Back Up Your Birth Control with EC

Today is the Back Up Your Birth Control Day of Action!

The Back Up Your Birth Control campaign focuses on increasing awareness of and accessibility to emergency contraception (EC). It's important to get the right information out there about EC. It is NOT the abortion pill. It is NOT dangerous. It is NOT 100% effective (no form of contraception is).

It always amazes me how little some women know about EC and how it works. In college I was the Women's Studies Major, well of reproductive health information, so people always came (some still come) to me with their questions. I'm going to put that hat on right now and provide a little 411 for those reading who don't know:

You use EC, also known as the morning-after pill or Plan B, up to 3-5 days after you've had unprotected sex in order to prevent a pregnancy. The sooner you take it after intercourse, the better. It basically works like amped up birth control -- it uses hormones to stop fertilization or implantation. Because of this, it doesn't actually stop a pregnancy if it's already happened. You should take a pregnancy test before you get the EC because it'll be useless to take it if you're already pregnant. I repeat, it is NOT the abortion pill. The side-effects are similar to what you'd experience taking the pill, perhaps a bit more intense depending on your body and the hormone levels you're used to.

Currently in the U.S., EC is available over the counter if you're over 18 -- YAAAAY! For the time being, those under 18 need to have a prescription, but the age is being pushed down to 17 and the courts are asking the FDA to consider removing the age restrictions. (You can take action to make that happen here.) ETA: There are other barriers to access that you can read about here (PDF), including cost, coverage, supply, etc.

So there's your education for the day. If you have any other questions, you can ask them in the comments or email me.

Head on down to the pharmacy and stock up on EC. Go with your friends and have them do the same. And keep a stash handy so you can help somebody out when there's an emergency.

(Cross-posted at Jump off the Bridge.)

URGENT Action: Bush's Conscience Rule

Bush seems determined to make some of his worst decisions in the final days of his presidency. He's just upped the ante by issuing the "conscience" rule, which gives health providers (including pharmacists) the right to refuse performing procedures or giving treatments that are against their religious or moral beliefs.

Here are a few scenarios in which this rule can be applied:

1) Somebody goes to the doctor, learns she is pregnant and subsequently decides to have an abortion (for WHATEVER reason). The doctor believes abortion is immoral. The doctor can not only deny giving her a completely legal abortion, but doesn't need to give her information on how to get one or who to speak to for counsel on having one.

2) A couple decides that in addition to wearing a condom, they will use birth control for extra protection. The local pharmacist, however, believes using birth control is a sin and refuses to fill the completely legal prescription. Said pharmacist does not need to refer the couple to another pharmacy that will fill the prescription.

3) A woman has been living with AIDS after a blood transfusion for several years. She moves to a new town and goes to get her prescription filled a new pharmacy. The local pharmacist believes AIDS is a punishment from God and refuses to fill the completely legal prescription. Said pharmacist, again, does not need to refer this woman to a pharmacy that will fill the prescription.

In all of these scenarios, I've used a different reason that might be against somebody's religious or moral beliefs. In all of these scenarios, the procedure or medication was completely legal. In all of these scenarios, the health provider was not required to give the patient the information they need to receive their legal health care.

If you're as outraged as I am, you can take action NOW! Planned Parenthood has an online petition. Rachel Maddow has posted the phone number for the White House on her show's website (with a link to an MSNBC article) so that we can CALL, CALL, AND CALL AGAIN. We need to act now in order to send a message that we want this rule reversed as soon as possible.

(Cross-posted at Jump off the Bridge)

Title X Money Could Go to Anti-Choice Clinics

As Ms. reports, the plan by the HHS to give medical workers the right to refuse services to patients on moral grounds might have yet another scary consequence for women:

The Bush administration is planning an 11th-hour rule change that could open a new spigot of government money to “crisis pregnancy centers”—fake, anti-choice clinics whose mission is to convince pregnant women not to have abortions (see Ms., fall 2008).

The proposed regulation, pending action by Bush’s Health and Human Services Secretary, Michael Leavitt, would give health care workers the “right to refuse” to provide women abortion referrals, unbiased counseling and even--depending on interpretation--birth control. Not only would this mean that U.S. women were no longer guaranteed full information from their health care providers, but, according to reproductive rights group SEICUS, it could also open up federal Title X funding—the bread-and-butter of comprehensive family planning clinics such as Planned Parenthood—to CPCs. Currently, Title X funding is reserved for clinics that provide women full, unbiased counseling about their reproductive options.

These 'crisis pregnancy centers' are deceptive about their anti-choice agenda, often include false information about abortion, and are finding their way onto campus referral lists with surprising frequency. For more details and some sharp commentary, visit Viva La Feminista. Also, we've written a bit about the HHS's proposed rule at TheFU here and here.

UPDATE: Feminist Law Professors has a post up discussing the campaign to expose these fake clinics. Go read all about it.

HSS Proposal to Let Doctors Refuse Abortions: Comment Deadline

If you haven't submitted your comments regarding the Department of Health and Human Services' proposed rule that would let any medical provider refuse any treatment to any patient at any time, today is the day to act. We know that this rule is intended to make it more difficult for women seeking medical help with abortions or birth control, yet anyone could be affected. If your doctor decides it would be against his code of ethics to provide fertility treatment to a WOC or a lesbian, for example, this rule would open room for him to refuse treatment. In short, this rule is not someone else's problem - it has the potential to impact all of us.

Tomorrow is the deadline, so it is imperative that we speak now. Two ways to submit comments include visiting the Regulations.gov website and submitting a comment on their site (docket number HSS-OS-2008-0011) or emailing consciencecomment@hhs.gov (put HSS-OS-2008-0011 in the subject line).

To be sure, the point of this HSS rule is to limit abortion access, and some will argue that it will not be interpreted in a way that will impact anyone but women seeking to terminate a pregnancy. Of course, even this intended interpretation of the HSS's proposed rule takes choices away from women and families and allows doctors to deny assistance to patients seeking medical care.

It is time for the anti-choice crowd to stop pretending that all situations are the same and attempting to to write rules to fit one ideal scenario in which bringing a pregnancy to term is a viable option. Who should make the decision in cases like those of Tiffany Campbell, who discovered that she must terminate one twin fetus or loose both? Who should make the choice for a woman who's life might be put at risk by bringing a pregnancy to term? Who should decide for a woman with limited financial resources living in a country where medical bills routinely bankrupt working people who discovers that the fetus would be born with an illness that would require constant care and frequent medical treatments? Who should make these decisions - some Bush appointee or a doctor who believes that it is his or her right to deny legal medical procedures to anyone deemed unworthy?

Please join us in telling the HSS that women deserve the right to expect their doctors to provide medical services, not over-simplified world views and moral judgments.

(h/t to This Is What a Feminist Blogs Like, which has tirelessly provided information on this proposal from the start.)

WHO: Social Injustice Kills

A recent report from the World Health Organization documents the influence of social injustices on people's life-expectancies and finds that social factors -not genetics - are the root cause of variations in health and lifespan between different populations. In fact, differences in living conditions between two neighborhoods located just a few miles from one another can mean a difference of more than twenty years in the life expectancies of the people of those communities. The BBC explains:

The World Health Organization (WHO) has carried out a three-year analysis of the "social determinants" of health.

The report concludes "social injustice is killing people on a grand scale".

For instance, a boy living in the deprived Glasgow suburb of Calton will live on average 28 years less than a boy born in nearby affluent Lenzie.

I was particularly struck by this chart, which documents the difference in average lifespans in two neighborhoods near where my parents currently live - Washington DC and Montgomery County:

The report also reminds us that a woman's chances of surviving childbirth are dramatically different depending on where she's living. "In Sweden, the risk of a woman dying during pregnancy and childbirth is one in 17,400, but in Afghanistan the odds are one in eight."

As we approach November's elections here in the States, I can't help but feel like the WHO report highlights what's at stake. The report's authors explain that:

"(The) toxic combination of bad policies, economics, and politics is, in large measure responsible for the fact that a majority of people in the world do not enjoy the good health that is biologically possible."

...

The report calls for governments to consider how all their policies impact on health.

The report highlights education, affordable housing, management of access to unhealthy foods and social security protection as key.

It also said that governments should take action to ensure a living wage for workers, and working conditions that reduce work-related stress and ensure a healthy work-life balance.

All of this highlights the fact that our own health, and that of our neighbors, is at stake when we cast our ballots. If we vote for candidates who would keep working women and the elderly in a state of poverty for the convenience of big business, if we support politicians who are not committed to social justice, we are essentially decreasing our nation's vitality - dooming it to sickness and early deaths.

Yet, how do I talk to conservatives in my own family about the importance of providing education, affordable housing, and security to everyone? When my brother-in-law tells me that it is not our responsibility to help the less fortunate 'because they are the victims of their own bad choices,' how do I respond?

Doctors Fear Impact of Immigrant Woman's Arrest

According to NPR, not long after 23-year-old library clerk Marjavi Angel-Martinez sought prenatal care in a North Carolina hospital, immigration officers found her at her job and questioned her about her legal status in the USA. The process to deport Marjavi has now begun, and South Carolina doctors fear that hospital records are being collected by law enforcement agents in an effort to find and deport immigrants. As Latino advocate Jose Alegría explaines the case, "Its a fact that she received medical care during her pregnancy, that is a fact. It is a fact that she was using someone else's social security number, yes." Yet, although Marjavi has pled guilty to misuse of a social security number, her arrest has dangerous implications for everyone living in the United States.

Peter Morris, medical director of one of South Carolina's largest networks of clinics, explains that all of society is impacted if members of a population are forced to avoid hospitals. If someone who has an infectious disease fears going to the hospital to seek help, for example, the entire community is put at risk. "If people come to our offices afraid that, if they tell us something, that information could be used against them ... that's something we all should fear."

Marjavi 's arrest came after Sheriff Terry Johnson promised to crack-down on immigrants, who he claims are a tax on Alamance County's resources. County leaders have also recently called for an investigation of the county's medical system. While it is legal for officials to request medical records as part of a health-care investigation, Pam Dixon of the World Privacy Forum explains:

What is rare here is to have information used to deport someone. What you don't want to have is a system in which someone goes to a public health clinic and then that is used [to punish her] - you don't want that.

Marjavi came to the States legally as a toddler, and she and her family have been living here since, even though their visas have expired. In the days since Marjavi Angel-Martinez was charged, her husband and family have also been arrested and face deportation too. The NPR story does not mention what will happen to Marjavi 's baby, who will be a legal US citizen if born here.

This story comes on the same day that the New York Times, in a piece about an immigration raid in Mississippi, reminds us of "a significant escalation of the Bush administration’s enforcement practices" in which those detained are not only being deported, but also "...imprisoned for months on criminal charges of using false documents." So it is quite possible that Marjavi, young and pregnant, will be separated from her family for quite some time before being deported.

Miriam of Feministing points to A Book Without a Cover as a site that helps citizens take action in the face of overly aggressive immigration raids. But I also think that Sheriff Terry Johnson might appreciate a letter letting him know that US citizens do not want to live in a society where our health is put at risk by a willingness to turn hospitals into branches of Immigration and Customs Enforcement.

(Image via)

On Underground Abortions, Anti-Choice & Pro-Life

ABC News has an article up about the fact that, surprise!, women are still having "underground" abortions. To summarize, there is a lot of information out there on the internet that lets you know what combination of drugs and such will induce a miscarriage. (My senior thesis was actually on the past, present and future of abortion, so I can add that there are several books that also have this info.) It seems that women are accessing and using this information in growing numbers. Now researchers want to know why.

I understand the need for actual statistics, but I can venture a few guesses as to what they will find:

1) Access to abortion is becoming quite the tricky issue. There are partial-birth abortion bans (FYI, this is a phrase anti-choicers contrived to fuel their own claims), parental consent/notification laws, public funding requirements, etc.

2) Abortion laws and regulations vary from state to state. Here is a breakdown of state differences from the Guttmacher Institute.

3) There is a general distrust of doctors in this country. Am I the only one who finds that I need to tell the doctor what might be wrong with me rather than the other way around?
EDIT: In getting caught up in my schpiel, I forgot to urge people that they should not stop seeing their doctors! GO TO YOUR DOCTORS! Yes, our health care system is not perfect, but doctors are trained and fully capable of keeping us safe in situations like these.

4) (Related to #3) Our health care system needs an upgrade. Stat. Abortions are expensive and many lack the resources to get abortion. Combine that with the fact that doctors can refuse to give you an abortion, and you've got a whole lot of obstacles hidden in the fine print.

5) There is serious shame and blame attached to abortion. This increases when dealing with people who have religious families and people from other cultures. Some women would rather see the problem go away quickly and play the denial game afterwards.

6) Access to the correct information is sometimes tricky. With all of these rules and obstacles, there is plenty of room for confusion. The article mentions a Mexican woman who just did not have all of the facts straight:

"She knew that abortion was legal in the U.S.," Grossman said, "but she thought that is was only for people who are legal residents."

I think we need to attack these problems from both sides. Not only should we advocate for better policies and clearer information from our government, but we should also rely on grassroots efforts to keep others informed of what the law says, what the alternatives are, and how to make sure that women are safe at all times.

And can we please stop calling the anti-choicers, "pro-life"? I am pro-choice. I am also pro-life. In fact, I don't know of ANY pro-choicers who are not also pro-life. I recently read that they're sometimes called pro-birth. I suppose this is also accurate, but since this particular group of people is usually the one against birth control and adequate sex education, I think anti-choice is more accurate. Erica has a post up over at the Feministing Community site about reclaiming the term pro-life. I completely agree with her. We need to start now.

Some great resources: NARAL, Planned Parenthood, Abortion Access Project, and National Abortion Federation.

(Cross-posted at Jump off the Bridge.)

HSS to Allow Doctors to Deny Treatments on Moral Grounds

Just when we were celebrating California's Supreme Court ruling that doctors can't refuse treatments to lesbians or gays due to religious beliefs, the Department of Health and Human Services (HHS) has started pushing to ensure that doctors can refuse to provide abortions based on moral grounds. HHS Secretary Michael Leavitt explains this new attempt to blur the line between health care provider and clergy this way:

"Freedom of conscience is not to be surrendered upon issuance of a medical degree," Leavitt said. "This nation was built on a foundation of free speech. The first principle of free speech is protected conscience."

Let me just point out here that there are many branches of medicine that a person could practice which in no way involve providing abortions, and only one that does. So perhaps the better answer would be for individual medical professionals to not choose fields where their duties conflict with their beliefs. Also unclear is whether or not doctors would be allowed to object to providing abortions to only certain types of people - say, on the basis of sexual orientation, marital status, or race.

Also worrisome is this:

The underlying laws deal mainly with abortion and sterilization, but both the laws and the language of the rule seem to recognize that objections on conscience grounds could involve other types of services.

That's right, under the HSS's new rule, any type of medical procedure could be denied due to any member of the facility's beliefs - since "regulation is written to apply to a broad swath of the health care work force," a hospital worker who decided it was morally wrong for him to, say, provide a certain type of person with lifesaving medications might be covered.

As PalMD of Denialism recently wrote, "...a physician must be careful not impose his or her personal beliefs on patients." In a discussion of Dr. Christine Brody's refusal to provide fertility treatments to Guadalupe T. Benitez (the act of discrimination that eventually led to the CA Supreme Court ruling mentioned at the first of this post), PalMD explains:

Conflicted with the doctor's faith. There's the rub.

This is a particularly perverse form of prostelitizing. It doesn't involve having coffee with an acquaintance and teaching them the Word. It involves a vulnerable individual, who comes to a qualified professional for help, and is turned away because of "improper" living and thinking.
...
For a physician to deny a patient care based on their own beliefs is a cop-out, and is a coercive use of their paternalistic powers.

The HSS is in the wrong and its new rule is aimed at denying medical services to women. Worse, as Broadsheet notes, the ruling:

...goes far beyond defending a medical worker's right to refuse to perform an abortion -- it also secures his or her right to refuse to "refer for, or make other arrangements for, abortions." In other words, a worker at a women's clinic, perhaps the only one for several hundred miles, can refuse to perform an abortion and refuse to refer the patient to someone who will.

This seems to be a serious attack on our medical freedoms.

UPDATE: Both NARAL and Planned Parenthood have letters you can sign and send to help ensure this rule does not go into effect. (h/t Jump off the Bridge)

Feminist Parenting: Advice, Doctors, and Dr.'s Advice

(Note to readers: As sometimes happens after I've posted in a hurry, I've reread this piece and discovered that, although it seemed fine when I pressed publish, something about it now doesn't sit well with me. Regular readers will know that we're geeky sorts of feminists here, and usually pretty good skeptics to boot. So, I'd like to stress that the advice of your doctor is not to be ignored. When posting, my intent was not to cast aspersions on the ability of pediatricians to give good advice, but rather to prompt some discussion about how new parents cope with the bombardment of suggestions that often accompanies pregnancy and birth - and how doctors can best help them sort the good from the bad.)

Part of the stress of being a new parent comes from having to sort through often conflicting messages about what's best for you, your family, and your baby. Grandma, Dr. Spock, Elmo - everyone seems to have an opinion on what you should be doing, and what you're probably doing wrong. Worse, this is pared with the realization that - possibly for the first time in your life - your decisions don't just impact you, there is someone else entirely dependent on you, upping the ante of each choice. Still worse - companies know that expecting and new parents are stressed about making healthy living choices, and will try to take advantage of our fears and confusion in order to sell crap like Mummywraps, designed to protect against "electro-smog."

Between the advice from other parents, half-believed "old wives' tales," and books like What to Expect when You're Expecting, it can be difficult to know what - or who - to believe.

Of course, your doctor should be the expert who sorts through all the woo and superstitions, and provides solid facts. Yet, even in the pediatrician's office, new parents can feel insecure about any choice they make, as Elena of California NOW explains:

“Is she still breastfeeding?”
...

“Yes, we’re still breastfeeding,” I said proudly.

“You need to work on weaning.”

I sat there in shock. After a year of strong breastfeeding encouragement I was suddenly supposed to immediately wean her?

“Well, we were planning to let her self-wean when…” I started.

The doctor cut me off in mid-sentence. “Is she sleeping through the night yet?”

“No,” I said, guiltily wondering if that was somehow my fault.

“That’s because of the breastfeeding; it doesn’t fill their stomachs enough. You also need to move her into a crib,” she said, looking at us significantly, “You need to be able to get more time as a couple. Move her into her own room if you can.”

Jesus Christ, I thought, is she actively trying to destroy any chance of sleep for me?... And who was she to tell us with that knowing look that my husband and I needed “more time as a couple”? When did my baby’s pediatrician get a say in our sex life?

Elena's experience brings up multiple issues new parents often face when at the doctor's office. Parents worry that the decisions they thought were best might hurt their child anyway. There can also be confusion about what is solid medical advice backed up by research, and what is simply a doctor's personal opinion. Finally, there's the conundrum of what to do when your doctor's advice goes against your own ideas about what's best for your family and relationships.

Of course, our blog's contributors include a couple of doctors and medical professionals, so we have to look at these issues from both sides. So, I'm inviting some discussion:

Parents: How did you decide what was good advice and what was baloney? How did you set your boundaries with advice-givers? Did you have any problems with your doctors, and how were they resolved? Finally, what tips would you give young parents just beginning the challenge of deciphering what's good advice and what's complete bunk?

Doctors: How do you help patients make the best decisions for themselves and their families? How do you help them figure out what of the advice they've been given, sometimes from beloved grandmothers, is tripe? Is there such a thing as feminist doctoring, or is it rather a question of having a good 'bedside manner'?

Part II of children are not just tiny adults: Newborn pain

I heard a great talk last week on neonatal pain. It was honestly not even a topic that I had considered before. Of course all humans have pain--it never even occurred to me that they might not. Apparently, it wasn't until about twenty years ago that the idea that a premature infant could even feel pain was medically accepted. The thought was that they were born before their pain circuits fully matured, and therefore were incapable of feeling pain. Newer studies in fact shown that premature infants are HYPER-sensitive to pain.

One great tip I learned while on my pediatric rotation is that the most important developmental milestone could be considered the social smile at 2 months old. Up until 2 months, it is very difficult to tell if a baby is in pain or sick. If a child has lost their social smile, there is an excellent chance they need more advanced medical care. So how do we tell if a newborn, or even more dramatically, a premature infant is in pain?

It is not as easy as you might think. Testing (and common sense) has shown that crying is completely non-specific. Babies cry if they are upset, hungry, tired, etc. Grimacing and withdrawal reflexes have also proven to be a poor indicators. Additionally, in the neonatal intensive care unit (NICU), for medical reasons, babies are often sedated or groggy from medications. This further blurs our ability to read any cues they might give us. There are >40 scales out there, but none of them are thought to be the ideal way to assess neonatal pain.

From the Archives of Pediatric and Adolescent Medicine is the study "Do we still hurt newborn babies?". In the NICU, in their study, each baby had on average 14 painful events each day. This ranged from pulling off tape, to heel sticks, to suctioning. Many times we don't even think to give any comfort during these procedures. Therapeutic options don't even have to be limited to just medication. You can dim the lights and noise to create less stressful environment and every medical student at some point has been on sweeties duty. This is where you dip the pacifier [or your finger] into a sucrose solution to let the baby calm itself on something sweet. This honestly works like magic. In this study, they found that less than 35% of newborns received any preceding intervention. Some studies suggest that neonates may be unable to experience the analgesic (pain relieving) effects of adult medications, such as morphine. They might just experience the sedative effects.

In my own work environment, cribs and incubators often have mirrors (so that the infants can look at themselves and receive visual stimulation), music, and mobiles. Hopefully other hospitals are also beginning to recognize the importance of treating neonatal pain; I just wish there were more quality studies out there to better guide us. Clearly, treating neonates like little adults just doesn't cut it.

Not only do neonates experience pain, they also remember it. The pain we experience as infants changes the way we will always react to pain. In mouse models, neonatal surgery affects the way adult mice react to pain stimuli. Similar results have been shown in humans. I have heard stories of former premature babies brought into the pediatrician's office who shriek if you touch their feet. Maybe they remember the heel sticks?

Quick Hit: Explaining HPV and Cancer

Denialism has posted a succinct description of the relationship between HPV (human papilloma virus) and cervical cancer.

So how can a virus like HPV lead to cancer? The short answer is simply that "HPV causes cervical cancer by screwing with two of our most powerful tumor suppressor genes." The long answer is really worth reading though, so go to!

(Image via the CDC)

Not A Gay Disease: HIV, Homophobia, and the Americas

When a friend of mine heard one of her medical school professors refer to HIV/AIDS as a 'gay disease,' she had to speak-up. "We need to be clear when talking to patients that it isn't being gay that puts people in a higher risk category, it's anal sex."

Noticing the stunned looks of her classmates, she assumed that they simply hadn't understood her point and attempted to clarify, "Look, while I was living in Honduras I had a friend who insisted that he wasn't at risk, because he sometimes had sex with women and therefore wasn't gay. His doctor had told him that only gay men needed to worry about HIV. We need to make it clear to patients that any unprotected sex puts them at risk, and it is unprotected anal sex with multiple partners - not identifying as gay - that increases your chances of catching the virus."

My friend has been shunned by many of her classmates since making her point. Apparently, honest talk about sex isn't ladylike - even in a hospital.

Yet disease isn't deterred by cultural taboos, and we are needlessly endangering people through this combination of homophobia and excessive prudishness. By stigmatizing homosexuality, and by making being openly gay dangerous, we encourage people to lead double lives and to lie about their sexual experiences - putting themselves and all their partners at risk. An unwillingness to openly talk about sex only compounds the problem.

As the New York Times reports, the myth of AIDS as a 'gay disease' is common throughout the Americas, and interferes with efforts to protect people:

Martín Márquez Chagoya, a gay man who has had H.I.V. for 14 years and counsels other men, visits a park in downtown Puebla [Mexico] where men go to have sex with other men, but he says his efforts to promote condom use there often fall on deaf ears. The No. 1 response he hears from men there is that they are not gay and are therefore not at risk. They say they are merely having sex with gays.

It is time we all acknowledged that fear and misinformation do not constitute a prevention plan.

In order to limit the spread of disease, we need to fight homophobia and discrimination. Here in the United States, we are currently working to pass legislation that would ensure that no one could be fired on the grounds of sexual orientation; but even if the Employment Non-Discrimination Act (ENDA) passes the Senate, it faces the risk of a presidential veto and fails to extend protection to transgender citizens. Denying legal protections to the LGBT community sends a frightening message to young gays - that they should stay in the closet. We cannot ask people to be honest about their identities while threatening the livelihood of anyone who is openly gay. If our societies paint homosexuality as something punishable, how are we to encourage young people to be honest about their sexual identities - even with their doctors and partners?

We also need to combat the myth that people's sexuality can always be fitted into neat little categories. As Professor Hector Carrillo of San Francisco State University recently explained to the New York Times, "Sexual identity is a very complex thing... We like to think that once someone figures out their sexual attraction, they will fit into the categories we’ve created. But life isn’t like that." A greater acceptance of how very fluid sexual identity can be for many of us would help combat myths about who is at risk.

We also need to stop kidding ourselves about the progress we've made. Sure, the world is a more accepting place than it was 50 years ago, but homophobia still kills. According to the Mexican gay rights group Letra S., "[b]etween 1995 and 2006, about 1,200 Mexicans were killed because of their sexual orientation." And violence against gay and transsexual citizens is not a country-specific problem, but is common throughout the rest of the Americas as well. Yes, even here in the States, where people come with the expectation of protection (rest in peace, Angie Zapata). Our governments need to ensure that hate-crimes are recognized as such, and prosecuted. Parents need to make sure that their children know that dehumanizing someone because of their sexual identity is evil. We cannot continue to create an environment of hate, and those who promote intolerance need to keep in mind that the ripple effect of acts of violence has the ability to impact us all in a multitude of ways.

We cannot fight disease with lies, threats, or platitudes. If we want to keep all of our citizens safe, we need to respect and protect them. And that means being honest - even about sex.

Male, Female, Other (Please Specify)

Over the weekend, a friend of ours stayed over and at one point started talking about women who are biologically men. He kept calling them men, and I kept correcting him and saying "you need to call them intersexed, you can't assign their gender for them." While I understood what he meant- that they have male chromosomes rather than female chromosomes- it annoyed me that he kept referring to them as men.

Lo and behold, ABC News must've heard our discussion because they have a story up about a woman, Eden Atwood, with male DNA.

Last week I was impressed with their coverage of the men wearing skirts story, and this story is also very good. Of course, I cringed when I saw them plugging the Medical Mysteries show right next to the video clip of Atwood, but I'll give them a pass for that one since they just want people to watch their show.

The article does a good job of explaining Androgen Insensitivity Syndrome (AIS) and presenting this woman AS A WOMAN. Her parents brought her up without telling her of her condition, and the doctors straight up lied to her:

"It turns out the doctors had lied to Atwood about having twisted ovaries. She really had internal testicles."

Go check out the piece, but also think for a minute about my gripe at the beginning of this post. People are very quick to fit others into boxes. Either somebody is a female or a male. Anything else means they're a freak. Even if we accept somebody as "biologically male, BUT..." it's often still about what label makes us feel comfortable rather than what makes them feel comfortable.

I understand the need to do that. Cognitively, our brain needs to make things as simple as possible. We want to quickly look at a person and sum up as much about them as we can without digging too deeply. There isn't anything fundamentally wrong with that. But we have to train ourselves to be smarter than our own cognition. We need to understand the different dynamics of every situation. We have to push ourselves to take people out of the boxes we try to put them in. So start unwrapping those bows and letting everyone out.

(Cross-posted at Jump off the Bridge.)

The Price of Pregnancy: Health Insurance and Motherhood

[Note to readers: We begin our series on feminist parenting with a discussion of an obstacle many women face as they decide whether or not to even try to become mothers - finding health insurance that will make pregnancy and giving birth affordable. The following article was written by Maggie of Of Counsel, who we are honored to have as a guest today.]

Most women are going to reach a point in their lives when they have to start thinking seriously about having a kid, whether intentionally or not. You look at your boyfriend, you think, “What would I do? What would he do?” You probably make a plan, just in case. You talk to your partner about whether and when and how. There are a lot of things to think about, even in the abstract. I’ve gone through this chain of thought before. I still do it now. But one thing that never occurred to me is how I would pay for it. And it seems I'm not the only one.

At some point, you have that double-take moment when you realize that health insurance doesn't necessarily mean you're taken care of, whether it's when you pick up a prescription or end up in the hospital. I lived a charmed life for a long time as far as health insurance is concerned. I was covered by my parents, then through my college, then as a government employee. I had good plans, good benefits, and a wide selection of doctors. Things changed for me in the last couple years, and I know I’m not the only one. I left government work and moved into a small office. I was lucky, they were one of the few small businesses that provide insurance for you at no expense. But my next job had no benefits at all. This meant I had to choose between finding an independent plan on my own or waiting for the enrollment period to join my husband’s very expensive plan.

I searched online, found a private plan with a surprisingly low deductible and co-pays that were about the same as what I’d paid in previous plans. I got a decent rate and signed on. It took a few weeks to get my full explanation of benefits, and it was during a perusal of it that I got to reading closely their information on maternity coverage. I’d been careful to choose a plan that provided maternity coverage, many don’t cover it at all. But there was fine print. No maternity benefits at all for the first twelve months, regardless of when the pregnancy starts. And after the first twelve months, I could only get maternity benefits if I had a family contract, meaning I had to have some other dependent on my plan, such as a child, spouse, or domestic partner. Otherwise I would have to apply for and pay extra for a maternity rider, which would still only kick in after those 12 months.

I had to wonder, why all the hoops? Whether it’s a boyfriend or a husband, joining a health insurance policy as a domestic partner seems like a pretty big decision. Moving back and forth between insurance plans isn't something you do lightly and it involves a lot of factors. I was in no position to add my husband to my plan. Worse, I wondered what I would do if he wasn't my husband. What if he wasn't around at all?

You may be thinking this isn’t legal, but it is. In 1978, the Pregnancy Discrimination Act required business with 15 or more employees to have health insurance with maternity coverage. But it doesn't cover individual plans like mine. It also may not cover a dependent spouse. And I’m not alone, approximately 9% of people in the US have these insurance plans that aren’t provided by their employers. That’s not counting the 15% of people who are uninsured. (Stats come care of the US census.) If you're already pregnant and are looking for coverage, you'll be denied. Pregnancy is generally considered one of those nasty "pre-existing conditions."

I had to wonder, when I ran into this problem, why it wasn't something I'd heard anyone talk about before. There are plenty of problems with health care today and plenty of talk about what to do, so why aren't we talking about this issue? My first look was to the presidential candidates. Obama's plan provides guaranteed maternity care for all insurance plans, though it's unclear if there would be limitations. As for McCain, for all my reading and googling, I haven't yet found any mention in McCain's health care plan on maternity coverage, but I have serious doubts. His plan is in favor of letting insurance companies compete in the marketplace, but there are concerns that this would lead to the exact kind of problems we're seeing in these individual plans. What if you pick a plan that's great for you without checking the maternity coverage? A March of Dimes study found that giving tax credits for coverage, as in the McCain plan, wouldn't actually help more women get covered.

The infant mortality rate hasn't fallen since 2000, instead the U.S. is holding steady. According to the CDC, only 84% of expectant mothers saw a doctor in their first trimester in 2005. 3.5% had late or no care. A study in 1996 found that women who aren't insured are 3 times more likely to go without doctor visits during the year they gave birth. In 1999, over 400,000 women were pregnant and didn't have health insurance. In 2001, 28% of uninsured people were women of childbearing age. (These stats from the March of Dimes report.) But I have to wonder about women who may not be reflected in these statistics: those who see their doctor, but limit their visits to their doctor because they can't afford to pay for more than a handful of them.

Just in terms of health, this kind of approach makes no sense. A woman who doesn't receive appropriate pre-natal care would present more of a health risk to her insurer both through herself and her child. Even the policies that cover maternity benefits have a tendency to limit their payouts to only a limited number of doctor visits or a limited amount of benefits. A study by the Kaiser Family Foundation looked at the potential expenses paid out-of-pocket by mothers with different insurance policies in three different types of pregnancies. Even a mother in a normal pregnancy and delivery with no complications could pay nearly $8,000 under certain individual policies providing maternity coverage. A c-section under the same plan goes up to nearly $10,000. A pregnancy with complications takes you over $20,000. Of course, none of these would apply to me if I got pregnant tomorrow, I'd be paying every penny myself.

If you consider yourself out of danger in a good policy, make sure you check all the details. The complications that go with insuring a pregnancy are seemingly limitless. What if during your c-section, the anesthesiologist on-call happens to be out-of-network? Plan to pay for it. What if your pregnancy doesn't all happen within the same calendar year, but spans two? That's a whole new deductible you'll have to start chipping away at. What is the definition of a "complication" anyway? Your insurance company decides, of course, and don't expect them to tell you in advance. Oh, and if your dependent teenage daughter gets pregnant, they don't cover her costs, either. Plans don't cover much else in the spectrum; many won't cover abortions or artificial insemination. Then there's my plan's discriminatory policy about having a "family contract" to get benefits, which makes it impossible for a woman on her own to get coverage.

It's easy to say anything aimed specifically towards pregnancy is discriminatory, after all it only happens to women. There's no similar condition for men. It will happen to most women at least once in their lifetime. Pregnancy isn't exactly an elective thing, like cosmetic surgery. And it isn't exactly something you get, like an illness. It's something between the two. It can be planned, it can be accidental, but for most of the women in the world, it's a possibility. The fact that there aren't completely effective ways to postpone pregnancy (the pill isn't perfect, ladies) means there is no excuse for an insurance company telling you when they'll let you get pregnant. When treated properly, pregnancy can be a lot less trouble than an illness. It's for a limited time, it's common, and the doctors who work with it are highly specialized. These should be reasons it's fully covered instead of reasons it's not.

We talk a lot about maternity leave in the workplace, a woman's ability to have children when she wants to and have flexible employers. We talk about birth control and abortion and what a woman's rights are when it comes to her body. I think getting proper maternity coverage is something we should be throwing into the mix. We should make it a priority in our country's fight for health care reform. A pregnant woman who wants to stay home with her child may not have that luxury if she'll lose the insurance policy when she leaves her job. And women who plan to work, but whose employers don't give them benefits, are left with no good options for their coverage.

The March of Dimes study I linked to earlier found no easy answers. Making coverage mandatory in individual plans will result in significantly higher premiums, meaning they won't be affordable for many women. They did find that government is going to have to step in to make sure this coverage is available instead of just leaving it to the market. We need to make this an issue at the forefront of our health care reform. We also need to make sure we know exactly what we're getting from our insurance coverage.

As for me, I'm waiting for the enrollment period to join my husband's plan where I'll be spending twice as much per year in premiums alone, and I'll still have to pay 20% of all maternity expenses. But for now, it's the best I can do.

Abortion Law: Two Medical Opinions, or Criminal Charges

A Kansas judge ruled Monday to deny a "...defense motion to dismiss a criminal case brought against one of the nation's few late-term abortion providers," Dr. George Tiller. As the Kansas City Star explains:

Former Kansas Attorney General Paul Morrison filed 19 misdemeanor charges against Tiller in June 2007, alleging he broke a 1998 state law requiring that a second, independent Kansas physician sign off on late-term abortions of viable fetuses. Two doctors, without financial or legal ties, must conclude that if the pregnancy continues, the mother will die or face "substantial and irreversible" harm to "a major bodily function," which has been interpreted to include mental health.

Tiller relied on Dr. Ann Kristin Neuhaus, of Nortonville, for his second opinion on abortions in 2003, and she had a financial relationship with him that is against the law.

Tiller's attorneys contend that the law creates an unconstitutional burden on a physician's right to practice medicine and a woman's right to obtain an abortion. They also argued that the Kansas law was unconstitutionally vague. His defense attorneys also challenged it on the basis of violating a right to travel because of the requirement a woman be seen by two separate physicians in Kansas.

For Dr. Tiller, this means that he will still have to stand trial, where it will be decided whether or not he had a financial relationship with Dr. Neuhaus that might have made her second opinions illegal under the state's laws. For women, this ruling means that we are willing to risk their health as we create obstacles to their being able to receive a legal medical procedure. For doctors, this means that physicians who decide that a patient's continued pregnancy puts her at risk of "substantial and irreversible" harm runs the risk of having criminal charges brought against them.

Will this ruling put women at a greater risk from pregnancy related injury and death?

Quick Hits: The 45th Anniversary of the Fair Pay Act and More!

Lindsay of Female Impersonators takes some time on the 45th anniversary of the Fair Pay Act to remind us just how much work still needs to be done to ensure fair pay for all who work in the U.S.A.:

...white women are still payed 77 cents to every white man's dollar, African-American women are payed 66 cents to a white man's dollar and Latina women earn 53 cents to a white man's dollar. Across the board through all different kinds of fields and education levels, unequal pay according to gender persists in the American economy and workforce as institutionalized sexism...

Here's what you can do:

Support the Lilly Ledbetter Fair Pay Act, which says that people can sue for pay discrimination within 180 days of their last paycheck, not 180 since their first paycheck. That means that if you've been working at the same company for five years and you've recently discovered that you're the victim of pay discrimination since hiring, you can sue your company for the past five years of pay discrimination...

Here's info on the Fair Pay campaign, a fact sheet produced by the National Women's Law Center, and most important, a letter to your senator supporting the Lilly Ledbetter Fair Pay Act. If you live in Alabama, Alaska, Arizona, Indiana, Iowa, Florida, Nebraska, New Mexico, North Carolina, Ohio, Texas, or Virginia, one or both of your senators voted against the Ledbetter Fair Pay Act the first time around. You need to write them and tell him/her to get their ass in gear and support the Ledbetter Fair Pay Act.

In case you were wondering, we've also written about fair pay and Lily Ledbetter - here, here, and here, for example. Remember, McCain has said that he does not support this legislation.

In 'other things I'm itching to discuss this evening':
1. The New York Times says straight couples have a lot to learn from lesbian and gay couples.
2. The Wall Street Journal discusses the marked differences in McCain and Obama's energy policies
3. The Washington Post wonders if doctors should or could pray with patients
4. The Chicago Tribune further discusses how the abortion issue will be used during the election, and what might be at stake
5. The Pew Forum on Religion and Public Life tells of moral dilemmas facing French doctors who are asked to perform operations to "reattach the hymens of women who want to appear as virgins." (UPDATE: for more on this story, visit Womanist Musings.)

Thoughts?

Sure, Tricking Babies is Fun, But is it Right?

From Women's Bioethics Blog, here is a little motherhood moral dilemma for your Friday morning:

A New York Times article ( “Experts Question Placebo Pill for Children” --May 27, 2008) raises the question of whether giving children placebo pills for minor childhood illnesses is an ethical practice. Based on the premise that pharmacologically inert compounds can actually produce improvements in some medical conditions, Jennifer Buettner, a mother of 3 small children, developed a cherry-flavored chewable dextrose tablet, the first branded, pharmaceutical grade placebo. The therapeutic effect is based on the power of suggestion. If parents use the placebo to “trick” their children into thinking that they are taking real medicine, the children will consequently feel better.

Notice that the brand name, Obecalp, is simply placebo spelled backwards. Mommies and daddies are tricky, no?

Of course, there might be a catch to this 'magic feather' catch-all cure for minor childhood complaints, as the New York Times points out. First of all, clinical studies that use placebos are usually double blinded - neither the patient nor the person giving the placebo knows its a fake, making it easier to fool the patient. So Obecalp might not work if the moms and dads handing it out know its a sham. Yet, your parents probably knew there was no Santa, and they still managed to fool you for years (man, were you gullible), so I'm not buying the kids-will-see-through-this argument.

A graver concern is that fake medicines could condition kids into thinking that popping pills is the solution to every problem:

“Kids could grow up thinking that the only way to get better is by taking a pill,” Dr. Brody said. If they do that, he added, they will not learn that a minor complaint like a scraped knee or a cold can improve on its own.

Dr. David Spiegel, a psychiatrist who studies placebos at the Stanford School of Medicine, said conditioning children to reach for relief in a pill could also make them easy targets for quacks and pharmaceutical pitches later. “They used to sell candied cigarettes to kids to get them used to the idea of playing with cigarettes,” he said.

Despite the controversy, Obecalp went on the market on June 1st - you can now buy it over-the-counter. So, we are left with the questions - is it ethical to give your kids a fake drug and tell them that it is medicine? What if you tell them it's just sugar, but it might help them feel better anyway? Will Obecalp create a psychological dependency on pills? Is this anything new, or have parents been taking advantage of the placebo effect since parenting began?

(Oh, and for the 'why is this a feminist issue' folks... 1. parenting continues to be a central concern for many women, and it unfortunately is a task that falls largely on mothers, whether they have a partner or not. 2. I'm a feminist, I want to talk about it, and this is my blog, gosh darn it!)

(Magic feather via)

Elderly Women in the USA are Disproportionately Poor

Part of appreciating our mothers and grandmothers on Mother's Day is recognizing the challenges that face them, and making sure that they don't have to face those challenges alone. So after the flowers have been sent and the cake has been eaten (you did get your mom cake, didn't you?), here are some facts to consider, brought to us by RetirementRevisited:

The largest segment of Americans living in poverty is elderly women...

More than 25 percent of all African-American women live in poverty, and 28 percent of older Hispanic women are poor. And single women over 65 (all races) experience a 19 percent poverty rate.

That's right, nearly twenty percent of women in the United States live the final years of their lives struggling to make ends meet below the the poverty line, surviving on less than $9,669 a year. The percentage of women over the age of 65 living in near poverty, with incomes up to $14,504, is even higher.

There are several reasons for why women face so many more financial challenges in their 'golden years' than men do:

First, women earn about a third less than men make during their working lives; that means they generate smaller contributions to Social Security, pensions and 401(k) accounts....

Perhaps most important, women live longer than men. At age 65, a woman can expect to live an average of 19 more years-three years longer than men. That means whatever she’s saved for retirement must last longer.

The result is a yawning retirement security gap. Here’s how it looks by the numbers.

What to do about this yawning 'security gap' is not quite as clear as its causes. Early planning is, of course, very important. So get your moms to start budgeting for retirement before they stop working, and make sure they are keeping some money for themselves rather than funneling it all into care of others. And do the same for yourself. A tip given by WISER Executive Director Cindy Hounsell is to look at what your Social Security will be and compare it to what you live on now. If there's a gap, and there probably will be, it needs to be addressed before retirement.

We also need to be ensuring that this pay gap between the sexes is not allowed to persist. For if it does, it will haunt us for years to come. Of course, making sure that you're making a fair wage isn't exactly easy in many environments, so we have to keep pushing to get the Lilly Ledbetter Fair Pay Act passed. It is the least we can do, for our moms and ourselves.

Thanks to Feminist Law Professors for pointing this inequity out.

South Dakota v. Roe

Like deja vu all over again, here comes another South Dakota initiative to ban abortion. Come fall, South Dakota voters will once again be asked to vote in favor of a bill that would make abortion illegal in their state. This new ban will be slightly different from the old proposed ban that barely failed two years ago:

This time the ban includes some exceptions for rape, incest, or the life and health of the mother. Some South Dakotans said the absence of such exceptions led them to vote against the 2006 proposal, which lost by 56 percent to 44 percent.

As Bean at Lawyers, Guns and Money notes, its elections season, so "Let the paternalism begin."

UPDATE: Cara of Curvature points out that this bill has lost the support of some anti-abortion activists due to these exceptions, referring to the Wall Street Journal's report that the "...modifications have cost... support from South Dakota Right to Life, which has said it can't support the initiative because it doesn't ban abortions in all cases." The WSJ article also provides us with this disturbing chart:

Is Life Expectancy Dropping for Many U.S. Women?

Most of us assume that, with advances in medicine and increasing awareness of the heath risks associated with poor diet and smoking, each generation of Americans will enjoy a longer life expectancy than the the generations that came before. Indeed, this has been the case throughout the 20th century. Yet, as the New York Times reports:

...new research shows that those reassuring nationwide gains mask a darker and more complex reality. A pair of reports out this month affirm that the rising tide of American health is not lifting all boats, and that there are widening gaps in life expectancy based on the interwoven variables of income, race, sex, education and geography.
...
The most startling evidence came last week in a government-sponsored study by Harvard researchers who found that life expectancy actually declined in a substantial number of counties from 1983 to 1999, particularly for women. Most of the counties with declines are in the Deep South, along the Mississippi River, and in Appalachia, as well as in the southern Plains and Texas.
...
The researchers found statistically significant declines for women in 180 of the 3,141 counties in the United States and in 11 counties for men. In an additional 783 counties for women and 48 for men, there were declines that did not reach the threshold of statistical significance.

You can read more at PLoS Medicine, in two papers entitled The Reversal of Fortunes: Trends in Country Mortality and Cross-Country Mortality Disparities in the United States and Eight Americas: Investigating Mortality Disparities across Races, Counties, and Race-Counties in the United States.

UPDATE: Since I posted the above, this news has been picked up by Women's Bioethics Blog. Sue Trinidad rightly notes that, since this decline in life expectancy mainly affects poor women, this is not just a health concern, but a social justice issue as well.