We need some WORK

I am embarrassed. I feel sick to my stomach every time I read people defending the many recent overtly racist attacks on president Obama. I wish I could say that it is only overt racists who act as apologists, and maybe it is a weird selection bias when reading comments section online of coverage of these incidents, but really? People think it’s OK to have a cartoon depicting Obama as a dead chimp and can’t see the difference between that and this? Do people really think that, because someone made a potato joke to them and, as someone of Irish descent, they decided to let it slide, that the Mayor of Los Alamitos can send out an email with a watermelon patch taking over the White House lawn and it’s OK?

I recently joined a group on Facebook called WORK – Whites Overcoming Racism through Knowledge. All I can do is try to point out to these apologists that not every white person agrees with them. All I can do is repeat that complaining about racism is not “playing the race card” or “whining”.

And, I can keep learning myself. Earlier this year, I didn’t understand why people were complaining that it was wrong to compare gays wanting to get legally married (in the context of the Proposition 8 and similar state provisions) to Loving v. Virginia. Although I still think there is room for nuanced conversations about history and discrimination of other groups in a certain context, but now I totally see why it is wrong, repetitive and annoying for blacks to constantly be the discrimination ruler against which all other oppression in measured.

So, my hope it, if I can grow and learn, other racism apologists can grow and learn. I will do whatever I can to make this happen, for me and for others.

Reversal of misfortune

I was happy to hear on NPR today that the Obama administration is finally getting around to reversing the Bush administration’s so called “conscience clause”. Unfortunately, it is hard to discuss the nuanced details of the HHS rule in soundbites. NPR failed to do this well when introducing the story and on their main page, by describing the rule by using this tag line: “The “conscience clause” allowed health care workers to decline to participate in abortions and other services.”

I have to give NPR credit, they did do a good job covering the issue in the full coverage. They pointed out that conscience exceptions have been protected for more than 30 years. They also pointed out (on the radio but not in this article) that the new rule permits people to anyone even tangentially related to the delivery of health care (including cashiers, receptionists and janitors) to refuse give information or referrals to care by someone who is not religiously opposed to whatever health care that person is opposed to, whether it be fertility treatment, contraception, abortion, blood transfusions, HIV drugs, you name it.

And, health care delivery systems have to certify that they are not discriminating against any people with religious objections to any medical treatment in hiring to receive any federal funds, like Medicare or Medicaid. So, theoretically, if Christian Scientists applied to work at a surgery center, they wouldn’t be able to discriminate against them in hiring. If they refused to do any sort of surgery, participate or facilitate any sort of surgery, and refused to refer to another staff member or another facility or even give any sort of information about surgery, they could not be fired or the facility would be discriminatory. In fact, if they were not hired, the surgery center would be open to loss of federal funds and reimbursement, and costly lawsuits. This certification of hiring people who would most certainly refuse to perform their job description was not mentioned in the NPR coverage, or most other coverage.

Rachel Maddow said this fails her “Amish bus driver” test today on her show. I was thrilled that she mentioned the words “contraception” and “abortion” in her coverage of the story. I love her to death, but I wrote her a letter recently complaining about her lack of coverage of reproductive rights issues. Glad she represented today.

I am so honored

One of my closest friends and his wife have invited me to be at their birth. It will be a hospital birth, so there are only two of us allowed in with her. No moms, no sisters, (and there are a few of these on each side who will be in the waiting room), just me and him. I fully realize what an honor this is, and how much this says about what they think of me. I am so excited!!

Linky dinky doo

I haven’t had time to post recently, but I have been reading lots of great stuff on the interwebs.

Time magazine has published an article called The Trouble with Repeat Cesareans. (H/t Rixa at Stand and Deliver) The author also has a post up at Huffington Post entitled Childbirth Without Choice. Even better than these two wonderful articles, The International Cesarean Awareness Network (ICAN) has a new database of VBAC policies in US hospitals. What a fantastic resource.

Rachel at Women’s Health News spearheaded a lot of concern when she posted about a proposed bill in Tennessee to drug test women under a dizzying array of mom blaming reasons. I was very happy with the flurry of outrage and support on the feminist sites. I think pregnancy issues, especially ones that involve having a baby, not preventing one, don’t get adequate attention on many of these sites. The National Advocates for Pregnant Women generally have good information on the issue of drug testing and subsequent imprisonment of pregnant women.

Edited to add: Rachel has expanded on her discussion of this topic with a brilliant post examining the many troubling aspects of forced drug testing on select pregnant women.

The National Family Planning and Reproductive Health Association has a post up about a resolution being introduced to include *gasp* women’s reproductive health issues to the national debate on health care reform. It would be symbolic, but hey, it’s a symbol we need. I am sick of women’s reproductive issues being dropped like a hot potato any time someone points out that it is controversial. (I’m looking at you, Obama.) I had a discussion with the lobbying arm of the American Osteopathic Association during a presentation on grassroots activism at our school. She told me that they don’t advocate for women’s reproductive health issues because it is controversial. She pointed out to me there are lobbying groups specifically set up to oppose such legislation. I asked her why that wouldn’t make it more important for them to advocate for women’s issues? I also asked her who is going to defend women’s health care if groups representing physicians won’t. She also said they don’t really do anything regarding Medicaid. I was pretty disappointed with this presentation, to say the least. It should have been called “Grassroots activism for those where the grass is already greener.”

I loved this post on Shakesville with book recommendations for coming of age boys. Thanks! Again, impressed with the parenting style coverage from a site that normally caters more to the childless and gay men.

Finally, on a non health related item, there is the issue of horrific, racist political cartoon comparing Obama to a gunned down monkey. As usual, Ill Doctrine has a good analysis of the many problematic angles of this story. I am saddened by how non progressive some of his commenters are. It is very clear that the context of the rag, the New York Post, paints the stimulus as Obama’s stimulus. In fact, that same day, on the previous page, there was a huge picture of Obama’s face next to headlines criticizing the stimulus package. And, the same cartoonist has published previous cartoons with Obama standing at a pad presenting his stimulus bill. Racist apologists who try to nitpick that the author of the bill wasn’t literally Obama make me ill. (No offense, Jay Smooth, for the use of the word ill.)

Antibreastfeeding Bingo

I want to be a Hoyden when I grow up!

Please go visit Lauredhel’s new Antibreastfeeding Bingo Card.

It is kind of sad how easy it probably was for her to come up with these. I have seen each of these comments repeatedly.

Breastfeeding disclaimer: Moms who can’t or choose not to breastfeed can obviously be wonderful, loving mothers, do have to deal with unfair judgment from some quarters, and this isn’t about that.

Email and reply

From my uncle:

The financial crisis explained in simple terms:
Heidi is the proprietor of a bar in Berlin. In order to increase sales, she decides to allow her loyal customers – most of whom are unemployed alcoholics – to drink now but pay later. She keeps track of the drinks consumed on a ledger (thereby granting the customers loans).

Word gets around and as a result increasing numbers of customers flood into Heidi’s bar.

Taking advantage of her customers’ freedom from immediate payment constraints, Heidi increases her prices for wine and beer, the most-consumed beverages. Her sales volume increases massively.

A young and dynamic customer service consultant at the local bank recognizes these customer debts as valuable future assets and increases Heidi’s borrowing limit.

He sees no reason for undue concern since he has the debts of the alcoholics as collateral.

At the bank’s corporate headquarters, expert bankers transform these customer assets into DRINKBONDS, ALKBONDS and PUKEBONDS. These
securities are then traded on markets worldwide. No one really understands what these abbreviations mean and how the securities are guaranteed. Nevertheless, as their prices continuously climb, the securities become top-selling items.

One day, although the prices are still climbing, a risk manager (subsequently of course fired due his negativity) of the bank decides that slowly the time has come to demand payment of the debts incurred by the drinkers at Heidi’s bar.

However they cannot pay back the debts.

Heidi cannot fulfil her loan obligations and claims bankruptcy.

DRINKBOND and ALKBOND drop in price by 95 %. PUKEBOND performs better, stabilizing in price after dropping by 80%.

The suppliers of Heidi’s bar, having granted her generous payment due dates and having invested in the securities are faced with a new situation. Her wine supplier claims bankruptcy, her beer supplier is taken over by a competitor.

The bank is saved by the Government following dramatic round-the-clock consultations by leaders from the governing political parties.

The funds required for this purpose are obtained by a tax levied on the non-drinkers.

Finally an explanation I understand …

My reply:

This is the second email I have received comparing people who are having their homes foreclosed on to alcoholics. This is after 8 years of our country spending money like a drunken sailor. If my husband, a sober schoolteacher, gets laid off this year as threatened, we will most likely have to default on our home loan. The stimulus package is giving 8 billion to the school districts in our state, and his job may be saved. I am very grateful. Teachers have already been laid off at my mother’s school. My older brother worked for Lehman Brothers, and his position closing out that company will end soon. The stimulus package has provisions so he can get help paying COBRA payments to keep health insurance for his family, including his son with a health condition. This kind of hostile email is only serving to divide our nation even more. With unemployment rates rising to 10% and more, it’s getting pretty pathetic to continue pretending this is an us and them world. The unemployed alcoholics you non drinkers complain about may be your own family members.

Please take me off of your email list.

I also got an email from my cousin (from the other side of my entitled, privileged, conservative family) comparing income taxes to a rich guy coming and buying drinks for a bunch of unemployed drunks every night. The moral twist: What if he doesn’t show up to buy them drinks the next night? Then who will pay for them?

I wrote a similar reply.

Bursting with pride

I am so proud to be included as an ally in the wonderful Tell it WOC Speak blog carnival. Renee of Womanist Musings is a radical’s radical, a blogger’s blogger, and, dare I say, a feminist’s womanist. She is fiercely intelligent and, I am guessing, very picky. I am very proud that my post on teen births rates being up, and the analysis of the rise being blatantly racist, was included.

Please go check out the entire “Hear us roar” carnival of posts.

Reply turned post, octuplet style, take three

On the slippery slope argument, I have written two replies. I wrote one on Shakesville:

As for the slippery slope argument, slippery slope is not a two word phrase that means analyzing any health decision = oh no, there goes reproductive rights. Much of this was done in the name of radical anti-choice positions, in which frozen embryos are precious snowflake babies, and selective reduction, regardless of the outrageous medical risk of a high order multiple pregnancy, is outright killing of babies and should not be done.

There is nothing wrong with asking for an acceptable ethical standard of care for women seeking IVF. In fact, outrageous cases like this and the unwanted quadruplets the same doctor transferred into another woman (without medical insurance to pay for her pregnancy) are much more likely to endanger women’s reproductive rights due to the huge, predictable (and yes, frequently out of control, hostile, sexist and classist) backlash than looking at these situations critically and making sure they do not happen.

There are multiple position statements on how many embryos to transfer that do not violate anyone’s reproductive rights. Medicine is not the same thing as ordering off of a menu. Health care practitioners should follow standard of care guidelines that protect their patients.

And, I wrote an earlier one on altdotlife:

I also wanted to answer the earlier post comparing controlling embryo transfer via IVF and requiring a patient to agree to selective reduction, to refusing to fill a prescription for birth control. I see many differences between these two examples. First of all, a licensed doctor wrote the prescription for the birth control. Birth control is standard medical care. 98% of women in the United States use birth control of some sort at some point in their lives. A pharmacist refusing to fill a birth control prescription is refusing to fill the prescription because it goes against his or her religious beliefs, not out of some concern for the health of the patient.

Now, if a doctor didn’t want to write a prescription for birth control for someone who has a history of deep vein thrombosis, (which can lead to pulmonary embollism or stroke and then death) then I would see it as being a similar situation to refusing to transfer six embryos. Health risk trumps reproductive rights. I would not write that prescription. I would offer her a copper IUD or some other non hormonal method.

If a doctor refuses to transfer six embryos or wants an agreement that HOMs will be reduced, we are talking about preventing or refusing a highly unusual situation outside of the standards of medical care. Many people have posted various links to position statements of medical organizations of fertility specialists about this topic. There is a difference between an intervention like this and standard medical care. No doctor should have to perform a procedure that he or she knows opens the patient and the future fetuses to extreme risk. One of the links from upstream has an infertility ethical specialist saying 50% of HOMs end in death or severe disability of the offspring. That is not acceptable risk, in my book. Birth control and abortion is remarkably safe in most situations, and is almost always safer than a full term pregnancy for most people.

Plus, do not forget, any doctor, resident, medical student, nurse, orderly, etc can easily refuse to participate in abortion services or refuse to prescribe birth control or perform sterilizations. Entire Catholic hospital systems do this, and it is even a struggle to get them to give emergency contraceptions to rape victims, even if they are the only place in town for a rape victim to be treated. It is not even questioned in the medical community (except for the EC for rape victims part. Some places states have passed legislation on this, thank goodness.)

A slippery slope is not a straight line. There is a lot of nuance here.

Standing up for birth

I love the dashboard on my blog that allows me to see who is linking to me. I have found a lot of great blogs, including Stand and Deliver. I guess, considering her blog title, it is appropriate that the first time I link to her, it is for a blog in which she discusses Ecuador instituting vertical delivery in a maternity ward. She links to a wonderful article, in which Dr. Luna (love the name!), the chief ob/gyn of the ward, describes vertical birthing as a Kitchwa tradition. He also claims “Vertical deliveries…have also helped reduce Caesarean sections from 18 to 8 percent at the hospital.”

This is not just the affectionate musings of a local practitioner. Vertical second stage delivery is supported by evidence based medicine. It is sadly not very surprising that a technique that is associated with “with a 4-minute shorter interval to delivery, less pain, lower incidences of NRFHR monitoring and of operative vaginal delivery, as well as higher rates blood loss of > 500 mL compared with other positions in 20 trials, including 6135 women” is rarely seen in US hospitals. This is one of the few interventions or techniques given a rating of A, which is defined as “The [US Preventive Services Task Force] USPSTF strongly recommends that clinicians provide [the service] to eligible patients. The USPSTF found good evidence that [the service] improves important health outcomes and concludes that benefits substantially outweigh harms.” Doula services also receive an A rating. Several common interventions, such as estimation of fetal weight, prophylactic tocolysis were given the rating of D, the lowest rating, which is defined as “The USPSTF recommends against routinely providing [the service] to asymptomatic patients. The USPSTF found at least fair evidence that [the service] is ineffective or that harms outweigh benefits.”

It is sad that an uncommon technique, upright birthing, is given the highest rating on a US government task force evidence based scale, but is still treated as a indigenous traditional novelty by journalists. A quick literature review would have validated this as a researched and well supported recommendation. The article is very supportive of the technique and mentions lower maternal mortality rates, don’t get me wrong. But, a mention of the evidence behind it that already exists would have been very welcome.

And I thought it was hard for me to watch

If anyone coming to this post from Shakesville is interested, I have a new post up about intersectionality and not diminishing other victims’ identifications. But, in the meantime, please continue reading this older post on FGM first.

*Trigger warning* This is a post with some rough stuff in it.

I went to a presentation of female circumcision, aka female cutting or female genital mutilation (FGM, as I will be using for the rest of the post) this past Thursday. I think I made the right decision to go, even though I had a test in two days that I was not well prepared for yet, and it was not a required lecture. I am one of very few medical students who go to lectures that are not required, but that is a whole ‘nother post.

The presentation was done by a woman who is a graduate student in our public health program who is from an area where FGM is performed. She did a wonderful job. She chose to include video of the procedure, including one instance of a three year old girl being held down by females of her community, one of whom I am assuming was the victim’s mother, to be cut as she screamed in terror. She also showed a montage at the end of her presentation with many shots of faces of young women screaming during the procedure, also held down.

I was struck by a list of the reasons why FGM is performed and by a series of interviews with women in Egypt who are circumcised about their support of the procedure. The list of reasons given is identical to the list of reasons given to support male circumcision. It’s seen as cleaner, healthier, the children will be more accepted by peers and by their future sexual partner, it is tradition, etc. The only difference, and this applies to the more severe forms of FGM that include stitching up what is left of the external genitalia at the end of the procedure, is that the woman cannot have sex or deliver a baby until some part of the procedure is reversed by cutting open the stitches. In the mildest form of FGM, the procedure is almost identical to male circumcision. In the most severe cases of FGM, in addition to all of the reasons above, the FGM is performed to control her sexuality and make her more “calm”. I am not sure if anyone argues that male circumcision will guarantee fidelity or calm the sexual desires of a male. I think it was, at some point, argued to reduce masturbation.

The woman making the presentation argued that FGM was an element of strong patriarchal traditions in these societies. I asked her at the end if it was possible that we have had so little success in combating FGM because we are asking patriarchal societies to value their girls MORE than their boys. We are not asking them to stop male circumcision, and it is common in these cultures and in our society.

As one of the women interviewed in her presentation video said, “We cut the girls and the boys. It’s what we do.” If male circumcision is considered normal and desirable not only in these communities we are trying to change, but in our own society that is claiming some sort of moral superiority about genital cutting, doesn’t it seem contradictory and problematic? She replied that she didn’t see the problem there, but she didn’t know much about male circumcision.

One of my favorite upperclassman was sitting next to me, and he asked if there should be some support of the trend of having doctors perform the procedure in a controlled environment, with anesthesia. Apparently campaigns against FGM are asking that no doctors or hospitals to be involved in FGM, and he thought the opposite, having more trained physicians involved, was preferable.

After the official presentation was over, I talked to him, and he is supportive of routine male circumcision. His instant comment was “No one asked my permission when it was done to me, and I plan on circumcising my son if I have one.” I think it’s pretty clear that support of male circumcision can easily cloud the immorality of FGM. He genitals were cut as a child, as were all of his male relatives. These women just need a good, clean doctor like him to do it, and they will be just as safe as the boys in our country.

I argued with him politely, asking him if he believed in prophylactic appendectomies to prevent appendicitis. When I told him that I had a discussion with a pediatric urologist who was against routine male circumcision, citing the high amount of repairs that her partner has to perform, he acknowledged that his own cousin had been damaged by a circumcision. This is not the first case I have heard of that involved damage due to a circumcision, and I have yet to hear of a male child in my circle of acquaintance having a serious urinary tract infection that could have been prevented by circumcision, or penile cancer, or HIV that could be linked to having an intact penis. (That research is highly controversial, BTW, and is not at all applicable to low risk males, such as males in the United States. Also, studies show male circumcision actually increases male to female transmission.)

As I said, I think I made the right decision to attend, but I was emotionally traumatized by the videos. I had what I consider to be traumatic flashbacks for the rest of the evening. I had a hard time focusing on anything else, kept seeing the videos in my mind, and misheard many things around me as if they were in the context of FGM. I cannot imagine what it would be like to have to have been the victim of FGM, since my privileged experience watching a video about it in that context is absolutely incomparable. I am also even more resolute in my choice to leave both of my sons intact.