Audacia Ray says

Embarrassing Sex Worker Activism:

WE PETITION THE OBAMA ADMINISTRATION TO: Decriminalize the practice/occupation of engaging in sexual activity between consenting adults in exchange for payment.

Dear sex worker activists: the Obama administration cannot make this happen. The criminal code is codified at a state level.

If you want to “decriminalize” aka chip away at the legal system that does harm in our lives, start researching the laws in place in your state and city that do this harm. There are lots of local laws that discriminate against sex workers and people profiled as sex workers. Like the fact that condoms can be used as evidence of prostitution, or that until it was defeated this summer, people profiled as sex workers (esp trans women of color) in Louisiana were being put on the sex offender registry.

Source: Waking Vixen

If you follow Dacia's link to the petition at WhiteHouse.gov you'll see the details of the petition are nice but vague, and that while the stated goal is "Signatures needed by Oct. 27, 2011 to reach goal of 5000," the "Total signatures on this petition," at least at the moment, are... 45.

Actually I expect the petitioners were hoping for the President to direct agencies under the control of the executive branch to back off, say, cooperation with multi-state law-enforcement "sweeps" or something.  Which wouldn't hurt.  But even then, since even then the initiatives arise from state and local levels and federal agencies such as the FBI really do mostly just cooperate, she's right that the place to go to work on this stuff is the state and local levels.

Which, since very often what's needed are human faces at human scale, local jurisdictions are probably the right place to make your cases.  And also very often it's the petty outrages like condom carrying as evidence, or sex work as sex offense* that cause the biggest law-related headaches.  And it's also often the merely venal outrages like cops shaking down sex workers for free "dates" as part of the "cost of doing business" that local activism is more likely to have some influence over.

I'd add that it probably really is state and local level activism that'll help incubate "best practices" decriminalization in the long run.  Because as we can tell from Sweden to Nevada to Holland to Australia to Vancouver(!) there are a lot of ways to do it wrong too.

Also, groundswell!  5,000,000 marchers on the D.C. Mall rarely have much impact, even with the backing of FOX news, so 5,000 petition signatures isn't going to cut it either.  If you're going to make a difference I'm... pretty sure it's going to have to be from the bottom up.

* Though, of course, never, oh never, is a customer put on the offender registry.  Even when the sex worker they select is working under duress.  Even when the sex worker they select is working under *age!*http://brilliantatbreakfast.blogspot.com/2011/09/big-dick-goes-to-canadian-pedophile.html

Having defended SlutWalk Toronto and its successor demonstrations with all the curmudgenliness I can muster I want to touch on a dissenting point. It's something that’s really been overlooked by too many people who’ve been looking at the Toronto thing as a ready made template for social action.

Specifically, I thought Aura Blogando’s well-reposted dissent was off the mark in one regard: there’s no way the best response for women in Toronto, Ontario, Canada, to take against an asshat Toronto police officer’s aspersions about Toronto women’s attire would be to organize a protest in New Orleans, Louisiana, U.S.A.

But she is on the mark that what was probably 100% appropriate for protestors in Toronto would not be appropriate for a similar protest in New Orleans. In fact even the name, which was perfect for circumstances in Toronto (where the word the cop used, “slut,” does not have such deep-rooted historical connotations in race, class, and legal proceedings) would be a disaster in New Orleans (where the word “slut” absolutely does have those connotations and according to Blogando, quite a few more!)

But where I think she, and a lot of other people, got their wheel in a rut is over the expectation that any initiative in one location must be a complete, branded template for every other location. On the planet. Or, worse, that one quickly-spun website in Canada should become the clearing house for all future local initiatives along those same lines.

It would just be a mistake if Blogando were the only one to make it, but she isn’t — since maybe the early 1980s rubber-stamped protests have been the norm not just in feminist circles but most progressive-left ones. (Nowadays it's protesters on the right who at least seem the most spontaneous, motivated, and self-organizing.)

But here’s the thing I think is important, which I think everyone else who’s enthusiastic thinks is important too: it sounds like a “well-intentioned” New Orleans cop would have used a different word to pre-emptively blame and shame rape victims. But it would have still been the same implication and so even using different word than “slut” it would have been just as major an insult. And so there’s pretty much 100% likelihood that flashmob-like initiators in New Orleans (who would not have been primarily white, Asian, east-Asian, and first-peoples Canadians but instead would be white, African-American, mixed-race, creole, central- and South-American, Caribbean, and southeast Asian) would have named their initiative after the word their local asshat cop used instead. Even if that word either had odd or irritating connotations elsewhere in the world.

And the point, which I think is more important than almost anything else, is that that’s what everyone could be doing! Responding in local parlance to local events taking local conditions into consideration in order to produce the highest local impact!

Out of context “SlutWalk” is a dumb name. And I think it’s kind of silly that everyone else is kind of reflexively imitating it title and all. And heck, if as Blogando and others suggest the word “slut” doesn’t have the same resonance in New Orleans or elsewhere then not only does it annoy some people it also isn’t going to resonate with local authorities who’ve been getting away with trafficking the same victim-blaming “advice” for years. So, yeah, in that case rubber-stamping the same name isn’t just uncreative it’s counterproductive.

Which raises the question: how can Blogando and others pioneer real, local initiatives that do will work where it’s needed most?

Because, yeah, why should anyone feel obliged to use terms in their protests that might have worked in the original location but have zero, or even negative meanings locally?

I haven’t been working on Slutwalk in part because I don’t like the name and I'm not sure I have anything to offer anyway that would offset the minor point that I'm a six foot four inch tall man. But I’d be the first person to get behind a more visibly decentralized movement the minute someone starts one near me. And I’ll be the first to get behind a public initiative you or Blogando initiate near you. Because name notwithstanding that’s what I think it exciting about the Toronto event and it’s successors.

Last spring Matthew Yglesias quoted Richard Ablin, discoverer of the PSA test for prostate cancer, on the cost of the test’s adoption (and misuse!), on both the healthcare system and patients themselves. (Emphasis Yglesias’s)

The medical community is slowly turning against P.S.A. screening. Last year, The New England Journal of Medicine published results from the two largest studies of the screening procedure, one in Europe and one in the United States. The results from the American study show that over a period of 7 to 10 years, screening did not reduce the death rate in men 55 and over.

The European study showed a small decline in death rates, but also found that 48 men would need to be treated to save one life. That’s 47 men who, in all likelihood, can no longer function sexually or stay out of the bathroom for long.

Albin said it in the NYT, here.

Yglesias adds

In the health care domain, in particular, a mix of weak science, bad economic incentives, and poor mathematical understanding leads to a fair amount of over-treatment. And over-treatment for cancer isn’t just an issue of spending money that didn’t need to be spent—treatment for prostate cancer normally has very unpleasant side effects and it’s really cruel to inflict it on men who don’t actually need the treatment.

He said it here.

Yup. Prostate surgery is necessarily pretty brutal. A urologist friend told me once that just to reach it you have to carve through some of the toughest, most interconnected muscles in the body. And then since the prostate completely surrounds the urethra, nearly all nerves and blood vessels to the penis, and the base of the penis itself, it’s extremely difficult for even very-targeted surgery or radiation treatments to a) remove cancerous tissue without b) severely degrading bladder control, erections, and anything else one might ordinarily do with a penis. Then you have to recover the use of all the pelvic and leg muscles and connective tissue the surgeons must go through to get to the prostate in the first place.

And then somebody, somewhere in the economy, has to pay for it.

All with a 47-1 chance that the debilitation and the expense was unnecessary.

And lest I seem to be dwelling disproportionately on prostate cancer, Yeglesias points out

...as far as cancers go, that’s totally typical. Reducing over-screening and over-treatment would probably save money (though it’s always hard to know what the long-term impact will be since everyone eventually gets sick and dies) and will definitely spare patients a lot of pain and suffering.

Anyway, while this post came up way before the recently raised concerns about the mistreatment of women in maternity I think it nicely illustrates the problem faced with distinguishing specifically misogynistic treatment of women in maternity with plain old ordinary mistreatement of people in medical treatment.

Most urologists are men, as of course are all prostate patients. And so by only the most convoluted reasoning could one construct a case that treatment was influenced by misogyny. And yet protocol is such that 46 men are effectively castrated and rendered incontinent at extraordinary cost for every one man who’s life and/or post-recovery quality of life is likely to be improved.

This is so not one of those “but men are mistreated too” arguments. Instead the point is that under present practice everyone is a potential candidate for mistreatment, with the result that distinguishing mistreatment motivated by misogyny (or racism, classism, ageism, ableism, or conversely by incompetence, indifference, or vindictiveness) is very, very difficult.

Or, approaching it from the other direction, finding ways to eliminate the sort of abuse and inconsideration that appear to be inherent in much of contemporary medicine (medicine of all stripes including much of alternative and “non-western” practice) would have two strong benefits in the fight against misogyny and other prejudice-based abuses.

First, it would just plain make the remaining cases of prejudice-based abuse vividly apparent.

Second and even more importantly, it would make it way more difficult for prejudiced practitioners to hide their behavior in the greater noise of non-prejudiced injury.

Case in point, the capricious 4th-degree episiotomy Chingona mentions in comments at Kittywampus would have been unambiguously targeted for prosecution were 2nd- or 3rd-degree episiotomies not also considered perfectly routine. But even better, under other circumstances whether it was motivated by sheer prejudice or merely by the OB’s personal pettiness it most likely wouldn’t have happened at all.

(Quick note for the majority of people who are seriously deficient in maternity practices. The entire medical justification for episotomies is to avoid 4th-degree tearing. Consequently a caregiver snipping one for shits and giggles ought to have been caught anyway. That it wasn’t… assuming it wasn’t… is evidence that that which is routine desensitizes supervisors and lay people alike from distinguishing actual abuse.)

Long before I first posted anything about sex and even longer before became an outright sex blogger my first experiences with online participation came in the pages of the old Usenet usergroups on pregnancy, childbirth, and infant care. My partner had terrible insomnia when she was pregnant and so I’d spend hours sometimes, late at night, on an old dial-up account, reading voraciously and nervously chiming in.

I was nervous in part because I’m a man (albeit a well-informed one who’s maternal grandparents had themselves been well-regarded authors in the field) but also because passions ran intensely high… or more accurately ideologically so… on certain topics such as vaccination, circumcision, breast feeding, episiotomies, and c-sections.

And because I was nervous I relied very heavily on a handful of texts and magazine articles, written mostly by well-regarded midwives, doctors, and other caregivers who trended heavily (but non-obsessively) towards natural childbirth, nursing, and childcare.

While on balance I’d rather have been in bed asleep most of those nights, became reasonably well-regarded, became very well informed, and generally had a very good time. (One of my last posts described the birth of our first child and I still treasure the kind words and best wishes we received from online friends and adversaries literally all over the world.)

Well, as my children have moved on to middle school those days are long behind me. And I’m still a man. And I’m still a little nervous getting into this. But remembering the intense rhetoric of those (still-ongoing, incidentally) debates I’d like to chime in alongside Amanda Marcotte and, just now, Linday Beyerstein of Big Think as being strongly in support of respect for women’s childbirth preferences and decisions but even more strongly opposed to calling it “birth rape” when their decisions are not respected.

Some factions within the natural childbirth movement are attempting to popularize the concept of “birth rape.” The idea is that women who are handled roughly, verbally abused, or bullied into unwelcome interventions during labor are literally being raped by their health care providers.

...

Some of what [UK-based reproductive-rights activist Amity] Reed is describing here _[link to the F-Word]_sounds like plain old assault and battery or verbal abuse. She also implies that some instances of so-called birth rape are medical procedures performed against the patient’s will. If a doctor performs a procedure on a competent adult patient against her will, that’s assault. Women in labor should have the right to refuse treatment if they’re mentally competent to do so.

...

“Birth rape” is an emotionally manipulative metaphor that encourages women to re-frame  traumatic experiences in a way that makes them seem even more traumatic. It’s difficult enough to come to terms with a disappointing, painful, or terrifying birth. To encourage women to recast that experience as a sexual violation, even when everyone agrees that the doctor did nothing sexually inappropriate, is cruel, not liberating.

She said it here.

I ought to add that I absolutely agree with the outrage Amity Reed and many other activists feel at the sometimes appalling treatment they receive, especially at the hands of “mainstream” industrial medicine. My first introduction to how bad that treatment can get came from a student-nurse friend who told me that where she was interning one of the Ob/Gyns was very up front with her staff about how she hated conscious patients (this was back in the day when anesthesia was common for deliveries) and how forceps were great when she was in a hurry for a cigarette! And by all accounts (such as Reed’s) that attitude is still alive and well. And disgraceful. And demeaning. And dehumanizing. And can be encountered not just among surgeons but right down the line to receptionists*. And most of all unnecessary and wrong.

In other words I recognize the reality of medical malpractice. But I also agree with Beyerstein and Marcotte that the treatment described amounts to legal definitions of answerable malpractice, and (one would hope) even assault and battery. But I also agree with them that it’s counterproductive on dozens of layers to call it rape.

In their respective pieces Marcotte and Beyerstein articulate why. I’d like to add two more:

First, all too often the callous mistreatment women receive in the delivery room is reflected in the emergency rooms, operating rooms, geriatric wings, psychiatric care wings, cardiac- and intensive-care suites, and neonatal wards of many of the same facilities. One can note that routine childbirth is not a medical event — as many natural childbirth advocates argue and as I’m inclined to agree. But to the extent childbirth happens in multi-purpose medical facilities it’s infuriating but not surprising that laboring mothers would be treated little different from other patients.

Second, and it’s a point related to the first, what in the Sam Hill has happened to us that we’re unable to recognize, let alone acknowledge, the emotional and psychological impact of “mere” assault and battery? When a merely inconvenient or uncooperative but non-violent geriatric or psychiatric patient is strapped to a bed and forcibly catheterized we call that highly traumatic and dehumanizing treatment assault and battery, not rape. And when a nurse slaps or quietly slips sedatives into the IV of a wailing teenager not because he needs it but because he’s disturbing other patients we call that instrumental abuse of a human being assault, not rape. Amplifying effectively-identical behavior in delivery rooms denies the severity, and the impact, of that behavior elsewhere in medical care.

Conversely, calling it medical assault and battery in the delivery room just as we call it assault when it happens anywhere else highlights what’s really going on rather than allowing mistreatment to be divided and conquered, sequestered, partitioned and, I think, gendered into one thing that happens to women in the maternity ward vs… something less significant should it instead happen (perhaps to the very same patients under other circumstances!) in, say, the burn unit, recovery room, or ICU.

As Beyerstein says, to call it “birth rape” is to invoke a grossly manipulative metaphor that we correctly don’t tolerate when it’s invoked by others consumed past reason by their own agendas. We shouldn’t tolerate from advocates of causes we support, no matter how strongly we support them. Update: Speaking of causes we support, we shouldn’t tolerate metaphor in the rhetoric of environmentalism either, where it’s entirely too common… and entirely not called out often enough. (Hat tip to Chingona.)

Note: I don’t think I should have to say this but I will: almost all direct providers of all forms of healthcare, from radiologists to reflexologists, from naturopaths to neurologists, and from cardiac surgeons all the way down to candystripers are skilled, diligent, effective, and compassionate towards their patients needs. The few who aren’t — the ones who sometimes seem determined to tar the whole enterprise with their own sordid and abusive antics — should be dealt with appropriately, not hyperbolically.

* Even midwives are not immune to mistreatment of their patients. While waxing enthusiastically about my partner’s experience with our midwife (a nurse practioner with admitting privileges at all area hospitals) a friend from the east coast told us her midwife had rarely looked at her, talked on the phone, stepped out for cigarettes, or just sat rubbing her forehead saying “oh my god, oh my god” during most of her very long but otherwise completely routine labor!