Michelle’s Mexican family never talked about sex. When she began thinking about birth control before heading to college she was on her own to make some really important decisions. And OBGYN Dr. Erica Montes offers tips for discussing family planning and avoiding misinformation about contraceptive methods.
Featured Expert:
Dr. Erica Montes, an OBGYN based in Arizona. Dr. Erica Montes is a Board-Certified Obstetrician and Gynecologist and a Fellow of the American College of OB/GYN. She received her medical degree from the University of Texas Health Science Center in San Antonio. She completed her residency at the University of Texas Southwestern Medical Center-Parkland Hospital where she was elected one of three chief residents at the largest program in the nation. Born and raised in Texas she graduated from the University of Texas at Austin with a BA degree in Biology with Honors. She is robotically trained on the daVinci Robotic Surgical System and excels in minimally invasive surgical procedures and in-office procedures. Medical interests include low- and high-risk obstetrics, contraception, treatment options for abnormal uterine bleeding and gynecologic surgery. She also believes preventive care is one of the most important aspects of medicine including immunizations; for which she was awarded "Arizona Big Shot" in 2014 by the Arizona Partnership for Immunization. In addition to her excellent clinical skills, Dr. Montes is fluent in both Spanish and English. She encourages patients to be active in their health care decisions. Outside of work she enjoys spending time with her husband and sons, traveling and learning something new every day. Learn more about her work here.
Dr. Erica Montes recommends this resource.
If you loved this episode, listen to Not Your Mamí's Sex Ed and Doctor's Mom Won't Listen to Medical Advice.
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Juleyka Lantigua:
Hi everybody. Today we welcome Michelle. From an early age Michelle knew that sex and sexuality were major taboos in her Mexican family. Even now as a young adult, she avoids the topics at all costs. But when Michelle was getting ready to go to college and decided to get an IUD she really wanted to be comfortable enough to talk about birth control and her experiences with her mom. Let's get into it.
Michelle: I'm Michelle. My pronouns are she, her. I'm from San Francisco, California. A first generation, low income college student. I currently go to Stanford. I'm studying psychology and art practice with a minor in creative writing. Growing up, I called my parents Mami and Papi. They were pretty open about most things, but in terms of sexuality, that was completely off the table. I kind of learned it all from school. I used to work as a sex-ed teacher and I used to be a peer health counselor. So, I've talked to my parents about the things that I teach to other people. I don't refer to birth control as like something that I take, but I refer to it as like part of the curriculum that I teach. For my mom, her response is like, "Eih." Like I told her what an IUD was. And I was like, "Yeah, it's this little tiny, tiny T-shaped thing. It goes into your uterus." And she was like, "Ugh." She thought it was pretty gnarly. She was very dramatic about it.
And to be fair, it is a dramatic thing. The procedure itself is pretty dramatic. The response would be even much, much, much more extreme if she knew that it was something that had personally happened to me rather than some abstract concept that I'm talking about as part of a curriculum. My particular high school was 50% LGTBT and extremely, like very, very sex positive, very open about talking about sexuality. I had people that cared about me and adults who were willing to talk to me about those things. But even though I felt very informed, it wasn't necessarily a replacement for the type of support you'd get from a parent. What I wish I was able to talk to my parents about is, I wish when something went wrong, that I felt comfortable enough to go to them about it.
Michelle I decided to get my IUD when I was about 17, I had kind of thought about the options. And I sat on it for about like six months, something like that. I could have done the shot. I could have done the implant. I could have done birth control, but the IUD just seemed like the simplest to hide. And also it was non hormonal, so I wouldn't have to worry about like getting adjusted to any type of hormones. And I was about to go to college in a few months. So I was like, "Okay, I'm not sexually active yet, but I probably will be within the next year and stuff." So me and my best friend, we like booked an appointment together at the Planned Parenthood in our neighborhood. I was very nervous and I knew it was going to hurt, but I didn't anticipate how bad the pain would be.
I went first and I remember gripping my friend's hand, like so tight. And she was like, "Wow, I'm now scared to get my IUD because I felt how tight you were gripping my hand when it was being inserted." Especially like as a 17 year old and as someone who had always got very light, or pretty light periods, it was more painful than expected. We got burritos afterwards and we went back to her place to rest a little bit before I hopped on the train and went back to my parents' place. And I remember having to hide it from my parents, hide the excruciating pain I was in. I was like, "Yeah, it's just period cramps, no big deal." But it would've been nice to be able to come home to my mom and be like, "Hey, I got an IUD, this hurts."
Even when we talk about, like, we inherit a lot of things about our bodies from our mothers. And it would've been nice to know how my mom reacts to birth control considering she's probably tried it. It would've been nice to know how she reacts to like different brands of birth control or if she's tried IUDs or if she's tried the implant or the shot. So then I wouldn't have to like, kind of stumble through each of them, trying to figure out which one works best for me. I'm 21 at this point, I'm going to be 22 in a few months. So I've had my IUD for almost four years. It's still like the elephant in the room. They don't know about it, but I know it's there. And like, I wish I could talk about it, but it's just not a conversation that could necessarily be had without her consequentially freaking out. For her to know that I'm on birth control would come with the implication that I'm sexually active.
She had told me about like all her friends back in Puebla in Mexico who had gotten pregnant at a very early age. She didn't want me to end up like all the girls she grew up with and stuff. So I guess in her mind, she thinks that, "Okay, the way only way I can guarantee that is if my daughter never has sex." Not talking about it, allowed her to think that it wouldn't happen. She has to figure it out at some point, that I'm sexually active. There has to be that kind of mother's intuition that that is happening. I want her to know that I'm taking care of myself the best way I know how to. And so far it's been working and her emphasis on my future and the care she puts in toward my future and her desire for me to get an education and not be like encumbered by the prospective teen pregnancy, is what made me go out, looking for that information to take care of myself.
Lantigua: Like Michelle, many first-gens may ultimately decide that conversations about birth control and sex are simply non-starters in their families. Totally fine, right? But there are those of us who want guidance and support as we make these decisions. How do we bridge these topics with our loved ones without causing major alarms? And what can we do to make informed decisions about our reproductive health? Decisions that are free from our family's reservations, fears and judgements. To help us figure it out, I called in an expert.
Erica Montes: My name's Dr. Erica Montes, I'm a board certified obstetrician and gynecologist, and I've been practicing now for 10 years in Arizona. And I am working with a woman's health company called Organon, and we are promoting how to have a conversation regarding birth control and how to find good options for each woman.
Lantigua: What did you hear as you listened to Michelle's story?
Montes: I kind of really resonated with it on a personal and a professional level, actually. Personally, as a Latina growing up in Texas, I didn't have the courage to talk to my mom about birth control. And so the first time I actually had that conversation was with a nurse practitioner as a college freshman on campus. I do tend to see young women like Michelle. And it's important to realize that especially as Latinas, we tend to have our first conversation around these taboo topics regarding sex and birth control with our doctor, our physician, our healthcare provider.
Lantigua: Do your patients give you insight into why they haven't had these conversations with their loved ones?
Montes: I think a lot of it stems around the fact that their parents feel uncomfortable bringing it up. Like Michelle brought up, she said, "My mom feels like if we don't talk about sex, it's not going to happen." And I see that day-to-day, I actually had a mom who was really upset with me because they were there with her daughter for a breast issue. And she was 17. She was about to graduate from high school, possibly going to college. And at the end of the visit, I asked the patient, I said are you considering birth control? What are your thoughts? Do you have any questions about that?
And the mom just really became upset with me. She didn't want to talk about it because if we're not talking about it's not happening. And in reality, I think it's important for these young women to realize that there's confidentiality between us as a physician and a patient. I always try to make it comfortable, because sometimes patients don't even want to bring up the subject. I think when they see me, it helps because they can say like she's approachable and it's important that we get down to understanding like what their background is, what their routines are, what their medical history is, and just really dive into what we want to do.
Lantigua: All right. So, Dr. Montes, can you give us a sense of why sexual activity seems to be such a cultural catastrophe around and for Latinos?
Montes: Yeah. I think it stems from our upbringing and generations in the past. A lot of it possibly has to do with our religion and most Latinos do grow up in the Catholic church. And I think that part is also part of why. But what I am finding though, is that more Latinas are definitely working towards careers. They're wanting to have a higher educational attainment. There's a lot more Latinas going into college. And with that, I'm seeing a lot more Latinas wanting to be able to plan for their future. They want to know how they can plan their families out, and they want to know what methods of birth control are available to them. One day I'll speak to a lot of older Latinas, moms that only speak Spanish. And they're still kind of hesitant to have me see their daughters. And then the other half of the day, or the next day, I'll speak to 10 young Latina professionals who'll say, "Dr. Montes, tell me what I can do to avoid unintended pregnancies."
Lantigua: The fact is actually that statistically first generation Latinas are having half as many children as their immigrant mothers. And I am actually a walking testament to that. My mom had four children. I have two, that gap between our mothers and ourselves is really growing. So before we get to Michelle's case, I'm going to ask you a really blunt question. Is it even important or essential that we have the conversation with our parents in light of so many other places we can get information?
Montes: I don't think it's essential. Honestly. I think we do know that if young women bring up the conversation with their parents, they're more likely to practice safe sex. They're more likely to just kind of feel more confident in their overall sexuality. I don't think it's essential, but if you're able to have that conversation with your parents, especially at a pivotal time when you're, for example, going off to college and you're maybe living on your own for the first time. Maybe when you're talking about going away, where you're going to be living, throw it in there at the end and say, "I really am considering starting a birth control method. I want to get your opinion on it. I want to know what your history was with different birth control."
I really liked how Michelle brought up the conversation or the topic about her mom, not knowing like her mom's history with certain methods and how that definitely can kind of help you make a good decision or what a good option is for yourself. And then once you'd have that conversation with your mom, then you can realize that even though she tried certain methods, that's not the only method that's available. Remember, there's pills, the patch, the ring, the shot. And then there's also the long-acting reversible contraceptive methods, which are the IUD or the implant that goes in the arm.
Lantigua: Let's say that a young person is wanting to get some sort of long term contraceptive method. How should they make that decision for themselves? This is not even about telling their parents or any loved ones. What are the things that they should consider when they're making that decision for themselves?
Montes: The first thing is to consider when are you considering pregnancy in the future? And even if it's a year from now or 10 years from now, a long-acting reversible contraceptive method is excellent. Because, two reasons. Number one, you don't have to think about it every day. And number two, it's very effective. And then I think with social media, there is a lot of bad information that these young women take to heart and they think, "Oh my God, if I do this, then that's going to ha ... if I use that method, this is going to happen to me." So look at research online, but also be able to find reliable and factual information. And one website that I wanted to share with you all is called www.whatsnextforher.com. And there's a lot of good information about how to have that conversation around choosing your method. And then also let's learn more about those long-acting reversible methods like the IUD and implant.
Lantigua: Thank you for that. All right. I'm going to ask you another difficult question. What is up with the double standard? Because in our culture, we encourage our boys to be men and go out there and conquer and have adventures and sow their oats. How do you handle that as a practitioner who is both from the culture and also trying to advance the culture around these delicate issues?
Montes: Yeah. I love this question because it's almost like we want to be modern, but traditional at the same time. Right. You know, a lot of times I tell my patients, I want you to bring your husband. I want him to come. I want him to know what his options are.
Once I get them in the room and I say certain methods, like for example, permanent contraception, which is another option, tying your tubes, can be riskier for a woman versus a male having permanent contraception. When I get them in the room and we kind of get down to the nuts and bolts of it, I think they have an eyeopening moment and say, "Okay, maybe this is something that I need to consider for my family."
Lantigua: Hmm. So bring them into the conversation.
Montes: For sure. And I do it all the time and sometimes they're probably like, "Man, Dr. Montes be quiet. I don't want to talk about that." But I'm like too bad, we're talking about it.
Lantigua: All right. Last question is about something that you've touched upon several times, which is disinformation and misinformation. Oh my God, this is one of the things that was the scariest during the pandemic, how much bad intel was circulating through Latino and other immigrant communities during the pandemic. Tell me how this shows up in your practice and tell us how young people can avoid getting caught up in misinformation and disinformation around their reproductive health.
Montes: I have patients who say, "On TikTok, I saw this about an IUD." Or, "On Instagram, there's this about ..." Whatever they mention. And I really, really like to hear those things because then it gives me more information to know what's circulating out there. And that's why I started working with companies, such as Organon to help kind of combat that information and also to have young women realize that everything you see in here on social media is not true. It's not real.
And when you're unsure, even if it sounds like a stupid question, we've probably heard it and the patient right next door to you, before having a conversation with you. So we want to be open and honest and we want to make sure that we're getting all the information out there to you. So you can make an informed decision about your birth control method.
Lantigua: Wonderful. Dr. Montes, thank you so much.
Montes: Thank you. I really appreciate it. And I hope this resonates with a lot of our audience and thank you again.
Lantigua: Okay. Here's what we learned from Dr. Montes today.
Ask questions, ease into a conversation about birth control with a medical professional or a parent, by first asking questions.
Get their thoughts, opinions, and past experiences. Doing so can set a casual tone and can help everyone, including you, warm up to the topic.
Get informed. When it comes to contraceptions, the options seem to be endless. So do your homework and find the one that best fits your own lifestyle and needs. And remember, beware of misinformation. Don't believe everything you hear or see on social media and always consult trusted sources and medical professionals when making decisions about your health.
Monica Lopez:
Thank you for listening and sharing us. How to Talk to Mami and Papi About Anything is an original production of LWC studios. Virgnia Lora is our show's producer, Kojin Tashiro is our mixer, Elizabeth Nakano mixed this episode. Manuela Bedoya is our marketing lead, and Juleyka Lantigua is the creator and host. I'm senior editor, Monica Lopez. On Twitter and Instagram, we're @talktomamipapi.
Bye, everybody, same place next week.
CITATION:
Lantigua, Juleyka, host. “Telling Mamí about My IUD.”
How to Talk to [Mamí & Papí] about Anything,
LWC Studios., September 5, 2022. TalkToMamiPapi.com.