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Stigma on Steroids: On Kansas Banning Abortion Providers From Schools

11:09 am in Uncategorized by RH Reality Check

Written by Carole Joffe for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

No school district, employee or agent thereof, or educational service provider contracting with such school district shall provide abortion services. No school district shall permit any person or entity to offer, sponsor or otherwise furnish in any manner any course materials or instruction relating to human sexuality or sexually transmitted diseases if such person or entity is an abortion services provider, or an employee, agent or volunteer of an abortion services provider.

Kansas High School

Kansas schools now forbid anyone with ties to abortion clinics.

The above provision is contained in a nearly 50-page bill that recently went into effect in Kansas. (A judge temporarily blocked two other provisions of the law, but allowed this one to remain.)

To be sure, the relentless assault on abortion that we are currently seeing in other state legislatures—Texas, Ohio, and North Carolina, among others—are far more consequential in the short run. Ambulatory surgical center (ASC) and hospital admitting privilege requirements really do have the capacity to shut down clinics. Should the Texas bill currently being considered become law—as is likely, despite the heroic efforts of the thousands of orange-shirters gathered at the capitol—the number of Texas abortion facilities would go from 47 to five in that huge state. Already, due to a similar ASC requirement, earlier rammed through the Pennsylvania legislature as a cynical response to the Gosnell scandal, a number of clinics in Pennsylvania have closed. And the bans on abortions after 20 weeks, adopted by a number of states, will affect a relatively small number of women, but typically those in desperate medical and/or social condition.

But other provisions of abortion legislation, of which the Kansas one cited above is a prime example, do a different kind of damage. They further the stigmatization and marginalization of abortion providers by making clear that these individuals are not welcome in that most central of community institutions: the schools. It is not just participation in sex education from which Kansas providers are barred. As Stephanie Toti, senior attorney at the Center for Reproductive Rights, which is challenging this law, told me, “This is unprecedented discrimination against abortion providers. … The prohibition on providers serving as ‘agents’ of a school district has the effect of barring them from serving as chaperones on field trips and engaging in most other volunteer activities.”

So abortion providers are at this moment banned from Kansas schools—and supposedly this will promote the safety of adult women getting abortions, as is the typical sanctimonious rationalization of the various laws we are seeing.

I asked several lawyer colleagues if they knew of other instances in which a whole occupational category was banned by law from volunteering in schools. They did not. Indeed, as far as I can tell, only sex offenders as a class are de facto banned from school grounds.

This shocking ban on abortion providers’ involvement in the schools leads me to recollect other instances I have encountered of attempts to isolate this group and keep them from community involvement. I think of a provider I’ve written about who I call Bill Swinton (not his real name), a family medicine doctor in a small town in the Pacific Northwest. He was deeply involved in both his church and his community, and served for three terms on the local school board. But he was defeated for a fourth term in the late 1980s, as the abortion wars intensified; needless to say, his status as a provider was the key factor in his defeat. I think as well of another doctor I’ve written about named Susan Golden (also not her real name), in a town in the Midwest, who integrated abortion provision into her family medicine practice. When she and her partner planned to take part in a community health fair, presenting on the care of newborns, the entire event was abruptly cancelled by the anti-abortion owner of the facility where the fair had been scheduled to take place.

As disturbing as these incidents were, they did not have the force, or the legitimization, of law. The Kansas provision does—and as such, takes the stigmatization of abortion providers to a new level.

Assuming the Kansas law, including this provision, is not overturned, we can only speculate as to what effects it might have. Speaking personally, I remember as a child the enormous pride I felt when my father, a cardiologist, came to my elementary school with his microscope and showed the class wondrous things. As a working mother, I recall how much I valued occasional volunteer stints in my daughters’ schools, getting to know both their classmates and other parents. It is very disturbing to contemplate that providers and their children will be deprived of these experiences. And it is equally disturbing to contemplate the messages that others in the community will receive from such a ban.

This provision truly is stigma on steroids.

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Evidence-Based Advocacy: How Do Abortion Providers Experience Stigma?

1:59 pm in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Evidence-Based Advocacy is a monthly column seeking to bridge the gap between the research and activist communities by profiling provocative new abortion research that activists may not otherwise be able to access.

DC Anti-abortion protest banner reads: 3500 Americans Aborted Daily

In today's culture, abortion providers face considerable stigma. Researchers at the University of Michigan study ways to mitigate its effects.

Ask anyone to tell you who’s doing the most innovative research on abortion provider stigma and they’€™ll tell you it’€™s Dr. Lisa Harris and her interdisciplinary team at the University of Michigan. Together they pioneered the Provider Share Workshop, a pilot project testing the possibility that a support group for abortion providers could help reduce the negative impact of stigma. She writes about topics that others in even the most pro-choice communities shy away from €”the need to have open and honest conversations about second trimester abortion provision, how stigma affects abortion complications, and, recently, the need to recognize conscience as a motivating factor in abortion provision. Now, Dr. Harris and her team, which includes social worker Jane Hassinger, and public health PhDs Michelle Debbink and Lisa Martin, have gone a step further and actually mapped out how abortion providers experience abortion stigma, coining a new term: the legitimacy paradox.

Based on their interviews with abortion clinic staff who participated in the Provider Share Workshop, Dr. Harris and her team theorize that the combination of stigma and silence perpetuate a vicious cycle:

When abortion providers do not disclose their work in everyday encounters, their silence perpetuates a stereotype that abortion work is unusual or deviant, or that legitimate, mainstream doctors do not perform abortions. This contributes to marginalization of abortion providers within medicine and the ongoing targeting of providers for harassment and violence. This reinforces the reluctance to disclose abortion work, and the cycle continues.

The marginalization of abortion providers within medicine and society at large is not a new issue. In fact, as Dr. Harris and others have written, negative portrayals of abortion providers go back at least two centuries in the United States. In the nineteenth century, the American Medical Association opposed abortion in part because non-physicians (such as midwives, osteopathic doctors, and others) were the majority of abortion providers at that time and took away valuable business from physicians. The AMA sought to criminalize abortion to push these competing practitioners out of business, and thus began the association of abortion provision with “deviance” from mainstream medicine.

As the women’€™s liberation movement made the case for safe and legal abortion in the mid-twentieth century, abortion providers were depicted as “back alley butchers.” This portrayal and the grotesque images associated with it communicated the very real dangers of illegal and unsafe abortion, but neglected that many thousands of safe illegal abortions that were provided by both clinicians and lay-people during this time. While the use of the “back alley butcher” imagery certainly helped to legalize abortion in the United States, Dr. Harris argues that it did so while further stigmatizing abortion providers.

To track how abortion providers experience stigma today, Dr. Harris’ team conducted a focus group with abortion clinic staff in a Midwestern abortion clinic. She documented that all abortion clinic staff, including clinicians, counselors, front desk workers, and others, feel the negative impacts of doing stigmatized work. Providers commented on encountering stigma in public discourse, such as in political rhetoric, from institutions, such as hospitals and churches, as well as in their every day relationships with family, friends, and even their patients. As a result of this stigma, providers often have to choose if and how to disclose their involvement in abortion provision, weighing the possibilities of relationship conflict and threats to their safety if they decide to disclose, or isolation and disconnection if they keep their work a secret.

What are the consequences of this stigma? One possibility is that it may contribute to violence and harassment of abortion providers. Dr. Harris and her team explain:

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I Was Raped: Figuring Out What Happened and Why It Felt Wrong (*TRIGGER WARNING*)

1:57 pm in Uncategorized by RH Reality Check

Written by Anonymous for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Five years ago, I was raped. I have never written or spoken those exact words before now; though I have shared the content of this story with those I’m close to, I have always stopped short of actually applying such a label to the experience. This kind of denial is not uncommon, as rape culture functions to normalize sexual violence, turning harassment, assault, and rape into such ordinary occurrences, we learn to see them as simply an inevitable part of every day life rather than recognizing them as the atrocities they are. And in fact, it’s that very hesitancy to identify myself as a victim of rape that has taught me what living in a rape culture truly means.

The circumstances of my rape seem to have been, unfortunately, common ones. I have, in the years since, read or heard slight variations of my story countless times from other women. The man was a close friend, trusted by me and adored by scores of volunteers at the organization where we’d met. He was in his early thirties, a little shy, a little awkward, and most known for his deadpan wit. I harbored a crush on him for many months, but I was in a monogamous relationship at the time and never acted on those feelings. We went out one day for a few beers together, something we did many times. I drank an amount that was normally tolerable for me, but for whatever reason, that day, it was not. Back at his apartment, I threw up. He — perhaps slightly tipsy, but in full possession of his faculties — comforted me. And a short time later, we were having sex.

I realize that for many people, questions of drinking and sex and consent can be a thorny thing. I don’t wish to engage in a lengthy discussion or debate here about whether it is ever possible for one to consent while intoxicated, or how we are to consider circumstances in which both parties are equally impaired. I do believe that there are, sometimes, situations in which one partner does not realize the degree to which the other is intoxicated. But I think it should be uncontroversial to say that if one is drunk enough to become physically ill, there is no possible way she can be considered capable of meaningful consent. In my case, I was never even asked for any kind of consent, anyhow, never asked if I was certain I wanted to be doing this, if I was feeling okay, if I was clear-headed enough to make this decision.

It seems to me, now, so cut and dry. If I heard this story about anyone else, even then, I would have zero hesitation in applying the label “rape.” But at the time, and for a long time afterword, I was unable to view my own rape for what it actually was.

Initially, I certainly did feel a strong sense of discomfort with what had taken place. It was surreal to think about how much mental presence I had lacked, as though I wasn’t fully inhabiting my body when it occurred. It felt as though I had been an object in the truest sense of the word, like my body had been used while I was not completely there. I knew that I had, at least to some degree, participated sexually. But it hadn’t felt like participation in anything other than a disembodied, robotic sense. The entire encounter felt like a thing that was happening to me, with all sense of my own agency removed from the picture — a sensation that remains haunting to recall. And yet, as I now realize is incredibly common for rape victims, I also felt ashamed. It is sickening to me, now, to recall that I was actually embarrassed that my legs and underarms hadn’t been freshly shaven, that I was self-conscious of what I could only assume was very sub-par sexual performance on my part. That I actually sent him a message the next day apologizing for being such a mess, thanking him for taking care of me when I was sick. Ironically, I was humiliated that he had seen me so weak and vulnerable.

I was unable to see him as any kind of predator. I thought too highly of him, cared about him too much. On some level, I recognized his behavior as wrong; I thought that as my friend, he should have at least tried to check in and make sure I was okay with what was happening. But I made excuses for him. I knew that I had been flirtatious with him, that he was probably aware of the feelings I had for him. I was in my mid-twenties, not a naïve teenager, and yet I believed that he would not have had sex with me unless he had feelings for me as well. Uncomfortable as the circumstances were, I still clung to some misguided notion that he cared too much about me to simply use me in that way.

Weeks later, when I confessed to him that I had feelings for him, he responded by ending our friendship. And though that certainly solidified my sense of being used and objectified, I was still unable, even internally, to name what had happened as “rape.” We continued volunteering together; I continued to witness how loved and admired he was by everyone around us. Whenever I heard someone gushing over how wonderful he was, I thought to myself: you have no idea. But I also knew that there was no possible way anyone would ever believe me even if I did want to come forward with the truth. They would believe what I still half-believed myself: that I had practically thrown myself at him, that perhaps, at worst, he’d had poor judgment in a moment of weakness.

Though my own definition of rape has never been one that necessitates physical struggle or force, when I actually thought about the idea of being raped, it felt like something I had no right to claim. No matter what my intellectual position was, deep down I still envisioned rape as a blatantly violent act, one which involved resistance and pain, one that felt terrifying in the moment. In spite of my utter lack of consent, I felt that it wasn’t really rape because I was not sufficiently traumatized, because I did not say no or put up any kind of fight, because he was someone I knew and was comfortable with and might very well have consented to have sex with while sober, not a stranger or someone I found frightening or revolting. And while I would never dream of applying any of those qualifications to challenge the legitimacy of someone else’s experience of rape, I spent years using them to delegitimize my own. This, to me, is perhaps the most frightening, pervasive, and powerful way in which rape culture functions: sexual violence is normalized to such an extent that we can become unable to identify it for what it really is even when we are victims.

I was, and remain, traumatized by my experience. But what upsets me the most, five years later, is not my memory of the actual events. What I find most disturbing, most difficult to confront, is my own denial, my own internalization of the social norms that allow for such acts to be commonplace. When I hear or read or write about yet another instance of victim-blaming or rape-denying, I cannot help but think about my own experience. And I cannot help but think about not only all of the survivors of sexual violence who never come forward, but also all of those who are unwilling or unable to even properly name what has happened to them, even privately in their own thoughts. It is terrifying to me that we can be so accustomed to these misogynist terms of engagement, we learn not to even recognize the violations enacted on our own bodies. And when I consider how I — a grown woman, a self-identified feminist who was not unaware the patriarchal structures we live with — still managed to deny the validity of my own experience, I can only begin to imagine how many other women have been unable to fully recognize similar acts of rape for what they actually are.

We are still taught, here in the 21st century, that rapists are lurking, predatory strangers. That they are men who, at the very least, give off a vibe of creepiness, or who openly display sexist behaviors. We are taught that they are not nice guys. We are taught to mistrust women’s stories of rape, particularly when the rapist does not fit our profile. We are taught to believe that there is more to the story, that the woman was somehow at fault, that she did something to encourage him, that she was asking for it. And when we are victims, we must then continue to live in a culture that dismisses our experiences, that encourages our objectification, that says over and over, in a multitude of ways: what happened to you was not rape. What happened to you was normal. What happened to you was your own fault. What happened to you is not something you have a right to be so upset about. It’s no wonder that some of us, if not a majority of us, ultimately turn those judgments inward. As Adrienne Rich wrote, “Where language and naming are power, silence is oppression, is violence.” And this is oppression working at its most efficient: it takes little effort to silence us when we are trained to silence ourselves. When we are denied the ability to even name our experiences, we are stripped of all ability to engage in dialogue about those experiences, and therefore also deprived of any means to collectively organize around–and fight back against–the injustices we’ve suffered. 

I am sharing this story now not because I believe it is unique, but on the contrary, because I believe it is all too common. I am continuously overwhelmed by the question of how we are to go about combating rape culture, to begin changing such deeply ingrained social norms. But it seems to me that the first step, at least, is to speak out, to tell our stories, to tell the truth, to challenge the narrative we’re fed about who is and who is not a rapist, and who is and who is not a “legitimate” victim of rape. Reading and hearing the stories of other women with similar experiences played a huge role in my own ability to finally face the reality that what happened to me was, in fact, rape. I can only hope that coming forward with my own story might play some small role in helping other women to do the same.

Abortion Stigma Is Simply Discrimination: Here Is How We Get Rid of It

10:55 am in Uncategorized by RH Reality Check

Written by Leila Hessini for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

A downcast woman

Why do we shame women for abortions? (Photo: gogoloopie / Flickr)

Last week, I attended the annual International Federation of Gynecology and Obstetrics conference in Italy. During the five days I was there, nearly 500,000 women had abortions. Many of these women faced stigma, a mechanism of social control used to dehumanize and devalue women who need, or decide, to terminate pregnancies.

When we began to examine the social construct of abortion stigma several years ago, we found that very little had been published. And yet, it’s really the root of all barriers that women — and even providers — face to obtain or perform abortions.  Why do we legally deprive women of a health care service that could safe their lives? Why are women forced to undergo a waiting period in order to get an abortion? Why are abortion clinics often separate from other reproductive health care clinics? Why do women trade safety for secrecy and turn to “back-alley” providers? And the questions go on…

Stigma contributes to the idea that women who have abortions are not the norm, although they are. The social construct of abortion stigma creates an “us-versus-them” mentality — in spite of the fact that in the United States one in three women have abortions and a much higher share of all women globally terminate a pregnancy sometime during their reproductive lives, abortion is still constructed as something that is wrong, inappropriate, or deviant. Discriminating against women is therefore considered normal; 26 percent of women live in countries where abortion is legally restricted and many more live in places where they have to justify their abortion. If this isn’t discrimination, I don’t know what is.

“How can this decision be wrong?” asks Dr. Nozer Sheriar, a gynecologist in India. “How can any decision, choice or action taken by 43 million women each year around the world be wrong?” If all the women in the world who have had an abortion live together in one country, he points out, it would be the third most populous country in the world. Think about the level of discrimination against a group so large.

My colleague and fellow presenter at FIGO 2012, Tracy Weitz, has also spoken out about abortion stigma in the United States, arguing that even in the pro-choice community, we further the stigma by creating hierarchies of women — some who deserve an abortion, some who do not. And who gets to decide who can have an abortion? Doctors, institutions and policymakers do. We insist on talking about abortion with language such as “safe, legal and rare,” which reinforces the notion that abortion is wrong and abnormal. And even abortion providers and clinics — sometimes unknowingly — create an atmosphere that stigmatizes women. Some American women have shared that paying for their abortion felt “like a drug deal” and others say the security, while justified, made it “seem all the more like a shameful, secretive thing.”

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Evidence-Based Advocacy: Expanding Our Thinking About “Repeat” Abortions

4:13 pm in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

 

Evidence-Based Advocacy is a bi-monthly column seeking to bridge the gap between the research and activist communities. It will profile provocative new abortion research that activists may not otherwise be able to access.

Poster: Break the Silence about abortions

Poster: Faviana Rodriguez / ihadanabortion.org

About 1.2 million abortions are performed in the United States every year, and of women seeking abortions, about half have had an abortion before. Women who have had more than one abortion are often targets of public-health interventions designed to increase women’s use of post-abortion contraception, or, to put it another way, to prevent them from having another abortion. Instead of seeing these women as “repeaters,” it’s time we viewed each abortion as a unique experience with its own set of complex circumstances.

Tracy Weitz and Katrina Kimport, sociologists with Advancing New Standards in Reproductive Health (ANSIRH), analyzed the interviews of ten women who’d had multiple abortions (full disclosure: I interned at ANSIRH this summer). Their research was part of several larger studies. The women interviewed varied in age, race, and geographic location, although most were from the Northeast or the West Coast. Together, they’d had a total of 35 abortions. Weitz and Kimport examined how these women thought about each abortion experience. Were they similar or different from each other? How did the circumstances of each abortion affect women’s emotional outcomes?

The researchers found that women talked about their abortions as separate events. Each abortion came with its own set of unique emotional and social circumstances, some more difficult or easy than others. In other words, a woman who’s had three abortions wasn’t repeating the same experience each time. Health interventions and policies that target women who have had more than one abortion should take into account that each abortion — and the circumstances of that pregnancy — may reflect a different emotional experience.

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Evidence-Based Advocacy: What Do Low-Income Women Think about Public Funding for Abortion?

10:18 am in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Evidence-Based Advocacy is a bi-monthly column seeking to bridge the gap between the research and activist communities. It will profile provocative new abortion research activists may not otherwise be able to access. 

September 30th marks the anniversary of the Hyde Amendment, which prevents Medicaid coverage of abortion in most circumstances. When activists and advocates talk about Hyde, we discuss the injustice of health care denial, the importance of grassroots abortion funds, and the stories of people who’ve sacrificed rent, food, and monthly bills in order to pay for an abortion their insurance won’t cover. And rightly so—there’s no denying that the more we talk about the horrific ramifications of the Hyde Amendment and the more awareness we raise, the better. We know what we think about Hyde. But what do women who are on Medicaid, the very people who are most affected by Hyde, think about the restrictions it places on their insurance coverage?

Amanda Dennis of Ibis Reproductive Health interviewed 71 low-income women who had  abortions while living in Arizona, Florida, New York, and Oregon, states that represent those operating under Hyde’s restrictions and those that have pro-actively provided Medicaid coverage for abortion. These women ranged from 18 to 35 years old, most reported having some college education, and a majority of them had surgical, first trimester abortions within the past two years. All of them met their state’s Medicaid income qualifications.

Most of the women supported government funding for abortion care; in fact, 82 percent said that they support Medicaid coverage of abortion. When asked about whether funding should be available in specific circumstances, however, they wavered. The interviewees didn’t think abortion should be covered if a woman could not afford another child. Similarly, they didn’t think Medicaid should cover abortion if a woman was not in a relationship with the person with whom she had sex. These views held constant even for women who were themselves in these same circumstances when they had their abortions. For example, a majority of the women cited financial instability as the most salient factor in their personal abortion decision, yet when specifically asked if Medicaid should cover abortion as a result of not being able to afford another child, 40 percent said no. Similarly, women often used disparaging language to talk about people who seek abortions for reasons they don’t approve of, again, even if they themselves had abortions in those circumstances.

This seems contradictory: why would women who have abortions for financial reasons disapprove of Medicaid coverage of abortion for the exact same reason? Dennis and her colleagues points to abortion stigma, explaining:

“Women said that they did not support coverage in these circumstances because they felt coverage would promote ‘irresponsible’ behavior…these circumstances conjured images of irresponsible, promiscuous, and callous women, which participants sought to distance themselves from in order to view their own abortion decision as consistent with their moral values.”

Dennis and colleagues propose that abortion stigma operates differently for low-income women, as they are battling both abortion stigma and welfare stereotypes. The researchers note that the overlap between stereotypes of women who have abortions and women on welfare are notable—they’re both thought of as irresponsible, lazy, and promiscuous, the exact qualities from which the women in this study were trying to distance themselves. Indeed, the shame associated with welfare reflects an American view that holds individuals accountable for their own poverty rather than recognizing the systemic determinants of poverty and health.

The point of this research is not to suggest that we should keep Hyde in place because low-income women themselves don’t believe that Medicaid should cover abortion in every circumstance. A person’s character, whether upstanding or “irresponsible,” should not determine whether or not they receive insurance coverage. This particular study uncovers just how pervasive abortion stigma is, so much so that even women who need Medicaid to cover abortion because they can’t afford another child don’t believe women like them deserve to have this coverage. 

The Hyde Amendment has made it acceptable to debate whether different pregnancy circumstances merit abortion coverage. As we see in this particular study, parsing out who does and doesn’t deserve abortion coverage based on the circumstances of a pregnancy only further embeds stereotypes about people who seek abortions, especially among those who need access to these services (in this case, low-income women). Research like this demonstrates that our work on the Hyde amendment can’t just be at the policy level. Repealing Hyde is not enough—it does not undo the damage of stereotypes associated with people who have abortions. We must advocate for policy change coupled with culture change, in which we both repeal Hyde and challenge the multiple stigmas and stereotypes associated with those who need Medicaid coverage of abortion.

If you are interested in having your research profiled, leave your contact information in the comments section. 

Have We Evolved in Our View of Transgender People?

10:20 am in Uncategorized by RH Reality Check

Written by Debbie McMillan for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

A pink-haired transwoman

Image: Aimee Ardell / Flickr

Like most people, the sum of who I am is much more than my individual traits. However, there is one fact about me that puts me way outside the mainstream. It’s that I’m a tran-sgender woman.

Last week, The Wall Street Journal reported that Massachusetts judge ordered prison officials to provide sex-reassignment surgery for a murder convict.

The piece started by talking about a transgender woman who used to meet in dark parking lots with other transgender people for support. “How things have changed since then for transgender men and women in America, who have made great strides in recent years toward reaching their ultimate goal: to be treated like ordinary people,” the piece noted.

I agree, strides have been made. But “great” grossly overstates the reality. Discrimination and misunderstanding is still rampant. I frequently feel that I’m assigned to a class of sub-humans. Even the judge who ordered the surgery said it was to treat “gender-identity disorder.” As a society, we still view transgender people as being against the natural order and place the blame on our minds, rather than where the real problem is: our incorrect bodies.

A recent article in the New York Times Magazine would indeed lead sympathetic readers to believe things are not so bad for transgender people and that there’s really just left over misunderstandings to clear up. The piece told honest, compelling, sometimes gut wrenching stories of good people trying to navigate the world for and with their gender non-specific children.

Consider that it was only in April of this year that the U.S. Equal Employment Opportunities Commission ruled that that discriminating against an employee or potential employee based on their gender identity is in violation of the Civil Rights Act. Forty-eight years after that Act passed Congress!

Twenty states now have laws prohibiting gender discrimination against LGBT people. However, that still means that 30 states do not.

I work with transgender people every day. Many of them have trouble finding housing or jobs, no matter what the laws say. Many of them are drug users driven to it, in part, because by living with the constant, unrelenting stigma we feel. It’s almost palpable.

I went to the street alone at 14 because I thought it was the only place for someone like me. I became a commercial sex worker because I believed it was the only occupation available to me. I looked around and saw that no one was going to give me a job.

Though I lived as a woman and looked like one, when I was arrested for solicitation, I was sent to the men’s prison. After one arrest for prostitution, I was thrown in the wing with the felons. When I inevitably contracted HIV, the doctors I sought continually called me by my birth name. When you have HIV, you want medical personnel who understand that your entire life changes the instant you get that diagnosis. Not someone who doesn’t bother to look in your eyes and see the very basics of who you are.

To be fair, these events happened to me 20 years ago. Back then, we didn’t have the word “transgender” and I was considered an effeminate gay boy. Things are different now but believing that there is significantly less discrimination because some people allow their sons to wear dresses is like thinking that because we have a black President, racism in America is gone.

Evidenced-Based Advocacy: (Mis)-Understanding Abortion Regret

11:09 am in Uncategorized by RH Reality Check

Written by Steph Herold for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Evidenced-Based Advocacy is a new bi-monthly column that aims to bridge the gap between the research and activist communities. It will profile provocative new abortion research that activists may not otherwise be able to access. 

“I Regret My Abortion:” we’ve all seen this infamous anti-choice sign, whether at a rally or outside a clinic. As pro-choice activists, our knee-jerk reaction may be to respond, whether aloud or in our own minds, with a reference to the plethora of research that suggests that relief, not regret, is the most commonly reported feeling after abortion.  Yet our knee-jerk reaction may be as stigmatizing as the anti-choice sign itself. When we rely on a relief/regret dichotomy, we leave little room for the complexity inherent in women’s reproductive lives.

Both the pro-choice and pro-life movements create simplistic narratives about women’s attachment to pregnancy. The pro-choice movement claims that women who have abortions do not experience regret afterwards because they form no attachment to their pregnancy, while conversely, the anti-choice movement claims that women always experience regret after an abortion because of an instantaneous bond with the pregnancy. 

The competing narratives of relief or regret alienate women who have more complicated relationships to their unwanted pregnancies. In her article “(Mis)Understanding Abortion Regret,” sociologist Katrina Kimport explores what makes some abortions more difficult emotional experiences than others (for a video abstract of her paper, see here).  She argues that instead of enforcing a relief/regret binary, we need to understand the emotional circumstances in which abortion decisions occur.

To explore what makes some abortions emotionally difficult for some women, Kimport draws on in-depth interviews with 21 women recruited through two separate secular post-abortion support talklines. She postulates that emotional difficulty related to abortion has at least three factors:

1. Social disapproval

Social disapproval encompasses stigma, personal beliefs about abortion, and expectations of certain emotional reactions. For some women, social disapproval takes the form of experiencing judgment about the abortion from friends or family. For other women, it means confronting their lack of grief about the abortion after expecting to feel sadness.

2. Romantic relationship loss

Women who fell into this category were predominantly experiencing grief over the loss of a relationship, not the loss of a pregnancy. This includes shifts in relationships, unsupportive partners, and break-ups (often as a result of the pregnancy, not the abortion). One participant elaborated on the significance of relationship loss, saying, “I don’t think abortion can be emotionally harmful. I think the people in a woman’s life who are not supportive of her can be emotionally harmful.”

 3. Emotional conflict between head and heart

Kimport defines this category as composed of women who “saw abortion as the logical choice in their current circumstances, but some significant part of them also wanted to continue the pregnancy.” This includes myriad circumstances, such as women who want to raise a child but know that they can’t realistically afford to parent, women who want to parent but not with their current partner, and even women with medical conditions that make a current pregnancy unsafe. Notably, there were no clear demographic patterns among women who fit this category, and belonging in this category often also experienced social disapproval and/or relationship loss, compounding their experience of emotional difficulty.

We know that most abortions are not emotionally difficult. So what can we learn from women who have emotional difficulty around abortion? Kimport’s goal is not to provide us with an exhaustive list of sources of emotional difficulty around abortion. Instead, she suggests a new framework that emphasizes focusing on a woman’s relationship to her pregnancy, allowing for complex, even conflicting feelings.

In our continuing efforts to speak about abortion experiences with authenticity, we need to move past a regret/relief dichotomy that debates the effects of abortion procedure. Instead, Kimport suggests ways of framing the issue that more expansively consider the woman’s experience, such as “some circumstances can make abortion emotionally difficult,” or, to put it more simply, some abortions are hard. Kimport’s study adds to the body of literature that asserts that it’s often not the abortion itself that causes emotional difficulty, but rather the circumstances surrounding the abortion.

It’s also important to note that emotional difficulty with abortion is not a reason to restrict abortion. Mandatory ultrasounds, waiting periods, TRAP laws, and other restrictions do nothing to improve the emotional experiences of women obtaining abortions — they do not make friends and family less judgmental, they do not improve relationships, and they do not help a woman overcome a head vs heart conflict.

Kimport’s article opens the door for a more nuanced discussion of supporting women who have abortions on their own terms. She also invites us to consider more complex questions: How can we change the feeling rules around abortion such that women don’t expect to feel grief afterwards?  How can we prepare women for the judgment they may face from friends, or from themselves? Kimport’s article provides more evidence that women need depoliticized support to process any complex feelings they may have after an abortion. It’s our job now to use her research to make that happen.

If you are interested in having your research profiled, leave your contact information in the comments section. 

Is Criminalization of HIV Transmission Effective? Swedish Case Reveals Why the Answer is No

10:32 am in Uncategorized by RH Reality Check

Written by Marianne Møllman for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

Image by Timothy Takemoto

Earlier this month, a 31-year-old woman in Sweden was sentenced to one and a half years in prison for having unprotected sex without disclosing to her partner beforehand that she is living with HIV.

Even a perfunctory news search reveals that this is not the first time the Swedish justice system has applied criminal sanctions to potential HIV-transmission. In January, a 20-year-old man was sentenced to eight months in prison for having unprotected sex without disclosing his status. In December 2006, a 34-year-old woman got two months, and in January 2003, a 32-year-old woman one year. All of these sentences also required the person living with HIV to pay monetary damages to their former sex-partners.

For anyone who cares about human rights from a health and discrimination angle, these cases raise multiple red flags.

For starters, consensual sex between consenting adults should, in principle, never be subject to government control or regulation. Moreover, the criminalization of HIV transmission has multiple negative outcomes. It leads to distrust in the health and justice systems; it can discourage people from seeking to know their HIV status; it adds to the stigmatization of those living with HIV; and it is ineffective in bringing down HIV transmission.

In fact, UNAIDS recommends that governments limit criminal sanctions for HIV transmission to cases where all of three conditions are met: the person charged 1) knows he or she is living with HIV; 2) acts with the intention of transmitting the virus; and 3) actually transmits it. UNAIDS also recommends that cases of such intentional HIV-transmission should be tried under generic criminal provisions for bodily harm or assault, and not under HIV-specific provisions.

Read the rest of this entry →

The Color of Genders: Inequality, Prejudice, and Violence in Everyday Acts

11:45 am in Uncategorized by RH Reality Check

Photobucket

Written by Antón Castellanos Usigli for RH Reality Check. This diary is cross-posted; commenters wishing to engage directly with the author should do so at the original post.

The other afternoon, I was in a rush, about to brush my teeth, and I remembered I had no toothbrush. In the morning, I had thrown out an old toothbrush thinking that I had to buy a new one, but I completely forgot, so I had to run to the nearest drugstore to get it. When I arrived at the drugstore, one of the employees, a woman, asked me which toothbrush I wanted. I scanned the options behind the counter, and I came upon a model I liked. The first toothbrush in the row was purple, so I told the lady I wanted that one. However, I was surprised when, instead of handing it to me, she started looking over toothbrushes of other colors (I thought she wanted to give me some options), disregarded a pink one (which I incidentally liked) and finally grabbed a blue one, which she put in front of me, telling me the price…

I would never have imagined that such an experience was meant to become one of the most shocking I have ever had regarding gender prejudice. Its apparent simplicity is what makes it so terrible. We can look at hundreds of statistical indicators and surveys that report gender inequalities in educational, workplace and political settings, however, the real magnitude of this phenomena is not to be found in numbers but in “meaningless” everyday occurrences (like my experience with the blue toothbrush), as they reflect that many of our rigid cognitive schemas regarding gender have not undergone significant transformations and that they have thousands of invisible expressions. Those expressions perpetuate inequality, prejudice and violence in a very powerful and dangerous way, as they can be internalized unconsciously in various contexts of socialization.

In response to this situation, the United Nations has set gender equality and the empowerment of women as one of its Millennium Development Goals, while the Millennium Declaration of the World Association for Sexual Health (WAS) also advocates for the advancement of gender equality and equity. These international goals demand strong political actions to trigger a re-imagination of gender through our entire system of social organization.  This re-imagination does not include “leading” men towards an “effeminate” type of behavior and women towards a “masculine” one and therefore “erasing” what we understand as “gender.” It is rather equivocal to think that gender can be eliminated, as it represents socio-cultural and psychological constructions of a biologically-based element: sex. Read the rest of this entry →