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Archive for the ‘contraception’ Category

For the first time since our congresscritters launched their attack on Planned Parenthood last winter, I have the feeling that public outrage has risen to a boiling point. The attacks continue, of course, but their extreme brazenness is finally provoking a robust counter-reaction. Maybe I’m just spending too much time on Facebook (and certainly my Facebook friends are far from a representative sample), but the Komen Foundation’s de-funding of Planned Parenthood – and subsequent backpedaling – seems to signal a change in the people’s tolerance of the war on women’s bodily autonomy. At the very least, it showed that millions of pissed-off women could use social media to defend health services for the most vulnerable among us.

Then Obama actually stood up to the bishops and told the insurance companies to cover contraception, period. As Katha Pollitt noted, he finally noticed that American women are more numerous than the bishops. Darrell Issa’s farcical all-boyz hearing on religious freedom contraceptive coverage earned a backlash as furious as the Komen decision’s. As usual, Jon Stewart perfectly skewered the hypocrisy:

Now, after a couple of days of public shaming by silent protestors at the state capitol, Virginia’s governor has been forced to “reconsider” supporting a bill that mandates transvaginal ultrasounds prior to abortion – and (in breaking news) its sponsor says she’ll kill the bill altogether! She claims an attack of conscience. (Yes, a woman sponsored this rapey bill. No, she didn’t have any ethical pangs until it became a national disgrace.) As Jon Stewart put it, the poor governor evidently didn’t realize the procedure is “like a TSA patdown for your vagina.”

Hey, we’d better not give the TSA any new ideas.

I’m also tickled pink at state legislators’ over-the-top proposals to regulate men’s bodies, for a change. Virginia Senator Janet Howell countered the transvaginal-ultrasound madness with a bill that would’ve required rectal exams before a man could be prescribed an ED drug. In Oklahoma, Senator Constance Johnson proposed (then withdrew) an amendment stating “any action in which a man ejaculates or otherwise deposits semen anywhere but in a woman’s vagina shall be interpreted and construed as an action against an unborn child.”

Now, Georgia Representative Yasmin Neal has put forward a bill to sharply restrict vasectomies: “It is patently unfair that men avoid the rewards of unwanted fatherhood by presuming that their judgment over such matters is more valid than the judgment of the General Assembly. … It is the purpose of the General Assembly to assert an invasive state interest in the reproductive habits of men in this state and substitute the will of the government over the will of adult men.”

It’s high time someone stood up for spermato-Americans!

Of course, no one’s seriously out to punish men. These legislators just put anti-choice laws through the Regender translator, instantly exposing their absurdity and cruelty. It’s telling that these mock proposals hold the power to shock, while anti-choice legislation remains business as usual. Georgia, for instance, is weighing one-to-ten-year jail terms for abortion after 20 weeks – which last I heard was still constitutionally protected under Roe v. Wade.

I’m hopeful, though, that these extremist proposals are galvanizing a majority that will force extremist legislators to back down. But not just yet. Let them keep horrifying every voter who’s ever used contraception. Maybe we can throw out all the Tea Partiers and Blue Dogs, come November.

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In my previous post, I promised I’d deal with feminist ethical objections to delving into the veracity of Palin’s claimed pregnancy with Trig. Is it illegitimate to ask questions about a candidate’s reproductive history? Are we invading Palin’s privacy, down to her very uterus?

The arguments for backing off from the tale of Palin, Trig, and her alleged Wild Ride fall into two main categories. (Let me know if you can think of others.)

1) Palin and especially her children deserve at least a modicum of privacy.

2) It’s always anti-feminist to second-guess women’s choices in childbearing and mothering.

On 1) privacy: As I mentioned in my last post, it’s standard operating procedure for presidential and veep candidates to disclose their medical records. While I would object strenuously to laws and policies that demanded the same of grocery clerks and accountants and locksmiths and (yes) college professors, the presidency isn’t just any job. There’s a reasonable case to be made for the citizenry knowing whether a candidate has a condition that might render her or him incapable of serving or exercising good judgment. We should have known, for instance, that Ronald Reagan was experiencing symptoms of Alzheimer’s.

We expect this disclosure of all candidates for the presidency and vice-presidency. Why should Palin get a pass? Why should her records remain private? Is it justifiable simply because she has a uterus? That would be sexist in its own twisted way, wouldn’t it – throwing us back to the days when ladyparts were still “unmentionables”?

Now it’s rather late to demand medical records be released, since Palin is no longer a candidate. But I think it’s still fair to say that Palin would have set the record straight on Trig’s birth, one way or another, had she only behaved like other candidates back in October 2008. Instead, she substituted secrecy for transparency (which didn’t surprise many Alaskans). She was nominated without any real vetting by McCain’s people, and they built an opaque wall between her and the press. She guarded her secrets while piling up lies. It’s not surprising that quite apart from Trig’s birth, the contents of her medical records would become subject to speculation.

Concern for the privacy of the Palins’ minor children (which included Bristol in 2008) is a legitimate and noble cause, one that I’ve consistently espoused. Let’s be clear: None of the brouhaha around Trig’s birth is actually about Trig. It’s about Sarah Palin.

The Palin children’s privacy has been breached, all right, but this has been almost entirely Sarah Palin’s own doing, apart from Bristol’s own self-promotion as a (*cough*) abstinence advocate. Who chose to use Trig as a political prop? Who decided to out Bristol’s pregnancy to the world instead of directly laying to rest the rumors about Trig’s birth? (Let us be clear: Bristol’s pregnancy in fall 2008 did not prove Sarah gave birth to Trig; it only made Bristol an unlikely mother to Trig unless he had actually been born earlier in the winter of 2008.) Who carried on a public feud with Levi Johnston’s family (which ultimately involved Palin’s grandson Tripp)? Who signed her family up for a reality TV show?

Mind you, I disapprove of the Gosselins and Duggars, too, for televising their children’s childhood. It’s just that none of them are running for president.

On point 2) – reproductive choice and trusting women – Melissa McEwan writes:

Birtherism, in which both conservatives and liberals are engaging, is a terrible and intrinsically misogynist game to play, entirely dependent on a belief that policing women’s bodies and reproduction is an acceptable recreation.

Actually, what’s going on here is not policing Sarah Palin’s body. What’s truly at stake is not what or who came out of her uterus. It’s what came out of her mouth. It’s her self-contradicting statements and outright lies.

McEwan tosses out a straw man when she says mockingly that the only acceptable evidence for “Trig birthers” would be video of Trig emerging from Palin’s vagina. Of course that’s silly. On the other hand, medical records showing that Palin truly was pregnant, underwent amnio, and gave birth when she claimed – well, that would be pretty darn conclusive. The unreasonable few would continue to hatch conspiracy theories. The rest of us – people like me and Litbrit – would say great; case closed; let’s carrying on dissecting why Palin, Bachmann, Trump, Santorum, and Co. are a danger to the United States. Andrew Sullivan would back off it too and devote himself more fully to his irrational quest for fiscal austerity. (Hmm, that’s one good argument for keeping the mystery of the Wild Ride alive.)

As I’ve written before, if Palin’s account of the wild ride is true, it displays epically poor judgment. By her own account, she board not one but two long flights after her water broke, without even stopping for a check-up before she left Dallas.

The party-line feminist response is: trust women. And I agree, we have to do that. Generally, women are trustworthy. That presumption underlies any pro-choice position on reproductive rights.

But what happens when a woman (or a man!) is reckless? What happens if a mother (or father!) makes egregious choices? Are we obligated to suspend judgment?

The consensus at both Shakesville and Feministe is that you turn in your official Feminist card as soon as you question the wisdom of anyone’s parenting or reproductive choices, no matter how irresponsible they may be.

Really?

To take a more extreme case, do I have to agree that it’s hunky-dory for a woman addicted to heroin and meth to have one baby after another, only to have them taken by Child Protective Services? As a matter of fact, I think it’s a pretty terrible situation. What makes me pro-choice is that I don’t want that hypothetical – but all-too-real – woman to be thrown into jail (as South Carolina has done, repeatedly, with pregnant women of color who are addicts). I don’t want her to be forced or coerced into Depo-Provera shots or Norplant. I do want the people who provide her prenatal and birth care (assuming she gets any) to compassionately counsel her about treatment programs. I want drug treatment programs to be abundant and free, so that no barriers prevent pregnant women from using them – unlike the many programs that have historically refused to admit expectant mothers! I want her caregivers to kindly and non-coercively explain her birth control options, including the potential benefits of long-term contraceptive methods (both the IUD and hormonal methods). I want her to have free access to birth control. If her children must be placed for adoption, open adoption should be the default unless there are very compelling grounds to separate the children from their birth mother.

That is a pro-choice position. I do see a need to exercise judgment. I do assert that childbearing while in the grips of an addition is a Bad Idea. Abandoning judgment, in such cases, would be abandoning responsibility. What makes this position pro-choice isn’t a refusal to judge; it’s rejecting punitive and coercive measures.

Now, Sarah Palin obviously is not comparable to a poor drug addict (unless you want to call power an addiction). Palin lives in a realm of privilege that insulates her kids, to some degree. CPS is not about to seize them even if she and Todd serve them Lucky Charms with crystal meth sprinkles for breakfast.

But the basic question still stands: Must feminists withhold judgment when a woman – or man! – makes reproductive or parenting decisions that are grossly unwise? Does it make us anti-choice to say that even though a woman has the legal right to implant eight embryos into her womb, it’s nonetheless an über-crappy decision? Does it make us anti-choice to say that medical evidence unequivocally shows that smoking is worse than crack for a developing fetus, and so every effort must be made to help expectant parents (not just mothers!) stop smoking?

And is it really anti-choice to say that Palin’s decision to fly home after her water broke not only potentially endangered her and Trig, but also exposed the whole plane to the risks of an emergency landing? I’m not saying “There oughtta be a law,” just that it was a piss-poor decision.

Again, this is not policing Palin’s uterus. This is questioning what went on in her brain. And if she runs again for POTUS, her brain is the organ that ought to concern us.

The good mother/bad mother dichotomy is still used as a cudgel. It’s one that feminists should always regard with deep suspicion.

But sometimes, bad mothering – and importantly, bad parenting – is egregious. When it occurs in politicians who position themselves as paragons of family values, it’s reasonable to ask about their general judgment and scrutinize them for hypocrisy. So while I regard it as out-of-bounds to criticize Todd and Sarah Palin for the fact that Bristol became pregnant, I do think it’s fair to criticize how they handled it in the national spotlight. When the Palins announced Bristol’s pregnancy instead of debunking the Trig rumors head-on, both parents threw their eldest daughter under the bus. (It was Sarah and her political who made that decision, but the First Dude was part of that inner circle and I’ll bet he could have vetoed it.) Similarly, it’s understandable that Sarah Palin would have kept her pregnancy quiet until late in the game. Most women who work for pay realize that they may be seen as less competent and committed once their pregnancy becomes public, and that goes doubly for female politician. What’s not reasonable is boarding a plane without any idea how imminent labor might be after leaking amniotic fluid.

If wanting politicians to exhibit sound judgment not just in public life but as private individuals – and yes, as parents – makes me an anti-feminist, so be it. Just let me know where I should turn in my F-card.

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I’ve got to disagree with Clarissa on this one: It’s not fair to equate pregnancy with a hangover (even if the nausea can be similarly overwhelming). Specifically, a student who misses class for pregnancy-related disability should not be treated the same as one who misses due to oversleeping or a hangover.

But let’s back up. Clarissa was responding to a post by The Feminist Breeder on prodromal labor, in which TFB also mentioned that she was feeling crappy enough in her 40th week of gestation that she just couldn’t hang with her college-degree program. Here’s the bit that set Clarissa off:

I have to keep going to class until I’m really in labor, and school is pretty far away.  My Tuesday class is a reasonable half hour away, but my Wednesday class is 90 minutes away in traffic.  If I started hard, active labor at school, I have no idea what I would do.  Also – get this – I left class early last Tuesday because I was so sick I couldn’t see straight, and my professor actually had the balls to dock me 20 out of 25 possible Participation points just because I had to leave.  Clearly she’ll be docking me ALL 25 Participation points for each class I miss while I’m doing a silly little thing like trying to have a baby, so I cannot take off a single extra day other than what is absolutely necessary.  (And yes, I am SOOO writing a letter about that.)

Now, I think jumping straight to a letter to college administrators, rather than trying so say, talk to her prof, is pouring gas on the flames. If a student has a beef – especially an adult student like TBF who’s got the cojones and verbal skills – she should first talk to the the instructor, preferably when she doesn’t feel on the verge of hurling. Personally, I would be much more receptive to a conversation than a formal complaint. Going slow offers a chance to preserve the student-teacher relationship as a collaborative one. Going directly to the administration strikes most teachers as an act of aggression (which is why I’ve never done that to my kids’ teachers, even when it might have been warranted). Often, too, the instructor will cool down and reassess a rash decision, opening the gate to a reasonable compromise. If not, there’s still time to write a scathing letter, though I suspect TBF, who could very well be in labor as I write this, felt the hourglass was empty (prodromal labor has a way of remininding one of the clock). And so I understand perfectly why she might skip negotiating and just lodge a formal complaint.

That said, I just can’t sign on to Clarissa’s reaction:

There is no doubt in my mind that her pregnancy is very special to this woman. It must also be very special to her relatives and friends. For strangers, however, of which her professor is one, it is neither more nor less special than another student’s hangover. Both the pregnancy and the hangover are the results of the choices these students made as adults. In my capacity as an educator, I don’t think it’s my place to judge whose choices are more legitimate and deserve of greater consideration. All I need to know is that the student wasn’t there and, as a result, didn’t manage to participate.

This is a false conception of “fairness.” As my friend Moonglow (who just happens to be the mother of a brand-new daughter, yippee!!!) told me today: “I never promise my kids that I’ll treat them all equally. But I do commit to treating them all fairly. That means knowing what each of them needs and when they need it.” (And if I misquoted you, my dear, please blame it on the delectable distraction of brie with fig jam.)

Much the same goes for my students. Last spring, a student of mine landed in the ER with appendicitis and only appeared two weeks later (full documentation in hand). I’ve had multiple students felled by mono, over the years. I’ve had students come to me with serious mental health issues (sometimes exacerbated by the portion of my syllabus dealing with sexual violence). I’ve had students totter to class on crutches due to slippery messes in the dorms. I’ve had students with arms in casts due to (ahem) barroom brawls.

I am not happy about the last category of problem – injuries that result from drunken stupidity – but I am grateful for those students’ frankness. And once a student acquires a disability, don’t I have an obligation – both human and feminist – to accommodate it? Would I not be a monster to mark down a student on participation just because his appendix tried to kill him? How could I live with myself if a student went into a spiral of depression, and I exacerbated it with rigid expectations of attending every single class meeting?

Last year, I had a graduate student announce to me that she was likely to give birth within the next couple of weeks. I was dumbfounded. I hadn’t even noticed she was pregnant, only that she’d put on a few pounds. (That alone should’ve given me pause, because I tend not to notice even major changes in people’s shapes. I’m obtuse that way.) The very next class meeting, she was absent, because she’d just come through labor. A week later, she showed up for class, her iPhone brimming with baby pictures. She worked very hard not to let her pregnancy interfere with her coursework, but I certainly could have found ways to accommodate her if she’d asked for more time off.

There’s an easy, pragmatic, fair solution to most of these situations. Exempt the student from work missed (as long as it’s not a major project) and weight the rest of their grade more heavily. This little trick works as well for a pregnant student as for anyone else struck by unexpected disability. The student does pay a small price, in that there’s more pressure on the rest of their work and less opportunity to dilute a crummy grade. But it’s a fair price that makes allowances for the fallibility and vulnerability of our flesh. However much a university might pretend that we’re all disembodied brains, in the end those brains still rely pretty heavily on their whole-body support systems.

I guess I’m a bit of a feminist-Marxist on these issues: from each according to hir ability, to each according to hir needs. That doesn’t mean abandoning all standards. It simply means realizing that life intervenes. Death intervenes. And all kinds of other shit – good, bad, and ugly – intervenes, too. Students are whole people, often needy people, coping with lives more complicated than we instructors often know. They cannot be reduced to their throbbing-in-a-petri-dish brains (or pickled-in-a-game-of-beer-pong brains, either).

This isn’t a matter of trusting my students. (Mostly they deserve my trust; sometimes they prove that they don’t.) It’s a matter of trusting my own judgment. I trust myself to distinguish between the student who couldn’t turn in her final paper on time due to strep and the one who added my class late, then fell asleep in the back row after a mere three minutes! Hey, at least he zonked out so fast I couldn’t take it personally; there was no time for me to bore him to sleep.

This is also an arena where I have to live true to my principles. Any feminist ought to be committed to disability rights. Heck, even Sarah Palin (a nightmare feminist, but a feminist nonetheless, in my book) at least pays lip service to disability rights. You cannot honor human rights without acknowledging that most of us, if we live long enough, will eventually live with a disability. You cannot work toward gender justice but then insist it’s only for those of completely able bodies and minds. What does that mean for me, practically speaking? If a student is struggling to achieve with a disability – of any sort, be it a physical, mental-health, or learning-style condition – it’s my job as an educator, feminist, and mensch to help them perform at their peak, on as level a playing field as I can cobble together.

But hey – isn’t pregnancy a natural, healthy condition? Well, for all the work that women’s health educators, natural childbirth advocates, and feminist historians have done to unseat the idea that pregnancy = disability, we do childbearing women an awful disservice if we insist that pregnancy never spawns disability. Most of us suffer at least debilitating fatigue. Most of us have stories about how we nearly ralphed at work. My students from fall 2002 and winter 2003 – when I was gestating the Tiger – can consider themselves lucky that I maintained a barf-free classroom. And I got off easy, compared to my friends who landed in the hospital, hitched to an IV, after weeks of incessant vomiting.

If you care about women, you must care about mothers, and thus you must be willing to honor pregnancy-related disability as real disability. And yes, pregnancy usually results from a planned, voluntary choice, these days, but not always; women still find themselves pregnant against their will, and they still sometimes decide to carry out a surprise pregnancy, even with the option to terminate. Anyway: Should I only make allowances for students’ injuries if they can prove that, say, the other guy started the fight, or the other driver broke the law? And do I really want to start interrogating a pregnant student about why she and her partner didn’t both get sterilized before they ever had sex (after all, every other contraceptive is fallible), or why she didn’t terminate the pregnanacy early on? That way lies fascism.

To be crystal clear – and fair! – Clarissa doesn’t advocate bare-bulb interrogations. She instead argues that one should never cut students slack when their free will contributed to their inability to participate; that a class missed due to a hangover is no different than one missed due to pregnancy symptoms, because in both cases, “choice” was involved. I trust Clarissa enough to believe her when she says she’s a good teacher – and actually, I trust that in a few more years, because she’s smart and tuned in to her students, she may very well trust herself to draw finer-grained judgments, which just might put the pregnant students in a different category from the hardcore imbibers.

But this other extreme – harshly penalizing pregnant women for making a “lifestyle choice” that most couples eventually make (but predominantly women  pay for) – sets feminism back a couple of generations. It tells women, “It’s fine if you want to compete with the men – as long as you’re just like the men!” Didn’t we leave that trap behind us in the ’80s, along with big hair, shoulder pads, and Tears for Fears?

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As of this writing, our so-called leaders are still engaged in budget brinksmanship. Alternet called it correctly: This is the Republicans applying shock doctrine. They are doing their damnedest to break democracy. They’re such patriots that they’re willing to delay paychecks reaching our already-underpaid rank-and-file troops.

The Tea Partiers, in particular, are willing to hold our government hostage to their unhinged plan to defund Planned Parenthood.

For the Tea Party, this seems to be a win-win. If they get to defund Planned Parenthood, they’ll have achieved an unimaginable victory in their war against women’s bodies, which otherwise the Senate would block. If they get to shut down the government, then it’s party time. Woo hoo! We’re gonna party like it’s 1995!

A lot can happen in 16 years of politics. Since Newt Gingrich threw his slimy wrench into the works, we’ve had presidential blowjobs, welfare reform, the rise (and now fall?) of the DOMA, hanging chads, Enron and Bernie Madoff, 9/11 and the security state, at least three U.S. wars (that we know of), torture and secret prisons, an economic meltdown, election of our first black president, the rise Mama Grizzlies, pistols at Tea Parties, the attempted assassination of a congresswoman, and gallons of Boehnerian tears. Oh, and a substantial portion of the present electorate was still in the Blues Clues or Britney Spears demographic in 1995, and they have no memory of Newt’s machinations.

Even Newt’s own memory seems to have blurred. In the late ’90s, the conventional wisdom held that the shutdown hurt the Republicans, making them look like the extremists they were (and are), and paving the way for Bill Clinton’s re-election. Back then, the Newtster concurred with with this view. By now, though, he’s hyping the shutdown threat as a positive, viable tactic for his comrades.

The Tea Partiers are practically drooling over the prospect of a shutdown. What more dramatic way to demonstrate their small-government cred to the voters back home? What better way for Rep. Mike Pence to show that women’s bodies are expendable that he really, really hates abortion? Sure, some of us will see it as childish and irresponsible to practice blackmail and hold women’s health hostage. We are the same people who already found the “me-first, me-second, and me-third” attitude of the Tea Party childish and irresponsible. (Not to mention cruel.) We are the same people who know that the Planned Parenthood funding in question cannot legally be used to subsidize abortions.

For Tea Party supporters, though, a shutdown is red meat.

As I write this, the talking heads on MSNBC are discussing whether John Boehner can deliver on a potential compromise deal that may have been hammered out behind closed doors this evening. My take on it: I don’t think he can. As right-wing as Boehner is himself, his Tea Party colleagues are neck deep in anti-government, anti-woman ideology. They see this as a matter of principle. They perceive, again, a win-win.

So I fully expect a shutdown. My hope is that the party will end as it did in 1995: with a lose-lose for the Republicans, who will look petty and extreme. (Which is, of course, exactly what they are.) In any event, the Democrats have already made such deep concessions that no one will be dancing. The compromise already reported includes the $33 billion in domestic spending cuts that Republicans have demanded.

What do y’all think? Will the shutdown happen tomorrow? Will it be deferred ’til later? Or will Captain Boehner deliver?

And is there any hope that Obama would veto a package that included the demolition of Planned Parenthood and/or the full $33 billion in cuts? Remember: The 1995/96 shutdowns only occurred after President Bill Clinton vetoed the heaping pile of a budget that the Republican Congress sent him. Obama frequently tries to frame himself as Reagan’s successor, but it’s Clinton who learned from Reagan not to negotiate with hostage-takers.

Update, 4/8/11, 12:15 p.m.: Maddow had a great segment on the potential shutdown tonight, arguing that unlike the mid-1990s, there’s no high-profile Republican to take the heat, as Newt did in 1995/96. I am now feeling like the game may be lose/lose, after all.

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Here’s an item from the annals of “no shit, Sherlock!” science: A UCSF study shows a stunning decrease in unintended pregnancy and abortion when women are dispensed a year’s supply of birth control pills at once. What’s stunning is not the basic trend line, but the magnitude of the study’s findings. Science Daily recaps it:

Researchers observed a 30 percent reduction in the odds of pregnancy and a 46 percent decrease in the odds of an abortion in women given a one-year supply of birth control pills at a clinic versus women who received the standard prescriptions for one — or three-month supplies.

Can I rephrase those numbers? Pregnancy declined by nearly a third, and abortion by nearly half!

This is such an an simple yet elegant idea, you’d think it would have occurred to someone decades ago. It’s also a politically charged idea in an era where Planned Parenthood is having to fight for its very existence.

Insurance usually issues a maximum of a three-month supply of any medication, including birth control pills. This is true even for medication that people clearly have to take for the rest of their lives, such as thyroid pills. (I haven’t been on the Pill in years, but I still sometimes come close to running out of my thyroid meds.) The situation is often tougher if you have to buy the Pill through a community clinic:

The findings of this study have implications for women using oral contraceptives across the country. Most oral contraceptive users in the United States get fewer than four packs at a time; nearly half need to return every month for resupply, according to a 2010 study published in Contraception.

Obviously, the requirement to physically show up at a clinic is most likely to hit poor women – and it will be most onerous precisely for these women, whose low-wage employers are unlikely to grant them time off for medical matters. As is so often the case in reproductive health, this is a social justice issue. I really hope this study will get the attention it deserves.

I adore this quotation from the project’s principal investigator:

“Women need to have contraceptives on hand so that their use is as automatic as using safety devices in cars, ” said Diana Greene Foster, PhD, lead author and associate professor in the UCSF Department of Obstetrics, Gynecology and Reproductive Sciences. “Providing one cycle of oral contraceptives at a time is similar to asking people to visit a clinic or pharmacy to renew their seatbelts each month.”

Of course, some Americans object to seatbelt laws – and even seatbelt use – as an infringement on their liberty. But I’m not talking about laws to require use of the Pill; I’m only saying that women should have access to it.

While we’re on the automotive analogy, isn’t the Pill more like a reliable set of brakes?

And wouldn’t the conservative attack on access be akin to sabotaging someone’s brakes?

 

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This week I’m reading Michelle Goldberg’s masterful The Means of Reproduction: Sex, Power, and the Future of the World with one of my classes. In it, Goldberg traces the history of foreign aid for women’s health – especially reproductive health – from its Cold War, Rockefeller/Ford/Guttmacher beginnings to the present era.

In 2011, well into the second decade after the UN International Conference on Population and Development in Cairo, you’d think we’d be well along the path blazed there: foregrounding women’s need for education and autonomy. Nuh-unh!! Instead, the proponents of women’s reproductive autonomy in developing nations and the Global South face constant friction and opposition from groups funded by the Radical Christian Right in the U.S. This trajectory toward radical rightwing interference is lucidly, chillingly described in Goldberg’s book. It’s as though women’s bodies became a proxy war for the tensions over reproductive rights and justice back here in the U.S.

And now, with the House of Representatives today voting to defund Title X funding, that proxy war has come home. For details, see excellent recaps by Lindsay Beyerstein and Jill Filipovic. The legislation wouldn’t affect abortions – except to inflate their numbers by making birth control less accessible to poor women and young women. No, the target here is broader. It’s a war against all women, but especially those who are poor.

When I was young and underinsured, I too turned to Planned Parenthood, and I’m forever grateful for their services. Some women are transiently poor, like I was. Many struggle with poverty throughout their childbearing years. All of us deserve affordable access to basic services like a Pap test.

I believe this even though – or especially because! – I had a few dodgy Pap test results in my early twenties. Those diagnoses of “cervical dysplasia” scared me. Cone biopsies were threatened. The cellular abnormalities resolved on their own, as HPV usually does. Had I progressed toward cervical cancer, Planned Parenthood might well have saved my life.

All women deserve preventive care, and that includes the prevention of pregnancy. This is sooo not rocket science.

Odds are good that the Senate won’t stand for the House’s crap. Still, I’m appalled that a majority in the House signed onto it. While some members may try to hide behind a figleaf of fiscal responsibility, that’s balderdash, as Amanda Marcotte argues:

Of course, rhetoric that attacks federal funding for contraception as a state-subsidy for promiscuity obscures the fact that continuing Title X is one of the more fiscally sound things the government can do: Research from the Guttmacher Institute demonstrates that every dollar spent on family planning saves the government four dollars down the road.

(Read her whole piece – it’s excellent.)

No, this is strictly culture war ammo, just as the Mexico City rule and all the other right-wing meddling into brown and black women’s bodies has to do with ideology and misogyny – not fiscal soundness.

This is merely the continuation of funding politics imposed on the “Third World” – now aimed at women that Chandra Mohanty once called the “Third World” in the United States. This is the redirection of contempt for brown and black women’s bodies to those women living within U.S. borders. Women like me – white, securely middle-class, employed, insured, and slouching toward the end of my reproductive years – will be just fine. It’s poor women of color who will suffer. College students who can’t tell their conservative parents that they’re on the pill. Appalachian women lacking any form of health insurance.

Senate? The ball’s in your court. Please show us that you consider women human beings whose health is as important as men’s – who should have a chance to participate fully in society – and who should not be written off if they lack racial or class privilege.

In the clip below, Michelle Goldberg suggests that the U.S. culture wars have affected women outside the U.S. more profoundly than women here at home. Up until now, she’s been right. As to the future? Well, that might just be up to the Senate.

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Gratuitous flowers for a sex post: Cascading morning glories captured by me, Sungold, in October, back before the frost bit ‘em.

The Denver Post ran an article today asking why an arousal-booster for women called Zestra can’t find TV stations willing to run their ads, even as Viagra ads are literally driving in circles around us. Historiann took the article to task for its casual disavowal of feminism, and I’ve got nothin’ to add to her critique except a vigorous nod of approval. Figleaf chimed in to say that the stations’ ad policies spotlight the illegitimacy of autonomous female desire.

What most struck me about the article, though, was its conflation of libido and arousal, which is endemic in “science writing” that reports on “pink viagra.” Here’s how reporter Mary Winter framed it:

Now, you would not know it from the $300-million annual ad campaign for erection-enhancing ads for Viagra, Cialis and Levitra, but women suffer more sexual dysfunction than men do — 43 percent to 31 percent, according to the Journal of the American Medical Association.

In other words, the potential market for flagging female libidos is huge. But here’s the irony: When the makers of Zestra went to 100 television networks and stations to buy ads, the vast majority refused them. The few stations that did take their money would run the ads only after midnight or during the daytime.

The stations “told us they were not comfortable airing the ads,” Zestra co-founder Mary Jaensch told “Nightline.” The double-standard here — men, you deserve sexual pleasure, and women, what’s wrong with you hussies? — is breathtaking.

So how about this ad: a Camaro, a woman, and a vibrating driver’s seat?

(This is just the end of the article; read the whole thing here. Winter is very sharp and witty on the Viagra ads!)

In a way, it’s unfair to pick on Winter, because most writing about female sexual dysfunction fails to draw basic distinctions between arousal, orgasm, desire, and libido. It also tends to ignore the reality of the physical pain some women experience (which K has explored eloquently at Feminists with Female Sexual Dysfunction.) In practice, women can of course have issues with any or all of the above, and problems in one area can easily spill into another. A woman  suffering from vulvodynia, for instance, might be able to orgasm, but if sexual activity hurts, that’s likely to dampen her libido. Another woman might have a generally low libido (meaning she doesn’t crave sex very often) but develop desire responsively to her partner, at least in certain situations. There are probably as many variations as there are women.

Now, getting back to Zestra and the Denver Post: Winter’s article refers mainly to libido. She’s partly on the right track, insofar as that “42 percent” figure refers mainly to women who complain about low libido. (Some feminists have criticized that figure as too high, but let’s set that debate aside for today.) Winter does hint at the primary issue here – arousal – in that apparent throwaway line about a vibrating driver seat in the Camaro. Why yes, I think quite a few of us gals might enjoy such a ride! But if we got a good buzz per gallon, that wouldn’t mean our libido was revving – only that our engine was purring smoothly.

Libido is not the primary target for Zestra, though Zestra’s website refers to a whole host of potential benefits: stronger libido, greater satisfaction, more earth-shaking orgasms, and a more harmonious relationship with one’s partner. (That last point comes up only in testimonials; the overall tone of the website is “try this for yourself,” not “use this to please your long-suffering husband.”) It’s being marketed to women who suffer from sexual problems of any sort due to illness (including cancer), postpartum changes, menopause, antidepressants, stress, and even widowhood. But what does it really do?

Zestra’s primary mechanism, as far as I understand it, is to enhance arousal and response during sexual activity. As far as I can see without having tried it myself, it looks like it might increase engorgement and/or creaste prickling sensations in a nice way. In the best case, yummy sensations start a cascade of increasing desire during lovemaking. As a topical agent applied directly to one’s ladyparts, Zestra doesn’t act directly on libido, which is regulated by the brain and a complex dance of different hormones and neurotransmitters (including estrogen and testosterone, but also thyroid hormone, stress hormones, dopamine and lots of other nifty “messenger” chemicals). A topical gel won’t directly influence that chemical brew. It’s only logical, though, that if sex is more pleasurable, some women might want it more. Biological anthropologist Helen Fisher has written about how hot sex with a new partner gives us a dopamine high akin to cocaine (quick summary of her ideas here). Maybe hot sex with in a newly reinvigorated relationship can give us the same buzz?

Also, the testing for Zestra relied on women who committed to have sex eight times in a month, so it’s unlikely many of them had a super low libido. (For more details on the testing, check out the clinical study.) These women were already open to regular sex. As a group they sound to me more like women who basically like sex but were frustrated by difficulty getting aroused. They don’t sound like the subset of women who’ve given up on sex – a group that constitutes about 15% of American marriages, by the way. (This according to Tara Parker-Pope in the New York Times, where “sexless” was defined as no sex at all with one’s spouse during the previous six to twelve months.)

In other words, the mechanism behind Zestra appears to be entirely different than flibanserin, an orally-administered drug recently rejected by the FDA for ineffectiveness. Flibanserin was supposed to increase libido directly by changing one’s brain chemistry. It too was compared to Viagra, and quite wrongly so: Viagra targets a mans plumbing, so to speak. It produces an erection (though it almost always requires mental and/or physical stimulation to be effective). Flibanserin left physical arousal untouched while aiming to increase psychological arousal and desire.

Calling flib a “pink viagra” was just misleading. In the case of Zestra, the comparison appears more apples-to-apples, since both Viagra and Zestra appear to work by increasing engorgement.

I still think it’s too bad that flib flopped. Yes, the drug was intended to be a Big Pharma Bonanza. I don’t really give a shit. If it had really helped women live better, I’d be all for it. I trust women to make decisions about their bodies (though I also insist on our responsibility to understand our bodies. At any rate, flib failed to gain FDA approval because it didnt work.

As far as I know, there’s still nothing  on the market that specifically helps women who only desire sex once in a blue moon. For some women, hormone therapy (sometimes including testosterone as well as estrogen) delivers a libido boost. But hormones carry some risk. Women fear breast cancer if they take estrogen and they fear growing a beard and unibrow if they take T. But these are the choices, because there’s no drug that specifically targets libido.

Zestra interests me because it seems to be quite safe (worst side effect: transient burning sensations in some rather precious real estate). I’m skeptical to the extent that their studies are pretty small. Unavoidably, the very fact of running a study is an intervention in itself. This can have real effects on its findings. How many of the couples studied would have had sex at least eight times in a month? If most would’ve had less, that means Zestra wasn’t the only independent variable. Perhaps the twice-weekly commitment, combined with a new toy or just wall-to-wall pictures of George Clooney and Jon Hamm would fire their engines just as well. I’m pretty sure I’d be off and roaring on that program! (Where do I sign up?)

Seriously, I have been meaning to try Zestra just for the fun of it, since it sounds like its potential benefits might not be limited to people suffering from difficulty with arousal … and, y’know, anything for science! I’ve got a packet of it in a drawer but I’m not so sure what my lab partner would think.

As always, I’m very curious if any of you out there in bloglandia have given Zestra a whirl? And if so – are you willing to dish? Pretty please?

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You probably caught the story a couple of weeks ago about Dubya seeing the remains of his mothers’ miscarriage in a jar. As New York Magazine reported:

After Barbara Bush suffered a devastating miscarriage, “she said to her teenage kid, ‘Here’s the fetus,’” [George W.] Bush told [interviewer Matt] Lauer, “gesturing as if he were holding the jar.” According to the Post, Bush says he got special permission from his mom to recount the private incident in print. Lauer reads an excerpt from the memoir where Bush, who had to drive his mother to the hospital, wrote, “I never expected to see the remains of the fetus, which she had saved in a jar to bring to the hospital.” In the interview, he tells Lauer, “There’s no question that affected me, a philosophy that we should respect life,” adding that, “[The anecdote] was really to show how my mom and I developed a relationship.”

As Knitting Clio explains, it’s actually not surprising that Bush mère and père were pro-choice, like other Republicans of their day. Dubya thus couldn’t claim a lifelong affinity for the anti-choicers. Given his fondness for conversion stories (e.g., the tale of how he was saved from alcoholism), it makes perfect sense that Dubya would present a dramatic tale to explain his departure from the family’s pro-choice legacy. Bush Jr. has denied that it was meant as a political morality tale, but it’s been received as one anyway.

What I originally found astonishing about the story was Barbara Bush’s apparent presence of mind. How many of us, in the midst of a miscarriage, would think to catch the fetal remains and put them in a jar? Grisly as it may sound, the remains might have been medically useful, indicating whether the miscarriage was complete, though I imagine her doctor performed a D&C regardless. I thought this was mildly strange but also strangely admirable.

Showing the remains to her son was a bit odder. Dubya offering this story to illustrate an evolving relationship? Well, that’s a whole ‘nother dimension of weird. Once upon a time, my mom showed me her gallstones in a jar. (Said jar resided in her medicine chest for at least decade, and might still be there.) Even accounting for the difference between gallstones and a miscarried fetus, I wouldn’t consider my mother sharing her gallstones a key event in our relationship. Frankly, I thought Dubya would’ve been well advised to just let the story stand as his anti-abortion conversion tale – full stop.

Today, the fetus-in-a-jar story took a turn for the outright bizarre. Here’s Politico’s transcript of Larry King interviewing Barbara Bush (via Shakesville):

KING: You also disclose, Barbara — George discloses something very personal about you, which he says you gave him special permission to write about. He wrote that when you once had a miscarriage, you showed him the fetus in the jar.

BARBARA BUSH: No, really, the truth is …

KING: We touched on it before. But we didn’t elaborate.

BARBARA BUSH: I didn’t put it in the jar.

KING: What?

BARBARA BUSH: It’s not in the library. No …

KING: I know.

BARBARA BUSH: George — Paula put it in the jar. And I was shocked when she gave it to him to. But, you know, memories dim a little bit.

“Paula” is evidently their long-time housekeeper. Why, for heaven’s sake, would Dubya tell the story differently after checking with his mother before publishing it? Barbara says memories dim, but why present this as the truth if they have two different recollections? Methinks her son is just in the habit of truthiness.

But the oddest thing of all is that Barbara Bush’s housekeeper would be handling a miscarried fetus. This raises all sorts of unsavory questions, such as where the fetus resided before it was placed in the jar. Did Paula handle the fetus on her own initiative, or did Barbara ask her to package it? And why would Paula give the fetus to Dubya?

Still left unanswered: the burning question of where that jar is now. I’d originally thought it went to the hospital with Dubya and Barbara – end of story. Now, all we know is “it’s not in the library.” Perhaps in the conservatory? With Professor Plum and a candlestick?

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Actually, this isn’t a truly new option, just one that has gotten no press up to now: using an IUD for emergency birth control:

A copper intrauterine device was 100 percent effective at emergency contraception in a study of almost 2000 Chinese women who had the device implanted up to 5 days after unprotected sex.

The device – called Copper T380A, or Copper T – continued to be effective at preventing pregnancy a year after it was inserted.

“It is by far the best emergency contraceptive option,” Dr. James Trussell, who studies birth control methods at Princeton University but was not involved with the current study, told Reuters Health of the device. “But many people just don’t know about it.”

Copper T, marketed as ParaGard in the United States, is a T-shaped piece of flexible plastic wrapped in a layer of copper that is inserted into the uterus. It works by stopping sperm from reaching the egg and by preventing an embryo from implanting in the wall of the uterus.

Led by Dr. Shangchun Wu at the National Research Institute for Family Planning in Beijing, China, the authors followed almost 2000 Chinese women who were implanted with the Copper T after coming into family planning clinics for emergency contraception. All of the women had engaged in unprotected sex in the previous 5 days.

(Read more at Reuters.)

Now, I have to admit I’m one of those women who remembers the publicity around the Dalkon Shield, including the subsequent lawsuits, and so I’ve never really warmed up to the idea of an IUD. But that’s just an emotional reaction. The safety record of the Copper T is very solid. Its effectiveness in the follow-up year of this study was similar to the overall track record of the IUD, with fewer than 1% of women becoming pregnant. (A few of them didn’t tolerate the IUD; either they expelled the IUD or had it removed due to side effects.)

The Reuters article also lays out the barriers to using an IUD as EC. You need to make an appointment with your gyno, and that may not be do-able within five days. The upfront cost ($500) is daunting if insurance won’t cover it.

One point that the otherwise thorough Reuters report missed: A few doctors still suffer under the misapprehension that inserting an IUD is too difficult in woman who’s never borne a child; it’s not, though it may sometimes be a bit trickier. This is a declining problem, but it’s still been an issue for some women (according to the commentariat at Feministe).

Despite these pitfalls, I can imagine the IUD being an excellent choice for many women who need EC. If you’re someone whose birth control is iffy because you have a hard time remembering to take the Pill, the IUD will solve that problem. If you only use condoms sporadically and therefore need EC, the IUD might be a good solution.

Especially for anyone who’s a repeat customer for EC, the IUD seems like a highly sensible choice. While IUD insertion can cause cramping (which can persist for a few days), Plan B can inflict pretty intense nausea. Having to chase down EC repeatedly is stressful for body and soul. Where 1 in 100 women will still get pregnant on Plan B, it’s fewer than 1 in 1000 with the IUD as EC. And in the long run, a woman who chooses the IUD is highly unlikely to face an unwanted pregnancy.

That’s not a panacea. But it’s a pretty excellent option.

Update 8/9/10, 10:30 p.m.: MomTFH, who (unlike your humble hostess) has actual medical training, added a whole ‘nother dimension to this in comments. Click here to read her whole contribution. A few highlights: “I was actually told by my ob/gyn that I wasn’t a good candidate, even though I had already had a baby, because I was divorced. (!!)

“According to a midwife who taught me about birth control, the reason why IUDs were not recommended for nulliarous women were because so many of them successfully sued over the Dalkon shield. The company had to pay a much higher settlement to women who never got to have children due to their injuries than they did to those who already had children. The indications for the newer IUDs, including the copper T, originally said the ideal candidates were parous women, but that is no longer the case. New recommendations say that pretty much any woman who does not have active pelvic inflammatory disease is a good candidate.”

She notes that the standard of care in the U.S. is to screen for STIs before insertion of an IUD, which would add to the difficulty of using an IUD for EC. I have to wonder if one reason for some practitioners’ coolness toward the IUD is that they worry women won’t take precautions against STIs, yet they also won’t need to come in for an annual exam (as they would if prescribed the Pill, patch, or shot) where an STI could be diagnosed and treated.

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Via the Daily Dish, here’s some rank foolishness from evolutionary psychology. Time magazine has a woefully uncritical recap:

A new journal article suggests that evolutionary forces also push women to be more sexual, although in unexpected ways. University of Texas psychologist David Buss wrote the article, which appears in the July issue of Personality and Individual Differences, with the help of three graduate students, Judith Easton (who is listed as lead author), Jaime Confer and Cari Goetz. Buss, Easton and their colleagues found that women in their 30s and early 40s are significantly more sexual than younger women. Women ages 27 through 45 report not only having more sexual fantasies (and more intense sexual fantasies) than women ages 18 through 26 but also having more sex, period. And they are more willing than younger women to have casual sex, even one-night stands. In other words, despite the girls-gone-wild image of promiscuous college women, it is women in their middle years who are America’s most sexually industrious.

So far, so good – or so I thought, until Time noted one of the most egregious failings of this “study”: the older women (or “cougars,” as Time repeatedly calls them) were recruited from Craigslist! Dudez!!! Has anyone explained to Buss Easton & Co. that folks on Craigslist – even the women – are mostly looking for one thing, and it ain’t quality used furniture? Did they even stop to make sure that the Craigslist participants weren’t offering paid erotic services? And did they notice that there’s no section in Craigslist for “women not seeking anything”? No rubric for “not interested in sex”?

I’m willing to believe that women do gain interest in sex from their late twenties through menopause, but the authors haven’t even proved this. Also, they’re comparing apples and oranges. The other one-quarter of participants were students at UT Austin, who presumably participated for extra credit and weren’t actively advertising for sex partners.

But let’s grant Buss Easton at al. their facts. Their interpretation (again via Time) is still complete bunk:

Why would women be more sexually active in their middle years than in their teens and 20s? Buss and his students say evolution has encouraged women to be more sexually active as their fertility begins to decline and as menopause approaches.

Here’s how their theory works:

Our female ancestors grew accustomed to watching many of their children — perhaps as many as half — die of various diseases, starvation, warfare and so on before being able to have kids of their own. This trauma left a psychological imprint to bear as many children as possible. Becoming pregnant is much easier for women and girls in their teens and early 20s — so much easier that they need not spend much time having sex.

However, after the mid-20s, the lizard-brain impulse to have more kids faces a stark reality: it’s harder and harder to get pregnant as a woman’s remaining eggs age. And so women in their middle years respond by seeking more and more sex.

(The rest of the Time article is here.)

First, why conclude that seeing children die would always spur women to have more babies? An alternative would be to invest more resources in a smaller number of children. Women also regularly saw other women die in childbirth. By the authors’ own logic, this trauma would have motivated women to avoid excessive pregnancies.

Also, jumping from individual psychological trauma to species-level hard-wiring of our lizard brains? They might as well leap over the Grand Canyon.

And then there’s the idea that just because we have some procreative hard-wiring, our sex drives can be reduced to our lizard brains, even today. Again: Dudez!! Lots of us lizard-brained women will not have sex with partner unless we’re confident we won’t get pregnant. A few years have passed since the advent of paleo-women. I do not think the same as a woman 200,000 years ago. (I wonder, though, if she’d reject the Pill out of hand. I kind of suspect she wouldn’t. After all, she would have known numerous women who died in childbirth.)

Interpreting the “data” is confounded by researchers’ age categories, which are incoherent and puzzling. For many women, there’s a huge developmental gap between 27 and 45. We become different people, changed by our work, our romantic relationships, and (often) motherhood. All of those changes also impact our sexuality.

There are also major issues with the way that age group is characterized. By whose calculus is a woman in her “middle years” already at age 27? Sure, paleo-women were lucky to live past menopause. So were my great-grandmothers. Today, the only people who consider 27 to be “middle years” are middle-aged men who think they’re entitled to a 20-year-old girlfriend. (I’m sure they’re prowling Craigslist, too).

But even in terms of biology, 27 is not past a woman’s supposed reproductive prime. Fertility undergoes a gradual decline. It’s still pretty high until one’s mid-thirties. It only plunges steeply past age 40.

(Source: Management of the Infertile Woman by Helen A. Carcio and The Fertility Sourcebook by M. Sara Rosenthal, via BabyCentre UK)

The arm of biology that’s relevant here isn’t evolutionary psychology, it’s endocrinology. Women’s hormonal levels do contribute to libido (though in ways that aren’t yet well understood; otherwise, testosterone would offer an easy fix to women troubled by low desire). Hormones begin to fluctuate in the run-up to menopause. For a few women, hormonal changes become noticeable in their late thirties. Others notice them in their forties. Some women note a drop in sexual desire during perimenopause, while others feel it surge, and still others see it fluctuate.

But even granting hormones their due, it would be silly to think they’re the only – or even main – factor in shaping women’s desires. A recent study (via Charlie Glickman’s sexuality blog) found that even at menopause, social and psychological factors matter at least as much as hormones when it comes to sexual desire and activity. Science Daily summarizes the findings of Dr. Sharron Hinchliff et al. in the Journal of Health Psychology (15:5):

Almost all [study participants] had experienced some form of change but the findings indicated that these were down to a number of external factors such as providing care for a relative, partner´s low sexual desire and the quality of the relationship, alongside biological factors such as perceived changes in levels of hormones. The findings therefore concluded that women go through many lifestyle changes during mid-life which are also contributing factors.

(The full summary is here.)

This study  further found great variability among women, with a minority actually reporting a resurgence of desire post-menopause. It’s easy to imagine social and psychological reasons for an uptick in libido: Kids leave home and empty nesters can romp with abandon. Menopause frees women from fears of unwanted pregnancy. Birth control is no longer a hassle. Experience and self-knowledge beget better sex. A great follow-up research project would be to identify those women who get more enjoyment from their sexuality after menopause, and figure out why their mojo has increased. This study suggests that looking at women’s relationships with their partners would be the obvious place to start.

Similarly, anyone with an imagination bigger than an earthworm’s could cook up more convincing interpretations of the Buss Easton et al. data. (Again, we’re overlooking that little Craigslist issue.) Past their mid-twenties, most women are more likely to be in a stable relationship than during their college years. Stable relationships lead to more opportunities for sex. We’re more likely to feel at home in our bodies. With more confidence, we find it easier to let our partners know what warms us. Not least, experience makes sex more fun, not less.

I’m not asking for rocket science. I only expect researchers to remember that we’re more than our reptile brains – and that even our reptile brains might be driven by more than just the drive to reproduce. Like the drive to feel pleasure. Or the desire for intimacy.

In other words, I’m looking for plain old science. The Buss Easton et al. study is LOLscience. Too bad I’ve stopped laughing. (Except for the Craigslist brainfart – that still tickles me.)

Note: I haven’t taken the time to read the original journal article by Buss et al, as its problems are on such a macro level that a closer look doesn’t seem necessary. I did look at the Hinchliff piece, whose major limitation is its small size (twelve in-depth interviews). Still, it suggests interesting avenues for future research.

Update, 7/21/2010: Upon being challenged by a commenter, I did go dig up the original journal article by Easton et al. (This commenter also pointed out – correctly – that Easton is listed as lead author, though it’s clear that Buss – as the only investigator with a Ph.D. – bears ultimate responsibility for overseeing the three graduate students on the project.) Here’s how I revised my assessment.

I read the original journal article closely and carefully. And I don’t think Time was unfair to this study at all.

In their original article, the authors never explain or defend their use of Craigslist to recruit study participants. That’s a massive omission. It boggles.

The full-length article raises other methodological issues, too. For instance, menopausal women made up only 6.2% of study participants (51 out of 827). This calls into question the robustness of any statistical conclusions drawn about the menopausal group – and this is a quantiative study, so sample size does matter.

Perhaps more damningly, the pool of respondents in the 27 to 45 group skewed very heavily toward the younger end of that range. Average age within that group was just 32.86. In other words, women over 35, whose fertility was beginning to decline more steeply, are not underrepresented within that group.

With respect to the researchers’ interpretation, Easton et al. do admit that sexual experience could play a role in women wanting more sex, but they immediately discount it because desire typically drops after menopause, when women have even more experience. Yet they don’t consider obvious confounders: the hormonal and social changes that accompany menopause. That makes their dismissal of experience awfully unconvincing.

Also, nowhere do they acknowledge that women’s material lives (children, relationships, homes, jobs) and psychological outlooks often change quite drastically between 27 and 45. This age group is drawn entirely from their hypothesis that declining fertility is the driver in making women more horny. It does not allow for any other distinctions to be made. (For instance, in the real world, I’ve known very few women in their late twenties who were worried about their fertility, while I’ve known quite a number of them in their late thirties. This matters crucially – unless we’re prepared to believe we’re merely automatons responding to the evolutionary pressures that existed many millennia ago.)

Finally, in actually reading through the study, I am dumbfounded by how teleologically the researchers proceeded. The women in the 27-45 bracket (those Time so cutely branded “cougars”) appear in the study as “reproduction expediting” women. In other words, something that the study ought to be testing for (are these women really seeking to become mothers?) is completely short-circuited and posited as fact by labeling these women as seeking to reproduce as fast and as often as possible. Once it’s assumed that sexual activity is identical with trying to maximize fertility, you no longer have to prove it. It becomes a background assumption. And yet, this is a massive logical leap.

Now, you might argue that women today are still just following the same program their foremothers did, back in the hunter-gatherer age – the so-called environment of evolutionary adaptedness (EEA) – and that even when we think we don’t want a baby, we actually do, because our evolved hard-wiring says so. Fine. But women today overwhelmingly break the link between sex and reproduction. Most of us quite consciously pursue sex lives that will allow us pleasure – to the point that many women (and men!) find it odd when they actually, intentionally try to conceive. The authors completely ignore the convulsive changes that effective birth control has wrought in women’s desires and their willingness/ability to pursue them.

Humans continue to adapt. We didn’t stop adapting in the EEA. Birth control is a monumental adaptation. Easton et al. would be far more convincing it they took it into account. Same goes for other social factors, such as slut shaming, which affects young women most acutely, and would tend to inhibit sexual behaviors. I’m not arguing that we’re blank slates. We have some biological hard-wiring (but with tremendous variation – not all women want children!). I’m even willing to say that some of that hard-wiring is a result of the EEA. However, when science dabbles in teleological thinking and unsupported assumptions and assertions, we might just as well discuss theology instead.

Mixed flowers in Berlin’s Rose Garden. I took the picture but can’t speak to their evolved psychology. The blossoms on the right appear to be hardy geraniums. The lavender flowers are not actually lavender, as far as I could tell. The dried foliage on the left may be post-menopausal?

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As more wobbly Dem congresscritters commit to supporting the health care package, I’m guardedly hopeful that Bart Stupak is about to consign himself to the dustbin of history.

Nonetheless.

I’ve got two “pro-life” reasons why wafflers like my own congresscritter, Charlie Wilson, need to vote yes and put themselves on the right side of history.

First, a study came out this week in the New England Journal of Medicine that demolished fears that universal coverage – even if paired with liberal access to abortion through insurance – will drive up the abortion rate. Dr. Patrick Whelan found that in Massachusetts, abortion actually declined after coverage was expanded to virtually all residents:

The national health care reform legislation that was recently passed by the Senate has been modeled, in many respects, on the Massachusetts reform law; both lack the “public option” that was included in the House bill, which was the focus of the Stupak–Pitts Amendment prohibiting federal subsidies for health plans that would pay for abortion. Therefore, I hypothesized that the early experience in Massachusetts might serve as a good model in which to examine whether a substantial expansion in health care coverage might result in an increased number of abortions.

The relevant part of the Massachusetts program is Commonwealth Care, which provides subsidized insurance to the self-employed, small businesses, and unemployed individuals with incomes below 300% of the federal poverty level. This quasi-public agency began coordinating care through five private participating health plans effective January 1, 2007. I sought to determine whether this increased availability of care has led to an increase in the number of abortions performed in Massachusetts.

The number of abortions in Massachusetts in 2006, the year before the new law was implemented, was 24,245, including 4024 among teenagers. I obtained data from the Massachusetts Department of Public Health for each of the two subsequent years. Some 158,000 people were enrolled in Commonwealth Care plans during the first year. The Urban Institute estimated that between the fall of 2006 and the fall of 2008, the proportion of adults with incomes below 300% of the poverty line who were uninsured fell from 24% to 8%; 63% of all newly insured adults were in either Commonwealth Care or the state Medicaid program.

In 2007, the first year of Commonwealth Care, the number of abortions fell to 24,128, and in 2008, it fell to 23,883 — a decline of 1.5% from the 2006 level (see graph). The number of abortions among teenagers in 2008 fell to 3726, a 7.4% decline from 2006. These decreases occurred during a period of rising birth rates, from 55.6 per 1000 women 15 to 44 years of age to 56.9 per 1000 in 2006 and 57.2 per 1000 in 2007 (the latest year for which data are available from the Massachusetts Department of Public Health), and an increase in overall population (in 2008, the Massachusetts population surpassed 6.5 million for the first time, and it was nearly 6.6 million in 2009, according to the Census Bureau). The abortion rate thus declined from 3.8 per 1000 population in 2006 to 3.6 per 1000 in 2008. Overall, since 2000, the number of abortions in Massachusetts has dropped by 12% (from 27,180 to 23,883) and by nearly 36% since 1991.2 The Massachusetts abortion rate has similarly dropped by a third, from 30 per 1000 women 15 to 44 years of age in 1991 to about 20 per 1000 in 2005, with most of the decrease occurring during the late 1990s.3

(I excerpted the main findings, but the whole article, including its graphics, is free and easily comprehensible to non-specialist readers.)

Or, to put it briefly, abortions declined both in absolute numbers and on a per-capita basis. The drop was steeper for teenagers.

Now, it’s possible that Massachusetts is simply mirroring national trends, where abortions have slowly declined in reason years (with, however, an upward blip nationally in 2006). But at the very least, it seems reasonable to conclude that in the biggest, best real-life laboratory we’ve got, access to abortion – which was a covered service for Medicaid recipients and the next-lowest income tier covered by Commonwealth care – did nothing to increase the number of abortions performed.

Whelan doesn’t speculate what other factors might be depressing the abortion rate, but I can think of two. First, there may be fewer unplanned pregnancies if Commonwealth Care is delivering family planning services and contraception to the neediest residents. Second, a woman confronting an unplanned pregnancy may be more likely to keep it if she knows she can count on good medical care for her child and herself. I don’t know enough about the details of the Massachusetts system to know if it really does provide decent reproductive health care, but this seems like a reasonable conjecture.

What would happen if we expanded the Massachusetts experiment nationwide? Well, the likelihood of an upward trend in abortions might be even slighter in more conservative states, where cultural attitudes discourage abortion. Those women might also be less likely to avail themselves of contraceptive services, so they’d benefit less from access to it. On balance, my gut feeling is that red states would continue to have more unplanned babies and shotgun weddings than blue states like Massachusetts, but their abortion rates will remain about the same. That’s just my instinct, and I could be wrong, but if Massachusetts women didn’t start aborting by the millions, do we seriously think the gals in Utah will?

The second “pro-life” argument I’d like our congresscritters to hear relates to our shameful maternal and infant mortality rates. Our ostensibly pro-life politicians are utterly silent on those two interlinked scandals. They shouldn’t be.

This week, Amnesty International released a lengthy, serious, well-documented study on maternal health in the U.S. (Go here for the link to the full, free report in pdf format.) At Mom’s Tinfoil Hat, Hilary writes:

It’s often asserted, including in this report, that infant and maternity mortality are key indicators in the health and social justice of a country.

I’d add that they ought to be key indicators for the seriousness of grandstanding “pro-life” politicians.

Take, for instance, the ranking of states according to maternal deaths. Maine comes out on top, with just 1.2 mothers dying per 100,000 live births. Vermont is second, at 2.6. You might object that these are small states with small populations, and that the number of women dying there is so small that figures may be deceptive. Could be. But then check out Massachusetts in third place with 2.7. Hmm, we’re starting to see a regional trend.

The District of Columbia rules the hall of shame with 34.9 maternal deaths per 100,000 live births, worse than Costa Rica. Georgia is second-worst with 20.5. (Figures are from pp. 104-5 of Amnesty’s report, Deadly Delivery: The Maternal Health Care Crisis in the USA.)

As Amnesty notes on its webpage:

During 2004 and 2005, more than 68,000 women nearly died in childbirth in the USA. Each year, 1.7 million women suffer a complication that has an adverse effect on their health.

This is not just a public health emergency – it is a human rights crisis. Women in the USA face a range of obstacles in obtaining the services they need. The health care system suffers from multiple failures: discrimination; financial, bureaucratic and language barriers to care; lack of information about maternal care and family planning options; lack of active participation in care decisions; inadequate staffing and quality protocols; and a lack of accountability and oversight.

So why should Stupak care? After all, these are just a bunch of women – disproportionately poor women of color – who should’ve kept their legs shut, right, according to Stupakian logic? In his view, aren’t these just throw-away mothers?

Well, when mothers die, babies sometimes die with them. Hemorrhage, eclampsia, embolism – all can endanger the infant as well as the mother.

While babies can’t yet talk, I don’t think it’s a big leap to say that most prefer not to be half-orphaned at birth.

Most significantly for Stupak and his allies, however, is that obstetric care benefits babies and mothers alike. Where mothers survive, infants are more likely to survive and thrive. That’s true here in the U.S. as well as globally. We do worse than Cuba when it comes to keeping newborns alive.

And guess what? Health care reform has the potential for helping mothers and (potential) babies get the care they need.

So I’ll be waiting to hear from Stupak and the bishops on how, exactly, killing health care reform will help preserve mothers and babies – and how, precisely, they can call the resulting deaths and complications “pro-life.”

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In a couple of my previous posts on Mary Daly, I mentioned that her secularized notion of “idolatry” – which she saw in first-wave feminists’ singleminded focus on suffrage – can be applied to modern-day feminism as well. Today, on the 37th anniversary of Roe v. Wade, I’d like to dwell on how “choice” has served as an idol – as a foundational concept that can’t bear the weight it’s been given.

“Choice” was an attractive term to the defenders of abortion rights in the 1970s because it provided a way to counter a growing “pro-life” movement without having to say that they were “pro-abortion.” Even today, defending “abortion” is a politically dodgy proposition. My Democratic ?? !! @*&$# congresscritter, Charlie Wilson, D-Bluedognia, proudly claims at every opportunity that he’s pro-life. He and his cronies are sure not going to come out in favor of abortion.

By now, though, we need a more flexible strategy, as lots of folks – especially radical women of color – have argued before me. What about access to abortion, birth control, sex education, prenatal care, and fertility treatments? How about reproductive rights and justice? What about bodily autonomy and self-determination?

Yes, it’s important that women have choices. It’s even more crucial that we have the material, social, and cultural wherewithal to exercise them.

Denying the means to exercise choice shows that we, as a society, just don’t trust women – especially those women who don’t already enjoy a panoply of privileges. Conversely, “trusting women” doesn’t matter a whit as long as their choices are highly constrained.

And while we’re at it, let’s remember than no one -  female or male, fertile or not – has real bodily autonomy without access to health care. Reproductive autonomy isn’t just a women’s rights issue. It’s a matter of human rights.

Addendum, 1/24/10, 3 p.m.: Based on the comments to this post, it looks as though I haven’t fully clarified why I think feminists would be wise to walk back from our overreliance on “choice.” From the get-go in the 1970s, “choice” referred to narrowly to the formal legality of abortion. It was a product of liberal feminism, which framed abortion in terms of negative liberty – or freedom from interference. However, that wasn’t nearly enough to secure reproductive rights for women, broadly conceived, including a right to birth control, sex ed, etc. This would have required the issued to be reframed in terms of positive liberty, which includes the resources and means to act and exercise one’s liberties. (I’ve written about these disparate concepts of liberty here.) “Choice” also failed to highlight even the violations of negative liberty perpetrated on women who were poor or non-white, such as coerced sterilizations and pressure to use abortion or long-term birth control.

In theory, of course, “choice” could embrace both notions of liberty and and could include issues beyond abortion. Despite some feminists’ efforts to expand the term, however, it continues to carry historical baggage. The popular understanding of “choice” is that it’s shorthand for legal abortion. Its meaning has constricted and frozen. I hear this from my students in women’s studies classes, as well as from critics within feminism. That’s why I’d prefer we stop privileging “choice” in favor of “reproductive rights” and “reproductive justice.” These concepts highlight the importance of positive liberties and challenge us to think about the whole spectrum of gendered health issues.

Thanks to figleaf and kb for pointing out that I didn’t connect all the dots – a hazard of writing when I probably ought to have been sleeping instead. :-)

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Via Ann at Feministing, I came upon Dana Goldstein’s excellent analysis of why a public option sans reproductive health coverage is doomed. She notes that while our congresscritters are under pressure not to fund abortions with taxpayers’ money, women will be less likely to choose the public option if it excludes abortions and other basic reproductive care:

After all, the typical woman spends five years of her life pregnant, or trying to become so, but a full 30 years avoiding pregnancy. Without good reproductive-health coverage and strong buy-in from women — who use more health care than men — it is difficult to see how a public plan would gain strength over time.

(Read the rest here.)

And there’s more: Women with private insurance may find their plans dropping reproductive care, whether due to market forces (as Ann implies) or conservative lawmakers’ meddling in insurance regulation (as Dana suggests).

Really, though, this whole debate rests on false premises. While the Hyde Amendment has prohibited Medicaid from covering abortions for over 30 years, abortions are already financed indirectly by taxpayer subsidies. Anyone with an employer-sponsored health plan gets their insurance tax-free. That’s a massive federal subsidy. Ann cites a NYT story that claims 50 percent of employers offer abortion services among their health benefits.

So taxpayers are already subsidizing abortion for women of the more prosperous classes. It’s just those poor women who’ve been excluded – ironically, the very same people whom anti-choicers demonize for having too many children. (I’m not advocating eugenic abortions for the poor, just noting the logical and fiscal inconsistency of many dogmatic foes of abortion.)

Up ’til now, even after a quarter-century of supporting abortion rights, I’ve tended to think, “Get reform passed, and then we’ll worry about specific services.” But Dana has convinced me that this isn’t just a distraction, though the ‘wingers will surely conflate public subsidies for reproductive health with their phantom death panels. This is a matter of reproductive justice for poor women, and a sustainable system for all Americans.

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Do y’all remember the transitive property from math? Here’s a refresher (though I’m sure you don’t need it): If a=b and b=c, then a=c.

From the Savana Redding case (the one on whether schools may strip-search their students), we know that some school officials consider ibuprofen in the same class as heroin.

A couple of months ago, a Virginia girl was suspended from school for possession of birth control pills. Gasp! They are obviously as dangerous as ibuprofen! The Pill can cause clots; ibuprofen can cause bleeding.

Ergo, the Pill is as dangerous as heroin; a=b=c.

Now, the girl from Virginia has turned the tables in the smartest way possible, by mocking her school’s lunacy. She went on Colbert and just deadpanned her way through her story. Her mom, on the other hand, could hardly keep from busting up. I loved them both.

Via Feministing; posted with vodpod

It’s the sort of story that Colbert is wont to make up – except this one was all true.

My husband’s comment: Do we have to worry about the Bear being busted at school for having a Lactaid in his backpack?

My reply: I really don’t know.

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I’m aware that the standard feminist position is to cast a jaded eye on medicine extending its authority over the female body. (In my academic life, I’ve spent hundreds of pages doing just this, with enough footnotes to sink the Queen Mary.) Versions of the birth control pill such as Seasonale (which allows for four periods per year) and Lybrel (which eliminates them entirely) represent further medicalization of women’s bodies. I agree with the assessment of the National Women’s Health Network: Women should have the option of menstrual suppression, but the drug companies need to knock off shaming women about their periods.

However, the standard birth control pill also offers some real health benefits beyond preventing unwanted pregnancy, which raises the question of whether menstrual suppression could confer additional benefits. Previous research has shown that the pill offers very substantial protection against the development of ovarian cancer. Now, a new study finds that women who have fewer periods, over a lifetime, are more likely to survive ovarian cancer:

Women whose menstrual periods start at a young age are less likely to survive ovarian cancer than their peers whose periods start later, new research shows. Similarly, women who have more menstrual cycles over their lifetime also have worse survival.

“Although we have relatively good knowledge about the influence of reproductive factors on the risk of developing ovarian cancer, knowledge is rather limited regarding the reproductive factors that may influence survival after diagnosis with this serious disease,” Dr. Cheryl L. Robbins said in a statement.

As reported in the journal Cancer Epidemiology, Biomarkers, and Prevention, Robbins’ group analyzed data from 410 women with ovarian cancer who were enrolled in the Cancer and Steroid Hormone study (1980 to 1982). During 9 years of follow-up, 212 women died.

Menstrual period onset before 12 years of age increased the risk of death by 51 percent relative to periods beginning at age 14 or older.

The results also indicate that patients with the highest number of lifetime menstrual cycles were 67 percent more likely to die during follow-up than were those with the lowest number of cycles.

The 15-year survival rates for women with the most lifetime menstrual cycles and those with the fewest were 33.3 and 56.7 percent, respectively.

(Source: Reuters)

To me, this raises questions about whether Seasonale and Lybrel might reduce the deadliness of ovarian cancer, and not just its likelihood of developing. This study didn’t look at menstrual suppression (I peeked at the original article, which isn’t freely available on the web). The researchers found no statistically significant relationship between use of oral contraception and survival. They thought this was surprising:

We were particularly puzzled by the lack of associations with parity or use of oral contraceptive in adjusted analyses because they accounted for the majority of anovulatory cycles in our cases. However, in unadjusted Kaplan-Meier survival analyses, oral contraceptive use was associated with improved survival, and although not statistically significant, it is noteworthy that HRs [hazard rations] for parity, oral contraceptive use, and breast-feeding were in the protective direction, as expected. It may be that power was limited to detect modest associations due to sample size. Alternatively, it is feasible that combined, the LOC [lifetime ovulatory cycles] component variables become statistically significant in the composite measure. Yet, another possibility is that age at menarche is driving the association between LOC and ovarian cancer survival, but because the HR of high LOC is greater than the HR of younger age at menarche, we find the synergistic explanation more compelling. Finally, we considered what effect additional survival data might have on the observed associations, and because of the lethality of this disease, we think it is unlikely that increasing follow-up would yield very different results from 15-year survival results.

(Cheryl L. Robbins, et al., “Influence of Reproductive Factors on Mortality after Epithelial Ovarian Cancer Diagnosis,” Cancer Epidemiology Biomarkers & Prevention 18, 2035, July 1, 2009)

So further research would be required to determine whether artificially stopping periods confers the same protection as late menarche and fewer lifetime menstrual cycles. It’s unlikely that many women in the study would have had a history of menstrual suppression, since the pills promoted for this purpose are still relatively new. (Of course, it’s long been possible to use regular birth control pills to stop periods, too, but it was never a common practice.)

Let’s posit, for the sake of argument, that future studies show that artifical suppresion of periods conferred better survival odds. Wouldn’t this be just one more step toward greater medicalization of women’s bodies? Not inevitably. There’s little reason to force women to get a prescription for the pill. Few drugs have been more closely scrutinized, by now. It’s safety profile is good enough that it could be an over-the-counter product. In Great Britain, the Lancet has called for the pill to be sold without prescription.

Here in the U.S., some ob/gyns might oppose an OTC pill. Birth control prescriptions are one of the main levers for getting women to show up for an annual exam. But by the same reasoning, you could make Tylenol and Advil prescription-only to ensure that everyone gets their check-ups.

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Here’s a guest post by Euchalon Grandy, swiped from my comments section, offered here with no commentary from me just yet except that I agree with almost everything he says. (Bonus points if you can pick the one spot where I have some qualms.) The first half of his comment is also worth a read. Everything that follows is his; I skipped the “indent quote” feature for better readability.

—————–

OK, so here’s my issue — Not necessarily in your post, but underlying this whole discussion [of withdrawal as birth control] I sense an assumption that unwanted pregnancy is so incredibly awful that it must be avoided at all cost.  Thus the ‘wear three condoms, use a diaphram, and you *are* on the pill, right?’ tone.

Now, I understand that for many women, including a sizable portion of American women, abortion is not safe, legal, or available.  For those women, extraordinary caution is justified.  However, for a good portion of American women, safe, legal abortions are still available.  Absent personal religious or moral objections, isn’t abortion OK as a backstop once contraception is used to bring the odds of pregnancy down to a reasonably low level?

What disturbs me is that this extraordinarily cautious approach to contraception implies that abortion is off the table as an acceptable way to end an unwanted pregnancy.  It makes me wonder if, after decades of exposure to the abortion prohibition movement, that movement has on some level won our hearts and minds about abortion, if not the right to it.  (When I say “we”, I mean feminist and feminist-oriented men and women who have no explicit personal moral objection to abortion).

After all, if we don’t subscribe to the idea that a human being is created at the moment of conception, and if we acknowledge that legal abortions are a relatively safe procedure, why do we give ending a pregnancy through abortion such weight?  For a number of practical reasons abortion is lousy as a first-line method of contraception.  But as a backup isn’t it similar in function to other methods of contraception?  Why do we treat it as an evil to be avoided if we don’t believe it to be evil? When we treat something as an absolute last resort, we strongly imply that there’s something very bad about it.

People like Obama talk about this common ground where ‘we’d all like to see fewer abortions’.  I’m not sure I agree.  When children enter the world unwanted, I’d rather see more abortions.  When women go through pregnancy and labor for no other reason than avoiding having an abortion, I’d rather see more abortions.  When young men and women for years deny themselves the joyfulness of a good sex life, I’d rather see more abortions.

For those of us who support the right to an abortion, aren’t we losing ground here?  Don’t things get a little worse every year?  Gay folks didn’t make much progress until the slogan ‘gay and proud’ came into common usage.  When will we come out of the closet?  What’s our slogan?  I’d suggest, if not ‘pro-abortion and proud’ at least ‘pro-choice and I just don’t think an abortion is a big deal’.  Those of us who identify as pro-choice are strong on the political right to an abortion.  It seems, however, like we’re conflicted and afraid when it comes to abortion itself.  The prohibitionists are very clear on both.

I would like to see a life-affirming narrative that supports abortion rights and abortion.  Life-affirming as in the better life the pregnant woman (and often her male partner) can have without the burden of an unwanted pregnancy/child.  Life-affirming as in pro-sex, taking a practical but not fearful approach to contraception.

If we take our cue from the prohibitionists and frame this issue as something that takes place only inside the uterus then it’s just an argument about death or not-death and we can’t win.  If we expand our vision to outside the uterus then we are pro-better-life, pro-freedom, and pro-sex.   With these values on our side, we will prevail over the narrative of death which the prohibitionists have used so effectively, but only if we have the courage to embrace not only the right to an abortion but abortion itself.  And it seems to me we ignore this at our peril when discussing contraception.

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A few days ago, Miriam at Feministing suggested we take another look at withdrawal as a contraceptive method. Up to a point, she’s right that “it might be a useful method in low-resource situations.” If, that is, we’re talking about the sort of grinding poverty where the partners can’t even afford condoms.

Overall, though, I’m really troubled by this idea. I think it’s setting women up for more unwanted pregnancies than they already experience. (I’m leaving aside the STI issue, not because it’s trivial, but because it’s self-evident that condoms are vastly superior.)

Right off the bat, I’m suspicious of the figures Miriam cites (which come from a Guttmacher Institute report) that portray withdrawal as statistically equivalent to condoms (18% of women became pregnant with “typical” use of withdrawal versus 17% with “typical” use of condoms over the course of a year). First, other sources show a much bigger gap. Planned Parenthood says 15% of women will become pregnant with typical use of condoms over a year, versus 27% with typical use of withdrawal. (Scarleteen cites two other sources that agree on this statistic for withdrawal. Ditto for condoms. Bear in mind that the Guttmacher report is based on a single study, which ought to give us pause right there.)

Now let’s compare the ideal conditions. Even with “perfect” use, the figures are 2% for condoms, 4% for withdrawal. (Both Guttmacher and PP agree on this.) So, for those of us who’re downright obsessive about avoiding pregnancy, that means withdrawal would be twice as risky! I don’t see that as trivial.

Secondly, if we’re talking about truly low resource conditions, it makes no sense to compare condoms and withdrawal. Instead, we should be asking how withdrawal stacks up against other free methods. The various rhythm methods – which Planned Parenthood calls “fertility-based awareness methods” – fail 12 to 25% of women per year. The proposal is to educate people on withdrawal, but honestly, how much needs to be said aside from “it only works if you do it on time, every time”? Where people are too poor to afford condoms, wouldn’t it make better sense to educate women to the point where they could use a fertility-based awareness method and approach that 12% figure? Where poverty is less absolute, condoms could be used on days when conception was more likely. Or scarce resources could be allocated toward fitting women for diaphragms, cervical caps, or IUDs, which don’t require major ongoing expenditures.

But the killer argument against withdrawal, to my mind, is how dependent it makes women on their partners. Much more than condoms, it puts a woman’s reproductive fate totally at the whim of her partner at a moment when he’s not clear-headed. This may not be a big deal in a long-term relationship devoid of abuse, where both partners trust each other, know their bodies, and wouldn’t experience a pregnancy as catastrophic. These, however, are mostly not the couples who need help and education on contraception.

Think about the fifteen-year-old with a twenty-year-old partner. Can she trust him with her future? What about the thirty-year-old mother of five in sub-Saharan Africa whose husband won’t wear a condom – can she hope he’ll more willingly commit to withdrawal? How about any hookup situation, never mind where or with whom?

Even for couples where the power differential is small and the trust is great, using withdrawal effectively requires much more than “good communication.” Miriam at Feministing writes:

But I think we can all agree that we want to promote communication around safer sex.

Yes, and the key word is “around.” By all means, talk about birth control before and after sex. Communicate your desires during sex. Negotiating contraceptive decisions or timing during sex is asking for trouble, however. I wouldn’t want to stake my reproductive future on complete and reliable communication at a moment when my partner (and maybe I) are both muddled with passion.

Can we even hold men wholly culpable when they promise to pull out but don’t? Is anyone fully compos mentis when they’re about ready to come? If you’re doing sex right, the guy shouldn’t exhibit Olympian detachment at the moment of climax. Myself, I wouldn’t want to be with a partner who was having to pull back erotically (and maybe emotionally too) in order to pull out. Condoms, at least, can be donned earlier, before arousal is at its peak, when both partners are still more sensible.

Any method that collides with people’s lived experience is bound to fail, over and again. Sex isn’t a game of Tiddlywinks in which you can change the rules and expect embodied experience – and thus behavior – to follow. Apart from those folks (men, mostly) who’ve internalized porn’s money shot fetish, doesn’t orgasm feel better for most men when they’re inside their partner? Don’t their female partners sometimes feel a loss, too, if detachment has to trump connection at a moment that should be about ecstasy, not calculation? Or if the lovely friction comes to a screeching halt right when she’s verging on orgasm, herself? Can the female partner really relax and enjoy if she’s wondering whether he’ll pull out soon enough? I’ve never relied on withdrawal, personally, but I’m certain I’d find it much, much more intrusive than using condoms.

Of course, withdrawal is a time-honored method. It was the method of choice for many couples in the early twentieth century, prior to the pill. It was quite effective when used with another time-honored backup method: abortion. In Germany during the 1920s, withdrawal was the primary method. Various dodgy douches held second place; all you really need to know about them is that whatever didn’t wash out got forced up into the cervix. So withdrawal was superior to douching. It was also clearly better than nothing. But the abortion rate was estimated at half a million per year – and this in a country of 60-odd million – despite abortion being illegal and often unsafe.

There’s a moment in the film The Abortion Diaries where one of the women telling her story says, “He said he’d pull out. And then he didn’t.” She’s retelling this because it’s the moment that led to her pregnancy. Her words are clipped and bitter. This, too, is a disadvantage to withdrawal: when it fails, someone is very clearly to blame. I have no idea how many other relationships have failed as a result, but the number can’t be trivial.

So I’ve got nothing against discussing withdrawal. And perhaps the Guttmacher authors are right in saying it has a place in providing extra insurance when used with other methods. (Even there, I can’t imagine compliance would be high: if you’re on the pill, will you really feel a need for you partner to pull out, too? If a guy is already putting up with the decreased sensation of a condom, will he be motivated to finish up outside his partner?) Still, there’s no reason to be “sanguine” about withdrawal. And there’s really no good basis for recommending it as a sole method, unless the alternative truly is no method at all.

Update, 5-21-09: This study continues to draw attention from the feminist blogs: Rachel at Feministe is skeptical, while Lynn Harris at Broadsheet gives it a more sympathetic reading. I’d like to repeat that this is just a single study and its findings differ from the existing literature. That doesn’t mean it’s wrong, but it means the discrepancy requires further explanation and can’t just be asserted as the new “truth.” According to the original study by Rachel Jones et al (.pdf), most of the couples using withdrawal were also using other methods (see Nat’s comments below, as she describes the kinds of strategies the researchers also found). It’s not clear to me that you can chart withdrawal on “safe” days against condom use on “less-safe” days and produce a meaningful comparison. These are apples and oranges! I’m having trouble linking the original study (it’s a .pdf) but you can get to it from the Guttmacher summary report. Its strong point, in my view, is its phenomenologically fascinating interview material, in which people talk frankly about how they use this method, how it feels, and how it fits into their lives.

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From I Can Has Cheezburger?

The Columbus Dispatch reports that Rod Parsley’s world-domination enterprise, aka his “church,” has established an anti-abortion counseling center in Columbus, located conveniently just across from a Planned Parenthood clinic.

Parsley’s center looks like a doctor’s office, though there is just one medical professional employed there, a registered nurse. Other nurses and doctors will volunteer their services there, [director Debbie] Stacy said. …

It will offer free pregnancy tests and ultrasounds to encourage women to give birth, Stacy said. It also will make referrals for other medical services, but not for abortions.

(Source: Columbus Dispatch)

This is nothing new, of course. Such “crisis pregnancy centers” exist all over the United States. But the Dispatch report offered this one truly telling detail:

Inside, women will find a portable ultrasound machine and pamphlets about sexually transmitted infections, RU-486, sometimes called the “abortion pill,” and how to say no to unwanted sex. The reading material all focuses on abstinence. The center does not distribute information about birth control.
(my emphasis)

And this too, is nothing new. It’s just one more piece of proof that for doctrinaire opponents of reproductive justice, the point is not saving “unborn lives.” It’s making sure that if you do indulge in sex, you’ll be penalized for it – with a baby.

I’m sure the resulting babies will be thrilled to know that they were their mom’s punishment for bonking without a license.

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Earlier I promised I’d post about the coolest things I learned at this year’s Berkshire Conference on the History of Women, and now I’m already at my next gig, the National Women’s Studies Association annual meeting in Cincinnati. My ordinary weekend travels usually don’t take me any farther than my local farmer’s market, so I’m a bit disoriented to be on the road so much. I feel like a character in a David Lodge novel.

But before I forget all I learned, I’d like to take a quick romp through the Berk highlights of the Berks. It’s probably skewed and idiosyncratic since I mostly sat in on panels related to bodies, reproduction, and sexuality. And I make no claim to fully represent the presenters’ arguments. This is a rundown of ideas that I thought were way cool. (Presenters’ names are in parentheses.)

  • Contraception among native Canadian communities was, well, a community affair, and not just up to individuals. Unpublished notes by white Canadian anthropologists of the 1920s and 1930s show that there were indeed individual actions one could take, such as bathing in the creek or nursing one’s baby to prevent conception. But many of the medicine women’s prescriptions triggered social surveillance. A woman might be advised to wear an otterskin bracelet dring the new moon or to paint her face red and her belly yellow. While my immediate reaction was, “Oh, interesting varieties of magical thinking,” that’s far from the whole story. Such visible tactics signaled that the community would be watching to see whether that woman became pregnant – and her husband was well aware of this. Unlike many modern nations where low birth rates have inspired pronatalist policies, these Plains tribes collectively wanted to regulate their family size because too many babies would restrict the group’s mobility. (Kristin Burnett)
  • If you follow media reporting on evolutionary psychology, you might image that Darwinian theory and feminism have always been implacable enemies. That just ain’t so. Early feminists such as Elizabeth Cady Stanton embraced the theory of evolution because it offered a chance to rewrite Genesis. If Eve is the mother of humanity and the source of all sin and suffering, and if the serpent picked on her because he knew she was inherently weaker than Adam, it’s hard to make a case for women’s full equality. By embracing evolution, Stanton, Carrie Chapman Catt, and others could argue that Eve wasn’t simply derivative from Adam; because Eve came after Adam, she must actually be a higher life form! However, few of these early feminists advocated jettisoning religion altogether. They just argued for a more nuanced, less literalist reading of the Genesis story. (Kimberly Hamlin)
  • It wasn’t news to me that early American feminists also generally embraced eugenics and saw planned mating and breeding as a progressive force. (And this, despite Francis Galton’s contention that eugenics was “a particularly virile creed.”) What did surprise me was how adamantly American conservatives rejected eugenics. Today, neo-eugenic ideas such as Depo-Provera shots for the poor tend to be held by conservatives and racists. In early twentieth century Europe, left-wing and feminist reformers advocated eugenic programs, but so did many on the right, albeit with much stronger racist overtones. So I was surprised to hear that American conservatives accused feminists of treating men like livestock and of simply demanding too much of men. Press coverage of early women who became single mothers by choice insinuated that some women wanted to render men unnecessary altogether – anticipating Maureen Dowd by decades, I might add. (Susan Rensing)
  • Wet nursing, a common practice in fifteenth-century Valencia, was tangled up in contradictory ideas about maternal duty and the balance of power between fathers and biological mothers. Contracts were struck between fathers and wet nurses that seemed to leave birth mothers out of the loop altogether. And yet, birth mothers exercised power in a variety of ways. In one case that landed in court, a birth mother named Lucretia – the concubine of a Dominican friar – claimed she’d been under contract to nurse her infant but gotten stiffed of her fees. Because the law held that if you fed your baby out of maternal love or piety you couldn’t be paid for it, Lucretia had to argue, perversely, that she had no maternal feeling for the child whatsoever. In a second case, a widow named Isabella sued the executor of her dead husband’s estate when he refused to fork over the fees for a wet nurse even though two surgeons and a midwife had certified her unable to breastfeed due to inverted nipples. She tried all manner of tricks: poultices made of chard, ointment, cupping glasses, and a technique called “opening” that I think I’d prefer not to explore further. The court ruled for Isabella, showing that mothers could hold their own in legal affairs and effectively defend the interests of their children. (Debra Blumenthal)
  • Conventional wisdom holds that since at least ancient Greece, women’s bodies were historically regarded as inferior and the male body as the healthy norm. This story turns out to be more complicated, though. A set of widely circulated broadsides sixteenth-century Germany depicted the female body as the norm. These anatomical pictures featured a lift-the-flap design, though not the transparent overlays that so fascinated me in the encyclopedia when I was a little girl. The female figure showed a small baby (not a fetus) inside the uterus. It also featured ducts running from the uterus to the nipples, reflecting the theory that menstrual blood nurtured the “fruit” during pregnancy and then transformed into breastmilk once the baby was born. The text alongside the diagrams describes the male figure as lacking a womb. Male spermatic vessels are said to be like the female spermatic vessels (that is, the ovaries). And most remarkably: the penis merited no discussion whatsoever! (Kathleen Crowther)
  • In contemporary Poland, abortion rights have been progressively restricted since the early 1990s. Like other East-Bloc countries, Poland’s Communists had legalized abortion. Between 1956 and 1993, first-trimester abortion was available on demand. Since 1993, women seeking an abortion have had to qualify under one of three possible indications: 1) genetic defects in the fetus, 2) rape or incest as the cause of pregnancy, or 3) health problems on the part of the pregnant woman. These indications are not so very different from the old West German framework. Yet abortion is vanishingly rare in Poland today, with only about 200 legal abortions performed annually. With a population of roughly 38 million, about 10 million of whom are fertile females, this figure is exceptionally low. Of course, it only points to the prevalence of illegal abortion. Even women with legal indications for abortion face insurmountable hurdles. Hospitals refuse to perform them. Women end up in the “abortion underground,” where the same physicians who publicly declare themselves “too ethical” to do abortion willingly perform them for high fees! The driving forces behind this are the power of the Roman Catholic Church in Poland, the idea that abortion was a Communist holdover, the lack of civil society including a women’s movement, and the absence of a discourse on women’s rights due to the old law portraying abortion solely as a public health imperative. The result? A fourteen-year-old rape victim was recently denied an abortion. Worse yet, she was taken out of her mother’s custody on the presumption that the mother must be coercing the daughter! (Wanda Nowicka)
  • Home pregnancy tests may be not only driving up the rate of recorded miscarriages. They may also be changing the meaning of miscarriage itself for American women today. Instead of waiting for confirmation of pregnancy after missing a period or two, or even waiting for quickening (fetal movements) as women did a century ago, women now use home tests even before they’ve missed a period. A positive line signals to many women not just that conception has occurred but that “there’s a baby” in there. But this sets women up for grief and woe: Of 100 meetings of egg and sperm, 57 never implant (and thus wouldn’t result in a positive test). Of the 43 that do implant, 10 miscarry before a doctor would declare the woman pregnant. These are the early pregnancies that home testing often picks up on. Of the 33 that continue, 4 will miscarry “clinically” and 29 will reach full term (give or take a few weeks). Your reporter Sungold exists only because her own mother experienced one of those 10-in-100 events a few months earlier. When she told me that she thought she’d had an “early miscarriage” just before conceiving me, I was incredulous: “What do you mean, you don’t know if you were pregnant?” Today, she’d have experienced this as a certain loss, and thus possibly as a more painful one. Indeed, this presentation argued that women now face a cultural imperative to grieve these very early losses irrespective of how they actually feel. (Lara Friedenfels)

And now I’m realizing why I didn’t have energy to blog the Berks right after the fact – my brain was still spinning. Now I’m back to the NWSA before I miss out on all the fun there.

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A Not-So-Bitter Pill

When I first went on the birth control pill in the early 1980s, its reputation was still clouded by the problems associated with the original, high-dosage pills of the 1960s. I worried about blood clots (my family has a history). I’m sure I wasn’t the only person to suspect that any pill that allowed me so much fun with so little worry would eventually cause cancer.

Well, there’s good news today. It turns out that taking the pill actually protects against ovarian cancer, and to quite a dramatic degree. The AP reports on a study published today in the Lancet that found a 20 percent decrease in risk for every five years a woman took the pill. This protective effect gradually declines over time once a woman stopped taking it. But even so, this is a massive effect, which could prevent as many as 30,000 new diagnoses of ovarian cancer each year, and which for most women vastly outweighs the pill’s small increased risk of breast cancer. The Lancet is calling for the pill to be sold over the counter in Great Britain.

Whoever said that the wages of sin are death? :-)

Image from onlybirthcontrol.com

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