Sunday, November 29, 2009

Why Contraception?

Since the question's been raised, and because contraception takes up significantly more of my time and energy than most peoples', we'll talk.

Because it should be said- I am fully aware that my ability to study, travel, write and advocate is contingent upon fact that I, as an educated western woman have complete and total control of my fertility and how my sexuality is expressed. I'm willing to acknowledge my bias and admit that if I lived in another place or time I might be a different person and feel differently, but I'm incredibly grateful to be a woman in the United States in the twenty-first century.

With that disclaimer-
Why do I believe contraception is so incredibly important?

1) 68,000 women per year die from complications of unsafe abortions.
2) 536,000 women per year -approximately 1 per minute-die of pregnancy complications and childbirth (90% of these are in Africa and Asia).
3) Globally, 50% of pregnancies are unplanned and 25% are unwanted.
(All statistics from UNFPA)

And then there's nutrition.... For one thing, as a fetus's bones are developing, it will leach calcium from its mothers bones and teeth if necessary. The ability to space pregnancies far enough apart that a woman's body has time to replenish calcium stores is important to both the pregnant woman and the fetus. Even in the U.S. we have remarkably high rates of spina bifida, because women of childbearing age don't consume adequate levels of folic acid- can you imagine how much worse this would be without the ability to control when pregnancies occur?

Contraception saves thousands of lives and prevents disease and disability around the world. Thus, it's critical. End of story.

Additionally, another huge effect of hormonal contraception is the impact of powerful estrogenic/antiestrogenic compounds on fish and amphibians, and what's being theorized about their impact on humans. It's going to be vital to find a way to control fertility without using powerful hormones. Yet another reason condoms are one of the world's greatest inventions.

Sunday, November 22, 2009

The post we'll pretend doesn't exist

I typically choose not to delve into my personal life here. However, this is important enough that I'm going to break protocol....and you, dear reader, take whatever's helpful from this, but we're all going to pretend I didn't write it, because I don't want to have the conversations it could initiate.

Previously, I've briefly touched on my history of self-harm:
Here, and here

Nov 13 several of my Facebook friends very visibly celebrated "To Write Love on Her Arms" Day. This was problematic enough for me personally that I had to point out that it might be counterproductive, and no one else seemed to realize it.

I'm not pretending to speak for everyone, but there are things that I wish people would take into consideration before plastering phrases all over Facebook.
So...briefly, as I try to avoid writing things that may be harmful or triggering to others:

1)"To Write Love on Her Arms" is really, really problematic phrasing. Switch out the implement, from a marker to an exacto knife or a razor blade, and the same gesture gives you self-harm. Not good imagery.

2)In winter/cold weather, self-harm is a much more sensitive topic, because the cold makes my scars hurt. It's also a much more vulnerable time, because my shoulders and arms stay covered.

3)I really, really, really HATE the word "struggle."

4) Via facebook and other impersonal means of communication, it's very difficult to communicate support and love. You certainly can't do so by joining groups and participating in events. And Facebook"raising awareness" doesn't do much for the people you claim to be trying to help- I don't care whether it's victims of human rights abuses or people who suffer from depression or deal with self-harm.

5)Self-harm is only part of the picture. And while, after scoping out To Write Love on Her Arms website, I can see that they address more than that as an organization, the name/slogan is horribly misleading. Also, this unnamed "her" is really irksome....I can't read the stupid slogan without feeling like a generic target. Yes, so I deal with self-harm impulses. I don't need my nose rubbed in this every time I log into Facebook for a week. There's a heck of a lot more to me than that one fact.

All opinions expressed are mine and mine alone. I know young women who have dealt with self-harm in the past who feel very differently- but I think this is a valid perspective as well, and needs to be considered, before people start randomly throwing things up on Facebook.

Wednesday, November 11, 2009

Christian Bleeding Hearts?

Given my great fondness for books and propensity for writing up lengthy reviews or responses, taking some time to blog a response to Half the Sky really was inevitable. Nicholas Kristof holds the distinction of being one of three living human beings I'm in love with (the other two being Barbara Kingsolver and Michelle Obama- I get along much better with dead people for some reason), so I'd anticipated this book all summer.
It didn't disappoint.

Kristof and WuDunn make their points about brutality without being excessively graphic, making this a book I can recommend to others (unlike, say Sunday at the Pool in Kigali). It's hard to imagine the amount of work that went into this book. Lots of first person interviews and a massive amount of time spent in the library. End notes are respectable, and do a decent job of pointing readers to primary sources. Personally, I had one issue with the end notes- the authors state that studies that evaluate the efficacy of abstinence-only sex ed have widely varying findings that correlate closely with the ideology of the organization conducting the study, but that two trends are clear: abstinence only programs delay initiation of sexual contact, but also result in lower rates of contraceptive/disease preventive practices. The assumption seems intuitive, however, I wish a list of journal articles consulted had been included. That's pretty much just specific to me, as a conservative Evangelical (or, perhaps more accurately: someone who would rather not offend conservative Evangelicals) with a strong interest in reproductive health. I realize I could spend a couple weeks closed up with PubMed and I could figure it out myself, but if someone else has done the work, I'd rather just double check their citations.

This misstep occurred in the chapter I found to be the most personally relevant: "Family Planning and the 'God Gulf'."

WuDunn and Kristof talk coherently about the "gag rule"- which I'd always assumed to be a more or less symbolic action. When Obama overturned it this year I was mildly upset, not being a huge fan of the idea of my tax dollars funding abortions around the world, but honestly, expected nothing else, given his previous abortion rights voting record. After finishing this chapter, and realizing *what* the legislation really meant, my feelings were more along the lines of "Thank God. And I can't believe that one day we're going to elect another Conservative who's going to do this again."

The gag rule meant that organizations like Marie Stopes International and UNFPA lost funding for programs that had nothing to do with abortion- programs that provided clinics and medical personnel to rural corners of developing nations. The "gag rule" meant no American tax dollars going to organizations that as much as mentioned "abortion," but it also meant increased infant and maternal mortality, including more deaths from unsafe abortions around the world. (And personally, I like my tax dollars to keep people alive)

And then, we have HIV prevention and condom use (enter the end note issue above). Authors point out that it was during the Clinton administration when condom donations saw their low point- 190 million in 1999. During the George H.W. Bush administration, this was 800 million condoms a year, and 400 million condoms per year of George W. Bush's 2nd term.

The authors attack some of the foundational misunderstandings about AIDS in Africa, and point out to both sides of the condom/abstinence debate that neither is the program with the greatest numerical success. (If you're curious, dear reader, the most successful program aimed at reducing the number of teenage girls having sex with older men). As an aside- they also agree with my conclusion that abstinence/natural family planning are strategies which depend on women having a status that *allows* them to stand up to their partners. (Further aside-I'm rather scared of what abstinence-only programs are doing to psyches of African girls who are rape victims, especially given how widespread rape in Africa is. I think there are some pretty major ethical issues with the abstinence lollipop "when he's done with you, all you have left for your next partner is a poorly wrapped, saliva-fouled sucker" approach)

Half the Sky commends Christians for their compassion, willingness to serve in remote areas, and their personal generosity. The book also points out the major problems that occur when liberals and evangelicals get so bogged down in their own ideology that they are unable to cooperate on the issues on which they agree.

"If there is to be a successful movement on behalf of women in poor countries, it will have to bridge the God Gulf. Secular bleeding hearts and religious bleeding hearts will have to forge a common cause. That's what happened two centuries ago in the abolitionist movement, when liberal deists and conservative evangelicals joined forces to overthrow slavery. And it's the only way to muster the political will to get now-invisible women onto the international agenda."- Half the Sky, Ch. 12: Family Planning and the "God Gulf."

That's the statement I'm trying to wrap my mind around, because it's hard for me to believe that's even possible. Regardless of my personal beliefs, I often conduct myself professionally as a secular bleeding heart-because I've met very few religious bleeding hearts, and I gave up on trying to convert evangelicals to social action after four years at a conservative Christian college, in an equally conservative area with insanely high rates of teen pregnancy, high school dropouts and drug abuse.

In contrast, a prof in my department whose emphasis is on Community Based Participatory Research recently guest lectured in my research methods course. She's done quite a bit of work with faith communities in this state, including a couple groups who sought her out as an expert on cervical cancer prevention. And apparently, these churches are genuinely concerned about the health of their members and communities. To the point of carrying out evidence-based teen pregnancy prevention programs, providing health literature, reminding women from the pulpit to get pap smears and mammograms.... this doesn't fit with the reality of the church I've encountered. This faculty member has been able to have a genuine partnership with women in these church communities, and they've had conversations I believed to be impossible in the faith-based context (for example, the church group initiated the conversation over the HPV vaccine -I was under the impression that I might be the only Christian in South Carolina who believes it's unethical not to vaccinate girls for a virus leading to a potentially deadly disease , considering the prevalence of HPV among U.S. females aged 14-59 years is already 26.8% [NHANES, 2003-2004]).

How much do I agree with Nick Kristof and Sheryl WuDunn, and Very Competent Tenure Track Professor? Obviously, I can't disagree, but there's a lot of work to be done. The distrust on both sides is not without cause. However, what troubles me most is an attitude among Christians that something cannot be objectively good unless it directly leads to "preaching the gospel" or "someone getting saved." In more reformed/educated circles this expands to "changing the worldview of culture," (i.e. influencing society in such a way that it is easier to live as a Christian in that society). But the underlying principle is still "Unless our numbers grow, unless the society we're 'ministering' to views us in a more favorable way, there is no point in service." Can this attitude be changed? Perhaps a better question is "If arrogance on the part of the Christian right leads them to provide healthcare/ESL services/etc as a means to increasing numbers, should that arrogance be challenged, because it ultimately has some positive results?" Which then causes one to ask "How much good are faith-based organizations doing, anyway?" And that's something that is highly specific to the organization. The "Conservative Christians are scary, bad people" position is *just* as indefensible as the "You cannot be a decent human being if you are pro-choice/pro-LGBT rights/pro-healthcare reform/a Democrat" attitude that I found so revolting in college.

Monday, November 2, 2009

again with sexuality in the Bible Belt

Returning to this discussion.
The whole evening was....intriguing. I felt a wee bit like an anthropologist, not being an LGBTQ individual, or a minority, and given that my Christianity looks radically different from what's typical of the Bible Belt.

But the most gripping moment was at the end, when the final audience question was asked.
"What strategies can be used to empower young people to use safe sex practices and how can the Church contribute?" Every nerve in my body was at atention- one of my professors has hinted at rumors that occasionally church members can be convinced that condom distribution was actually their idea, and I thought Bishop Rawls was going to share the secret.

My mouth literally dropped open when Bishop Rawls started talking about building bridges/relationships and moving beyond dialogue. She continued with "I'm owning how important it is that my life speak more [than my words]." This led into a discourse on the lack of role models for LGBTQ people, and the need for healthy relationship modeling. She offered the example of counseling young ladies- when she receives "inappropriate energy" her response is "Baby, you can be in a relationship with an older woman who won't abuse you."
Wow. Having grown up in the church, and being a pastor's daughter, I've heard a gazillion things about the dangers of counseling leading to affairs. And an equal number of ways to keep the minister out of trouble- "keep your office door open" "never counsel or be alone with someone of the opposite gender." But to actually step away from the fear of sexual harassment charges and infidelity to turn "inappropriate energy" into a moment for teaching and comfort....that's a new one for me.

Dr. Simmons followed this up with the observation that the relationships most modeled on TV are typically those of white men. Valid point. However, I think we also need to address *how* relationships are modeled on TV and movies. Why the heck is it okay to depict unprotected sex with someone you met hours ago in a PG-13 movie, or on network television? I'm so angry with this season's premier of House. Or, breaking away from STIs and unplanned pregnancies for a minute- one of my colleagues pointed out in class that she believes part of the reason for the current high divorce rate is that people are looking for relationships that look like the movies, rather than relationships that have the potential to be both long-lasting and positive. My prof responded to the comment with the hopeful observation that this may begin to change, as we watch the Obamas model a strong marriage to the nation. Those thoughts alter my perspective things like the 10 page article in the NYT magazine this past week about the Obamas' marriage (note that I've only skimmed the first two pages and haven't actually read the beast). At first glance, this seems intrusive, disrespectful, prying, meddlesome....(can you tell I'm a pastor's kid? The thought of *anyone* living in a fishbowl is repulsive to me). But when considered as something we as a nation desperately need- the image that marriages can stay strong, can be a vibrant partnership as opposed to a convenient division of bills, chores and childcare, it's not so hideous.

Mr. Patterson concluded the discussion with the observation that "talking about safe sex doesn't reach someone's heart." And when someone in need of love is offered something that seems good, they will take it, regardless of whether that involves risky sexual practices. Men and women pick partners because of who they see around them, and the issue of safe sex must be addressed internally before externally.

Absolutely no discussion about the importance of knowledge of safe-sex practices and the availability of protection. Yet suddenly I was feeling a bit naive and reprimanded- for looking for an easy solution to a complex problem. I know better, really. But how do you design a reproductive health intervention program around healthy relationship modeling and mentorship? Patterson has been involved with several programs -Many Men, Many Voices for one- that take this approach. I need to spend some time looking at strategies and crunching numbers, but resonates. But before I sound like I've been converted to the "Let's try to connect with high schoolers and show them that there are cool people who don't have sex" approach of the Christian college I graduated from (can't use the term "alma mater"-I've always felt that we were at war) and the local crisis pregnancy center in that area- I think the Bible Belt taboos we have about discussing sexuality are dangerous and irresponsible. Teenagers need the knowledge to make informed, safe decisions, regardless of whether we agree with those decisions.