How We Treat Inter-sexed Babies: Part 1

Bianca I. Laureano

Part one of a three-part series examining the practice in the United States of shortening and cutting of enlarged clitorises in babies with congenital adrenal hyperplasia (CAH) .

Recently there has been a burst of discussion regarding unethical and questionable research conducted in the United States on babies whose assigned sex at birth was female but who were born with enlarged clitorises. Many of these stories shared outrage over the practice of shortening the babies clitorises, and most especially about the ethics surrounding the “follow-up” examination conducted by Dr. Dix P. Poppas.

When I first heard about the article Bad Vibrations written by Drs. Alice Dreger and Ellen K. Feder it came to me from a good friend who had introduced me to several activists working in Africa around female genital mutilation and ritual cutting practices. As I read the article I had a few problems with the responses and writing about Dr. Dix P. Poppas who was shortening (i.e. cutting) the clitorises and following up with the young children as they aged.

My issues are as follows: 1. This is not a new practice in the United States, 2. The “professionals” quoted were not people who were the best to be quoted on the topic, and 3. How/When will the outrage presented lead to action? I will share each of these positions and discuss them in depth over three posts. I’m doing this because I tend to write a lot because I have a lot to say and want to make sure readers don’t get overwhelmed reading the screen! Today, I’ll focus on issue number one: This is not a new practice in the United States.

In the United States it is common practice for physicians to examine the genitalia of newborn babies. It is also not an unusual practice to measure the size of a baby’s clitoris. I remember in my master’s program in human sexuality education, one of my professors sharing with our class the device (basically a “ruler”) that is used to measure a newborn child’s external genitalia (clitoris, penis, testicles). I’ll admit I was shocked at this. I asked a friend who is a pediatric physician the name of the device and she told me there are multiple ways that physicians are trained to measure such body parts.  She said that  “actually the rulers we use to read TB skin tests – very small, also one can use calipers.”

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In the book Adolescent Health Care: A Practical Guide by Lawrence S. Neinstein, Catherine M. Gordon, Debra K. Katzman, David S. Rosen and Elizabeth R. Woods, published in 2008, Chapter 58 on “Hirsutism and Virilization” states that for a physical examination for signs of virilization practitioners shall:

Check clitoral diameter or index. A clitoral diameter >5 mm is abnormal and is a measurement that can be easily followed up. The clitoral index is the product of the vertical and horizontal dimensions of the glans. The normal range is 9-35 mm, a clitoral index >100 mm suggests a serious underlying disorder (page 750).

If you have not yet read Sexing The Body: Gender Politics and the Construction of Sexuality by Anne Fausto-Sterling, add that to your summer reading list as soon as possible! I’m using chapter 3 of the book: Of Gender And Genitals: The Use And Abuse Of The Modern Intersexual this summer in my Sociology of Human Sexuality course I am teaching.

In the text Fausto-Sterling discusses what unfortunately happens all too often to babies born with “ambiguous genitalia” or as Fausto-Sterling says, “mixed genitals.” Fausto-Sterling writes:

“Oddly, the contemporary practice of ‘fixing’ intersex babies immediately after birth emerged from some surprisingly flexible theories of gender. In the 1940s, Albert Ellis studied eighty-four cases of mixed births and concluded that ‘while the power of the human sex drive may possibly be largely dependent on psychological factors…the direction of this drive does not seem to be directly dependent on constitutional elements.’ In other words, in the development of masculinity, femininity, and inclinations toward homo-or heterosexuality, nurture matters a great deal more than nature. A decade later, the Johns Hopkins psychologist John Money and his colleagues, the psychiatrists John and Joan Hampson, took up the study of intersexuals, whom Money realized, would, ‘provide invaluable material for the comparative study of bodily form and physiology, rearing, and psychosexual orientation.’ … They concluded that gonads, hormones, and chromosomes did not automatically determine a child’s gender role.

“Today, despite the general consensus that intersexual children must be corrected immediately, medical practice in these cases varies enormously. No national or international standards govern the types of intervention that may be used. Many medical schools teach the specific procedures discussed in this book, but individual surgeons make decisions based on their own beliefs and what was current practice when they were in training—which may or may not concur with the approaches published in cutting-edge medical journals. Whatever treatment they chose, however, physicians who decide how to manage intersexuality act out of, and perpetuate, deeply held beliefs about male and female sexuality, gender roles, and the (im)proper place of homosexuality in normal development.” (p. 46-48).

I share these quotes with you because, although the babies whose sex assigned at birth as female had one of the most common types of intersexuality–congenital adrenal hyperplasia (CAH)–the determination of their sex came from what their genitals looked like. These quotes also demonstrate the decades of research and “work” physicians have done with and on human patients. The decisions by physicians are embedded in paradigms that run deep and that overlap with how intersexuality and “mixed-sex” people are seen as needing to be “fixed” to live a “normal” life.

Many people commenting on this study expressed confusion and disgust with how parents have chosen to have their children clitoris’ cut/shortened/operated on. Fausto-Sterling’s discussion of parental consent and information is that:

“[d]octors, because they generally view intersex births as urgent cases, are unaware of available resources themselves, and because the medical research is scanty, often simply tell parents that the condition is extremely rare and therefore there is nobody in similar circumstances with whom they can consult. Both answers are far from the truth” (p 51).

This is an institutionalized practice. I’ve discussed with many friends and colleagues in the field of sexuality and sexual science the need to train doctors and practitioners on various aspects of human sexuality. Of course, this “training” has rarely been provided, and when it is provided, it comes from people whom many advocates today would consider as perpetuating a rigid and dichotomous ideology about gender and how genitals are supposed to look. When I discuss genitals with my students I use a popular analogy that vulvas and penises are like faces. Many have the same parts and work in similar ways but they all look different, not always the same.

I’m an advocate of having sexologists who do not have medical degrees train doctors on how to work with and speak to families of children born with genitalia they would consider different. In addition, I think it’s also a good idea to have people who have become adults and were categorized as intersex speak with providers and share their histories and experiences.

In part three I will discuss advocacy efforts by various groups in the U.S. and abroad surrounding this topic and provide references and resources to their work and activism. The questions in part three will include: How can we learn and build from past efforts to create change within our communities while also producing knowledge to help shift rigid ideas about genitals and gender?

Part two will focus on who is considered worthy of quoting as an “expert” and how that affects our ability to acquire and create knowledge. Who is included and excluded and what limitations exist? How do we hold our “experts” accountable when the work they do continues to harm and hurt our communities?

Commentary Violence

How We Can Disrupt the Pattern of Anti-Abortion Violence

David S. Cohen & Krysten Connon

In the face of yet another clinic attack last month, this one in Colorado Springs, everyone who cares should be asking the same thing: What can we do to stop another act of violence?

Read more of our articles on the Colorado Springs Planned Parenthood shooting here.

The Planned Parenthood attack in Colorado Springs last month was not an isolated incident. Rather, it is part of an ongoing story of anti-choice extremists using violence to end lawful abortion. In the face of this pattern, everyone who cares should be asking the same thing: What can we do to stop another attack?

Unfortunately, this question arises again and again, after each tragedy. Since 1993, there have been 11 people murdered by anti-abortion terrorists. In all of these cases, murder was already against the law. Plus, since 1994, the federal Freedom of Access to Clinic Entrances Act has protected against clinic blockades and violence. In other words, even with laws on the books meant to prohibit them, these tragedies still happened.

Existing laws can be improved, of course, but the solution to anti-choice violence must be broader: It lies in destigmatization, depoliticization, and de-escalation.

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Why is abortion, a procedure almost one in three women will have in their lifetime, not talked about more often? Why is it so out of the ordinary that a recent episode of Scandal was celebrated for showing its main character obtaining the procedure? Why are abortion clinics separated from those providing other medical care? The answer to all of these questions has a large part to do with the stigma associated with abortion.

Abortion stigma is one of the main contributing factors to dangerous anti-choice extremism. When abortion is seen as different from other medicine and morally wrong, radicals take that message and translate it into aggression. After all, there’s no targeted and politicized violence in the world of dermatology or heart surgery. That’s because patients and providers of that care are not shamed and alienated like they are when it comes to abortion.

Furthermore, abortion has long been a political football, in part because of the way it has been so highly stigmatized, and that has only increased of late—which, in turn, worsens that stigmatization. Since 2010, there have been a record number of anti-choice laws enacted throughout the country. The passage of these laws has strongly correlated with increased harassment of providers, something that has been found by academic research as well as the recent Feminist Majority Foundation study showing that targeting of providers has increased from 2010 to 2014, the same timeframe in which this record number of new restrictions has been enacted.

The courts can work to further that stigma, such as in the Texas case the Supreme Court is hearing next month. Texas has regulated abortion clinics to almost non-existence, requiring doctors and clinics to jump through hoops that are not medically necessary and that no other similar health-care provider must follow. If the Court upholds these regulations, it will send the message that abortion care is not regular medical care.

But depoliticizing means more than just reducing the ways that abortion is needlessly restricted. It’s also about toning down the violent rhetoric. When providers are regularly called “murderers” or “baby killers,” the environment is not one ripe for reasoned discussion of a divisive issue. Rather, it’s one that primes people to take matters into their own hands.

The Colorado murders are a perfect example of this. Since July, when the anti-choice front group the Center for Medical Progress (CMP) released its deceptively edited videos, Planned Parenthood has been in the national crosshairs. It has been routinely attacked by the media, Congress, and presidential candidates. Presidential candidate Carly Fiorina in particular has been among the loudest in attacking Planned Parenthood, with her outrageous and discredited claims that the organization is not only “selling baby parts”—claims that originated with the CMP videos—but also keeping fetuses alive to harvest their organs.

It’s no surprise, then, that Robert Lewis Dear Jr. was reportedly talking about “selling baby parts” during his arrest in Colorado Springs. This seems to suggest he was following the lead that was set for him by the extreme politicization of the issue.

And on a local level, policymakers and law enforcement need to work every day to de-escalate the environment around abortion facilities and providers. Abortion clinics are often the scene of aggressive protests. Spend a Saturday morning observing your local clinic: In many places in the country, you will find people shouting, carrying gruesome signs, and following patients.

Some states and municipalities have tried to protect clinic entrances by forbidding the presence of protesters within a certain area around them, but last year the Supreme Court found that a Massachusetts law that created a 35-foot buffer zone around clinics was unconstitutional. However, this doesn’t mean nothing can be done. Smaller zones, like the 15-foot buffer zone in Pittsburgh, have so far been upheld in the face of a constitutional challenge following the Massachusetts case.

Other policies can also help to de-escalate the situation around clinics. Laws that protect against blockades, harassment, stalking, excessive noise, and other behavior that hampers good medical care tend to raise fewer constitutional concerns than buffer zones. For instance, every court that has addressed the constitutionality of FACE has found that it does not violate the First Amendment, and noise ordinances have been upheld around clinics as neutral ways to protect patients. These laws, as well as better policing to enforce them, can help patients and providers enter and exit clinics in a less charged environment. They also, when written clearly, give police clearer guidance on how to handle the conflict with anti-choice protesters, which decreases the likelihood that officers’ individual beliefs about abortion will influence how they respond.

Beyond the clinic environment, providers need to be better protected from the routine targeting they face. Their identities and personal information, including home addresses, can be kept from public discovery through laws like California’s Safe at Home Program, which should be a model for every state in the country; crimes against them can be sentenced more harshly when said crimes are based on their status as abortion providers. Municipalities can also enact residential picketing laws that restrict or outlaw protesting in front of an individual’s house and disturbing the peace and quiet that we all seek from our homes. These reforms won’t prevent all crimes, but they can help create a more normal, less terrorized life for abortion providers.

Despite the court decisions whittling away at Roe v. Wade and increased state regulations, abortion remains a legal right in this country—and patients and providers deserve to access it without fear of violence. But there are still extremists who feel they must take matters into their own hands. Only by destigmatizing abortion, de-escalating the environment around clinics and providers, and depoliticizing the issue as a whole can we make any headway into preventing another radical committing yet another act of terror.

Commentary Abortion

Eleven Inane and Insulting Anti-Abortion Arguments (and How I Shed the Shamers)

Valerie Tarico

Here are eleven shaming themes I've encountered, along with my responses, to help other pro-choice advocates prepare for the muck that's likely to get slung our way as the right wing continues its crusade against reproductive health-care providers.

Cross-posted with the author’s permission.

If recent right-wing insanity has driven you over the edge and you’ve decided to tell the world that you think Planned Parenthood is a good place or abortion care is a good thing (or even decided to share a personal story), you will need to get prepared for the muck that’s likely to get slung your way.

Fortunately, once you move beyond your inner circle of people who matter, much of what flies through the air will be ignorant comments and insults from people who don’t. As someone who is public about why I am pro-abortion, and about my own story, here are eleven shaming themes I’ve encountered, along with my responses.

1. You should be against abortion because you exist.

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How would you feel if your mother aborted you? 

How would I feel? I wouldn’t. Try this exercise: How would you feel if your mother had partnered up with someone other than your dad? How would you feel if she had a headache the night you would have been conceived? How would you feel if she had rolled over in the opposite direction after sex on that key night in history and a different sperm got to the egg first? Hint: People who don’t exist don’t have feelings.

2. It’s a baaaby.

It is a tragedy that Tarico killed her first-born because she wanted a “better baby.” (LifeNews)

These babies, and we all KNOW these are babies, have committed no crimes, yet you and yours sentence them to a horrible, painful death.

“Firstborn”? Uh, no. That was the whole point. My firstborn (who exists only because of my abortion) is now a junior in college and, although I’ve had my moments, I’ve never once tried to kill her. But the LifeNews writer’s slip perfectly reflects the anti-abortion movement’s inability to tell a fetus from a child. Zygote, blastocyst, embryo, fetus: To anti-choice advocates they’re all babies or pre-born children. They use these words over and over, as if repeating them often enough will somehow make us all decide that an acorn is actually an oak tree and having a carton of eggs in the fridge is the same as owning a dozen chickens.

3. If it’s human, it’s a person.

The fetus is alive and has human parents and human DNA so we know they are human. [After this people will come up with conflicting arbitrary definitions of what makes a human a person.]

The only definition that makes sense is that someone becomes a human at conception because that is the only meaningful change in someone’s life. (BennyW)

How could a human individual not be a human person? (Pope John Paul)

At one point, anti-choice activists co-opted the Dr. Seuss phrase, “A person’s a person no matter how small,” from the book, Horton Hears a Who. Seuss’ widow Audrey Geisel, a long-time supporter of Planned Parenthood, was not pleased. In the book, the phrase refers to tiny people who sing and shout and live in community with each other and who value their own lives and world. That’s what makes them people—not sharing Horton the elephant’s species. Even children recognize that human and person are two different concepts. That is why we are able to imagine a Seuss character or fictional extra-terrestrial like Wall-E, or even an intelligent animal like a dolphin as a sort of person with moral standing. What makes personhood is the ability to feel; to have preferences, desires, and intentions; to be aware and even self-aware; to live in relation to others; and to value our own existence. Fetal “personhood” trivializes each of these.

4. If you’re capable of abortion, you’re capable of killing anyone.

Not sure why we need to put time limits on these things? 3 months … 3 years … judging by all the arguments listed above, we should be able to snuff out the kid whenever it becomes convenient.

If somebody is making things inconvenient for you just slaughter them. Kind of like ISIS. 

To quote Mother TeresaIf a mother can kill her own child, what is left for me to kill you and you to kill me? There is nothing between.

Look around you. Almost a third of the women you know over age 40 have had an abortion—and many of them have had several. How many of them do you think have killed an infant? Infanticide was practiced regularly on every continent by our ancestors who had no other means to control their fertility, but where people have access to modern contraceptives and abortion, infanticide becomes exceedingly rare. Most people have little trouble differentiating abortion from murder and they instinctively choose abortion over infanticide just as they choose contraception over abortion when both are freely available.

5. You must be a bad mom, and your kids would think differently of you if they knew about your abortion.

How does your daughter feel knowing that you killed her sibling?

One of my daughters wouldn’t exist without my abortion and the other one adores her. How do they feel about my abortion? Grateful. The Christian right constantly slurs women who have ended pregnancies by suggesting that we love our children less—or are incapable of loving children at all. In reality, the vast majority of women who have abortions either already are or go on to be devoted moms. Six in ten women who have an abortion already have a child. In fact, our commitment to mothering is why many of us choose to end an unsought or unhealthy pregnancy.

6. God loves each and every precious “snowflake.”

God doesn’t make mistakes. God makes miracles happen.

The Magisterium of the church has constantly proclaimed the sacred and inviolable character of every human life, from its conception to its natural end. (Pope John Paul)

If God doesn’t make mistakes, the existence of babies with no brain or no limbs or a teeny, slow-suffocation quantity of lung would suggest that He’s a rather big jerk. In these situations, prayers for healing fall on deaf ears. Miracles are on the rise, but only because compassionate doctors fix God’s mistakes by repairing defective infant hearts and palates and other incapacitating deformities. If every snowflake is precious in His sight, God has a peculiar way of showing it, because spontaneous abortion is a critical part of reproduction—one of the key mechanisms for producing healthy babies. Most fertilized eggs self-abort at some point before maturing into babies—billions to date. Why? Spontaneous abortion stacks the odds in favor of healthy babies being born to healthy moms who will be able to nurse them. Therapeutic abortion supplements spontaneous abortion when the natural “abortion mill” in a woman’s uterus fails to identify and expel an ill-conceived pregnancy.

7. If you abort a defective fetus, you can’t respect or value people with disabilities.

You aborted a baby that *might* have been blind? All the blind people in the world, and Helen Keller, spit at your selfishness. Shame on you. What on earth will you do if your child ever becomes disabled? Kill her? 

Valerie, I hope that someday you will know the kind of joy that my “bundle of risks” has brought to my life. Veronica will be 26 tomorrow. She will never walk, talk, see normally, feed herself, be toilet trained, etc. She has the mental ability of a nine-month-old. It is my privilege to care for her each day.

Anti-choice activists forget that to many of us, a fetus is a potential child like the countless potential children we have said “no” to by abstaining from sex or using birth control. For me and my husband, who see it this way, it would have violated our moral values to carry forward a fetus infested with parasites, as in our first pregnancy, or one with knowable genetic defects, which we ruled out in the second. Would we have loved and cared for a baby born blind or a child who got injured along the way? Of course! What a bizarre and insulting question! Fencing my yard and teaching my kid not to play in traffic doesn’t mean I would abandon her if she were to get hit by a car.

8. Women like you are naïve victims who need protection from your own ignorance.

[O]nce a father or a mother who are seeking an abortion see an ultrasound, it’s true that upwards of 90 percent of them decide not to have an abortion. (Rachel Campos-Duffy)

If abortion were not legal, I never would have chosen to have one. (Anti-abortion activist Hannah Rose Allen)

Forced ultrasounds, scripted warnings of (false) abortion risks, legally mandated descriptions of fetal development… According to the latest anti-abortion strategy, the only way to protect hapless females from physical and psychological harm is to take the choice out of our hands. How inconvenient that abortion is far, far safer than childbearing, which kills 800 American women each year. In other disappointing news for anti-choice individuals, women who have abortions don’t suffer increased rates of anxiety and depression. Also, in contrast with Campos-Duffy’s fabricated statistic, 98 percent of women who see the images from a mandatory ultrasound go through with their abortion, meaning they know their own minds. It’s true that deciding to end or carry forward a budding life is a big deal. And like any big decision, some women or men will regret their choice. But 90 percent of women report that the primary emotion after their abortion was relief and, even among those with mixed feelings, 80 percent still say that the choice was right for them.

9. Abortion is selfish.

There is no better example of selfishness leading to an even greater evil act; the destruction of an innocent human life. This selfishness is so obvious and disgusting that abortion proponents manufacture and inflate all sorts of ridiculous situations to make their case as though the only option is to kill.

Set aside the fact that on a planet denuded by human need, one on which almost 20,000 children starve to death each day, it can feel selfish to have a baby… Yes, choosing, instead, to finish high school is selfish. Choosing to save for a reliable car or first month’s rent is selfish. Choosing to join the military is selfish. Choosing to become a teacher or doctor or engineer or artist is selfish. Choosing to prioritize time with your husband is selfish. Choosing bubble baths and bedtime stories with the kids you already have is selfish. But choosing not to do these things can also be selfish! I could go on the offense here: Choosing to spend your time and money pursuing the (dubious) bliss of heaven is selfish. So is “letting go and letting God” manage decisions (like parenthood) that are your responsibility. So is trying to impose what seems best for you on everyone else. Everything we do is selfish to some degree. That doesn’t mean our decisions can’t also be wise, prudent, loving, brave, generous, or altruistic.

10. A child is the punishment you get for slutting around.

You should keep your legs together. 

Your lack of control over your own hormones, stupidity, carelessness, laziness, and inconsiderateness created another life within you.

[Better birth control would] turn our girls into whores [like you] who are as well versed in preventing pregnancy as any working girl.

She should have to deal with the consequences.

I confess, I’ve never been able to wrap my brain around this one. On the one hand we are told that every child is a blessing, no matter how ill-conceived. On the other, we are told that a child is what slutty sluts deserve for having sex outside of marriage. Even more twisted: If you got raped, the baby is a blessing. If you had sex of your own free will, it’s what you had coming. Can we at least pick one or the other?

11. God hates abortion even more than He hates fags.

God HATES those who shed innocent blood! (J. Melton)

Given that women have been ending ill-timed pregnancies for millennia, the Bible is remarkably quiet about abortion, with a few vague references that together can be interpreted in either direction. One writer even prescribes a rather nasty abortion potion. Mercifully, a growing percent of people, including many Christians, don’t think the Bible is the perfect word of God. More and more see human handprints all over it, especially in its demeaning passages about women.

Someday unintended pregnancy may be a thing of the past, and abortion may be largely obsolete. Until then, millions of us will be guided by our own moral values and life goals to end pregnancies we believe are ill-conceived, so that we can devote our lives to the people and dreams that we hold most dear. If God’s self-appointed messengers insist on arguing and insulting and shaming uswell, that’s their choice to make, just as we make ours.