rates of bullying, exclusion, and discrimination, which puts their safety and academic success in danger.

When it comes to Human papillomavirus (HPV), an extremely preventable and treatable disease, Alabama has some of the worst HPV rates in the nation. Young people are not learning about HPV or the HPV vaccine in their schools. This is especially troubling considering that Alabama has one of the highest cervical cancer-related mortality rates in the U.S. In order to better ensure that young people have access to information on HPV and the HPV vaccine, it is absolutely vital to address stigma around HPV and the vaccine, increasing parent’s understanding of the vaccine, and ensuring providers are recommending the vaccine in the same way that they promote other vaccines. 

 There are clear barriers to HPV prevention, treatment, and education, specifically for Black women (including a shortage of gynecologists in rural areas, transportation costs, etc.,). Still, lack of access to sexual and reproductive health information was a prominent restriction for women receiving HPV care in the state. It isn’t just rates of cervical cancer that are disproportionately impacting Black Americans in Alabama; with property taxes and the education system in the state rooted in discrimination, students in underfunded school districts are not receiving the sex education they need.

It’s time for Alabama to provide the life-saving sex education that its citizens deserve. The state can (and should) do this by mandating medically-accurate, de-stigmatizing, and inclusive sex education programs and updating the state code. Alabama must also ensure the education of HPV and the HPV vaccine in schools, to parents of students, and in community-based organizations that can provide effective outreach to communities.

Links from this episode

Annerieke’s publication, “It Wasn’t Really Safety, It Was Shame”
Human Rights Watch on Twitter
Human Rights Watch on Facebook
Real Education for Healthy Youth Act
The Youth Access to Sexual Health Services

Transcript

Jennie: Welcome to RePROs Fight Back, a podcast where we explore all things reproductive health, rights and justice. I'm your host, Jennie Wetter, and I'll be helping you stay informed around issues like birth control, abortion, sex education and LGBTQ issues and much, much more-- giving you the tools you need to take action and fight back. Okay, let's dive in.

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Jennie: Welcome to this week's episode of RePROs Fight Back. I'm your host, Jennie Wetter, and my preferred pronouns are she/her

Jennie: Just a tiny bit of housekeeping at the top. If you haven't already, make sure you subscribe to our podcast on your favorite podcast platform, that way you never miss an episode when it comes out, which is especially important. If we have some surprise bonus episodes that come out that way, you know that they're there right away. Also, if you love the podcast, it would be really amazing if you could take a moment to rate and review us on your favorite podcast platform, it helps other people find the podcast. And that would be wonderful to bring more people into the fold of repros right now, I am thinking about procrastination. I've been doing a lot of it, which is fine. One of the things that happens when I procrastinate is you find really random projects that you've been putting off that all of a sudden have to be done right away and needed to be done. Right now, I’ve waited for like five years, but today is the day it has to be done. So, I had one of those recently, where like, I have this really big wall behind my couch, and I had hung a couple of big picture frames on it that had some handmade art I did in them. They were always just placeholders. I was always going to do something different, but I couldn't leave it blank. So I had to have something up. Well, I had decided I really wanted to do a gallery wall to showcase a bunch of pictures I've taken from various trips that I have taken. It's been on my mind. It's been something I've been wanting to do for years. Well, all of a sudden it had to be done. I had to get it done. And so I found this great kit that had all the frames and it had this amazing template that you could just tape to your wall. And it showed you exactly where to put the nails. So everything came out perfectly. I mean, in theory, because my pictures are not perfectly straight, which fine. I think it's mostly me because I feel like I've mentioned before-- I can be a bit of a perfectionist. I think most people, and I've showed them pictures of the wall, they haven't noticed that it's a little crooked, but that's okay. I think that's mostly in my head. I mean, pictures are obviously a little, not in straight lines, but the overall effect is great. I'm just really excited to have some of the pictures I've taken on various trips up and I can change them out whenever I want, which is really exciting.

Jennie: And I ordered several prints from Liberal Jane, and if you haven't checked out her shop, make sure you get a chance to check her out. She is on Instagram. She has amazing repro-related art. So I have a couple of prints of hers that I hung up in this gallery wall. I think my favorite one that I have right now is hex the patriarchy. It makes me happy, but there's three or four of them that made it into my gallery wall and I'm really excited to have them up. So thank you Liberal Jane for the amazing prints that I ordered. I'm very excited to have it done and I can't wait to change it as I someday get to do more travel and take more pictures. So it was really nice to have this new thing done, but again, it was really just a tool of procrastination. That's okay. I got the things done that I was procrastinating on, so it's okay. And I'm just very excited to have this wall done. It was on my list for a while. I don't know that I have anything else super exciting that's been going on. I've still been doing baking. I don't know that I've baked anything super exciting recently. Oh, I made these really amazing chocolate chip cookie bars. I got the recipe from King Arthur Flour. They were delightful. They made me very, very happy. I will definitely make them again. And I've been telling everybody about them because they were delightful. But other than that, not too much new has been happening. Same old, same old, like many of you I'm still trapped at home. I don't know what my two kitties are going to do when I ever go back to work in the office because I'm pretty sure they are like; “this is the new normal you're home all the time. And we love it”, which everybody keeps talking about cats being like, no, I need you to leave. Literally right now, I am looking at both of them sitting on my table, staring at me while I podcast. So I don't know what they're going to do when I'm not here anymore. So with that, let's take it to the episode. Instead of the hearing me talk about my two little fluffy kitties this week, we had a great conversation with Annerieke Smaak Daniel at Human Rights Watch. We talked about sex education in Alabama, and we talked about HPV and cervical cancer in Alabama and how the state of Alabama is failing people. So it was a really important conversation and it was great to do a deep dive into a specific state instead of just doing a broad overview of sex education. So with that, I will take you to my interview with Annerieke.

Jennie: Hi Annerieke. Thank you so much for being here.

Annerieke: Hey Jenny, thanks for having me.

Jennie: Before we get started do you want to do a real quick introduce yourself and include your preferred pronouns?

Annerieke: Sure. Um, my name is Annerieke Smaak Daniel. I'm a Fellow in the Women's Rights Division at Human Rights watch and my pronouns are she/her.

Jennie: Really excited to have you on. We have had a couple episodes where we have talked about the importance of sex education and what sex education looks like around the U.S. but this is the first time we're going to kind of do a deep dive into a state and talk about what's happening. So I'm really excited.

Annerieke: Yeah. I'm excited too. Thanks for this opportunity.

Jennie: So before we talk about all the things that are happening, do we wish to do a little bit of background and talk about what does sexual health and HPV look like in Alabama right now?

Annerieke: I guess, going back to this research and why we looked at sex ed and HPV in Alabama, this was a follow-up to previous HRW research on racial disparities and cervical cancer mortality rates in Alabama. So all of this research comes from that. So cervical cancer is a human rights issue. It's tied to discrimination, to poverty, to inequality. It's highly preventable. It's highly treatable. No one should be dying of the disease right now, but every year about 4,300 women in the U.S. die and Black women die at disproportionately high rates. So when Black women are dying at alarming rates from a disease that's highly preventable, it's highly treatable, It's a clear failure of our government, and it's a clear indication of racial discrimination and inequality. And so Alabama has one of the highest rates of cervical cancer cases and deaths in the country. And then Black women in Alabama are nearly twice as likely to die the disease than white women. So a previous Fellow at HRW, Kelly Flannery, led the research, looking at these racial disparities in Alabama to really understand why Black women are dying at such disproportionately high rates. So the research found that there are barriers that exclude Black women from the healthcare system, and it prevents them from accessing the reproductive health care services, the information that they need to prevent treat cervical cancer. So among many other barriers that came up such as a shortage of gynecologists in rural areas, transportation costs when women have to pay a lot of money or have to secure transportation to get to doctors who are far away for follow-up care, the lack of health insurance among these different barriers, lack access to information on sexual reproductive health came up, women reported not having information to prevent treat cervical cancer. So we're talking information on HPV, the importance of routine gynecological visits and screenings, how to recognize the abnormal symptoms, information on their bodies and sexual health…all of this information had women had, they'd be better informed to take steps to prevent cervical cancer, to treat it at an early stage. So that research led into this research on sexual health education, because Alabama is just really missing an opportunity by not providing young people with information on their sexual and reproductive health. The state has high rates of cancers related to HPV. Yet young people aren't learning about sexual health. They're not learning about HPV or the vaccine in school and vaccination rates across the state are very low so that they can just be doing so much more to provide young people with information, to make these informed decisions, to protect themselves, to stay safe, to lower their risk of preventable deaths. Instead, the policies are restricting access to this information.

Jennie: So I think that leads us into, maybe we should talk about what does sex education look like in Alabama?

Annerieke: Yeah. So Alabama is failing young people when it comes to sex ed, the state doesn't have a mandate requiring sex ed. So the decision whether to teach her or not is really left up to local school boards. It varies throughout the state. The state code on sex ed is horrible. If schools do decide to teach it sex ed, the state code requires a focus on abstinence, and then it contains outdated language, medically inaccurate terminology. So for example, it references STDs instead of STI, it completely leaves out HIV and AIDS, and it has really harmful and stigmatizing language around same sex activity. So if you teach sex ed in Alabama, educators are required to say, quote, “homosexuality is not a lifestyle acceptable to the general public.” And that homosexual conduct is a criminal offense under the law. And it's horrible. We know it's not.

Jennie: That's wild.

Annerieke: I know. And that's verbatim in the state code, this harmful and accurate information. It isolates LGBT students. It promotes harmful messaging. It doesn't affirm them. It doesn't create a safe, inclusive environment for them in schools. In the past few years, there's been legislation introduced to update the state code in Alabama to make it more medically accurate, to remove the stigmatizing language, but it hasn't passed yet, but groups are working really hard in Alabama and really fighting to update the state code. But the result of all of this is most young people in Alabama are receiving abstinence only education. And they're learning so little about their sexual health by receiving abstinence only education that shames adolescent sexuality, it's stigmatizing young people. And that's actually the title of their report that I wrote, quote, “It Wasn't Really Safety, it was Shame” quote. That was a quote from one of the young women that I spoke with. And that was her describing her experience with sexual health education in Alabama. It wasn't meant to inform young people and really improve their health outcomes. It was meant to shame them.

Jennie: I just think about my own sex ed experience, and I had very much kind of the same very abstinence only… it didn't prepare you for life. And I just think about how harmful that is later in life, or even then trying to navigate your sexual health in a healthy manner.

Annerieke: Exactly. And it's like, they have such little information to go from. Basically, almost every young person I spoke with received abstinence-based education. So beyond the basics of anatomy and reproduction, they learn so little about their sexual health. It left them totally unprepared to understand their bodies, to prevent and treat STIs, to engage in safer sexual behaviors, to build healthy relationships, to understand, to navigate consent. All of these major building blocks for understanding your sexual health, your reproductive health, making informed decisions. They don't even have to begin with. So they're left with the major gaps in information, and it's carried into adulthood for a lot of them. I spoke with young people in their twenties, early twenties, mid-twenties, and some who otherwise felt really knowledgeable about their sexual health at this point in their lives. But they had to piece it together. It was them actively going out, going to college groups, learning in courses after they graduated from high school, really trying to get a grasp on this information that they didn't get in school.

Jennie: Yeah. It's just so harmful. And it just is so frustrating to me that kids are not getting the information they need to make informed decisions.

Annerieke: Yeah, for sure.

Jennie: So I think you talk about it being ineffective, but it also can be harmful.

Annerieke: Right? Yeah. I mean, abstinence only programs don't lead to safer sexual behaviors, but you're right. So it's not only ineffective. It's harmful-- it withholds information that young people need. And also this is information that they have a right to have. It stigmatizes and shames adolescent sexuality. It creates a climate of fear. So, many of the young people I spoke with believe that the information that they did get in school was meant only to scare them into saying no to sex. This came up so many times. So being shown graphic photos of STIs, hearing deeply harmful metaphors. So comparing condoms to snicker bar wrappers. And there was one young woman and her story really sticks with me. And she described how the abstinence only educator in her school took a cup of water and went around and had all of the boys in the class spit in it, and then tried to have one young boy drink it. He said, no, obviously. And then she compared that cup of spit to girls who have sex before marriage, what are we doing to our youth? What is this message that we're sending them? It's making them ashamed to openly discuss their health concerns, to talk to adults, to talk to their parents, to seek out trusted sources of information. And then they're turning to their friends, to the back of the bus, to internet to get this information. And we know that's not always accurate. We know it can lead to dangerous misconceptions. So overall, just so many of the young people that I spoke with told me how deeply harmful the sex ed they received was. And a few of them said that even as adults, they're still trying to shake that

Jennie: I relate to this so much. So I went to Catholic school and had sex ed from a nun. So you can imagine it was very shame-based obviously. And yeah, like it sticks with you forever… some of the stuff-- I work in reproductive health and sexual health--and still have that innate shame that was put into me back then when I was young, so my formative years, when you are really making your opinions and starting to think about these things, and it's really hard to get rid of that.

Annerieke: Yeah. And that just really follows young people into adulthood.

Jennie: So you talked about the requirement in the law about mentioning homosexual activity being illegal. So what does this mean for LGBTQ youth getting sex in Alabama?

Annerieke: Yeah. It's especially harmful for LGBT youth. So Alabama is one of six states in the U.S. with laws that restrict the discussion or promotion of homosexuality. So often referred to as “no promo homo laws”. And research has shown that LGBT students who go to schools in states with “no promo homo laws”, these hostile environments, they have less access to resources around their safety, their academic success, their wellbeing in schools. GLSEN has done really good work around this. And then in 2016, HRW also published a report and it found that LGBT students face bullying, exclusion, discrimination in schools in states like Alabama and other states where policies don't support LGBT youth. But this really resonates with our findings from the research-- sex ed in Alabama is not inclusive of LGBT youth. It doesn't create a safe environment for them. It's not supportive. It doesn't affirm them. Abstinence only education just reinforces heteronormativity. And so in my research, I ask questions when I do the interviews and only two of the young people I spoke with and I spoke to 45, had discussed sexual orientation and gender identities in school. And for most, when I asked them if they discussed these topics, if they've learned about it, the reaction was just so strong. No, not at all, not in the least bit. It's a forbidden topic. That's just how much it's excluded from health within schools in Alabama. And one young woman told me that her health teacher, he actually told the class that homosexuality was a sin before covering sex ed, which was abstinence based. Can you imagine being in that class as an LGBT youth and how you would feel? So it's really bad. And then the fact that it's written into the state code, it's just adding another layer.

Jennie: It's just shame on top of shame. So you mentioned upholding this heteronormativity. It also makes me think back to what you were talking about earlier, when you talked about one of the people talking about the sex ed, they got talking about the cup of water and really thinking about how it's holding up patriarchal structure too, because talking about the cup of water was focused on girls. It was “what boy is going to want a girl that is like this cup of water?” It doesn't often go the other way.

Annerieke: Yeah, no, you're right. And that came out so many times too. And there was just so much shame around girls. Don't be sluts, don't have sex before marriage, and not so much an emphasis on exactly what you just said. It goes both ways.

Jennie: And I feel like, I mean, this is going back way back to my sex ed. Consent was often wrapped in that too. Right? It was imperative on the girl to say, no, it wasn't that consent is a conversation and that you are consenting to things together.

Annerieke: Yeah. And, but then you have young people in Alabama and across the U.S. and they're not learning about consent. So it's like they have no basis for understanding even what consent is, how to navigate consent, how to have difficult conversations. They're just not learning yet.

Jennie: I'm excited to see that states are starting to introduce consent into their curriculum, but it's still so far and few between states that mandate it. So now that we know what sex education looks like in Alabama, are they talking about HPV and the HPV vaccine in sex education? Are they even learning about this at all?

Annerieke: No. I mean, young people just, aren't learning about it in schools. And we're talking about a vaccine that's effective at preventing cancer. It prevents most of the strains of HPV that can lead to cancer and utilize widely. It could possibly wipe out cervical cancer for future generations, but no young people aren't learning about this in schools. And just to put it kind of into context. So out of the 45 young people that I spoke with only five recalled learning about HPV in school at all. And for most they said it was covered very briefly when learning about STI and only three learned about the HPV vaccine. So most of the young people, just didn't know much about the virus. Didn't know much about the vaccine. Didn't understand how the vaccine prevents cancer, how HPV is tied to cancer. And it's like a mystery to a lot of young people. And again, talking to some young people like in their twenties who otherwise felt pretty knowledgeable at this point in their lives about their sexual health. Even they didn't really have a strong grasp on HPV and the vaccine. I remember there was one young woman I spoke with and she was telling me how she had been exposed to HPV and was doing a bunch of Googling, trying to figure out what it is. And one of her friends told her, “Oh, you know, you don't have to worry about it. It's not a thing. You have it, but you don't have it.” So it's like this kind of misinformation around it. And then another young woman was telling me that she didn't even know until she was 22 years old, that the HPV vaccine was a preventative measure against cervical cancer. And we're talking about the state with one of the highest mortality rates from cervical cancer in the country. This is a vaccine that could help prevent these deaths and young people don't even know about it.

Jennie: Yeah. It's really tragic that kids aren't learning about this in school. So since Alabama, the sex education, if you can call it that isn't teaching about it, what else can we do to ensure that young people are learning about it and are getting the vaccine?

Annerieke: So addressing the stigma around HPV and the vaccine since HPV is an STI, parents often just see it associated with sexual activity. Some parents might even see it as a green light to let their kids have sex if they're vaccinated. So they're not necessarily understanding it as a cancer prevention tool. And we really need to reframe it as just that if you tell parents this will prevent an STI, that's so different from telling them this will protect your child from six types of cancer in the future. So it really makes a difference how we frame it. And then increasing parent's understanding of the vaccine is super important. Some parents just don't know about the vaccine. They haven't heard about it. They don't know that it's for everyone. They might think it's only for girls. They might've got that messaging in the past. They might not know at what age their child should be vaccinated. So increasing education around it is important too. And then the other thing which I didn't realize until I started this research is the difference that recommendation from a medical provider has. So whether or not a doctor provider strongly and effectively recommend the vaccine has a big impact on whether parents actually vaccinate their children or not. But a lot of medical providers just aren't recommending it, especially if they feel uncomfortable discussing sex with parents. And the vaccine is given at a young age. So that adds to the uncomfortable atmosphere around these discussions, but they might not recommend it. They might present it as optional. They might differentiate it from other adolescent vaccines, but all of this just sends mixed messages to parents about how important the vaccine really is. So providers really need to recommend it strongly, effectively. There's a lot of research that's happened to really understand the most effective way to recommend it to parents. And it's just really important that the message gets across. It prevents cancer, and it's not just preventing an STI.

Jennie: So that makes me think of something you talked about earlier, and that was the racial disparities you were seeing in cervical cancer. Do we want to go back to that? Because I think that now that we have an understanding of the ways that young people in Alabama are not getting educated about it, it seems like a good time to revisit that.

Annerieke: So we know sex ed can save lives. It provides information to protect health, to stay safe. It can help prevent cancer like we've talked about. So all of this information is life saving, but unfortunately it's not provided to everybody. So in Alabama property taxes are rooted in discrimination. The education system inequitable. So this has left schools, particularly in rural, less wealthy regions of the state, like the Blackbelt region, without adequate funding. And so when schools are underfunded and they're struggling to even provide the required courses, required services for their students, optional programs like sex ed just aren't offered. So it's the students who are living in these under-funded, these neglected school districts. And they're often Black students who are losing out on the access to this life saving information. So when you compare them to their peers, more affluent districts who did receive this information, they might be less likely to take steps to lower their health risks. So this unequal access to information, it creates disadvantages. It could lead to these racial disparities that we're seeing like the racial disparities in cervical cancer mortality rates. Mandating comprehensive sex ed and providing state funding to actually support it throughout the state would ensure that this information is available to all young people, not just those who are living in well-funded districts. And so just tying it to what we're seeing now with COVID, I mean, we're seeing the disproportionate impact that COVID is having on Black people. We're seeing the impact of structural racism, systemic inequalities. There's so much work that needs to be done to address these historic inequalities, but providing sex ed for all young people would be one step in the right direction. When you look at discrimination, inequality, and how it means that certain people who are often Black or often living in poverty, don't have access to information that can save their lives. It's just so infuriating.

Jennie: I feel like every day almost, or maybe that's just how it feels right now. There's more data coming out about how systemic racism is impacting health. So you see the disparity in maternal mortality. There was just something this week talking about infant mortality, and now cervical cancer. There's just so much that is impacted by all of these policies.

Annerieke: Yeah, for sure. I guess the way that I look at this, it's just access to information. We're not talking about providing money or resources, which is a whole other ballpark, but just providing access to information. That's already there in school, students who are going to school, they're learning about math. They're learning about science. They're learning about history. This information should be presented in the same way as those other topics. When you talk about student success and achievement, being healthy, being able to protect yourself to make informed decisions, to live a healthy life. That has to be part of the equation. When talking about student success.

Jennie: I feel like that leads us perfectly into what can Alabama do? What steps can they take to help rectify this?

Annerieke: We can start by mandating comprehensive sex ed that's medically accurate, that includes all young people, including LGBT youth, and at the very least update the state code to make sure it's medically accurate, remove the stigmatizing language around same sex activity, remove the emphasis on abstinence, just work with what they have to make sex ed more inclusive and comprehensive for all students, even if it's not mandatory at this point, but really it should be mandatory for every student. And then Alabama needs to do more to increase awareness of HPV and the vaccine. So starting with educating young people in schools, all young people should be learning about HPV and the vaccine. We need to educate parents. We need to inform them of HPV, how it works as a cancer prevention tool and schools have a big role to play in this. It can be sending home materials to parents that can pass information out at events. There's so many different ways to engage with parents and to ensure that this information is passed along. And so then I think Alabama really needs to provide funding and support to community based organizations and groups, communities are built on trust and existing relationships. And so they need to have information, resources, tools to provide education and outreach. When talking about sexual health, the HPV vaccine, we're talking about a vaccine in a state with a history of medical exploitation and abuse of Black people. So this trust is so important. There was a group that we've been working with, in one of the counties, and they were involved in the cervical cancer research. And I've been in touch about the follow-up project and they want to host a table at a wellness fair around HPV and the vaccine because they really want to get this message out to their community members. And so you just think how much more impactful that would be coming from them than me coming in there as an outsider, trying to educate the community on HPV. So really there needs to be funding and resources going to these community-based organizations.

Jennie: I always like to end the podcast with an action listeners can take, so what can listeners do around this issue?

Annerieke: So I would encourage listeners to learn more about the sex ed policy in their states, contact your state reps; advocate for comprehensive sex ed that's inclusive. Even if you were one of the lucky ones who received comprehensive sex ed, there's just no guarantee of that for other students in your state. So just do what you can to change it, to make it more inclusive and relevant to everybody, and then contact your members of Congress. Please make sure that they co-sponsors two critical bills around comprehensive sex ed and sexual health in the U.S. So the first bill that I would say, so the Real Education for Healthy Youth Act, it's sponsored by Senator Cory Booker and Representative Barbara Lee. And so this would ensure funding for comprehensive sex ed programs. And it would also work to eliminate funding for abstinence only programs. And then the Youth Access to Sexual Health Services Act is sponsored by Senator Mazie Hirono and Representative Alma Adams. And so this would ensure that historically marginalized, young people, so young people of color LGBT youth, it would ensure that they have access to sexual and reproductive health care and services, and then advocate for legislation that increases awareness with HPV and the vaccine among parents, guardians, young people in schools, within communities. And then I would say that everyone listening now can learn more about HPV and the vaccine. Do your research, educate yourself and your peers, have these conversations. There's a vaccine that can prevent cancer, but so many people don't know about it. They don't understand it. And there's just so much we can do to change that. And even if it means just starting within your own network of family and friends, it can make a big difference.

Jennie: Well, Annerieke, thank you so much for being here. It was great to talk to you and I learned so much.

Annerieke: Thanks, Jennie. So nice to talk to you too. And I'm glad that we had this conversation.

Jennie: Thanks for listening everyone. And we'll see you on our next episode of RePROS Fight Back. For more information, including show notes from this episode and previous episodes, please visit our website at reprosfightback.com. You can also find us on Facebook and Twitter at RePROS Fight Back, or on Instagram at reprosfb. If you like our show, please help others find it by sharing it with your friends and subscribing, rating and reviewing us on iTunes. Thanks for listening.

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