Just how many experts does it take to assign someone a gender? The female South African winner of the 800m race at track and field world championships in Berlin has been asked to prove that she is a woman.
Just how many experts does it take to assign someone a gender?
The female South African winner of the 800m race at track and field
world championships in Berlin has been asked to prove that she is a
woman, the Guardian reports. And to prove herself female, she must submit to and pass a battery of tests:
Nick Davies, a spokesman for the International Association of Athletics Federations (IAAF)…described the tests necessary to determine the gender of an
athlete as "an extremely complex procedure" involving medics,
scientists, gynaecologists and psychologists, the outcome of which is
not expected for several weeks.
Caster Semenya, 18, had never competed outside of Africa when she logged this year’s best time. Her youth and her relative lack of experience led officials to question her gender.
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While Semenya herself has not commented on the investigation, her father, Jacob, said: “I raised her and I have never doubted her gender. She is a woman, and I can repeat that a million times” (via the New York Times).
The Times coverage of the story underscores how many different factors play into sex determination. Genes, hormones and genitalia can align in ways other than strictly "male" or "female," the Times explains:
Complicated cases are common. For example, a disorder known as
congenital adrenal hyperplasia gives women excess testosterone from a
source other than the testes — the adrenal glands. In mild cases,
genitals may appear normal and often no one suspects the problem. Women
with the disorder are allowed to compete as females…
Then there is a list of rare genetic disorders that can
confuse sexual identity. Some genetic males, for example, have
mutations in a gene needed to form testes. Although they look like
women, genetically they are men, with an X chromosome and a Y
In El Salvador, Maria Teresa Rivera was convicted of aggravated homicide after experiencing an obstetrical emergency. She is scheduled to have a new day in court on May 11, when she will argue that there were judicial errors in her original trial.
In November 2011, Maria Teresa Rivera unexpectedly went into labor, giving birth in the latrine of her home. The birth was dangerous and unattended by any medical professionals; the fetus died. Like many women in El Salvador, where abortion is completely illegal, Rivera’s medical crisis led to her being charged with and convicted of aggravated homicide; she was sentenced in 2012 to 40 years in prison.
Rivera’s sentence is the most extreme of “Las 17,” a group of women who have been imprisoned after obstetrical emergencies. Now, she is scheduled to have a new day in court on May 11, when she will argue that there were judicial errors in her original trial. If the judge rules in her favor, she will be freed from prison. Advocates say that her case could influence public sentiment about other similar cases around the country.
With the support of the Agrupación Ciudadana por la Despenalización del Aborto, a Salvadoran feminist organization, Rivera has been fighting her case for several years, as reported earlier in Rewire. Along with the rest of Las 17, she requested a pardon from the Salvadoran government in 2014, but her request was denied.
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“Rivera represents the maximum will of the state to criminalize women in this country,” Morena Herrera, president of the Agrupación, explained in an on-the-ground interview with Rewire. “Her sentence is the longest of any of the women with similar convictions; at 40 years, it is practically a life sentence.”
Fortunate To Be Alive
Maria Teresa Rivera, who shared her story on camera from prison in 2013, was a 28-year-old factory worker in 2011. She was living with her young son and his grandparents, her ex in-laws, in a very modest home in the outskirts of San Salvador. Rivera, the sole provider for the family, supplemented her factory work with house-cleaning in order to pay $13 a month to keep her son in a neighborhood Catholic school and purchase his asthma medication.
One night, according to court documents, Rivera said she awoke with intense thirst. But when she arose from her bed, she felt dizzy and then fainted. When she regained consciousness, she felt a strong urge to defecate and went to the latrine outside the house. As she sat in the latrine, she had intense cramping and “felt as if a little ball fell from her body.” Then she fainted and fell to the ground, where her mother-in-law found her in a pool of blood and called an ambulance to take her to the hospital. No one at the scene—family or paramedics—reported hearing any sounds of a baby, and no one realized she had given birth.
Rivera told doctors, attorneys, and others that did not know she was pregnant. She had been experiencing bleeding during the time of the pregnancy, which she interpreted as her menstrual cycle. Neither she nor any friends, relatives, or co-workers noted any physical changes that would indicate a pregnancy. She had also had two doctor visits for other complaints during those months, and no doctor had diagnosed her pregnancy. According to her own estimations, the last sexual contact she’d had that could have resulted in pregnancy had been six months earlier.
She arrived at the hospital in a severe state of shock from extreme blood loss, fortunate to still be alive. Doctors told her she had given birth and wanted to know where the baby was. Medical personnel contacted police, who went to her home to locate the deceased fetus. Rivera was detained by police at the hospital and has been imprisoned since that time.
Interrogation While Hospitalized
Multiple national and international organizations, including Amnesty International and the Center for Reproductive Rights, along with numerous medical, legal, human rights, and academic experts, have analyzed Rivera’s case in the years since her conviction. Harvard University sociologist Jocelyn Viterna and Salvadoran lawyer Jose Santos Guardado Bautista, for example, used parts of Rivera’s story and court documents in their 2014 analysis of systematic gender discrimination toward Las 17 within the judicial system.
Viterna and Bautista noted, for example, that the only witness testimony the judge considered credible was a supervisor from human resources at the factory where Rivera worked. Contrary to Rivera’s testimony, the supervisor testified that Rivera asked for time off for doctor appointments in January 2011 because she was pregnant. The judge refused to allow testimony from neighbors and friends who stated that they had never seen Rivera show any signs of pregnancy.
“Had Maria Teresa truly reported a pregnancy to her employer in January of 2011, she would have been 11 months pregnant when the birth occurred in November,” Viterna and Bautista observed. “This testimony is nothing short of preposterous. Nevertheless, this is the only witness testimony that the judge deems ‘credible’ in the final sentencing.”
According to Viterna and Bautista’s report, “The judge admitted that there was no evidence that Maria Teresa had done anything to hurt her baby. The judge also admitted that there was no evidence of any motive for why she would want to kill her baby.” However, he still convicted her of aggravated homicide.
A 2015 resolution from the Salvadoran Attorney General for Human Rights (Procuradoría Para la Defensa de los Derechos Humanos or PDDH in Spanish), which provided a formal opinion on violations of Rivera’s human rights, supports Viterna and Bautista’s findings.
The PDDH resolution observed that Rivera faced a slanted system even before she got to court:
At the First of May Hospital where Rivera was taken, the criminal investigation was prioritized over her right to health. She was subjected to interrogation when she was still in Intensive Care and without legal representation. In addition, the medical personnel did not seek information about her health history; they limited themselves to examining the birth canal, carrying out the extraction of the remaining placenta, and discharging her the following day, without attending to her overall health.
Both the PDDH and Viterna-Bautista reports noted that the judge relied on shoddy, unscientific evidence to convict Rivera. According to court records, the autopsy report for the fetus said its cause of death was “perinatal asphyxia.”
“It is perhaps worth reiterating that there were no signs of trauma on the [fetus], either externally or internally. It is perhaps worth reiterating that, despite the judge’s conclusion that the [fetus] died from suffocating within the latrine, the fetal lungs were clean with no sign of fecal matter or other materials inside them. Rather, the autopsy concluded that the [fetus] died of a medical condition—perinatal asphyxiation—that could have occurred before, during, or after the birth. Clearly, there is no evidence in these documents proving homicide,” Viterna and Bautista wrote. “Perinatal asphyxiation,” they said, “is a medical condition.”
Still, the judge interpreted the autopsy report to mean that Rivera had carried out an intentional criminal act. He also ignored the portion of the autopsy report stating that the umbilical cord could have been separated by its fall into the latrine. As quoted by the PDDH resolution, he wrote:
There is no doubt that the baby was born alive and was full-term and that the detached umbilical cord was cut by the mother …. This judge does not give credibility to what the accused says when she states she did not know she was pregnant …. She knew she was pregnant and that brought with it the obligation to care for and protect this young person she carried in her womb. In this sense, the fact that she went to the latrine, she did it with the intention of violently expelling [it] so that inside the latrine there would be no opportunity to breathe and in that way cause its death and then be able to say it was a [spontaneous] abortion.”
The judge also based his conviction, the PDDH resolution said, on the results of a DNA test showing the fetus was genetically related to Rivera.
“No evidence was introduced to show that Rivera had taken any intentional action to cause the death,” the PDDH resolution concluded.
Convicted by Patriarchy
Rivera’s legal representatives will likely use many of these inconsistencies as evidence for procedural judicial error in court this week. A favorable outcome in her trial can represent a significant step forward for women’s human rights, particularly sexual and reproductive rights in El Salvador. The country’s 1997 absolute ban on abortion, along with a 1998 constitutional modification to declare that life begins at conception, created the social, cultural, and legal environment that has justified courts sending women such as Rivera to prison for documented obstetrical emergencies, not even attempted abortion. According to the global organization Ipas, more than 600 women were incarcerated between 1998 and 2013 under the abortion law.
As the PDDH resolution noted, “in El Salvador, there exists a culture of the promotion of motherhood as the only form of self-realization for women, and the creation of the binomial ‘woman-mother,’ which locates women as instinctive and not rational. This imposes upon women [duties of] sacrifice, abnegation, and the prioritization of children over their own human conditions, behaviors that are not demanded in equal proportions from men.
“Women find themselves with a social expectation to comply with the role ‘woman-mother,’ even in the health system where women should be assured of conditions free of discrimination and obstetric violence,” it continued.
Advocates and researchers have argued that this sexist framework contributed to Rivera’s conviction. As Viterna and Bautista wrote, the trial judge claimed that Rivera “‘decided to carry out her criminal plan within the area of her household, looking for a moment during which there weren’t any other persons around to carry out this homicide,’ as if a woman has complete control over when, where and how her body will give birth.”
The PDDH concluded that “the judge convicted Rivera under subjective criteria with a heavily sexist ideology,” saying that Rivera’s rights to the presumption of innocence were overruled by such an ideology, unsupported by any medical or scientific evidence.
Rivera’s case, along with that of Carmen Guadalupe Vazquez (who was one of Las 17 granted a pardon in 2015 when the Salvadoran Supreme Court recognized judicial errors in her case), is representative of a consistent pattern toward this group of women that the Agrupación has been documenting.
“Correcting these judicial errors is very important, first of all for Rivera and her young son, so that she can go free, but also for all the other women in similar circumstances. It’s also necessary for those who work for justice in this country, particularly women’s reproductive justice, to see that the work has concrete results,” Herrera said.
Herrera hopes that a positive outcome will continue to make visible this pattern of judicial error and “move other cases [of Las 17] forward more rapidly and bring greater justice to the judicial system.”
According to IThe Agrupación is currently representing more than 25 women imprisoned with similar convictions: the original 17, two of whom received pardons, and others who have entered the system more recently.
“Maria Teresa’s story illustrates the systematic ways that women’s rights are violated: the right to health, the right to privacy in one’s life, the right to doctor-patient confidentiality, along with all the judicial procedural rights such as the presumption of innocence,” Herrera said in an interview with Rewire.
“The judicial system in El Salvador is the part of the state that has changed least since the signing of the 1992 peace accords” that ended the Salvadoran civil war, Herrera said. “Not just in how it deals with women, but how little sensitivity it demonstrates overall with regard to human rights.”
The pharmaceutical industry launched a campaign in January of this year to persuade the FDA to approve such medications in the name of equality—which overlooks the fact that most of the drugs being considered simply don’t work.
The cultural impact and multibillion-dollar profitability of male-targeted impotence drugs has prompted a rapidly accelerating race to create a similar drug treatment for women. Despite more than a decade of research and millions of dollars spent on development, however, the U.S. Food and Drug Administration (FDA) has yet to approve a single drug treatment for cis women dealing with sexual problems. In response, the pharmaceutical industry launched a campaign in January of this year to persuade the agency to approve such medications in the name of equality—which overlooks the fact that most of the drugs being considered simply don’t work.
This campaign, called Even the Score, hinges on the fact that drugs to treat so-called female sexual dysfunction (FSD)—an umbrella term for a number of disorders, such as hypoactive sexual arousal disorder, female sexual arousal disorder, orgasm disorder, and sexual pain disorder—are disproportionately unavailable when compared to those for erectile dysfunction. Therefore, the campaign’s supporters claim, the FDA is holding drugs meant to treat women’s sexual problems to a higher standard—which, they say, is preventing women from making informed choices about their sexual health. And their tactics are working: Even the Score’s backers don’t just include Sprout Pharmaceuticals, Trimel Pharmaceuticals, and Palatin Technologies, all of which have worked to develop medications for FSD. Its website also lists several prominent women’s rights and reproductive justice groups as supporters, and it has enlisted many legislators in the fight too.
No amount of slick marketing, however, can get around the fact that the drugs currently being proposed for FSD just don’t work. There are many reasons why the proposed drugs may not have been effective in increasing women’s sexual enjoyment; chief among them are the heterogeneity of female sexuality and, of course, research demonstrating that sexual problems are mostly shaped by interpersonal, psychological, and social factors. Nevertheless, pharmaceutical executives will continue to drum up hype over the possibility of a “pink Viagra,” because the potential market is estimated to be over $2 billion a year.
As this push continues, it’s vital to consider how much of the discussion around female sexuality is fact—and how much is fiction.
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Myth: 43 percent of women suffer from female sexual dysfunction.
Fact: Even the Score and others urging the FDA to weaken its standards claim that there is an enormous unmet need for medical treatments for FSD. The claim that 43 percent of women suffer from a sexual dysfunction was first made in 1999 in an article published in the Journal of the American Medical Association. This “43 percent” figure emerged from an analysis of responses by 1,749 women and 1,410 men to a set of questions about their sex lives. Women who reported lack of sexual desire, difficulty in becoming aroused, inability to achieve orgasm, or anxiety about sexual performance within the last two months were labelled as having a sexual dysfunction. The researchers also noted that women were more likely to suffer from sexual dysfunction if they were single, had less education, had physical or mental health problems, had undergone recent social or economic setbacks, or were dissatisfied with their relationship with a sexual partner—all reasons why someone might be less inclined to become aroused that have little to do with physiology. In the years since the report’s publication, scientists have revisited the validity of this study and rightly challenged its problematic conclusions.
Myth: There is a norm of female sexual function.
Fact: The implied parallel between female sexual dysfunction and male impotence is inaccurate and problematic. The word “dysfunction”—medical jargon for anything that doesn’t work the way it should—suggests that there is an acknowledged norm for female sexual function. That norm has never been established. Although male sexuality is more complex than sheer physical arousal, erections are quantifiable events that scientists can measure in objective terms. By contrast, cis women’s sexual response is, by and large, qualitative, and difficult to subject to clinical trials. Furthermore, as we all already know, sexual desire differs over time and between people for a range of reasons largely related to relationships, life situations, past experiences, and individual and social expectations—and “normality” can vary widely from person to person. Without downplaying the significance of any woman’s pain or distress, there can be real danger in defining difference as “dysfunction.”
Myth: Female sexual dysfunction is a defined disease category.
Fact: Without an empirical standard by which we can assess female sexual function, it is extremely difficult, if not impossible, to come up with an effective treatment criteria for FSD—which, again, is an umbrella term for many different disorders. But that hasn’t stopped drug manufacturers from trying. In fact, every time a drug sponsor claims to have a new solution for women’s sexual concerns, the supposed reasons for the dysfunction changes. Over the past 15 years, drugs affecting vaginal blood flow were tested on women who were deemed to be suffering from FSD due to “insufficient vaginal engorgement.” Then, corporations and the media hailed testosterone patches as a magic bullet because FSD allegedly resulted from hormone deficiencies. Most recently, re-purposed antidepressants have gained scientific currency, as women are being told that their low libido is due to a chemical problem in their brains.
Myth: Drug developers are searching for a solution for women’s sexual concerns.
Fact: The pharmaceutical industry is driven by profit. As such, if a solution is not found at the bottom of a pill bottle, its front-runners are simply not interested. If product development-driven research were happening in a balanced context, with proportionate attention being paid to all the causes of women’s sexual concerns, the focus on only biomedical causes and solutions might not be so damaging. The focus on pharmaceutical rather than emotional solutions has serious limitations, including the fact that they are simply unlikely to be effective. And the way the industry has shaped the FSD discussion threatens to make women’s sexual experience a “performance” issue, much like it has with men’s.
Myth: There are 26 drugs approved for men, and none approved for women.
Fact: On its website, Even the Score continues to inaccurately claim that there are 26 drugs approved for men, and zero for women. This claim perpetuates a miscalculation. It counts each brand-name drug and many of its identical counterparts as unique treatment options, which artificially inflates the number of drugs available for men. In fact, there are six different FDA-approved drugs available for male sexual dysfunction, including erectile dysfunction. Nevertheless, the inflammatory claim of gender bias has garnered press and political attention.
Myth: The standard for FDA review of male impotence drugs should be the same for FSD drugs.
Fact: Even the Score’s gender equity argument ignores the real safety difference between FSD drugs that are currently being tested and the drugs approved for men: a different indication for use, specifically the dosage and administration. All but one of the drugs approved for men are taken on an as-needed basis, whereas the most recent drug being tested for women is very similar to an antidepressant. Sponsored by Sprout Pharmaceuticals, flibanserin is a central nervous system serotonergic agent with effects on adrenaline and dopamine in the brain; it requires daily, long-term administration. This raises toxicological concerns that make it appropriate for the FDA to subject that type of drug to an elevated safety scrutiny. Substantial adverse events reports and dropout rates in the latest flibanserin trial also need to be taken seriously. Women have answers to the age-old question, “What do women want?” Just ask us: We want and demand products that are rigorously evaluated, safe, effective, and meet our real needs.
Even the Score’s attempts to make this a conversation about gender equality are misleading and dangerous; although the FDA should be held accountable for gender equality, it should not compromise the safety of women’s health by approving a drug that is not effective and not safe. The FDA should continue to balance a serious and respectful incorporation of patient input while maintaining a rigorous, science-based review standard for drugs and devices they approve.