September 2010 – Page 5

Comprehensive Sexual Health

A new article in the Journal of the American Medical Association, authored by Andrea Swartzendruber, who has a master’s in public health and Dr. Jonathan M. Zenilman, calls for a national strategy for improving sexual health. The authors write:

… [T]he United States lacks an integrated approach to sexual health. Public health programs such as sexually transmitted disease (STD)/human immunodeficiency virus (HIV) prevention and family planning are categorically funded and organizationally fragmented, and federal reproductive health programs in the past decade emphasized abstinence. As a result, sexual health indicators are poor. Incidence of HIV has not decreased since the 1990s,1 and rates of STDs, unintended pregnancy, teen pregnancy, and abortion are higher than in many developed countries. “Sexual health” does not appear once in the more than 1,000 pages of the new health care legislation. Nevertheless, the public is keenly interested in sexual health, as evidenced by the uptake of recent medical advances. For example, there are an estimated 17 million prescriptions for erectile dysfunction annually, and 26 million doses of human papillomavirus vaccine have been administered since its licensure in 2006.

Building on the 2001 Surgeon General’s Call to Action to Promote Sexual Health and Responsible Sexual Behavior, we propose that a framework promoting health and responsible behavior can serve as a unifying goal and improve health indicators.

This strategy includes a national public awareness campaign, integration of sexual health services into primary care, comprehensive sex ed, and ensuring funding access for sexual health services (condoms, contraception, and STD testing are issued by name).

In the conclusion, the authors argue that “Politicization of sexual health results in division, bad policy, ineffective programs, and poor health outcomes.” Exactly. Instead of paying for effective programs, funding abstinence-only education, something that has been proven ineffective. I’d love to see us adopt a national strategy that seeks to treat sexual health as part of one’s overall health instead of as a hot-button political issue.

But though investing in STD testing and awareness about more responsible sexual behavior, the study didn’t mention abortion or pregnancy care as part of sexual health care. This is the heart of the problem with arguing for better sexual health education and care. Part of sexual health education and care necessarily includes talking about unintended pregnancy and therefore abortion. As we saw with the Stupak/Nelson debate, abortion is increasingly viewed as somehow separate from other kinds of medical care. Here, it’s left out of the discussion on sexual heath.

I’m all for increasing STD testing and improving access to comprehensive sex ed and contraception. If we really tackled all that stuff in a comprehensive way and really integrated it with the rest of health care, it would have a significant impact on unintended pregnancy. But unintended pregnancy will still occur, even if we have the best sexual health education in the world.

I’m glad that these two authors are arguing for better sexual health education in such a prominent publication. And I understand why the left it out. As abortion has become so politicized, lots of serious people exclude it to avoid getting derailed into an unproductive discussion about abortion. But I want to see us get to the point where abortion access is perceived as part of sexual health — and all medical care.

Making Outpatient Abortion Services a Reality

This is the third in a series of posts coming from the Global Maternal Health Conference in New Delhi, the first conference of its kind. According to EngenderHealth‘s Maternal Health Task Force’s website, ‘Every minute, a woman dies from complications related to childbirth or pregnancy. While most maternal deaths are preventable, poor health services and scarce resources limit women’s access to life-saving, high-quality care.’ Check out the conference’s live streaming schedule. You can follow the conference on Twitter, too: the Maternal Health Task Force and EngenderHealth are @MHTF and @EngenderHealth; the conference hashtag is #GMHC2010.

This guest post is cross-posted from the Maternal Health Task Force blog. Its author, Janna Oberdorf, is the Communications Manager at Women Deliver.

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Every year, an estimated 20 million unsafe abortions take place. And of all maternal deaths, unsafe abortion accounts for 13%. Imagine if we could change that. Imagine if we could make a serious dent in the deaths and morbidities that are caused from botched abortions, from unhygienic surgeries, and from unskilled providers.

Now, imagine if we could change that with a few simple, low-cost pills.

Why a Trend Piece on Small Breasts Is Problematic

The New York Times had a piece yesterday in their Style section talking about A-cup (or smaller) women. The article was written by Catherine Saint Louis who wrote about teen botox not that long ago. I know body image issues (of which breast size is just a small part) are extremely personal, but I find it more than a little odd that the Times decided to write a trend piece on small-breasted women.

Though certainly nearly every woman is insecure about her breasts at some point in her life (or maybe for nearly all of her life) the idea that small-breasted women are marginalized and need to “take back” the idea that they can be attractive is odd, to say the least. Small-breasted woman are almost universally small in other ways, and it would be hard to say that skinny women are marginalized. As we’ve seen, skinny women are usually held up as the ideal and the standard rather than an anomaly.

Let me first say I completely the understand the struggles of being an unusual size — large or small. I’ve been really lucky (privileged, even) that I have an average bra size and my struggle for buying them is more out of laziness and dislike of lingerie departments than it is over a challenge to find something that fits.

But this article is deeply problematic. The story itself starts with a rather poor assumption: “The parade of heaving bosoms in Victoria’s Secret catalogs not only suggests that bigger is better but also that supersizing with a push-up bra is universally desired.” While the models in Victoria’s Secret catalogs certainly emphasize the models’ breasts more (particularly with Photoshop), it would be false to say that Victoria’s Secret is a store that sells bras for large-breasted women, which is what the “heaving bosoms” description seems to imply. I know women whose breasts were too large for Victoria’s Secret. They, like many other mainstream clothing companies, cater to the masses, which means they have a lot of 34B bras and probably not a lot of the larger and smaller sizes.

To be fair, it is worth pointing out that not all small-breasted women want push-up bras — something I’ve heard small-breasted women complain about. Just because a woman’s breasts are small doesn’t necessarily mean she wants to make them bigger.

Some small-breasted women have complained about their small breast size, referencing the 1972 Esquire article, “A Few Words About Breasts” by Nora Ephron. Others, the article says, are proud of their flat-chested status, evidenced by Facebook groups like “Flat Chested and Proud of It!” and “Flat Chested Girls United.”

It’s great that this article is promoting the acceptance of small breasts, but it would be nice if they did the same for large-breasted women. Instead, the article fails to really address that diversity in women’s bodies includes the DD in addition to the AA. The only acknowledgment of such women in the article is “In recent years, as people’s weight has ballooned, breasts (mostly made up of fat) have only gotten larger, and commensurately bra cup sizes, too. K-cups now exist.”

That’s it. K-cups now exist.

Many will probably also take issue with the link of breast size to weight. While there is a correlation between weight and breast size, large breasts are not necessarily and indicator of “ballooning” weight.

The next line: “Brandishing a tiny bosom may be a reaction to that trend.” Um, reaction? Did breast size suddenly become matter of choice and not something related to your overall body size and genetic makeup (or willingness to undergo plastic surgery?). Women don’t just decide large breasts are so over and they’re going to trade in a D-cup for a AA-cup.

We should be focusing on acceptance of all types of bodies — not just offering a round of applause to women with small breasts.

I don’t mean to imply that the struggles of women with small breasts aren’t valid — they are. I’d just like to see the New York Times take on the issues of women with large breasts — of which there are many — with equal vigor. But I’m not holding my breath.

Feminist Heroes

RBG. Mama of all grizzlies indeed.

Fat and Health.

Jezebel posted today on a perennial favorite among feminist bloggers: the BMI. This was prompted by a doctor in the New York Times talking about how useless a measure it is for personal health.

Here’s my response: of course it is. It’s an index. This is what indexes do, they aggregate individual pieces of information to tell you something about a whole. The BMI was never intended to be used as a measure of personal health, but was instead meant to tell us something about entire populations. It’s usefulness on that score remains intact: you can broadly say that, if America’s BMI average is increasing, Americans are getting fatter. Unless it can be explained by something else, like a population-wide protein-shake/weight-training-routine frenzy, which is unlikely to happen.

But here’s what that doesn’t mean: that using your weight as one of the things that assesses your health isn’t useful at all. That’s what Dodai seems to be implying at Jezebel when she says this:

In our society, we’re so quick to call someone who appears to be fat “unhealthy.” But health is not a quality that can be judged or seen with the naked eye. There are thin people who smoke and don’t eat any vegetables. There are obese people — including Steven N. Blair, one of the nation’s leading experts on the health benefits of exercise — who jog every day. You can’t see genetic material, a decaying liver or gingivitis in a photograph.

Can you judge health with a naked eye? It’s true, you can’t. But let’s be honest, there’s not an epidemic of fat runners out there. Those people are outliers, and not everyone is an outlier. I’m with people who argue that we shouldn’t focus solely on weight in public health debates, and that we should be talking about eating better and exercising as a way to promote health without reinforcing, intentionally or not, the notion that some body types are better than others. But, by and large, (pardon the expression) weightier people suffer health problems that are well documented. It’s not that thin people are necessarily fit. It’s that America as a whole is unhealthy, and one of the ways we can document our decades-long decrease in activity is by documenting our expanding waistlines.

In all, this demonization of the BMI is odd. I’m outside my normal BMI range, but I’ve never had a doctor say, “Boy, are you overweight!” I have had doctors ask me what’s happening when I come in for my yearly check-up and my weight’s gone up or down. They’re never concerned when I’ve put on ten pounds; they’re concerned when I tell them it’s because I’ve stopped exercising. Likewise, no doctor talks about my weight when she does routine blood tests, listens to me breathe or feels my glands. I’ve only ever heard doctors talk about the BMI in public health contexts; when they talk about groups of patients or populations as a whole.

At the same time, I hope a doctor would tell me if I’ve put on too much weight and it should cause concern. That’s what doctors are for. Counseling you on the health risks of, whatever. Weight can signal a lack of activity or too many donuts, and that shouldn’t irk anyone. Yet, it does.

UPDATE: Comments to this post are closed, since just about everything possible to say has already been said. Thanks, everyone, for reading and commenting.

Distorting Relationships

This is the fourth in a series examining issues raised by a blog post from Chamber of Commerce Senior Communications Director Brad Peck, where he suggested that women’s interest in closing the gender pay gap amounted to a “fetish for money,” and the subsequent apologies for it by himself and Chamber COO David Chavern. Part 1, Part 2 and Part 3 at the links.

Although Peck’s meaning could perhaps be interpreted differently, one way to read his suggestion that women “pick the right partner” in the context of a post about wages is that if a woman wants to make the “individual choice” to have children, she can compensate for the decreased pay she will receive by picking a husband who earns enough to make up for her depressed income.

Of course, there is a term for a woman whose only interest in a male partner is his paycheck, and it’s not a nice one – gold digger.

Restrictions on Choice in States

Yesterday the Center for Reproductive Rights released a report that gave a deeply depressing rundown of all the ways states have worked to restrict reproductive rights this year. Reading the whole report is worthwhile, but here are the highlights.

There are some major trends in states this last year:

Ultrasound requirements or restricting doctors to read state-mandated language: It seems requiring ultrasounds before women can obtain an abortion are the hot new thing in the states, even though requiring an ultrasound seems to have no effect on a woman’s decision have an abortion.

State Stupaks–a.k.a. exchange bans: The Affordable Care Act, which was passed by Congress earlier this year contained a compromise on abortion coverage known as the Nelson Amendment. That amendment allows states to enact their own bans on abortion coverage in private insurance plans sold through state-based exchanges. As of the writing of the CRR report, five states–Arizona, Louisiana, Mississippi, Missouri, and Tennessee–have enacted bans and two other states, Florida and Oklahoma, have passed bans that were vetoed by the governor.

Personhood and parental notification ballot initiatives: I already wrote about Alaska’s parental notification ballot initiative that was passed by voters last week, but Colorado and Mississippi are both going to be voting on initiatives that would define life as beginning at conception. Colorado will have this initiative on the ballot this fall–possibly aiding in turnout for Republican candidates–and Mississippi will vote on it in 2011. Defining life as beginning at contraception is problematic. The proposed initiative is designed to be a direct challenge to Roe vs. Wade thus defining abortion as murder and miscarriages as involuntary manslaughter. It would also likely outlaw most forms of contraception. Also because changing the definition of “person” would literally affect thousands of laws.

The CRR also has a rundown of what happened in several states this year:

Arizona: Enacted a ban forbidding any public funds from being used to pay for abortions except in cases of rape or incest. This includes all public employees in the state and additionally enacts an exchange ban.

Idaho: Passed a conscience clause for health care providers and pharmacists, allowing them to refuse to provide abortion care, birth control, or emergency contraception.

Louisiana: Passed a law forcing closure of any clinics that are in violation of TRAP laws previously passed by the state. Passed a law excluding physicians that provide abortions from a state fund to defray malpractice costs. Passed an exchange ban. Passed a law requiring a woman seeking an abortion the option to view an ultrasound, hear a description of the image, and receive a printout of the ultrasound.

Mississippi: Passed an exchange ban except in cases of threat to the woman’s life, rape, or incest.

Missouri: Passed a law requiring a woman take a trips to an abortion provider at least 24 hours before she receives her abortion, known as a “two trip” law. At that first visit, she’s required to receive a packet of information that must contain the following sentences: “The life of each human being begins at conception. Abortion will terminate the life of a separate, unique, living human being.”

Nebraska: Passed a law banning abortion at and after 24 weeks with exceptions for the woman’s life or irreversible physical impairment. Passed a law requiring doctors to notify a patient of any possible risk from abortion, fining doctors $10,000 if he or she misses telling a patient of just one risk.

Oklahoma: Passed an ultrasound requirement before a woman may obtain an abortion. Passed a law requiring abortion providers to collect detailed demographic information and publish it online. Passed a law protecting doctors who lie about fetal abnormalities or other information that might factor into a woman’s decision of whether or not to have an abortion. Passed a health care provider refusal law, allowing providers to refuse to perform abortion and other services to patients. Requires doctors to be in the room when a woman swallows a medicated abortion pill. Passed a ban on sex-selective abortion.

South Carolina: Required providers to distribute biased information about abortions to patients before she obtains one.

Tennessee: Requires abortion providers to post large signs that say it is unlawful to coerce a woman into having an abortion. Passed an exchange ban, no exceptions.

Utah: Passed a law making it a crime for a woman to cause her own miscarriage, meaning each miscarriage has the potential for criminal investigation. Passed a law requiring an ultrasound before an abortion.

Virginia: Banned public funds from being used for abortion, including for public employees.

What’s notable about these laws is that most of the action on reproductive rights is on restricting access rather than expanding it. So much is happening on the reproductive rights front at the state level, but it is getting very, very little media attention. Often, reproductive rights activists don’t hear about the legislation until right before or right after the laws are passed. It’s an issue I found so important that I planned a panel about it at the Campus Progress National Conference this summer, featuring Jordan Goldberg, the author of the CRR report. (You can view a video of the panel here.)

Groups like the Center for Reproductive Rights do their best to stay up to date on state laws, but they can’t do it alone. If Colorado passes its personhood definition, for instance, we could eventually be looking at a Supreme Court challenge in a court that’s been unfriendly to reproductive rights. The important thing to remember is that much of the battle over abortion access is happening at the state level.

Local Context Matters to Women’s Lives: A Report from Delhi

This is the second in a series of posts coming from the Global Maternal Health Conference in New Delhi, the first conference of its kind. According to EngenderHealth‘s Maternal Health Task Force’s website, ‘Every minute, a woman dies from complications related to childbirth or pregnancy. While most maternal deaths are preventable, poor health services and scarce resources limit women’s access to life-saving, high-quality care.’ Check out the conference’s live streaming schedule. You can follow the conference on Twitter, too: the Maternal Health Task Force and EngenderHealth are @MHTF and @EngenderHealth; the conference hashtag is #GMHC2010.

This guest post is cross-posted from the Maternal Health Task Force blog. Its author, Sara Stratton, is the director of MNCH/FP programs at IntraHealth International.

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To the business world, it’s location, location, location. Here in Delhi, though, at the Global Maternal Health Conference, the mantra is context, context, context. There are many ways to improve and save women’s lives, but the success of any given intervention depends on local context. What works in one country or one community may not work in another. Many people here are talking about the importance and value of understanding how and why an intervention succeeds or fails at the local level. This means investigating and evaluating not just how widely an intervention reaches or the quality of the services, but also the specific, local factors that play into its uptake and impact. How do these realities affect whether an intervention that saved lives in one place would work equally well somewhere else?

This idea of the importance of the local context became woven into presentations on the first day of this groundbreaking conference. In one session, a representative of the SEWA Rural Society for Education, Welfare and Action, Rural (SEWA Rural) talked about how they had found that in Gujarat, India, a woman’s decision to deliver at home or in a hospital in her last pregnancy often influences where she delivered in a subsequent pregnancy. The question for us all to ponder was raised: is the key to saving women’s lives to encourage them all to deliver in hospitals? If so, how much would this cost? Can governments really afford this now? How far would women have to travel to a hospital? The reality, though, is that for some communities, encouraging hospital- or health facility-based delivery may be part of the answer, but in others it may still be an impractical approach. This question led to a discussion about home delivery versus institution-based delivery—as well as the value of traditional and trained birth attendants.

Whether we are talking about where women deliver, how they deliver, who helps them deliver, what we are really talking about is how we evaluate and minimize a woman’s risk during pregnancy and childbirth. Where distance and a lack of health facilities make facility-based delivery improbable, a community may need programs that improve the quality of care offered by trained birth attendants during a home delivery even though in an ideal world there would be another option. What I’m hearing in Delhi is, in some ways, what I already know. There are no easy answers. We must support communities to succeed within the context of their own limitations in terms of the availability of and access to health facilities and health workers. At the same time, we have to remain committed to helping communities to change these limitations.

Really I Just Blame Facebook

The summer between my freshman and sophomore years of college was simply idyllic. I spent my days working on an ocean-front lobster shack and my nights out around Portland, Maine. I may not have made a lot of money that summer, but I made friends that will last the rest of my life. And I met Earl.*

I was 19. Earl was a 32-year-old line cook. My mother was super pleased.

Looking back, I recognize that Earl was my first love. I had other boyfriends prior to him, but I was devoted to Earl. I know I wasn’t the first waitress he messed around with; I doubt I was the last. That summer he taught me lessons about sex and love that I still carry with me today.

Earl had no plan for his life; he went where opportunities took him. He had grand ideas that I would drop out of college and spend winters with him working at a Colorado ski lodge. I envied his ability to live from day-to-day without set goals and romanticized the idea of dropping all responsibilities and just living life.

Eventually my Type-A sensibilities kicked in and I bid adieu to Earl. As he made his way from Maine back to Colorado he stopped by to see me at college. It was an awkward experience which made me realize how little we really had in common. When Earl pulled out of the gates of my university, I was honestly glad to see him go.

And then, as he should, Earl faded away. That summer and their stories became inside jokes for friends and a way to tease me around new boyfriends. While I always looked back at him and that summer fondly, it was clear that the past should remain in the past.

Until, one Thanksgiving, he added me on facebook.

It took me a few days to approve him. Six years had passed and I was unsure how or why he wanted to reengage. Finally, I relented. We sent some e-mails back and forth and updated each other on our lives. I had finished college and was working for a non-profit communications group in San Francisco. He had driven up to Alaska with his two dogs and lived on a piece of land far removed from any signs of civilization; months passed when he didn’t interact with any humans.

After the initial catch up we lost touch again, and then he sent me an e-mail last weekend. His e-mail prompted me to visit his profile and passively see what was going on in his life.

The discovery shocked me. Apparently he spent much of his recluse life writing epic facebook posts on his opposition to New York’s proposed Muslim Community Center. His posts were hateful, racist and uneducated. I was appalled. I shared his notes with friends, and they too shared my disgust. I thought he must be uninformed about the proposed building and decided to send him a note about his inaccuracies.

People told me not to do it. They told me there is no way to win an argument when the other person has hate in their heart. But I believed that he simply did not understand the facts surrounding the cultural center. I want to be the type of person who stands up for what they believe; who pushes people to look past their own feelings of prejudice. I was sure that a clear-headed factual post could resolve any issues he may have.

As you’ve guessed by now, my post did not resolve anything for him. In fact he responded with more racist and hateful language. A choice quote:

“When they start a Holy War and change America into a Muslim state, I’ll still be their [sic] fighting for your rights. Your [sic] much too pretty to be covered in a veil.”

I wanted to respond again, to really try and help him see how our country had the opportunity to be the very best we can be, but instead resorted to ignorance and hate speech. But I’ve realized (finally) that there is nothing I can do to change his mind. My task now is to resolve how someone so hateful could have meant so much to me at one time.

I’m tempted to subscribe him to the e-mail lists of the ACLU, the Anti Defamation League and the Southern Poverty Law Center. But like my e-mail, I know that won’t do anything to change his mind.

Instead I’ll do what I should have done the day he added me on facebook: leave the past in the past.

*Not actually his name! But, like the hurricane, he needs to go away.

Hostage Situations

Over at The Daily Beast, Beverly Willett writes about New York’s new no-fault divorce laws, using her own divorce to illustrate her point that no-fault laws are bad for families, marriages and society. She sees marriage as a permanent, life-long commitment; when her husband had an affair and tried to divorce her, she fought it. She was able to fight the divorce because of New York’s archaic divorce laws — laws which were changed last month to put the state more in line with the rest of the country. Under New York’s old fault-based divorce laws, a partner filing for divorce had to demonstrate infidelity, cruelty, etc in order to obtain a divorce. Those laws turned divorces into lengthy processes which were often economically and emotionally costly. They required one partner to be a wrong-doer in order to dissolve the marriage; they gave the partner who wanted to maintain the marriage more power than the partner who wanted to leave it.

Marriages are tricky things, and no-fault divorce is certainly not without its draw-backs. There are many situations, like Willett’s, where the man leaving the relationship against his wife’s wishes also controls the purse strings. Willett quit her job to stay home with the couples’ children; her husband leaving the marriage presented significant financial difficulties for her. Women’s work in the home is under-valued in divorce proceedings, and women are often financially harmed after a divorce because courts do not fully recognize the work done at home as “real” work.

As an aside, too, this is why many feminists cringe when we hear marriage promoted as a good way for women to obtain financial security, or when books and articles are published about how smart girls should marry rich, or when we hear conservatives say that being a stay-at-home mom is The Most Important Job In The World For Every Single Woman — being a mother is an incredibly important job, and it is work, but it’s not socially recognized that way. Truly valuing motherhood would require actually valuing it when it comes time to divide dollars — but the people who promote motherhood as a woman’s one and only true calling are the same ones who are quick to turn on mothers who find themselves suddenly single. Those women are selfish gold-diggers if they think they are entitled to half of the marital assets; they didn’t contribute to the marriage; etc etc. If a woman marries and stays at home because she trusts that that’s the best way to a stable life, she may be in for a very nasty surprise if her husband decides he eventually wants out. Marriage, with or without no-fault divorce, is not a guarantee of stability or safety; far from it.

Anyway. The plight of women who are financially insecure when their husbands leave them is very real, and it is a feminist issue.

But the answer is not to handcuff people in marriage.