Commentary Human Rights

Eliminating Female Genital Mutilation—A Public Health and Cultural Perspective

Dr. Belkis Giorgis

Culture is one of the most sensitive aspects of people’s lives, particularly as it relates to sexual and reproductive behavior, attitudes, and norms. Therefore, when we talk about female circumcision (I still cannot call it mutilation), we should always look at this cultural practice as one of many good and bad things that happen to women universally, and not only to African women but women worldwide.

Cross-posted with permission from the Global Health Impact blog.

I was circumcised when I was eighty days old, as is the tradition in Ethiopia. My sister was three. My mother had tried to spare us, but her aunt discovered that we were not circumcised and took it upon herself to have us circumcised.

Years later, I asked my aunt why she did it. Her response was not defensive. On the contrary, she responded very matter-of-fact: My sister and I were circumcised so that we could find a husband, have children, and become women. This is the cultural ideology that most Ethiopian women believed at that time, and unfortunately, that many still adhere to in the 21st century—an ideology and practice that is detrimental to a woman’s health.

Female genital circumcision alters or causes injury to the female genital organs for non-medical reasons. There are no health benefits for girls. On the contrary, the procedure can lead to severe bleeding, infections, and problems urinating, during sexual intercourse, and complications in childbirth, as well as later cysts and increased risk of newborn deaths—not to mention the severe pain and shock of the procedure.

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As a person working in the area of public health, I believe that the eradication of female circumcision is a priority for girls in Africa. In the 1980s, the issue of female circumcision was brought to light in the western world. As a young African feminist, I wrote and argued for not using the term mutilation when describing female circumcision. I argued this because I did not see my mother or my aunt as people who mutilated me, but as people who allowed the act to be performed out of ignorance, love, and compelling cultural traditions. They felt that for me to be a woman, to have children, and to find a husband, I had to undergo this operation. During that time, the sensationalism around these issues also made feminists and pan-Africanists like me believe that a double standard was being used in defining, denying, and indicting our culture.This is precisely why I pose this food for thought regarding the use of the term mutilation: from my cultural lens, for example, a woman who gets breast implants belongs to a culture that glorifies a woman’s youth and beauty in such a way that it forces some women to resort to operations – like breast augmentation – that are not necessary. But then again, it is hardly ever said that a woman mutilates herself when she gets breast implants …

Culture is one of the most sensitive aspects of people’s lives, particularly as it relates to sexual and reproductive behavior, attitudes, and norms.

Therefore, when we talk about female circumcision (I still cannot call it mutilation), we should always look at this cultural practice as one of many good and bad things that happen to women universally, and not only to African women but women worldwide. The manifestations of this culture are varied and the interpretation we give to each of them should be informed by a respect to how people view their culture and that of others.

While I vehemently fight for the elimination of this culture, as one who has been a victim of it and a public health professional, I challenge readers and those of us working to eradicate this practice to view it within the larger framework of how women suffer from different forms of oppression in the name of culture throughout the world – as the recent United Nations ban on Female Genital “Mutilation” articulates. The ban is a significant milestone towards the ending of harmful practices and violations that constitute serious threats to the health of women and girls. It is a very important step to bringing about cultural and attitudinal change: we cannot hide behind our cultural traditions to defend practices that harm women. On the other hand, we also cannot judge and indict people who in the name of culture perform acts out of ignorance and a lack of understanding of the harm such practices have on women.

As we commemorate International Day of Zero Tolerance to Female Genital “Mutilation”/Cutting, we must continue to work toward eradicating the practice—even as we push toward culturally appropriate descriptions and intervention—and improving the health of women and girls in all parts of the world.

Follow LMG at @LMGforHealth and MSH at @MSHHealthImpact

Commentary Politics

No, Republicans, Porn Is Still Not a Public Health Crisis

Martha Kempner

The news of the last few weeks has been full of public health crises—gun violence, Zika virus, and the rise of syphilis, to name a few—and yet, on Monday, Republicans focused on the perceived dangers of pornography.

The news of the last few weeks has been full of public health crises—gun violence, the Zika virus, and the rise of syphilis, to name a few—and yet, on Monday, Republicans focused on the perceived dangers of pornography. Without much debate, a subcommittee of Republican delegates agreed to add to a draft of the party’s 2016 platform an amendment declaring pornography is endangering our children and destroying lives. As Rewire argued when Utah passed a resolution with similar language, pornography is neither dangerous nor a public health crisis.

According to CNN, the amendment to the platform reads:

The internet must not become a safe haven for predators. Pornography, with its harmful effects, especially on children, has become a public health crisis that is destroying the life [sic] of millions. We encourage states to continue to fight this public menace and pledge our commitment to children’s safety and well-being. We applaud the social networking sites that bar sex offenders from participation. We urge energetic prosecution of child pornography which [is] closely linked to human trafficking.

Mary Frances Forrester, a delegate from North Carolina, told Yahoo News in an interview that she had worked with conservative Christian group Concerned Women for America (CWA) on the amendment’s language. On its website, CWA explains that its mission is “to protect and promote Biblical values among all citizens—first through prayer, then education, and finally by influencing our society—thereby reversing the decline in moral values in our nation.”

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The amendment does not elaborate on the ways in which this internet monster is supposedly harmful to children. Forrester, however, told Yahoo News that she worries that pornography is addictive: “It’s such an insidious epidemic and there are no rules for our children. It seems … [young people] do not have the discernment and so they become addicted before they have the maturity to understand the consequences.”

“Biological” porn addiction was one of the 18 “points of fact” that were included in a Utah Senate resolution that was ultimately signed by Gov. Gary Herbert (R) in April. As Rewire explained when the resolution first passed out of committee in February, none of these “facts” are supported by scientific research.

The myth of porn addiction typically suggests that young people who view pornography and enjoy it will be hard-wired to need more and more pornography, in much the same way that a drug addict needs their next fix. The myth goes on to allege that porn addicts will not just need more porn but will need more explicit or violent porn in order to get off. This will prevent them from having healthy sexual relationships in real life, and might even lead them to become sexually violent as well.

This is a scary story, for sure, but it is not supported by research. Yes, porn does activate the same pleasure centers in the brain that are activated by, for example, cocaine or heroin. But as Nicole Prause, a researcher at the University of California, Los Angeles, told Rewire back in February, so does looking at pictures of “chocolate, cheese, or puppies playing.” Prause went on to explain: “Sex film viewing does not lead to loss of control, erectile dysfunction, enhanced cue (sex image) reactivity, or withdrawal.” Without these symptoms, she said, we can assume “sex films are not addicting.”

Though the GOP’s draft platform amendment is far less explicit about why porn is harmful than Utah’s resolution, the Republicans on the subcommittee clearly want to evoke fears of child pornography, sexual predators, and trafficking. It is as though they want us to believe that pornography on the internet is the exclusive domain of those wishing to molest or exploit our children.

Child pornography is certainly an issue, as are sexual predators and human trafficking. But conflating all those problems and treating all porn as if it worsens them across the board does nothing to solve them, and diverts attention from actual potential solutions.

David Ley, a clinical psychologist, told Rewire in a recent email that the majority of porn on the internet depicts adults. Equating all internet porn with child pornography and molestation is dangerous, Ley wrote, not just because it vilifies a perfectly healthy sexual behavior but because it takes focus away from the real dangers to children: “The modern dialogue about child porn is just a version of the stranger danger stories of men in trenchcoats in alleys—it tells kids to fear the unknown, the stranger, when in fact, 90 percent of sexual abuse of children occurs at hands of people known to the victim—relatives, wrestling coaches, teachers, pastors, and priests.” He added: “By blaming porn, they put the problem external, when in fact, it is something internal which we need to address.”

The Republican platform amendment, by using words like “public health crisis,” “public menace” “predators” and “destroying the life,” seems designed to make us afraid, but it does nothing to actually make us safer.

If Republicans were truly interested in making us safer and healthier, they could focus on real public health crises like the rise of STIs; the imminent threat of antibiotic-resistant gonorrhea; the looming risk of the Zika virus; and, of course, the ever-present hazards of gun violence. But the GOP does not seem interested in solving real problems—it spearheaded the prohibition against research into gun violence that continues today, it has cut funding for the public health infrastructure to prevent and treat STIs, and it is working to cut Title X contraception funding despite the emergence of Zika, which can be sexually transmitted and causes birth defects that can only be prevented by preventing pregnancy.

This amendment is not about public health; it is about imposing conservative values on our sexual behavior, relationships, and gender expression. This is evident in other elements of the draft platform, which uphold that marriage is between a man and a women; ask the U.S. Supreme Court to overturn its ruling affirming the right to same-sex marriage; declare dangerous the Obama administration’s rule that schools allow transgender students to use the bathroom and locker room of their gender identity; and support conversion therapy, a highly criticized practice that attempts to change a person’s sexual orientation and has been deemed ineffective and harmful by the American Psychological Association.

Americans like porn. Happy, well-adjusted adults like porn. Republicans like porn. In 2015, there were 21.2 billion visits to the popular website PornHub. The site’s analytics suggest that visitors around the world spent a total of 4,392,486,580 hours watching the site’s adult entertainment. Remember, this is only one way that web users access internet porn—so it doesn’t capture all of the visits or hours spent on what may have trumped baseball as America’s favorite pastime.

As Rewire covered in February, porn is not a perfect art form for many reasons; it is not, however, an epidemic. And Concerned Women for America, Mary Frances Forrester, and the Republican subcommittee may not like how often Americans turn on their laptops and stick their hands down their pants, but that doesn’t make it a public health crisis.

Party platforms are often eclipsed by the rest of what happens at the convention, which will take place next week. Given the spectacle that a convention headlined by presumptive nominee (and seasoned reality television star) Donald Trump is bound to be, this amendment may not be discussed after next week. But that doesn’t mean that it is unimportant or will not have an effect on Republican lawmakers. Attempts to codify strict sexual mores are a dangerous part of our history—Anthony Comstock’s crusade against pornography ultimately extended to laws that made contraception illegal—that we cannot afford to repeat.

Culture & Conversation Family

Breastfeeding, Bias, and Men Who Give Birth: Q&A With Trans Activist Trevor MacDonald

Britni de la Cretaz

In his new parenting memoir, Trevor MacDonald talks about pregnancy and breastfeeding as a trans man—and why we must dislodge the idea that bearing children is only women's labor.

Pregnancy, birth, and breastfeeding are acts often associated with womanhood. We talk about pregnant women and nursing mothers, but this language—which depends on the male-female gender binary—seems inadequate as trans and nonbinary folks are increasingly visible in the parenting sphere.

With his first book, Where’s the Mother?: Stories From A Transgender Dad, Trevor MacDonald hopes to blow the conversation wide open. MacDonald is a Canadian author who has been blogging about his journey as a nursing man on his blog, Milk Junkies, since 2011. He also facilitates a Facebook group for trans folks who nurse, and he initiated and helped design a University of Ottawa study focusing on the experiences of transmasculine individuals with pregnancy, birth, and infant feeding.

MacDonald’s book explores his transition from living as female to living openly as a man, and how that transition ultimately led to his decision to carry and birth a child with his partner.

By sharing his experiences and documenting the many challenges he faced as a man who planned to give birth and nurse his baby, MacDonald asks readers to reconsider everything they think they know about what it means to be a gestational parent. By the end of the book, readers come away understanding that despite a person’s gender, pregnancy and nursing are universal experiences and valid regardless of how they happen. MacDonald’s voice is an important and necessary one in the birthing community, and there are surely many more people out there like him.

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Rewire: You talk a lot about struggling to find literature that you related to because pregnancy, birth, and breastfeeding are typically only associated with women—and motherhood. Can you tell me about the kind of language you’d like to see used to talk about these experiences and why it’s important?

Trevor MacDonald: I think I was a bit naive at first when I was reading those materials. I felt like, “If only the authors knew, I’m sure they would have used different language. They just didn’t know about people like me.” And that’s definitely been the case for some of those authors. Many are starting to change language and using words like “parents” or “pregnant people.” It’s a simple shift, really.

Where I was naive, though, is that there are some people who really don’t want to use inclusive language. Ina May Gaskin is one. I had read her book [Ina May’s Guide to Childbirth] during my first pregnancy and had been so inspired by her writing, and the birth stories are so valuable and needed. I was so hungry for information about what others had experienced. I love that book so dearly, and to realize she really was opposed to including gender-diverse people in her writing was really upsetting. [Gaskin signed this open letter by Woman-Centered Midwifery, a group of “gender-critical” midwives who believe that biological sex determines gender and were concerned about the Midwives Alliance of North America’s use of gender-neutral language to talk about pregnancy and birth.]

It’s also really important to me to point out that no one needs to throw out the words “mother” or “woman”; you just need to include more words. So you could say “women and men and gender-nonconforming people” or “parents.” It’s nice to have more than one word to mix things up a little bit.

Rewire: What was the decision to carry a baby like for you?

TM: It was something I’d never thought I would do until after I transitioned and after getting together with my partner. For me, transitioning in the medical way that I did [through hormone therapy and top surgery involving breast removal] made me comfortable enough with myself to contemplate carrying a baby. Before that, there was so much stress and constant background noise in my thoughts and in my life to do with gender, with bathrooms, and with all the ways I really wasn’t comfortable. When I transitioned and so much of that fell away, I started to consider things I never had before. It helped that I was able to present as male throughout my pregnancies because I had taken testosterone [before pregnancy]. Those things enabled me to express my gender and present myself during pregnancy in ways that were comfortable for me.

Rewire: Did you experience any gender dysphoriathe distress or discomfort that occurs when the gender someone is assigned does not align with their actual gender—during your pregnancy?

TM: For sure, but for me it was more around medical stuff than around everyday living. In my everyday life, I was still presenting as male. But with health-care providers, especially providers who specialize in prenatal care, they’re so used to everything being woman-centered, and it’s really important to some providers to use woman-centered language.

I didn’t have any providers who had worked with an openly trans client before, so people certainly had trouble with the language. One midwife offered a blanket apology that she was going to have trouble remembering to use the right words and that she didn’t mean to be offensive. For me, I think I would have preferred if she had made more of a commitment to trying to change her language—going beyond apologizing, but trying to do something to remember to use my pronouns. I think it must be hard when it’s your first client who has asked you to use new language. It’s a new skill that has to be practiced and learned, like any other.

Another place where I sometimes experienced challenges was when people at work who had previously been using the correct pronouns for me switched to using the word “mom” and female pronouns when they found out I was pregnant.

But for me personally, in my body, I didn’t feel like the experience of being pregnant triggered dysphoria. It was more the way society responded to me that did.

Rewire: Birthing at home was something important to you. Can you talk a bit about why that option felt safest?

TM: I think the difference for me was that care is different. In Canada, we have midwifery care that is part of the health-care system, and it is covered by insurance. We still have a shortage of midwives, so not everyone who wants one can get one. I was fortunate to get midwives for both my births. For me, the continuity of care that they provide and that you get with a home birth is important.

At a hospital birth, there is no way to meet all your providers before you go there and labor, and I felt like there might be a lot of explaining that I might have to do. I did go to a hospital during pregnancy and another time when I had a miscarriage. I had to come out to every provider there, starting with the first nurse and every subsequent person that I saw. Each person needed to hear the same story about how I, a man, was pregnant. One doctor even had a lot of questions about how I could no longer be taking testosterone and still have facial hair. I couldn’t imagine having to explain those things and educate during labor.

Even with midwives, though, it’s not a magical recipe for getting exactly the kind of care that you need. I still had midwives at my first birth that I hadn’t met before.

Rewire: How do you think care providers—whether they’re doctors or midwives, or lactation consultants—can best support families like yours, or people who are not women but may be giving birth or nursing their babies?

TM: I think considering the topic, doing reading and practicing using the language ahead of time, before they ever meet their first trans or gender-nonconforming client is really important. There are more and more resources available now and places to go to read about people’s experiences, and there are a number of different medical associations who have called on their members to do exactly that. This is so they are not asking their individual patients to educate them, particularly when that person needs care and is in a vulnerable position. That’s not the time to be asking questions that they could learn about in other places.

Rewire: Finding donor milk for your son Jacob seemed to be quite a challenge. You mention that you produce about a quarter of the milk your baby needed, and the rest had to come from donors. Can you talk about what some of the challenges to finding donor milk are? Do you think protocols that see milk sharing as “risky” keep babies from being breastfed who might otherwise benefit from receiving breast milk?

TM: I think some of the taboo against milk sharing is really starting to shift in our culture right now. Currently, a lot of regulatory bodies—for example, the Food and Drug Administration and Health Canada—have a position against peer-to-peer milk sharing—like through Facebook groups like Human Milk 4 Human Babies, where we found many of our milk donors.

But La Leche League (LLL) has actually changed their position on it. LLL’s leaders, who facilitate their local support groups, used to not be allowed to discuss peer-to-peer milk sharing in any way, but last year the organization released a statement with a new policy. Leaders are allowed now to share information and can say that these milk sharing websites exist. It would be a great shift if other groups start to take a position more like LLL, where they can provide information. It would be awesome if medical professionals started to tell patients that these networks exist. Karleen Gribble has written papers about the ethics of peer-to-peer milk sharing and the ethical implications of letting patients know about it and how care providers could discuss risks and benefits, not just of peer-to-peer milk sharing, but of using formula.

In pop culture, when people talk about being worried about milk sharing, the fear most often brought up has to do with diseases like HIV. But something we had to consider as well was the medications that people were taking and whether it could be passed through breast milk. Many people who donate milk through peer-to-peer sharing do so because formal milk banks have such strict requirements around who can donate to them. Formal milk banks are not necessarily in competition with peer-to-peer milk sharing, which is important to understand.

Rewire: You talk a lot in the book about milk donation and the community that sprung up around you to help your family achieve your breastfeeding goals. Can you speak about the support you received and how it affected your breastfeeding journey?

TM: We met people that we otherwise never would have met and never would have become friends with. Many of our milk donors are still our friends, and they were such a diverse bunch of people. From a Mormon donor to a military family to a Mennonite family, all these different kinds of families from different backgrounds came together to help us feed our baby. It was amazing to meet these different people and to realize that despite us being a different kind of family in this one particular way, what was most important to all these people was that a baby needed breast milk.

Rewire: It sounds like prior to having your son, you didn’t know any other trans people who had nursed their babies. Has that changed? Are their experiences similar to yours?

TM: Before Jacob, I only knew about the guy, Thomas Beatie, who went on Oprah. I didn’t know anyone in person. I knew a few trans people who had children prior to transition. Through writing my blog, that’s how I first started to connect to a lot of other trans parents and people who were carrying babies while being out as trans. People asked me questions through my blog about how I navigated the medical system and a lot of questions about breastfeeding.

I also got a lot of questions from cisgender women as well, who were grappling with all kinds of different breastfeeding challenges. Many people deal with low milk supply and try to use a supplementer, like I use to nurse my baby (since I only make about a quarter of the milk my baby needs, I use a supplementer to deliver the milk at my chest, which allows me to feed my baby at my chest). So many people can relate to these challenges. A lot of the time, it’s a private struggle that people have, and it’s intense but you don’t necessarily talk about it that much. All kinds of people reached out to me because they could relate to these issues.

Rewire: What do you wish you had known before giving birth to Jacob?

TM: I wish I had trusted my own instincts a little bit more, and given myself more space to just see what my body would want to do in labor. I felt like I was looking to my care providers and my doula for suggestions, and I’m sure a lot of people have that experience when they’re going through something they’ve never been through before.

Rewire: What do you hope people take away from your book?

TM: I really hope that it will open up conversations. I hope it will provide opportunities for people to talk more about gender diversity, not just generally, but in parenthood and related to pregnancy and breastfeeding. If this book contributed to a conversation that way and opened up discussion, that would be amazing. I would be really thrilled.

This interview was conducted by email and by phone. It has been lightly edited for length and clarity.