About Me

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Policy provokes me to think and write. I currently work in ivory towers inspiring people to engage in their world. I am a student of the human condition and my classroom is the world. I don't need credentials to have an opinion but I've got paper to prove I know a few things about public health, social welfare and economics. I'm coming out of the tower and taking the words to the people and hope you will send some words back at me.

Sunday, November 20, 2011

Sex and the stigma of money: a discussion on whoredom (aka prostitution)

Whoredom and Free Sex
Call a woman a whore and you have declared verbal warfare.

Underlying this aggression is the notion that sex, because it is so valuable, should be given freely and that money contaminates the mutual exchange of physical intimacy.

I have taken a few economics classes recently and despite the discipline's ability to confound intuition and everyday logic, this concept of 'free is better' still escapes my young economic mind. My mathematical mind can't seem to conjure up the right equation either.

It is said that money can't buy you love (though some may disagree) but why should it not buy you sex? Legally.

It appears to be more socially acceptable (though more by young adults than us older folk) to get drunk and have sex with some recently met acquaintance than it is to soberly and intently have sex where money changes hands. (And for the purposes of this piece I will focus on women getting paid by men).

The question for me is: If sex is so valuable, why can't women charge for it?

Patriarchal Ancestry
The answer lies in patriarchy. Should women be free to sell their bodies as they wish then the 'sexual value' of women goes down. What is not valuable in freedom has no value in control. Rape becomes less of a weapon because there is no man to incite to anger, no woman to shame. The woman will always hurt when violated but when the free sexual expression of women becomes hers to do with as she wishes, then the shame and stigma of sex - in all its forms - decreases.

In the USA there is a stigma attached to sex (thus all the talk about our uteri and what we can do with it when). We would much rather talk about money. (In Europe talking about money is as taboo as talking about sex in the USA). There is a puritan undercurrent (Ok, far from undercurrent but a big tsunami :-) that says that abstinence before marriage really is the ideal. And for a woman, a 'big number' of partners prior to marriage makes her less valuable. Just as it was in medieval times.

As for the white dress at marriage (and even quinceaneros)???? I cannot even begin to get started without busting my carotid artery. All I can say is that when 'tradition' becomes the excuse to participate in one's own oppression then...... As for the giving away from father to husband..... Well... I digress.... Sort of.

What I Am NOT Talking About
Be clear that this is not about sexual exploitation of minors (age of consent being a topic for another day), nor am I talking about the trafficking of women (though it is highly entangled with this notion of women's sexuality being owned by men). I have worked as a social worker with pregnant and parenting teenage girls. I have worked with teenaged girls who were pimps (rare) and I have known pimps and whores. I am not naive about the power dynamics, the violence or the exploitation. The diatribe that is this post is about free will. 

I am not naive enough to think that all women who would exchange sex for money have the privilege of the woman in the opening chapter of Superfreakonomics - where her 'straight' career as a professional led her to do the math and realize that sex for money was an excellent career choice if not for the social stigma attached. That and its emphasis on youth led her to study economics. But her fading glory is no more an issue than that of the sucked, tucked and plumped actress or aging model. Her issue was the 'legitimacy' of what she did. The kind of thing you don't talk about in 'polite company'.

Why Be a Whore?
Here are a few reasons why women become prostitutes:
  1. It pays well. Women still earn less than men (though closing the gap as they get more educated, have fewer children and more men go missing from tertiary education).
  2. The hours are flexible. Her time is her own. Yes, she can go to PTA meetings. Just because she gets money for sex doesn't mean she doesn't have a 'normal' life too.
  3. Autonomy. Her time is her own. As is her money. Despite what most people believe from watching too many police vice shows, most whores do not have pimps. And most brothels are run by women. Heidi Fleiss, the Mayflower Madam and the houses of 'ill repute' frequented by many a politician caught in flagrante delicto literally and metaphorically.
  4. It puts women in the power position (and many others:-)
  5. It is edgy (it still will be when legal) and gives a rush
  6. Because some women really like sex and are good at giving sexual pleasure.
  7. Because they can. Some women may find it challenging to contemplate sexual intercourse without a long-term relationship (and whores make much of their living from long-term regulars). But it's not for anyone to judge what it must be like for her (Discovery Channel has numerous shows on jobs most people would hate to do), it is simply for her to have the right to make her living as she pleases.
It is the latter which is at issue because right now a woman can choose to make her living as a whore but she will be flouting the law. So she not only risks reputation (which bankers and politicians and doers of many dirty jobs seem fairly willing to do) but she risks arrest, which has negative long- and short-term impacts on her life and those around her. The scarlet letter is more likely to be on Twitter or on Facebook than attached to her dress. The movie 'Easy A' made fun of just how easily an adolescent's reputation can get ruined in high school even if she's doing it for free or not doing it at all. But its not so funny if you are that girl.

So Why Make Prostitution Legal?
(For an excellent and much more recent discussion on the socioeconomic pros & cons see The Economist, August 9-15, 2014.  Click here for their discussion and cover story - in the same issue - on "how new technology is shaking up the oldest business".)
  1. It recognizes a woman's right to do what she wishes with her own body. Article 23 of the UN Declaration of Human Rights states that "Everyone has the right to work, to free choice of employment, to just and favorable conditions of work and to protection against unemployment". There really needs to be no more reason than this but there are.....
  2. Stop the hypocrisy. Any major city has printed ads in the back of their free weeklies for 'escorts'. Really? In those outfits and with those names? Really? Noone's having sex, just conversation and companionship?? Right.
  3. Regulation minimize exploitation and reduces crime. (See Article 23 in #1 above). We have a whole body of institutions that regulate other forms of employment for the same reason. Regulation would give women rights and protection and increase the likelihood of condom use and decrease violence and rape, because she would have the protection of law and stigma would be less likely to discredit the validity of her voice. Leaving prostitution in the shadows makes it a place where criminals can hide.
  4. Regulation equals taxation (and perhaps licensure) and increased income for the state. 
  5. Legalization would give legitimacy if not social standing, but that would come. Times change. Values change. People get over themselves. 
I have no moral judgement about prostitution because I  see it as a woman's right to do with her own body as she wishes. As for the men who visit prostitutes? He's got money. He wants sex. He pays. As one man told me once in Jamaica about building a house for his mistress: You gotta pay to play. Most men get that from the time they are 13 and asking a girl out for their first date.  

I am not a fountain of information on the legalization of the sale of sex but if marijuana can get legitimacy then the only thing standing in the way of the legalization of the sex trade is the patriarchal remnants and religious abhorrence to all things jointly female and sexually related. There is also the puritanical objection to hedonistic pleasures. And if that's all that's in the way...... it's going to be a long fight.

For the real life story of one of those 'call girls' who was really doing it to pay for her PhD (yes. for real) see the original blog of the woman on whom the books and TV shows are made, see the website of Belle du Jour: probably the most famous whore of the 21st century to date.

For more information about the issue of legalizing prostitution, visit the website of the International Union of Sex Workers.

For an interesting documentary on the legalities of prostitution that explores the laws of New Zealand, Canada, and Sweden: 'Buying Sex'

For a discussion of a recent study that explored the stereotypes regarding underage prostitution, click HERE.

For the complete UN Declaration of Human Rights, click HERE.

Monday, November 14, 2011

Humpty Dumpty, straight marriage and what gay people are thinking

Can all the kings horses and all the kings men and civil union policies and the Defence of Marriage Act and lots more legally entangled people put marriage back together again? I dont think so but let's entertain the thought. Today I am really asking the question: What does marriage equality mean? And though you may not find the answer below, that's where my mind started. First some disclaimers:

1. If you're looking for an advocacy piece on gay marriage this is not it but you will get the point at the end if you're patient enough to read through my why I think marriage is.... well.... I'm not really sure. 2. I am not a believer in the institution of marriage because its balance of power is not in a woman's favor. Gay marriage presents a whole other set of factors which I may explore on another day. 3. I have no idea what gay people are thinking but it gets attention in the title. 4. Who knows? I may lose my mind over someone and..... well.... my mind cannot imagine it no matter how hard I think so on I go with my discourse.

We have a Dream Act, and we have various marriage acts, and we have the American Dream (For a great Vanity Fair article on the disappearing American dream click here).

America is a land of dreamers. Go west young man (kill Native Americans along the way but I digress.... Silicon Valley and Redmond here we come!!!!) And you would have to have your head far up in the stratosphere to dream that your marriage, among all others, will succeed. A\I wonder what else I could sell someone by telling them there is a 33% chance of failure in 10 years (see CDC data) with the highest risk being the first year after giving birth to that first little baby? I couldn't sell a car with those stats. Or even a bed or a television. But people put their happiness, financial well-being and future on the line for love.

At one point a few years ago, a pro-marriage website listed more than 1,000 social rights and benefits that came with being married. The Nolo Press website lists some of the categories into which marriage benefits fall: tax, government, medical, employment, estate planning, death, housing, consumer etc etc. The law also considers all children born within a marriage to be that of the father (I am not sure how much of a right or benefit that affords the husband but it can be quite beneficial to the mother or the child).

What our imaginations fail to consider is that these laws were written under certain assumptions and they can be rewritten to be inclusive of other forms of partnerships that make a family and not just the institution of marriage which was primarily a way to guarantee transition of property across generations. Women like to ignore the historical context of this because it makes them 'uncomfortable'. As does the historical context of black and white relationships make us 'uncomfortable'. At least in the latter case we thought it unconstitutional to oppress one race by another. So it should be that it is unconstitutional to oppress one sex by another. And before individuals go beserk on me: oppression is collective, not individual so I am not accusing any one person but this is a cultural norm.

In places like Norway where there is no such legal connection between marriage and social benefits there are much lower rates of marriage and relationships last much longer and their high rates of out-of-wedlock births is not the tragedy it is here (For more info click here). Furthermore, among OECD countries the USA still has one of the highest rate of marriage (and we win by a long shot on the multiple marriage per person count) with only Turkey and Cyprus higher, and the highest divorce rate. So since we are getting married younger and getting divorced more and getting married more.... maybe we want to re-consider what we are doing. Because we ain't doing it right. (For loads of data on OECD marriage rates click here and for data on other forms of partnerships in the OECD, click hereยบ)

It is for these rights and benefits and social recognition that gay people want to get married. At least, so I read. Or perhaps they too want the pomp and circumstance of virginal white dress and splashy suit and a party. (By the way folks a party can be had at any time to celebrate anything you please and you can dress anyway you want). But from Bridezilla to the dress to My Big Fat Gypsy Wedding, there is a cult of marriage that holds women in its sway and I wont insult my wonderful friends who have gotten married by saying anything about how they behave once they say yes. And don't get me started on the knight in shining armor on one knee bit with a shiny thing that represents love. Really??????

When I ask many people why they want to get married they talk about tradition and the romance as if everyone had a double extra large scoop in a whooper waffle cone of Disney and Once upon a time (though they clearly weren't reading Grimm). Women who give me the tradition nonsense make my eyes go swirly.... REEAALLYY???? Tradition??? The tradition of your father handing you over to another man to take care of? ("I can't wait for my Dad to walk me down the aisle"). The white dress that represents purity? (You gotta be kidding me!) And I do not care if you write your own vows..... The 'tradition' is based on a history of ownership and control that in many ways still exist today especially legally. You are not 2 people joining as 2 people; under the law if he runs up debt you owe it too.

And what really fascinates me is how selective we are with our 'traditions'. When people want to display the Confederate flag, black people get huffy and talk about what it represents. And yet those same people will 'jump the broom' and join an institution which has historically and presently oppressed women. (Ignore the stories of women cleaning out a man for his  money. For the most part, women are thrown into poverty when they get divorced. And as women ask for more than 70% of divorces then I wonder why we are bothering to say yes in the first place). If you dress in black face - symbolizing negative stereotypes of black people - its a PC incident of epic proportions but all around the country on any given day, women put on a dress that symbolizes their control by men who pass them one to the other across generations as chattel. No matter that blackface is comedy, this voluntary signing up for an institution, and signing away of autonomy is a collective psychological process that stuns.

There is a documentary currently out called Miss Representation (to see trailer, click here) that look at how women are portrayed in the media. And there have been precedents to this sequence - the 4 editions of Killing Us Softly did the same thing for media in the 70's, 80's and 90's. (For a clip of Killing Us Softly 4 click here). There is no question in my mind that these images infiltrate young minds. My poor kid had to miss a lot of the 'girlie' stuff cuz I wouldn't have it in my house. I tried not to play radical feminist mom but when she told me she had decided not to play lacrosse (after begging me to) because girls were not allowed to check and what was so different about girls from boys when they are young?" she asked. Well, then.... I figured feminist mommy job was a job well done :D.

Well, again, not a bunch of numbers but if I'm wrong on anything, send me feedback. The wonk in me tries to get it right but sometimes my human fallibilities may win out.

So I ask my gay friends: "So what is it about this marriage thing you want again?" "Is it the right to get divorced?" "Is it the legitimacy of coupledeom by the state?" (Or perhaps the church?) Or perhaps because there is no man/woman dichotomy and no history of oppression to weigh it down, you have the chance to do marriage your own way and show straight people how it can be done.

Friday, November 11, 2011

Feeding healthy food to hungry children: The Healthy Hunger-Free Kids Act of 2010

This is an advocacy post so I wont make it too long. I will just provide you with the basics and the links to explore more. But this one is an easy one. Really. Healthier food for kids???!!! We have to advocate for this???? Seems we do!!

About the Healthy Hunger-Free Kids Act of 2010 - as benign a political decision as can be but in today's political climate there are no guarantees. There are forces working to block the passage of the bill in Congress even though tens of thousands of parents and organizations have lobbied to get this bill passed. The House of Representatives wants the USDA to start from scratch because they don't like a few things. You check out the details using the links I have provided here and decide for yourself.

Last year, the Senate unanimously passed the Healthy, Hunger-Free Kids Act (HHFKA), requiring USDA to update school nutrition standards. Once these new proposed school nutrition guidelines are implemented, our nation's school children will have access to healthier meals that include more fruits, vegetables, whole grains, and low fat milk; less sodium, unhealthy fats, and calories; and better accountability and compliance with the standards. The legislation authorizes funding and sets policy for all the USDA's core child nutrition program including the National School Lunch Program, the School Breakfast Program, Women, Infants and Children (WIC) among others.

The US Department of Agriculture has revised their school food standards to make the foods more healthy for children who get lunches and breakfasts at school. The new guidelines reduce unhealthy fats, calories and salt, and include low-fat milk and more fruits, vegetables, whole grains and represents the first time in 30 years that there has been a chance to make some changes that will reduce the health risks (associated with obesity, and high fat or salt intake) of the foods children now get served at school.

It seems that there are certain commercial interests who actually want to fight against these changes despite Michele Obama's Let's Move program that has a goal of reducing childhood obesity.

My sister runs a charter school and to provide healthy lunches for her children she has opted out of the federal lunch and breakfast programs and spends an extra 60 cents/meal (than the USDA option) to provide healthy food for the children at her school, Newark Legacy Charter School, in Newark, NJ - a place with what are called food deserts i.e. it's hard to find fresh fruits and vegetables. She works with a company called Revolution Foods to provide these meals. They have a philosophy that keeps sugar and bad fats out of kids meals and keep it on the fresh side. But it costs more than what the USDA programs cost but healthy kids in places that are not only often in places that are hard to find fruits and vegetables but parents don't have the money to afford them and so school is where the kids often get their primary meal.

It just takes a click on the congress and rep links above to find your legislator and make your opinion known. Now get to it!!

For more on childhood obesity: Healthier Generation

Hey hey ho ho!! This processed fat, salty, high calorie lunch has got to go!:

Thursday, November 10, 2011

Poverty 101 v1.0: The metrics of it all

The Technicalities of Counting the Poor

One month after announcing that approximately 46 million Americans (~15%) are poor, the Census Bureau revised their number to include another 3 million people. What changed? The Census has decided to: 1. include non-cash welfare benefits; 2. account for medical care and transport; and 3. take into account the changing composition of families. (For a Census press release on income, poverty and health insurance in 2010, click here).

Who is poor? What does 'poor' mean?

According to the Census Bureau's calculation - available in the press release noted above - poor in 2010 meant an income of $22,314 for a family of 4!!! That is a NATIONAL figure based on the Consumer Price Index and includes only the bare necessities of life. In any city in the USA, one person living on $22,314 would find it challenging. (For 30 years of poverty threshold data, click here).Using data from CommunitiesCount - a government and non-profit collaboration in the King County area of Washington state that includes Seattle, in 2007 a family of 4 with one working adult would require ~$50,000 to afford basic  necessities.A single parent household with 2 children would require ~$58,000. These dollar amounts refer to what is called 'a living wage' - which means exactly what it says: the wage needed to live at a basic standard (includes childcare, transportation etc etc). In 2007, Washington's minimum wage was $7.93/hour and if someone worked all 52 weeks at that wage they would make $16,494.40 before taxes.

The sum point of the previous paragraph is that the federal poverty line is actually a federal destitution line and having a job does not mean one can keep themselves out of 'real' poverty (vs the poverty as defined by the USA).

Using the federal minimum wage of $7.25/hour as a guideline (note that some states have a higher minimum wage than the federal one), a single person would make $15,080 per year working 40hrs/week for 52 weeks. And the poverty threshold for a single person under 65 in 2010 was $11,344. (For state and federal minimum wage data from the Department of Labor click here).

Counting the poor has been a statistical challenge for many governments in the OECD. At what point is someone poor? Should the notion of 'poverty' be absolute or relative? (The USA uses an absolute measure which is not the way most OECD countries measure poverty). What should be the basis for calculating 'poverty'?

Calculating 'Poverty'

The Census Bureau is responsible for counting people living in the USA.They measure a lot of 'metrics' (a very trendy word in the world of data) and they do it often, although they are mostly known for the decennial headcount. The Office of Management and Budget established the official measure of poverty in Statistical Policy Directive #14 and based on the Orshansky thresholds (for a complete history of the poverty measure click on this link) which were based on the threshold that the one major consumption item for which there was a minimum adequacy standard was food.

Without going into geek mode, the Census Bureau uses most sources of income to count the poor (defined BEFORE taxes). Though according to The Guardian (a British news outlet), the Census way of counting the poor is not very 'sophisticated'. What they do NOT include is an interesting list: capital gains/losses, non-cash benefits such as housing and food subsidies (until this current 'recalculation). The poverty measures were designed in 1963 - 1964(!!) and were based on food budgets of people in economic distress. At the time, food was the most significant fraction of a families budget. This food budget was based on a 'food basket' of items that were chosen to feed a family of 4  - 2 parents and 2 children.

The Cost of Food and Housing

The most glaring error in the system is that it is based on a food budget, which is a much smaller proportion of a family's budget than is housing. Typical 'ideal' budgets allocate 30% of income for housing. For a single person at the poverty threshold in 2010, this would mean $284/month on housing - practically impossible in an urban area other than perhaps dying Detroit. Which leads to another major complaint of the 'absolute' measure of poverty: there is no geographical variation i.e. poverty thresholds are the same for rural Mississippi as they are for Manhattan. This is why some states set a higher minimum wage than the federal government does.

So you'd think that with all this practice, they would get it right. But when it comes to the poor they have been screwing up for quite some time. And despite many voices calling for a new system for counting poverty, they  have been resistant to change.

The Importance of Counting the Poor

The number of the poor is a critical factor in the calculation of health and social welfare budgets because this measure is used to calculate eligibility for benefits. Some benefits are universal, e.g. Medicare, which means that someone is eligible without accounting for income or wealth. Other benefits such as Food Stamps are dependent on the relative income of an individual relative to the 'poverty line' i.e. the cut-off line for poverty status. The relative number of poor people year over year also helps a government to measure to what extent social welfare benefits are succesful in moving people out of poverty.

Fighting Poverty

I tried to be brief but poverty is not that simple. Neither is being poor and sometimes that reality gets lost in the numbers. See below for a list of links to organizations that fight poverty in all sorts of ways. The pic below is rather optimistic because we wont end poverty in a capitalist system but we can make poverty less painful (less holes in the safety net) and more 'real' (i.e. use real-life budgets and not some outdated theoretical notion from 50 years ago).

(National Women's Law Center) http://www.nwlc.org/ 

Tuesday, November 1, 2011

Genital cutting (aka circumcision), condoms and HIV prevention in Africa

It was in 2009 when I got a most provoking announcement from Marie Stopes International - (A UK based sexual health NGO) that in partnership with the Bill and Melinda Gates Foundation, Population Services International (PSI), The Population Council, and Johns Hopkins Program for International Education in Gynecology and Obstetrics (JHPIEGO), they were going to provide 'voluntary' male circumcision (MC) services to more than 650,000 men in Africa in an effort to curb the HIV epidemic. (There is now a male circumcision for HIV prevention clearing house where all you ever wanted to know about male circumcision in HIV prevention is there). Included with the MC services was going to be 'behavior change communication' to "highlight the need for safer sex practices and continued condom use".

So here's the bit that got my attention: "continued condom use". If they are continuing condom use, what do they need with circumcision?? So if I am one of these 650,000 men, why would I get circumcised for my 60% reduction in HIV infection risk, if I still have to wear a condom??? Why don't I just keep my foreskin and wear a condom???? Consistent use of a condom reduces the risk of HIV transmission between 80 and 90%! Of course, condoms prevent the transmission of other sexually transmitted infections such as chlamydia, gonnorhea, syphillis etc. So cutting reduces risk by 60% and condoms reduce risk by 80-90%. And somewhere inside me (and I wont even bother checking the stats for this) I have a feeling that we could give a man enough condoms for a lifetime for the cost of all the training, healthcare services etc that go into this cutting campaign.

And note that the World Health Organization and UNAIDS both see MC as a key intervention in preventing HIV in Africa. So if in the words of Regina Rabinovich, who was (July 2009) the Director of Infectious Disease Development in the Gates Foundation Global Health Program "Studies confirmt hat safe, voluntary male circumcision has been shown to reduce HIV transmission rates and help save lives", then why do we not have such a campaign among uncut men in the USA and the proverbial North??

So let me get this..... white folks in Europe and America are keeping their foreskins. The ethnic groups in Africa who don't cut avoid cutting as part of their cultural practice. Now perhaps this is where I ask the question about why there is promotion of male cutting at the same time we limit female cutting?? (But I will not revisit the reading of Alice Walker's book in San Francisco so many years ago where the men hijacked the female cutting conversation so that is for another rant). Yes... I know... one is 'voluntary' and one is involuntary.

This 5 year program will end in research findings that will be disseminated widely of course and help figure out how to 'scale up' around the world.

Again, I ask, why would any man sign up to get snipped and then wear a condom?? Is HIV the only sexually transmitted disease that we are trying to prevent or should there not be a broader emphasis on sexual health?

And I was wondering why in countries where basic healthcare is a luxury, that several of the world's leading health organizations, would focus significant infrastructure and fiscal/human resources on cutting the foreskins of African men.

In the meantime, there I was in Uganda, in an area where the percentage of the population that was HIV+ was near 15% and the state run clinic couldn't find a condom anywhere. So I had to hustle several thousand from St Francis Healthcare Services so that women and men could protect themselves. But there are resources for a surgical procedure in rural areas of Zambia, Kenya, Swaziland etc where national networks of public, private and NGO health service providers will voluntary cut men in places where women have a challenging time finding prenatal and delivery services. Nurses were trained in the procedure so that  up to 150 men a day could be cut in some facilities. Now again.... is Africa so flush with nursing capacity that cutting men can fall within their professional purview???

This rant is not to argue the priorities of healthcare service delivery but it is to question the delivery of this particular healthcare 'service'. A service that is so rare in the UK, that people have to travel to find doctors who will circumcise.

So the questions are this: Why Africa? Why circumcision and not condoms alone (as a condom still has to go on top of a cut penis)? Is this a good use of severely limited healthcare resources? Is this a good use of collaboration? And though I dare not say where this SHOULD fall on the healthcare services delivery hierarchy, I'm just wondering if there was nothing else we could be spending this money on? (yes, bad grammar but i'm pissed).

Monday, October 31, 2011

Preventing the health hazards of adolescent sex: Condoms, sex ed, and the HPV vaccine

Today, the topic of the day is HPV. I'll start with the facts, get them out of the way and get on with the rant.

According to the Centers for Disease Control and Prevention, HPV is the most common sexually transmitted disease in the USA with more than 50% of all sexually active people getting the virus at some time in their lives. Almost all cervical cancer is linked to HPV. Most of the time HPV goes away by itself within 2 years and does NOT cause health problems. Some strains of HPV cause cancer if they remain in the body for a long time and there is presently no way of knowing which people will develop cancer or other health problems. All women are at risk of cervical cancer and most cervical cancers occur after age 30. The National Cancer Institute estimates that in 2011, 12, 710 women will get cervical cancer and 4,290 will die of the disease. This works out to 8.1 cases and 2.4 deaths per 100,000 women per year - a fairly rare illness in the USA (but much more common and deadly in the economically developing world).

I have no qualms against preventing deaths and illness but the risk of cervical cancer is very low as is the risk of death from the disease. So we are immunizing a generation for a rare illness that already has a way of prevention (Yes. Condoms don't prevent 100% but neither does the vaccine). The HPV vaccine, with Gardasil (sold by Merck) being the most popular, has been widely marketed as a way of preventing cervical cancer by immunizing against four forms of HPV that cause the disease (as well as genital warts and vaginal cancer). Recommended age range for immunization is ages 9-26.

I have based much of a career on the belief that sex should be a safe and pleasurable activity that occurs between consensual partners. It shouldn't cost us our lives or our fertility or our social status.

But the politics of sex is why I have slowly gotten out of the sex business.

And nowhere is the politics of sex more volatile than in adolescence. (Well, the AIDS business has become less politicized but still a pit of snakes).

I get it. This is a country of prudes. People who like their sex on the sly instead of out in the open. (Thus the ever constant stream of 'scandals' that are just normal sexual behavior but conducted by famous people).

So when the chance to 'prevent cervical cancer' came along in the form of an injection, the pharmas (Merck in particular) were more than happy to talk about the prevention of HPV - a sexually transmitted disease - as a way to prevent cervical cancer. But not much talk of sex even though the early age of immunization - 11 - was closely tied to making sure a girl (and now boys) get their shot before they are exposed to HPV - through sex. (Age 11 is when many medical practitioners recommend it but on the website Gardasil is recommended for children as young as age 9).

So let's get this straight...... It is not okay to talk sexual health to children at age 11. We would not dare give children a condom at age 11, without societal outrage. However it is ok to give them an immunization at age 11 that prevents an STD (before sexual intercourse exposes them to HPV)

Call me paranoid but the safety record of drugs related to my reproductive parts is not the greatest and as these immunizations have not been around for 70+ years (the average length of time the children getting it now will live), perhaps we should use the opportunity (if you still want to be part of the medical experiment) to pass on some information while giving the shot. If we are going to give a shot related to a disease acquired through sexual behaviors then just maybe we could give a little spiel on behaviors that promote sexual health; like abstinence (yes, every sex ed volunteer preaches abstinence, not just religiously conservative ones), sexual pleasure from behaviors that do not require intercourse such as sexting (and whatever happened to hand jobs?), the use of a condom and monogamy (the holy grail of sexual relationships).

The focus on preventing cervical cancer and not a STD is really excellent marketing!!! In fact, it seems noone really wants to talk about the sexual behavior of adolescents. It appears that sooner or later we'll just give shots against gonnorhea, syphillis, chlamydia, and the lot, to spare us the necessary conversations or the necessary healthy behaviors. (Sorta like the stuff that makes you able to eat fat without it making you fat).

Abdicating a conversation for an immunization shows how far this country will go to avoid necessary conversations about sexual behavior. When I taught my 10 year old about condoms, everyone thought it was too young and yet they could not understand why I would not give her the HPV vaccine. Huh??? Isn't my condom talk and the immunization both based on the assumption that she may soon have sexual intercourse? When mothers told me that they do not want to imagine their daughter's having sex so they would not talk to them about sex and then packed them off for their Gardasil shot, my brain got a little fuzzy on the logic.

The shot separates us from the reality of adolescent sex. I live in a state (Washington) where the law says there should be comprehensive sexual education for young people. (But Washington has ex-state attorney and current senator who want to legalize marijuana and we have 2 female senators and 1 female governor - all democrats so it's not exactly the USA:). I find it interesting that elementary school children can learn about their stomachs when they learn about digestion but all the parts just below the stomach get ignored. As if they aren't there.

Here's the deal: almost everyone will have sex sooner or later. Let's acknowledge that, teach everyone how the sexual and reproductive health organs work (even married people need to know this), teach them how to take care of them and protect them and let's see how much the sexually transmitted disease rates would drop, unplanned pregnancy rates would drops (married people have this problem too), infertility would drop (often caused by undiagnosed STDs) and hey, even the abortion rate (lots of married people have these) would drop. And isn't that what everyone wants? (Yes. Lefties don't like abortions either).

So is it too much to ask that before the 11-year old gets the HPV vaccine, they get a sexual health class and some condoms, sign a form that says they understand what the immunization is for and that they received the class and the condoms, and then get their stab in the arm. Now that would be public health done the 'right' way instead of the 'easy' way.

Saturday, October 29, 2011

Dear Missouri, Re: the fetus, the baby and PAID maternity leave

Missouri and Mississippi have decided that they will decide when life begins. Too many US states have god complexes which make them think they have the wisdom (hahahaa!!) to decide when life begins and the authority to decide when it ends. And oh... by the way.... just because the law (of Missouri of all places!) says its so don't make it so.

Of course, this law is about abortion. And whatever the beliefs of the governor or the laws of the state, when a woman in Missouri wants an abortion she will leave the state to get one. Contrary to the belief of many, the decision to have an abortion is a tortuous one that women do not take lightly. That "Oh shit!" moment of a positive pregnancy test is one of the most feared moments in the life of a woman unprepared (emotionally, psychologically and financially) for a child. If this country was more child friendly in its social welfare policies perhaps women would not go through the mental and physical anguish of termination. 

And while they are legislating their way up my vagina, they all may want to work on legislating more men to be the kind of people with whom we would choose to have a child. Get them a job. Charge them when they hit me. And don't make it like climbing Everest for a rape charge to stick.And as for child welfare policy.... where do I start??? 

Well I think I'll start with maternity leave. Yup... right at the beginning. I could go on and on about how many women do not have access to medical care during pregnancy because so many doctors wont take Medicaid but that's another rant for another day. 

Today I am focusing on maternity leave though it's hard to talk about it and not included all the other sanity-provoking policies related to children in this 'advanced' country.

Ok... so now I have a baby. This is the point at which Republicans talk to me about personal responsibility (I'm not responsible enough to decide about my own body but I'm responsible enough for a child. Yeah. Ok. Makes sense. NOT!). And it begins with maternity leave (and it continues so far into the future that I will be provoking enough family policy to keep this blog filled for a long time to come). It seems that once I have this baby the Reps so want me to have, then I am on my own.

Sure there is this Family and Medical Leave Act (FMLA) which throws all kinds of leave into one 3 month pot and god bless ya if your mom gets sick and you have a baby in the same year. Anyway, say it's just me and this baby. And I dont work for one of the top law firms or corporations that are competing for top talent so give them paid maternity leave to attract and retain them. If I'm just a regular working girl, what do I do? I take UNPAID leave. And if I'm just a regular working girl how do I afford to take an unpaid leave when my expenses just increased? (Subsidized childcare is also a topic for a later rant).

A 2004 Harvard study of 168 nations found that 163 had some form of paid maternity leave. The USA was one of the countries, like Papua New Guinea and Lesotho, that did not. The countries who are members of the Organization forEconomic Cooperation and Development (OECD) average 18 weeks of paid leave!!!!

And what really pisses me off is that feminist activists in this country do not want to provoke this policy because they think it makes us stand out as needing different treatment than men. Really???? We grow humans. We incubate them for 9 months. We have the feeding implements that can be their sole nutritional source for more than 6 months. The men did a poke 9 months prior. Who can argue a huge difference and it's time that women acknowledge the difference, own the power in that difference, and demand what we need to take care of the next generation. Our social welfare policies push poor women to work and social norms support middle class and wealthy women to stay home. Taking care of one's own child should not be an economic luxury!!! In fact, it's cheaper to pay a mother to stay home and take care of her child than to pay for subsidized childcare. But it's not just about money, it's about values. (Oh so many rants for later days).

Maternity leave is a key factor in the gender gap in wages and employment and in the ‘family gap’ in income that exists between women with children and women without children. Much of the gender gap (40-50%) in income can be explained by the family gap differential due to marital and parental status among women. 

The absence of paid maternity leave in the USA has been perceived by feminists and public health professionals as anti-woman, anti-child and anti-family because it does not provide income for the woman post-childbirth nor does it support the 6-month breast-feeding recommendations of the American Pediatric Association. 

Not many women can afford to take unpaid leave and the women who work for companies where paid leave is a perk are more likely to be able to afford to take an extended leave. By making work incompatible with motherhood, women are forced to make hard choices between taking care of their children and being in the workforce.

There is no coincidence in the poor health outcomes we have for infants/children in this country. We do not seem to care what happens to them once they are born but spend way too much time worried about them in utero. It's hard to find affordable quality childcare, public schools suck, juvenile justice facilities are full to overflowing, high school graduation rates are low and college costs more than a condo. 

By making work incompatible with motherhood, women are forced to make hard choices between taking care of their children and being in the workforce. And men do not have to make this choice. Leaving the workforce because of motherhood not only reduces our present income but our lifetime income and our pensions and makes us dependent economically on men - which doesn't work out so well for so many women. (Note to self: future rant on child support collection). The price of motherhood need not be so financially challenging. Or as is happening all over the OECD, women will simply choose to opt out of the motherhood game altogether. And that demographic challenge is not one that is easily fixed. Just ask Japan or Germany or any country where the demographic pyramid is scaring the statistics out of any pension administrator.

Doing research on this topic for an economics class on gender and family, it was really hard to find a rationale for the resistance to paid maternity leave in the USA so I'm not sure why we're stuck in some sort of policy dark age (along with universal health care --- oh way too many rants to write). But I thought I'd end on a positive note and give props to a couple companies (among many) that stand out in this area.

Ernst and Young, which in 2010, was listed among the top 10 family friendly companies by Working Mother Research Institute, provides new mothers with 12 weeks paid leave and 10 weeks unpaid leave. Bank ofAmerica, which was also on the top 10, gives a paid leave to either gender of 12 weeks and allows them to take a total of 26 weeks. 

Women, when you're thinking of where to work, maternity leave policy should be part of your background research (but keep it out of the interview:) if you are thinking about having a child. In the meantime, stay away from Missouri and Mississippi.

Thursday, October 27, 2011

What provokes me

The current political climate in the USA and in Europe is enough to provoke anyone to comment (or rant in my case). So I don't feel particularly unique in that context.

But I am more than a bit of a pain in the arse when it comes to talking about policy. Why? Because I tend not to take sides. And when I do, it's not usually consistent with the 'side' I may have taken on another policy. I admit: I do not judge policy through some political lens but rather through the lens of: Does this make sense? Why? And for who?

In a country full of centrists (Democratic Reps and Republican Dems), its a pretty easy thing to go either way. In the USA there is a new group of people that have actually brought some right to what has always been a center game: the tea drinking folks. To make it really fun there needs to be a whacko left to join them. I use the term 'whacko' because despite my sharp brain and that of commentators around the world it's pretty tricky business to make policy sense of the tea party - that brand of republican so 'interesting' they provide political entertainment at a time when the state of the world gives us need of a little laughter inspired by incredulity.

I am tired of 'the left' (which in the USA means 1 mm left of center) making logical arguments about policies that they think will pass. Why not just throw a hail mary? (For those readers not American or football friendly that's 'longshot'). What is so wrong with just 'going for it'? It is not as if the logical stuff is getting through Congress anyway. So if there is a real left out there, perhaps what's on offer by the Dems will look so 'sane' that the Reps will happily give it a vote. Or just perhaps Dems should give a rats ass about what Congress will pass and give the people what they want and then let the Reps take the heat for shutting it down.

Where is the Faux News on the left? (Yes. A whole channel full of ranting lefties of various persuasions). Where are the people willing to propose radical leftie ideas (No! Healthcare for all is not a left idea because even right governments, fascists and dictators accept this as a policy norm). Where are the people willing to say leftie stuff that will have people sit up and take notice. Where is the 'tax party'? The party that promotes more taxes for the rich and for corporations? Are there enough people to follow Warren Buffet's lead?

Occupy Wall Street (and main streets all over the USA) is a populist movement demanding changes in the way banks and corporations operate but perhaps they need to occupy DC. Where lobbyists on K Street suck up cash and hedge their bets on either side. Where interests, special or not, get traded like monopoly game pieces. Occupy DC would hold elected officials responsible for making the choices the people want them to make.

Right now, the USA will have a hard time disengaging from capitalism at its greediest while trying to encourage business to occupy Detroit and shiny up the rust belt. Greed drives growth. Or it did. And we all went along for the ride. A home for everyone and everyone a stock trader. We bought 3 cars, shopped our fill on eBay and bought more stuff at Costco than we could use in a lifetime; or even used at all.

So that's what I'm going to be writing about: stuff that pisses me off and annoys the hell out of me. Policies for poor people that benefit the rich. Policies that have an underlying addition problem that a preschooler would notice. Policies that have goals and objectives not slightly related to their stated outcomes.

Policies like the small government proposals of the Republicans that have their hands so far up my uterus I'm all for them making government quite a bit smaller (at least in that respect) until they stop telling me who I can marry and what to do with my body.

This will be my Faux News channel. I wont make up the data (I've got a professional reputation to uphold) and I will not be careless in my interpretation (my brain just wont let me) but when policy provokes me I shall write and hope that you too get provoked.