healthcare policy

More Evidence That Using Possession of Condoms as Probable Cause for of Sex Workers Is a Really Bad Idea

Posted by figleaf | Tags:
Mon, 2011-11-14 12:43

New York based sex-worker advocate Crystal DeBoise has a positively charming example of how anti-prostitution tactics produce results we'd... probably rather not have produced.

Last winter, “Sheila,” a sex worker in her early 20s, had just finished her counseling session with me at the Sex Workers Project, and was heading out the door. Sheila was seeking counseling from the Sex Workers Project to help her make a career change, but had no financial support and was still working in the sex industry. I gestured towards our colorful shoebox of condoms, lube and pamphlets about safe sex and reminded her to take whatever she needed. She looked at me as if I were suggesting she walk into the January snow barefoot and said, “Are you crazy? I’m not carrying those things around! You want me to get arrested or something?”

Sheila was referring to a situation in New York that permits the use of condoms as evidence of prostitution, resulting in their collection and confiscation from women who are detained by the police. This practice is an outright slap in the face to the decades of hard work that public health advocates have undertaken to increase safe sex, decrease HIV and create a positive shift in the cultural acceptance of condom use. This policy discourages a stigmatized and marginalized group of sexually active people from carrying the tools they need to be healthy and safe. And this occurs despite the fact that the New York City itself runs a free condom distribution program because “Using a condom every time you have anal, oral or vaginal sex protects you and your partners from getting HIV and other sexually transmitted diseases … and prevents unplanned pregnancies.”

Source: Feministe

I'm pretty sure you could find the random conservative fundamentalist, or cartoonishly stereotypical pimp, or neo-conservative "feminist," or trans-phobist, or heck, even gay basher who really, truely doesn't care that sex workers are discouraged from protecting themselves or their customers from illness or death by anti-condom police policies.  But I don't think you'd find very many.   Therefore I'm not sure what, exactly, the appeal of the we'll bust you if we catch you with condoms policy really is.

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Amanda Marcotte on the False Equvalence Between What Everyone Believes and "What Everyone Believes"

Posted by figleaf | Tags:
Wed, 2011-11-09 10:33

Amanda Marcotte on the pro-choice "Mississippi miracle"... and the power of the secret ballot.

It's not something I've ever seen an extensive study on, but the folk wisdom of pro-choice circles is "pro-life in the streets, pro-choice in the dark", as it were. In other words, there's an intense amount of pressure to identify as "pro-life" in conservative communities, even if you secretly disagree. To be vocally pro-choice is to be marked as a pervert and a feminist, and so it's avoided, to the point where some polling data suggests that half of people who identify as "pro-life" are actually pro-choice, at least to some extent. Certainly enough that they're not willing to see women thrown in jail for having miscarriages. Because of this intense social pressure, I suspect many people who side with pro-choicers on this law or that law won't say so to a pollster over the phone. Not only are you admitting out loud something that can get you marked as a "pervert" in your community, you may be doing so in front of friends, colleagues, or family members who overhear your conversation with the pollster. No wonder so many people say they're "undecided". But when you actually have your ballot in hand and you know that no one will ever find out how you voted, a solid percentage of voters go with common sense (and with sex!) instead of prevailing community pressures. Frankly, the way the poll numbers turned out, it appears many people who said they would vote yes on 26 instead voted no.

Source: Pandagon

That sounds about right.

I think I'm coming down with another cold, or at least I'm feeling a little muzzy-headed. So I can't remember the sociology term I'm reaching for. But it seems to me like this is another one of those cases where public sentiment is dominated by the desire of a majority not to be outed as "the only one who feels that way." When, in fact, the majority really doesn't feel that way. And where, in fact, the kind of understandable desire not to be outed when it seems like "everybody else" feels that way is kind of strong. And where, I suspect, the urgent desire not to be outed leads to sometimes increasingly zealous efforts to go the other way. Thus you have people like J. Edgar Hoover or Rev. Haggard leading the charge against homosexuality. Or people like Herman Cain or Dan Quayle spouting sometimes ridiculous affirmations about no-exceptions anti-abortion policy while totally considering it a free choice for their own family members.

I think it's a big problem with so-called "conscience clauses" for healthcare providers, the ones that allow, say, pharmacists to refuse to stock emergency contraception due to their (nominally!) "private" objections. When, in fact, they may personally only be succumbing to public expectations in their communities... expectations set, as Amanda suggests, by a majority in the community who... themselves don't think it's a problem but definitely don't want to be seen as "the only ones who feels that way."

Update: I didn't read far enough before posting this, but Amanda draws the same conclusion in her post.

When they say things like, "the only way to prevent STDs is for two virgins to marry and stay faithful" or "contraception thwarts God's intentions for human sexuality", they face a chorus of amens from people who then often turn around and demonstrate, with their behavior, that they simply don't agree.

Again, that sounds right.

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Anti-Choice Dakotans Think Letting 1 Man Die to Kill 99 Women Is Worth It Unless Komen Fund Kowtows to Anti-Science Doctrine

Posted by figleaf | Tags:
Sat, 2011-03-19 23:31

Oh this is just getting ridiculous! Beth Saunders says

Two North Dakota bishops have created a list of organizations that “good” Catholics should not support with money or volunteer work – mostly for abortion or contraception-related reasons.

...

Susan G Komen’s crime is that it “refuses to acknowledge the link between abortion and breast cancer.”

Source: RHRealityCheck.org

Since they think there's relationship between breast cancer and abortion they may imagine only women get breast cancer. And given the anti-abortion/anti-contraception movements visceral disdain towards women...

I wonder if it would make any difference if they realized about 1% of breast cancers occur in cis men?

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Ever Notice How Much the Anti-Abortion Debate Relies on Racial, and Often Racist Stereotypes?

Posted by figleaf | Tags:
Wed, 2011-03-02 17:45

Photo via Sociological Images. Cached as a bandwidth-conserving courtesy
Photo via Sociological Images.

So when I saw the billboard model anti-choicers picked for their “most dangerous place for an African American is in the womb” anti-abortion campaign -- a late-elementary school girl in a light top with a wary, kind of stunned look on her face -- it really bothered me but I couldn't quite put my finger on it.  She seems pretty old for their usual cutesy baby poster-child pics.

Amanda Marcotte gave me the clue I was looking for.

Sean Hannity, yelling at Juan Williams for suggesting it’s a good thing if women can choose when they give birth: “I’m pro-choice in this sense, Juan.  If you choose to get in the back of the car with someone, if you choose to make out with them, if you choose to grab, grope and fondle, if you choose to take one article of clothing off after another, guess what? You made a series of choices, Juan.”

What I enjoyed was the realization that Hannity thinks people stop fucking when they get old enough to have apartments of their own, and don’t have to make out in the back seats of cars.  Is this a widespread assumption on the right?

Source: Pandagon

I thinks she's exactly right.  Adult women pretty much don’t have sex in cars.  For one thing, last I checked you pretty much can’t have sex in a car.  Unless it’s sex in a mini-van (not that uncommon but not what Hannity is imagining) or... sex in back of the kind of large “pimp-mobile” American sedans I suspect he is imagining.

That’s what Hannity thinks abortion is all about: teen pregnancy.  Early teen pregnancy.  At the hands, no doubt, of “big black studs” driving around in welfare Cadillacs.  Who thanks to Planned Parenthood's enabling are able to, like, totally get away without paying "the wages of sin."

This African American pimp/teen-whore stereotype is a total fixation for ‘wingers.  It’s no coincidence that Lila Rose got actors to pretend to be pimps for her failed video sting of Planned Parenthood.  Same, of course, with James O’Keefe’s sting against ACORN.  (Even when they used white actors, as when O'Keefe himself pretended to be a pimp, their attire and demeanor was straight out of 1970s-style urban-black exploitation iconography.)

I’d just add that the right almost has to demonize stereotypes of very young African American girls and older, underworld partners because the alternative is confronting the majority of women who actually do get abortions.  Because the reaction when a lower-middle-class working or college-bound woman in her late teens or early 20s gets an abortion, or a married woman who doesn’t want any more kids gets an abortion, or an even older married woman who's amniocentesis or ultrasound reveals profound disabilities the reaction is a lot less, um, viscerally satisfying.  Instead, when it comes to their own daughters, friends, sisters, mothers, and wives it tends to be almost... sympathetic.

Don't get me wrong.  They could debate the issue on its actual merits.  Hard to imagine it ever occurring to them.

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Health Consequences of Assuming Men are Baseline Normal: Turns Out Women Are Usually Anemic for Same Reasons Men Are

Posted by figleaf | Tags:
Sun, 2011-02-06 02:26

Oh this is great! I've mentioned elsewhere the insights that can be gained from dropping the assumption that (relatively affluent, anglo-euro, military-age) men are the neutral baseline against which all other humanity should be measured. It's a great way to reveal otherwise invisible ways gender construction affect men. Well, here's Kate Clancy laying out a just plain classic example where assuming men are the baseline screws women.

And without forgetting that we really are talking about a rather dangerous assumption that women's iron levels vary (because they have periods) while men remain constant (because they don't), what I'm really excited about is how nicely the charts illustrate the point: they show one thing when you assume men are the baseline, something else entirely different. And in this case more medically true and medically useful! (All emphasis hers.)

Check this out.

[M]ost people assume that the sex difference in iron stores in males and females, which begins at puberty, is due to the onset of the period and looks like this:

Figure 1. Made-up data to demonstrate the assumed way the sex difference in hemoglobin is produced.

However, the sex difference in iron status in males and females derives from an increase in male iron stores at puberty, not a decrease in female iron stores. This has to do with oxygen transport and testosterone (Bergstrom et al 1995). This means that the difference that occurs at puberty actually looks like this:

Figure 2. Made-up data to demonstrate the actual way the sex difference in hemoglobin is produced.

Second, the main culprit for iron-deficiency anemia (IDA) in men is upper-gastrointestinal bleeding, so when men present with IDA the first thing they do is an endoscopy. When women present with IDA they give her iron supplements and tell her to go home because it's just her ladybusiness. Kepczyk et al (1999) decided to actually do endoscopies on women for whom a gynecological source was diagnosed by a specialist for their IDA. They found a whopping eighty-six percent of these women had a gastrointestinal disease that was likely causing their IDA. Therefore, menses likely had nothing to do with their IDA, and the assumption that menses made them pathological actually obstructed a correct diagnosis.

The majority of the women in that study were bleeding internally, and no one had figured it out until then because they had periods.

Source: Context and Variation

The post is important because it illustrates the way extremely old gendered assumptions meant no one bothered to check for what would otherwise be an obvious and parallel reason for anemia in women.

But what I really like is how those two charts illustrate what happens when you drop that  assumption. As soon as you switch the frame of reference suddenly men are the variable. And looking at the second chart we're really variable!

This isn't just significant for reasons of gender-blind assumptions. You look at the second chart and suddenly a sex-specific illness like hemochromatosis in men stops looking so inexplicable: after puberty men's hemoglobin levels start to spike upwards.  There might be advantages but past a certain point iron levels can too high.

That's still kind of academic compared to the consequences of neglecting to consider GI bleeding in women. If women are already "borderline anemic" (now a.k.a. "normal") then identifying and dealing with significant causes like that instead of assuming along with Aristotle that a couple of teaspoons of undiluted blood lost in menses was making the difference. (Hello? Even though donating a whole pint in 20 minutes doesn't?)

Via a science link roundup from Not Exactly Rocket Science

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Know Any Pro-Choice Activists Who'd Prefer Abortion to Contraception? DIdn't think so.

Posted by figleaf | Tags:
Thu, 2011-01-27 20:57

Amanda Marcotte says

I know I sound like a broken record on this, but it’s important never to forget that anti-abortion activists also object to the means to prevent unintended pregnancy, and hence the need for abortion, and are better understood as forced-pregnancy activists than anti-abortion in any meaningful sense.

Source: RHRealityCheck.org

Yup.  Raise a hand if you know anyone on the pro-choice side who prefers abortion to unplanned, unwanted pregnancy.  The main activists on the anti-choice side tend to be anti-choice as opposed to merely anti-abortion, productive ways of preventing unplanned, unwanted pregnancies have never been much of a priority for them.

(And yes, I still think the pro-choice side could do more to drive a reasonableness wedge between the genuinely anti-choice hard core and the vast majority of folks who are uncomfortable with abortion but totally fine about contraception and sex ed.)

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The Story Behind the Story Behind the 20% of Brit Women Use EC Story... Plus an EC Product Packaging Suggestion

Posted by figleaf | Tags:
Thu, 2011-01-06 12:03

Ever notice how sometimes the deeper one digs the more interesting some news tidbits become?

In a news-roundup post, Beth Saunders of RHRealityCheck.org passes along with insufficient comment a tidbit from an anti-choice website that...

Twenty percent of British women used emergency contraception in the past year, according to a survey by the Co-Operative Pharmacy.

Source: RHRealityCheck.org

If you go to the site itself (LifeSiteNews) you get a little more background... but obviously you also get more anti-choice slant (emphasis mine)

A Co-Operative Pharmacy survey of 3000 people found that 20 percent of women aged 18 to 35 took the “emergency contraceptive” pill last year. The same group said they had typically used the drug, which only acts as a genuine contraceptive in some cases, when they had had sex after using drugs and/or alcohol.

The poll further found that up to 250,000 women had used the drug two or more times during the year. One in fifty 18-21 year-olds said they used the MAP as their normal form of contraception. One sixth of the women surveyed said they had contracted a sexually transmitted disease.

Source: LifeSiteNews

And if you go to the actual Co-Operative Pharmacy press release you get the same core information minus (shock, gasp, surprise!) mention of "only acts as a genuine contraceptive in some cases."  Which is good because, of course, that would be factually incorrect.  Here's the straight story from the source.

Thousands of women risk waking up on New Years Day with more than a hangover as over one in five blame partying with drink or drugs for not using contraception with a new partner, figures* reveal today (1 January 2011).

The Co-operative Pharmacy, part of The Co-operative Group, questioned 3,000 people about contraception and found that one in five women aged 18 to 35 years old have used the morning after pill in the last 12 months. One in six women admitted to having had a sexual disease.

The research also revealed that the preferred method of contraception for almost half of all women was the pill and two out of five favoured condoms. 250,000** women have used the emergency contraceptive three times or more and more than one in 50 of those aged 18 to 21 said they preferred to use the morning after pill as a regular form of contraception.

Source Co-Operative Pharmacy

I don't feel qualified to comment on on-the-ground experiences (feel free to chime if you know otherwise) but it sounds like most pharmacists don't agree that EC is all that great on one's system.  From the Co-Operative press release:

Mandeep Mudhar, Head of NHS Development at The Co-operative Pharmacy, said: “Our research shows that some women are taking unnecessary risks with their health. The morning after pill should be a last resort to prevent an unwanted pregnancy after having unprotected sex or if another method of contraception has failed, such as if you have forgotten to take one of your contraceptive pills.

“However, the emergency contraceptive pill does not protect against sexually transmitted infections. Pharmacists provide free accessible advice about contraception but we would always urge people to use a condom, particularly with a new partner, as it offers the greatest protection.”

That sounds about right.  I'd just add, though, that the key word above would be "particularly with a new partner."

Few young single people have "Jersey Shore" style lifestyles where they're prepared at every moment to be ready to fall into bed with someone new.  Instead, most young single people, women as much as men, tend to go through sexual "boom and bust" relationships.  And for people for whom hormonal contraception is an option (obviously only women so far, darn it) it often doesn't feel worth the hassle and often the discomfort of staying on a medication you may expect to need only a few times a year.

To that extent that most women who report using emergency contraception as their "primary contraceptive" are almost all still using it only once a year we're not necessarily talking about a giant epidemic of "irresponsibility" here.  Nor, I would add, does that suggest epidemics of "promiscuity" either.  Unless by promiscuity you mean "once last year."

The EC/STI connection is a little more problematic.  First of the STI question seems to have been about lifetime experience with STIs whereas the rest of the survey reports about annual experience with contraception.  I mention this only to tidy up the numbers, not to minimize the actual risk.  Second, by focusing on the EC angle the story almost necessarily underplays the story of very large numbers of people using no protection for first-time sex.

Proposal: I know it sounds counterintuitive but I think it occurs to  me it might be a very good idea to encourage manufacturers and/or pharmacists to include a condom in every package of EC.  It's counterintuitive because one tends to view EC as something you take after the fact.  And indeed it is.

EC is not, however, always purchased after the fact.  I expect it's a lot easier to remember that if you've already Backed Up Your Birth Control it might be easier to remember you've also got at least one backup condom.  And even if not?  Well, you've still got a condom for next time.  Even if, as those survey numbers suggest, next time also happens to be next year.  And one way or other, knowing there's a condom in the box "puts the idea into consciousness" as the new-agers say.

Extra credit if the condoms have the retro-20th-Century "for prevention of disease only" motif!

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Get Out the Vote: Pro-Life Till Birth, Anti-Care After is Just Around the Corner Unless You Turn Out and Bring Others With You

Posted by figleaf | Tags:
Mon, 2010-11-01 13:03

So a headline glimpsed through USA Today vending machine said it looks as though tomorrow will be the biggest “wave election” turnover in the House and Senate since the post-Watergate 1974 election.

Some very good progressives are on the verge of being cast out of office. As are some pretty lousy ones. All to be replaced by those who’s ambition is not only to enact the Ten Commandments but also to repeal the Sermon on the Mount and repudiate his sermon at the Last Supper.

They’re viciously committed to at least two relevant policies: First, not just to withhold funding but to actively outlaw all abortion — even in the case of rape and incest (hey, conservatives want grandchildren just like people do.) Second, to make sure that the minute such children are born that they receive no healthcare beyond what the mother can afford.

Just think what a lesson liberal/lefties are going to teach that nasty Barack Obama by sitting this one out!

Or you could do the right thing and not only vote yourself but volunteer in your neighborhood to get out the vote. As I will be doing. For the first time.

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BTW That Childbirth Thing? There's a Categorical Difference Between Believing It Will Hurt and Believing it *Should* Hurt

Posted by figleaf | Tags:
Tue, 2010-09-21 15:47

Speaking of misogyny in obstetrics, Jessi Fischer of The Sexademic digs up a… fascinating quote about near-universal attitudes about women and the pain and danger of childbirth.

Kristoff and WuDunn’s book “Half The Sky” [link —fl] (where I found the preceding Mather quote) contains an illuminating passage about attitudes towards women and childbirth:

In most societies, mythological or theological explanations were devised to explain why women should suffer in childbirth, and they forestalled efforts to make the process safer. When anesthesia was developed, it was for many decades routinely withheld from women giving birth, since women are “supposed” to suffer. -Half The Sky, page 116

But now many of us do not have to suffer. We have the technology to stop massive hemorrhaging, deal with infections and stitch up vaginal tears. In this brave new world, we forget the inherent dangers of pregnancy and childbirth.

Read the quotes in context here.

And, of course, with it being not just a medical problem but a societal one, and when patients, as members of society themselves, can be as convinced of the virtue of suffering as their families and caregivers…

That’s when it’s really, really a good idea to pay attention to caregivers who pay attention to their patient’s wishes as well as their needs.

Which, I think, is just one more reason I think it would be really, really great if more people, caregivers, family members, and prospective mothers as well, paid more attention to people like birth educator Penny Simkin. Her “Pain Medication Preference Chart (pdf)“ not only really covers the maternal preference spectrum (from “desire that she feel nothing; desire for anesthesia before labor begins” all the way over to “desire that the mother forego all medications, even for cesarean delivery!”) but also includes sensible, respectful coaching advice for those and all the (far more likely) points in between.

Absent Shulamith Firestone’s dream of artificial wombs I don’t know if we’ll ever reach a point where pregnancy, childbirth, and recovery carry no risks to health or life. But we can still do a heck of a lot more to make childbirth a more patient-focused, patient-directed, and patient-centered.

Step one would be ditching the assumption that it’s not only going to hurt, it’s supposed to. The notion of inevitable suffering in childbirth, or the virtue of it, let alone the notion of divinely mandated suffering(!), can lead to all manner of unnecessary complications, abuse, and outright medical violations by caregives, and passive resignation by victims.

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Harriet Jacobs on How Rape Exceptions Work in Anti-Abortion States... Or How They Don't

Posted by figleaf | Tags:
Fri, 2010-02-05 23:56

Harriet Jacobs of Fugitivus, who works in a municipal (I think) legal justice system and volunteers to help pregnant minors obtain parental-notification exemptions for abortions has the rundown on just how her state’s (and very likely most states’) rape-victim exemptions work. Or rather don’t.

I’m not saying that there aren’t some stone cold stupid obnoxious young boys out there who are getting their counterparts pregnant. I know there are. When girls who were knocked up by age-appropriate boyfriends come in, the boyfriends come with them (and make out in court). Girls who come in alone, I assume, didn’t have a boyfriend; they had an abuser. Now, technically, there’s a rape exception in the notification law. If you have been raped, you do not have to go through the judicial bypass — you get a bonus abortion, no paternalism attached! But because, lord knows, women are big fat liars about rape, and because women will resort to desperate measures to acquire medical care that we all know they don’t really need (what they need is a baby), a girl can’t just say she was raped and get a free bypass. She has to report her rape to the police. And since the police are going to tell your parents anyway, well, in for a penny, in for a pound.

I can’t conceive of any possible scenario where a girl reports her rape to the police, but hides her pregnancy and subsequent abortion from her parents, the police, the investigators, the judge, the jury, and the attorneys. I suppose it is possible, but is it probable? Is it reasonable? We don’t trust these girls with the decision to have or not have children, but we think they should be capable of maintaining an intense secret after a horrific trauma and during police and attorney interrogation?

So the exception for the bypass law is, in this case, completely self-defeating. For a girl to meet the criteria for the exception, she will no longer need the bypass. Which again shows you the intent of the law, and the exception: neither were ever instituted with the intention that they be used. Additionally, knowing that the rape exception was only added after intense public pressure illustrates its function quite clearly: the rape exception is to make politicians look like something less than paternalistic monsters, while preserving the paternalistically monstrous power to deny all young women (including rape victims) the right to access desperately needed medical care.

She said it here.

When I was a teen peer counselor back in the days before the Supreme Court decided Roe v. Wade my home state had a variety of too-clever-by-half laws that defined things like 10-month review processes for pregnancy terminations. It was part of the insult legislators routinely added to add calculated insult to often very-real injury.

This sort of unusable rape “exception” suggests only that they’re more sophisticated, not that they’re any less clever-by-half, nor any less interested in insulting and injuring.

It’s still not ok.

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