Reply turned post, parenting judgment style

I used to write more about mom on mom judgment than I do now. But, every now and then I see a conversation online, and it brings me back into the common discussion of what is acceptable to “judge” and what is not.

On PhD in Parenting, this conversation comes up every once and again, and it did on this post on parenting styles on vacation.

Here is my reply to the cries of “don’t be so judgmental!”:

I think there is a fat line between mommy judgment and deciding which parenting tactics aren’t for you.

I hate it when I see parents yelling at their kids, repeatedly, for doing something when they could get up and do more effective disciplining up close, but are too busy with their own texting or book or conversation that they don’t want to bother. Know where it’s worse? On a school playground. With both of my kids, I observed the playground first before choosing a preschool. If the adults huddled in a corner and yelled at the kids from afar, and missed acts of aggression, you betcha my kid didn’t go to preschool there.

But, I am not condemning parents who I see do that once as “bad parents”. I am not condemning the adults (teachers, teacher’s assistants, whatever) at the preschool [where] I saw this as awful teachers. In fact, I use this “judgment call” “opinion” or whatever you want to call it to catch myself, too. If I am doing something similar, like yelling at my kids repeatedly from my keyboard (who me? never…), I will think “You’re doing that thing you hate” and hopefully get off my tuchus and discipline more kindly AND effectively.

Are we really defending screeching at children from afar? Of course, a parent may have a hurt foot or a disability. Of course, a child may have an immune disorder, and may need stuff wiped down. I am the type of person to travel with snacks, but mostly because 1. the food at resort style places is obnoxiously expensive and 2. it’s usually pure crap. Do I judge parents who let their kids eat it? No, when I can afford it, I splurge a little and relax my standards for my kids. Are we talking about kids with severe allergies here who need their own food? No. And, again, I would never use that as some sort of end-all-be-all judgment of the quality of parenting.

We aren’t talking about exceptions, we’re talking about parenting choices, here. Screeching from afar = poor discipline, and I don’t feel overly judgmental saying that.

I was stuck in a long line at DisneyWorld once next to a mom who had just gotten out of a tour in Iraq. She was with her young son, who was the same age as my older son at the time. I still remember to this day the nasty and sarcastic way she talked to her son the whole time we stood next to each other, and it was the good part of an hour.

I have no idea what it is like to leave your child for a tour of duty in a war. Just thinking about it, and I do often, because I am a ruminating bleeding heart like that, makes me want to weep for our society. I cannot imagine what it would be like coming home and having to reconnect with a child, while dealing with all of the complex feelings and guilt. I am not judging this woman as a parent. What I do know is that the experience in the line for a mere 45 minutes of their life was excruciating to me, and it broke my heart for the boy.

She could be a great parent. I am not saying I am a better parent. I am not saying that I haven’t been bitingly sarcastic or nasty to my children, or that you couldn’t play back a recording of some things I’ve said that would make me cringe. Or that could easily be torn apart on a blog.

There may have been some problematic points in the original post in which she seemed to be guessing at motivations for the behavior, and I can see how that could rub someone the wrong way. But, criticizing screeching, or valuing a scheduled feeding for an infant who is howling on an airplane over just feeding the poor thing, is just looking at a snapshot of an action and reacting. It’s not mommy wars, in my book, and leaves room for a defense of such choices without name calling.

Reply turned post, participatory medical education style

I have had the benefit of communicating to physicians who like to teach on the internet, not just in the real world. DoctorJen was really helpful with my KALI questionnaire. I have communicated with Dr. Fogelson of Academic Ob/Gyn, whose blog has inspired a reply turned post of its own.

Dr. Onyeije, a Maternal Fetal Medicine specialist, is also communicating with me about ethics, risk presentation and paternalistic (or not) obstetrics.

Here was his comment on reply turned post, Academic thought on VBAC style.

Just wanted to chime in and echo your comments regarding how risk is communicated and how it is received. What I’ve found is that there are multiple different ways to communicate risk and (perhaps just as many ways) to receive such information. It’s a two way street and problems can occur when the recipient and communicator are not on the same wavelength.

I certainly see this when counseling patients regarding all types of screening tests.

I’ll be interested to read your thoughts on risk perception.

I answered:

I have thoughts! I wrote a little bit about it here, but that is just the tip of the iceberg. Prenatal screening can be really problematic. High false positives in some screening tests can be emotionally devastating to a patient, especially if the physician and staff communicate risk poorly.

I know of a couple who called off their baby shower and told everyone they were getting a 20 wk termination over a “positive” quad screen – a high AFP level. And this was AFTER I personally warned them about the poor specificity of the test. Then, this couple who had told me they weren’t going to get amnio (prior to the quad screen) got an amnio, and of course, the amnio results were within normal range.

I have heard of a woman passing out at work and hitting her head on the desk because someone from her OB office called and told her her fetus has tested positive for Down’s syndrome. Not only was this incorrect, it was, again, just a quad screen result, not a diagnostic result, but they hadn’t even told the patient what the test was screening for until they called with the results. Every subsequent pregnancy she got the same low AFP, and then a “normal” amnio. Every pregnancy she got the amnio anyway.

Same thing with gestational diabetes screening. UpToDate is currently full of information about how unreproducible the results are for the initial challenge test screening and the GTT, and how there aren’t universally adopted thresholds. But, how many women have been bumped up to “high risk” by a GTT test, and then possibly even sectioned due to possible fetal macrosomia? I don’t even want a baby getting unnecessary heel sticks after every feeding, which is protocol in some places if the mother had GD. Especially if it subtly tells a new mother that her child will be hurt every time she attempts breastfeeding. It’s not worth it if it’s due to an imprecise diagnosis. I have another set of friends, the mother is a medical student, and the father has a PhD in psychology. She got a positive challenge test screen, and had a “freak out” (their words, not mine).

These are anecdotal studies, but I have read research about the anxiety these screening tests cause women.

Itching to write, but tooooo busy (and clitoris)

I have a post brewing about reproductive health care and enlisted women, but right now I am up to my eyeballs in stuff to do.

I am catching up on reviewing the chapters I am assigned for the new Our Bodies, Ourselves. It’s been really exciting. I have been researching the anatomy of the clitoris for the last two days. (Hello, weird search engine hits to my blog). I am having trouble finding a consistent, comprehensive description in one source. I was watching Rachel Maddow interview Ana Marie Cox while reading about the clitoris last night – I feel like I earned an honorary lesbian card. (OK, now I’m asking for the weird search engine hits. But, it’s better than being caught by surprise by even weirder ones. You have no idea.)

My Essential Clinical Anatomy is passable, but not detailed enough. I can’t find my Netter’s, and I feel sorry for whoever has it, because it stank of formaldehyde and had some very questionable stains on some of the pages. I wish my library has access to the Journal of Urology, since it has what appears to be a good article on it. In fact, I am kind of surprised it doesn’t. I did find an interesting article in the Australian Nursing Journal by Helen O’Connell, who is the author of the unavailable J. of Urology article, in which she complains of the, ahem, shortcomings (her word) of the treatment of the clitors in anatomy texts, including Grey’s Anatomy.

Anyway, as usual, my “I’m too busy to post” post has gotten long. Two reviewed chapters, one eggnog Bundt cake, a few batches of spiced nuts and Christmas cookies, and a roasted chicken from now, I hope to be writing about military reproductive health care.

Edited to add: I had no idea the clitoris was so complicated! (Insert joke here). I think I get it. Well, as much as I can when the sources aren’t consistent with their terminology.

Hop into a tub of Cialis

Do you know what I hate? Pharmaceutical commercials.

Cialis has a new ad campaign I keep seeing on the T.V. machine, that goes something like “When is it time to get out of the tub?” as far as I could hear as I was fumbling toward the mute button. I came up with some answers:

When the water gets cold.
When my toes and fingers get really wrinkled.
When I’m done washing myself.
When I’m falling asleep. (I only get to take baths late at night, after the kids are asleep.)
When the wine glass is empty.

Nulliparous psychosocial induction

I have been reading about induction recently, specifically, nulliparous induction for psychosocial reasons with an unfavorable cervix. In English, that is a first time mom, getting a labor induction for non medical reasons, and her cervix is not dilated or softened.

Induction of labor is relatively common. I recently sat with a doula client during her induction with Cervidil (Dinoprostone). (Not a comfortable placement procedure when you have a posterior, undilated cervix. It seemed more painful than any contraction I have ever seen.) Before it was applied, she was chatting with the nurse, who was 38 weeks pregnant. The nurse was happily anticipating her own induction, saying “I want to get her out before she’s too big.”

I briefly mentioned that estimations of fetal weight were not evidence supported and notoriously imprecise. I didn’t feel it was appropriate to mention that, at least according to the textbook we used for our women’s health system, induction was not recommended for suspected macrosomia. In fact, I had to point that out, politely, after class, to our pharmacology professor. She would read from the lecture notes, then pepper the lecture with the story of her own delivery, which was a failed induction for suspected macrosomia. She had a cesarean for fetal distress. The way she told the story, that was a good treatment decision, and suspected macrosomia was an indication for induction. I showed her the section in our textbook, said I thought it seemed contradictory, and suggested she talk about it with the head of the department.

I knew induction + macrosomia has an association with shoulder dystocia. Well, I was trying to find out more information about induction and Bishop score. Although this particular doula client met the ACOG recommendation of reaching 39 weeks gestational age, I was fairly sure a favorable Bishop’s score was more important. I had told this to my doula client when she mentioned the 39 week induction. I understood why she wanted it. She was on strictly limited maternity leave. Her mother was flying in. Anyone who has been pregnant full term or has talked with women who are in their late third trimester knows they are usually extremely uncomfortable and sick of being pregnant. She was no different.

Also, her obstetrician had already predicted, several weeks before, that she would go into labor a full ten days before her due date. Yes, it was the nature of her job that she was on her feet a lot, but who says that to a nulliparous woman with a long, closed, posterior cervix? I certainly don’t mean to imply she was setting the stage for a 39 week induction that she could work around her clinical schedule, but talk of induction started to happen as soon as that ten-days-before-due-date due date passed. I mentioned the Bishop’s score, and she seemed to think her obstetrician thought her cervix was ready. But, when we got to the hospital for the induction, her cervix was closed and posterior. I didn’t hear an exact effacement, but even with a generous guess, there is no way she was above a Bishop score of 8. I don’t think her doctor told her that it meant she had twice the risk of a cesarean. I didn’t think it was appropriate to tell her, since they didn’t do the cervical exam until the Cervidil was ordered and unwrapped, and she was admitted for the induction that she and her physician had decided was right for her at her last prenatal visit, and the physician was managing the induction over the phone.

Well, when researching the decision making that goes into these common inductions, I have read some interesting things. The first was on the Cervidil site I linked to above, that lists “Patients in whom there is evidence or strong suspicion of marked cephalopelvic disproportion” as a contraindication for Cervadil. In other words, suspected macrosomia.

Secondly, on the ACOG website, a recent article about quality improvement by Dr. D. Ware Branch, Jr., says:

“[B]eginning nearly 10 years ago, the program sought to implement a systematic, multi-institutional approach to discourage elective inductions in nulliparous women with a Bishop score of less than 10.

During the first several years of the project, the number of elective inductions in nulliparous women with an unfavorable cervix decreased from approximately 105 per month (15%) to 60 per month (6.7%) in the 11 hospitals that participated. The total number of elective inductions in nulliparous women also declined by two-thirds.

Currently, the proportion of nulliparous women with an unfavorable cervix undergoing elective induction within the Intermountain Healthcare system is less than 5%. Some facilities have even disallowed any nulliparous inductions whatsoever.”

Also, when rereading ACOG’s Practice Bulletin on Induction, (which is problematic for a few reasons) I noticed it states “Although trained nursing personnel can monitor labor induction, a physician capable of performing a cesarean delivery should be readily available.” Hmm, that sounds remarkably similar to the recommendation in their Practice Bulletin on Vaginal Birth After Cesarean, which states “VBAC should be attempted in institutions equipped to respond to emergencies with physicians immediately available to provide emergency care.”

I am not trying to say that elective inductions should never be done, not even that they should never be done for psychosocial reasons. However, I doubt many nulliparous patients are given a risk explanation for an elective induction that is in anyway similar to the common treatment of VBAC. I am also fairly sure that elective inductions in nulliparous women for psychosocial reasons will not be banned from many facilities, like VBAC currently is. As far as I could tell by this interaction between my client and her nurse, elective induction for nulliparous women seems pretty standard, at least in my area. The quality improvement article from the ACOG website was reassuring, however.

Things that brighten my day

I have been having a frustrating time on different levels recently, and I found myself looking up various things on the internet to cheer me up. I am going to put them all here, so I can find them and watch them when I am having a rough day. And, if it helps someone else in a similar sitch, all the better.

I don’t know how to code it to do descriptions when you hover over it, so I will provide short descriptions underneath to make it more accessible to those who can’t watch it for one reason or another. If you don’t want spoilers, don’t read the text under each. This is an a cappella tribute to John Williams, the composer of the Star Wars theme, among many other movie themes. All the lyrics are Star Wars based. The singer is wonderfully talented, and the lyrics are very funny for any Star Wars geek. My five year old trying to sing this and getting half the words wrong, and not knowing the original movies for most of the themes, also cracks me up.

That is the “They are naked, and they do dance” skit from Monty Python’s Secret of the Policeman’s Other Ball. It is suitable for work, as long as laughing until tears are streaming down your face over something with no intelligible words is suitable for your work. They sing “Oom cha cha cha cha cha” over and over, and are wearing full suits, but pretend they are covering their privates with pieces of paper. It’s even funny without the sound, although the exuberant CHA CHA CHA!! at the end makes it for me. I may have to make this the representative Monty Python bit, even though I watched about an hour of clips with my 10 year old the other day. Watching his reaction and being able to share something like that with him was almost as fun as watching the Dead Parrot sketch for the 1,000th time.

A female farmer from Chad in a beautiful green dress, swinging a large stick that has been fashioned into a crude farming tool above her head, with a look on her face like she can conquer ANYTHING.

Female farmers. This is a link to a photo series of females farmers around the world at Shakesville. I sent it to my mentor as a birthday greeting. These women are beautiful.

This is Weird Al’s White and Nerdy. It’s a bunch of inside nerd jokes, gangsta style.

Autotune the News cracks me up. They take the Autotune, which is the scapegoat of bad hip hop right now, and use it to take clips of the news, turn it into melodies, and use it to do a hiphop parody of recent events. It is total wonky fun. This one has some funny stuff about smoking lettuce (original footage from the floor of the Congress!) and lots of Katie Couric.

Where the Hell is Matt? I feel kind of silly explaining this well known internet phenomenon, but here goes. Matt dances. Everywhere. With everyone. It is breathtaking. The music is beautiful. The faces, smiles, and commonality of (almost) everyone shown renews my faith in humanity, for four minutes at least.

My son, at his 2nd birthday, covered in chocolate and joyfully feeding me chocolate cake

Chocolate, cooking, and my kids almost always can cheer me up.

I took pictures of my older son every Valentine’s Day for a while, so we could make our own cards instead of buying ones with licensed characters (TM) on them.

Sarah Haskins! They’re all good, but I like this one in particular. Maybe because I really hate cleaning.

Here’s the site description: We all know women love to clean. But do you know why? Here’s the dirty little secret…
Sarah Haskins learns that life is more exciting with a little help from Dawn, Swiffer, Mr. Clean, Glade and Lysol.

Nice to find an uncracked pedestal

When I was a child, I had a book of Norman Rockwell’s illustrations art that I used to joyously pore over. I remember even doing a report on him for school, and I had to make sure he wasn’t too much of a commercial artist to qualify.

In my previous life before motherhood and medical school, I actually went to art school and was a portrait artist. I could never even begin to touch the hem of Normal Rockwell’s garment when it came to the emotional quality he could bring to his faces, much less his exquisite technical skill. I never, ever mentioned being inspired by him in art school, however. No one else mentioned him either. I was busy discovering other portrait artists like Francis Bacon and Sigmund Freud.

There is a Normal Rockwell exhibit at a nearby art museum, and I really want to go. I was listening to a story on it on my local NPR station (you guessed that I listed to a lot of NPR already, right?) and I was stunned and impressed by their coverage of his dedication to civil rights. I was also stunned and disgusted by their explanation why none of his pieces depicting civil rights for African Americans were ever in the Saturday Evening Post; they had an official policy that blacks could only be portrayed as servants: waiters, housekeepers, etc. This was in the 1960’s.

(Another example of very institutionalized racism, and why I had the “there is no such thing as a race card” this very morning. Before I heard this story.)

I am looking forward to seeing the exhibit, especially two pieces that I had never heard of until they were described on the radio this morning. It used to mildly annoy me when they did stories about art on NPR and tried to describe the works, but I am so happy they do, now. (Obviously, it is beneficial to the visually impaired, also). Here are internet versions of two of the pieces at the exhibit: (click to embiggen)

“The Problem We All Live With”

This piece depicts four federal marshals escorting a black six year old girl (SIX!) to school in Louisiana. All the white parents pulled their children out of the class, according to the coverage. There is a tomato smashed on the wall behind her, as if it just whizzed past her head. And, the N word is emblazoned, lightly, on the wall above her head.

The second piece they described: (click to embiggen)

“Southern Justice” (Murder in Mississippi)

This hair raising image depicts the shootings in Mississippi during the civil rights era. I am fairly sure they are the shootings that lead to the movie “Mississippi Burning”. Only the blood on one of the victims is in color, and the rest of the piece is in black and white. According to the radio story today, he actually purchased a pint of human blood to make sure his portrayal was accurate.

It’s nice to find out more about someone I love (and may have been a little embarrassed for loving) and be even more in love with them.

White fat, black art

A Canadian friend recommended the show White Coat, Black Art from CBC Radio. I have enjoyed several of the shows. There’s one on burnout, which is supposedly worst in ob/gyn. She wanted me to listen to the show on obesity. (Link to mp3 of “Fat Doctors”.)

I was kind of napping while I listened, but I played it twice and I think I got most of it. I think they thought they were showing “both sides of the issues” by having advocates for bariatric surgery, and someone who lost weight through diet and exercise. But, it was a very judgmental show. No one argued that not all obese people need to be fixed, either with surgery (which they started the show with) or diet and exercise, which the other two segments suggested.

I was struck by some of the people in the support group. Like, the one who was talking about how you could never tell a heroin addict to just take it 3 times a day in small amounts, but we expect people with food issues to self regulate food consumption. I am happy the doctor at the bariatric center emphasized that no one chooses to be morbidly obese, and no one gets morbidly obese by making poor choices.

I also kind of related to the doctor at the end who talks about being overweight and struggling with weight loss and her self image, which I am sorry to say. I feel a lot of self hate and guilt (and I have gained even more weight. I am afraid to weigh myself.)

I loved it when she said she secretly thinks “I would hate to live like that” when people give her weight loss advice and discuss strict, boring diets. I admit, people tell me about getting their “butts kicked” by their spinning instructor, and it makes me wonder if sedentary life isn’t worth it. But, I felt better about myself when I was in better shape. I like many types of exercise. It doesn’t hurt to fit in my clothes, either.

I guess it made me feel a lot of self hate, but I didn’t realize it at the time, because I am surrounded by that attitude constantly. I was just reading a maternal mortality review (pdf) today, and they were analyzing trends of BMI and maternal complications. But, I know this is a multi faceted issue. Obese women get more unnecessary interventions, including more inductions and more cesarean sections. And, the maternal mortality rate is much higher for African American women, who are more likely to be obese when of childbearing age.

I am afraid I may get passed over for a residency spot because I am obese. Spots are competitive, and are based on interviews and personal interactions with people on the team at the site. I know some people don’t think obese people make good doctors, some people think a person who is forty and obese may not be a good investment for four years, since I may succumb to some sort of fat complication, die young, and be a waste of their training. And even more people have unconscious negative reactions to fat people. We do worse in interviews, period.

Anyway, thanks for the recommendation. It was definitely worth the listen and gave me a lot to think about.

Fertility is unfair

I have a good friend who is getting surgery right now. A very, very wanted pregnancy that she paid dearly for, injected herself with hormones for, got eggs harvested for, got embryos transferred for and went on bed rest for, and it ended up implanting as an ectopic pregnancy. She will most likely lose a fallopian tube.

All four of my pregnancies were unplanned. All of hers have been a struggle. All of the fear and frustration I have felt trying to prevent pregnancy she has felt from the opposite side, probably multiplied by a million.

Fertility is incredibly unfair.

Please send her good thoughts.

Still injured and busy

I still have a busted finger, even though it is feeling a lot better. I am also swamped with various things going on in different aspects of my life right now. So, I am going to throw up some links for your reading pleasure.

Jennifer Block of Pushed Birth, one of my favorite writers, has written about two of the stories I wanted to write about, so I can just link to her. She covered Dr. Christine Northrup’s wonderful article about reclaiming our birth right. I have been a fan of Dr. Northrup since before I had kids or was interested in medical school, and as a mother and future ob/gyn, I adore her even more.

The other story is about a woman being forced to travel 300 miles to get her VBAC attempt. An attempt at a trial of labor should be offered to every good candidate for a vaginal birth after cesarean. This recommendation is found in the same ACOG (American College of Obstetrics and Gynecology) Practice Bulletin (#54, to be exact) that hospitals, insurance companies physicians point to when they deny women the attempt. Nice selective application of the care standards. In fact, the recommendation to offer the option to most women is a Level A recommendation (based on good scientific evidence) while the recommendation to have physicians immediately available for emergency surgery is a Level C recommendation not based on evidence, but just ACOG expert consensus.

Hmm, I seem to be typing a lot anyway.

OK, keep that story in mind, because it has intersectionality with another issue I want to talk about.

But first, don’t forget to check out the SEIU site story about the woman who was told to be sterilized by her insurance company because of a prior cesarean!

OK, now to the intersectionality issue. The story at the SEIU site and the second link at Pushed Birth have something in common – people attempting to force women to do things with their reproductive organs against their will. If you followed the link about the woman who has to drive for her VBAC attempt, the pregnant protagonist has “Enter your body without my permission? Sounds like rape to me” on her car, and Jennifer Block chose that as her post title. There are good posts on the subject of using the term “birth rape”. Some people have a problem with that term, thinking it is somehow unjustified for the victims to appropriate the term rape.

I also was involved with a discussion on female genital mutilation (FGM) on a website recently, and many commenters criticized people who drew parallels to routine male circumcision. Like I do in this post. They think this somehow diminishes FGM.

On that same site, someone was complaining recently about a friend whose wife has a disassociative disorder (I swear I am going somewhere with this), and was accusing many other people of trying to claim they also have a similar mental disorder when he didn’t deem them properly diagnosable. Someone else on the board tried to compare that to the “understandable” anger of mothers of autistic children who get angry at people who are “socially adjusted” and still claim to be in the autistic spectrum.

OK, my point. (Ow, my pointer finger. Must go back to hunting and pecking with my other fingers).

My point is that there is definitely room for nuance when someone is discussing the particular hardships of one’s own or a loved one’s particular issue, whether it be sexual assault or autism or FGM or whatever. People should get individualized attention. Hijacking is not always appropriate. For example, when I was involved on the post about FGM, I honored the original post, and at the end of my comment, I linked out to my post about the intersectionality with all genital cutting, and didn’t try to hijack the conversation to be about routine newborn circumcision in the developed world when the original post was about repairs of FGM preformed in developing countries. The post I linked to (linked above) is ALSO about FGM in developing countries, and then goes into the ethical and practical problems of condemning only one type of genital cutting (although FGM is easily arguably worse in many ways) when almost all of the arguments against it apply to all genital cutting, including that of intersexed or ambiguously sexed children, and are hard to convincingly apply to just one type of genital cutting.

Anyway, my point is (sore), finally, that it is not necessary to diminish other victims’ experiences or identification with a form of oppression or disease or disorder or diagnosis in order to support people who have a different, more accepted or more typical association with that disorder, issue, disease, diagnosis, etc. I don’t think my dad, who was in a wheelchair for 12 years, benefited at all if I railed against people with silent appearing disabilities who parked with Handicapped parking passes. I don’t think non verbal or other more “typical” autistic presenting individuals benefit if we diminish autistic identifying (and/or diagnosed) individuals who more easily pass as neurotypical. I don’t think victims of sexual assault benefit when we say victims of “gray rape” or “date rape” or “birth rape” can’t say they felt assaulted and sexually violated and raped.

I was “gray raped”, and I still don’t feel like I can say I was really raped or even sexually assaulted in that instance, because I don’t want people to tell me to get over myself, I don’t deserve to be in such a serious category. This is not the same thing as criticizing people for saying they were “raped” by paying money to the IRS or at the gas station. That is diminishing rape. But am I? Some people say yes. Some people say I am diminishing rape by NOT loudly identifying my acquaintance lack-of-consent sex as rape. It’s hard enough for me to talk about.

And I don’t think I’m wringing my hands and saying “Oh, but what about the menz?” when I point out it’s awfully hard to successfully tell cultures in other countries to stop cutting the girls’ genitalia but please continue cutting the boys.

Can we talk about the ways our problems intersect without diminishing each other?