The Deeply Rooted Parallels Between Female Genital Mutilation and Breast Implantation

@RHRealityCheck

Last week, a UK government review of the French breast implants that have caused panic from Australia to Uruguay concluded that there is no evidence the implants should be removed. The Australian Medical Association thinks women should at least get their implants checked out. But neither the reviews nor the media coverage of the implant panic has dealt with the real question at stake: what makes women voluntarily cut open their bodies to permanently implant foreign objects to the potential detriment of their health?

The answer to this question is potentially uncomfortable. I have often asked the students in my health rights seminars to articulate the principles that make us distinguish between voluntary female genital mutilation in adult women and voluntary breast augmentation surgery. Apart from the fact that the former makes us queasy and the second doesn’t, there really is none.

To be sure, female genital mutilation (FGM) is often performed on girls who are unable to consent to—or, indeed, understand—the violence asserted on their bodies. And, because FGM is prevalent mostly in places where health infrastructure is weak or non-existent, the intervention is often unsanitary and ultimately can be deadly.

But even if FGM were carried out in the best of clinical conditions on a consenting adult woman, we call it a human rights violation. Why? Because it is an intervention which is carried out solely to satisfy stereotyped notions of what a women could or should be, and which has:

1. no discernible health benefits;
2. a negative impact on women’s sexual health; and
3. permanent effects on women’s health more generally.

FGM is often justified with direct reference to fixed gender roles, in particular in the sexual realm. Women “should be” sexually passive and “should not” experience sexual pleasure. Or women who have not undergone FGM are “unclean” and cannot properly serve their husbands. In countries where many see marriage as a woman’s only real possibility for financial security, the intervention is less of a choice, even when performed on adult women with their outward consent.

Breast augmentation surgery is carried out for similar reasons with similar risks and results. The intervention carries no discernible health benefits and potentially has a negative impact on women’s sexual health, as well as a number of other potential serious health effects. As the panic in December 2011 has shown, it is, in fact, not entirely clear how great the chances for complications are. Moreover, breast augmentation surgery is carried out solely to satisfy stereotyped notions of what women could or should be: sexually available and attractive to men. And as with FGM, for some women the intervention might be linked to financial benefits: well-endowed women win out in dating (and marriage), and waitresses with larger breasts generally get better tips than those less well-endowed.

I am not suggesting that we deem breast implants and other selective and exclusively cosmetically motivatednipping and tucking as  human rights violations. I am suggesting, however, that we question the underlying stereotypes that lead to unprecedented growth in cosmetic surgery procedures in the United States during the worst depression since the 1930s. If the only reason for an intervention is that others think that’s what we “should” look like, and if the intervention is both semi-permanent and potentially damaging to our health, maybe what we “should” do is reconsider.

Of course, social motives and stereotypes are incredibly hard to both identify and change. When I was in Iraqi Kurdistan a couple of years back as part of a research team looking into the practice of FGM, I was struck by the individual sense of responsibility felt by the mothers, aunts, and sisters who had subjected their relatives to the practice. They were aware of the social connotations, but felt personally responsible for the consequences of the intervention on the girls in their charge. One mother said to us after her interview: “You must think we are monsters.”

Not long after, I had to physically restrain my own daughter while her dentist extracted a rotten tooth. As I was holding down my scared child, both of us crying, I felt connected to that woman through the same absolute belief that what I was doing was for the best of my child, even if it hurt her.

And so I know that nothing is solved by directing guilt or shame at those who, in a specific social context, feel that FGM (or breast implants) is for the best of their child (or themselves) because it is the only way to be accepted by their group or society.

The government, however, can help to change such perceptions. In the case of FGM, much has been said about supporting criminal prosecutions with community action for change. In the case of breast augmentation surgery, the road might be less clear though it is discernible. Research has shown that where girls enjoy and like their bodies, they are more likely to postpone their sexual debut and less likely to be in abusive relationships. Presumably, when these self-aware girls grow into women they would also be less likely to want to alter their bodies, in particular in a way that would affect their sexual health.

So if a government wanted to avoid another silicone implant panic, mandating comprehensive sex education in all schools would be a good start. That, and ensuring that women don’t depend on tips, dates, and marriage for their financial wellbeing. We are not there yet.

The FBI, Sandusky, and How We Think About Rape

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On Tuesday December 6, the Federal Bureau of Investigation's Criminal Justice Advisory Policy Board voted in favor of changing its rape definition, which currently dates back from 1929. The old definition covered only female victims and archaically -- and imprecisely -- referred to intercourse as "carnal knowledge," whereas the proposed change is gender-neutral, contains a relatively objective description of sex, and does not require physical force. If the director of the FBI approves this change, it has the potential to change how we think about rape.

At least in part. Another equally important part is the definition of rape in the American Law Institute's Model Penal Code which remains unchanged.

Here is why that matters.

As a society, the way we think about most social phenomena -- including sexual assault -- is influenced both by facts and morals. Neither is immovable or entirely objective. Facts depend on how you study and define them, and morals depend on who you are. But in the United States, the way we think about rape has, for decades, been operating with an outdated version of both.

With regard to the facts, the FBI's rape definition determines what gets counted as rape in national crime statistics. These figures are used, among other things, to decide on government use of resources for rape prevention, and to determine the success of government efforts to prosecute this crime. A restricted definition is likely to lead to underestimates, which, in turn, leads to the assignment of insufficient resources to deal with rape. And, because government efforts to prosecute for rape often are judged by comparing number of rapes to numbers of cases filed, investigated, and prosecuted, FBI's definition also affects the evaluation of justice system effectiveness in this regard.

Of course, even if we use the current, potentially underestimated, figures for rape, resources allocated for prevention and prosecution of rape are insufficient and sometimes misused, and prosecution percentages appallingly low. However, a more accurate count of when and how rape happens can at least provide arguments for policy change.

With regard to criminal law -- the ultimate guide on what society believes is "right" and "wrong" -- our moral compass has been equally obsolete. The U.S. Model Penal Code, which was adopted in 1962 by the American Law Institute to provide guidance for state criminal law reform, does not reflect what we have learned over the past 4 decades about rape through service delivery and care. Unlike FBI's rape definition, unfortunately, change to the Model Penal Code is not imminent (though explorations of a potential project to do so are underway) and the deficiencies are potentially more glaring.

Over the years, scholars have explored many problems with the various sexual offence definitions in the model code. The four most conspicuous are these:

• The need for an "objective manifestation" of force - -that is, visible signs of physical force -- before forced intercourse counts as rape in the eyes of the law (we now know that threats, verbal violence, and other forms of non-physical coercion are equally if not more effective in subduing a victim).
• The definition of rape as always having a male perpetrator and female victim (the recent allegations of rape of boys by Penn State coach Sandusky have made abundantly clear that rape can happen across the board);
• The deliberate exclusion of marital rape from any criminal sanctions (it is now hopefully beyond discussion that spouses don't owe each other sex--even the Mexican Supreme Court has now acknowledged this); and
• The focus on the victim's sexual past and previous behaviour towards the perpetrators and others.

This latter part is particularly worrisome.

The Model Penal Code explicitly excludes date rape and rape of former partners or even those the perpetrator has casually dated or maybe just kissed or held hands with (the victim must not be the "voluntary social companion" of the perpetrator at the time of the crime, and should not have "previously permitted him sexual liberties.") This would also exclude rape against sex workers, which is a relatively frequent occurrence in part because many people believe sex workers automatically have consented to having sex with everyone because they make a living out of having sex with some.

At a time where the use of date rape drugs reportedly are on the rise, and where police officers already believe women are much more likely to lie about rape than victims of any other crime, there is no room for legal ambiguity.

Forced intercourse is rape whoever committed it, whatever the victim wore or said, and wherever it occurred. The American Law Institute should follow the lead of the FBI and update its definitions to reflect reality.

Penny-Wise and Pound-Foolish: Proposed Funding Cuts for Response to Violence Against Women

@RHRealityCheck

This week, Senators Leahy and Crapo introduced a bill to reauthorize and amend the Violence Against Women Act (VAWA), a federal law first enacted in 1994.

This is mostly good news. The VAWA mandates federal funding for victim assistance and transitional housing, strengthens provisions to penalize offenders, and requires states to provide a certain level of services with a view to preventing violence from occurring in the first place.

The bad news is that the proposed bill substantively slashes the funding for the implementation of the bill, reducing the authorized funds by more than $144 million (almost 20 percent) of 2005 levels over 5 years.

To be sure, the federal government has to save quite a lot more than $144 million to overcome its spending deficit, and Senator Leahy justified the cuts by reference to heightened efficiency through the consolidation of services.  But if it is indeed possible to consolidate services and do more with less, would it not have been appropriate to ask, first, if the current funding levels adequately cover current needs?

To start with, it is clear that violence against women in the United States has not gone away these past 20 years.  The Centers for Disease Control estimate that 25 percent of women in the United States experience domestic violence some time in their lives, and that adult women experience over 5 million instances of violent assault annually.

Adolescents—even young adolescents—are also affected.  Over 70 percent of our 7th and 8th graders report they are “dating,” and in a 2009 survey published by the Centers for Disease Control about 10 percent of students overall reported being physically hurt by someone they were dating.

In addition, the economic downturn has substantially affected women’s ability to leave abusive relationships. In the best of times, women who want to leave an abusive partner worry about finding employment and housing, especially if they also need to provide for children.  During economic crises, these concerns increase dramatically and are exacerbated by the fact that governmental and non-governmental service providers usually face funding crises of their own and may have had to cut services. 

In 2008, the National Network to End Domestic Violence found that, on one day alone, almost 9000 requests for services went unmet because of lack of resources.  In 2009, that number had increased by 300.

The National Domestic Violence Hotline, set up by VAWA, reported that calls to the hotline increased by over 19 percent in the 12 months after the September 2008 market crash.

The director of the government’s Office on Violence Against Women testified before the Senate Committee of the Judiciary in May 2010 that, between the first quarter of 2008 and the first quarter of 2009, one shelter alone reported a 44 percent increase in persons sheltered, a 74 percent increase in crisis response, and a 124 percent increase in calls requesting shelter

But most pointedly, domestic violence costs society a lot more than the $144 million the introduced bill would save by downsizing responses to it.  Those 5 million assaults on women annually resulted in nearly 2 million injuries, of which more than half a million required medical attention, the Centers for Disease Control estimated in 2003.  Victims of domestic violence lost nearly 8 million work days and 5.6 million days of productivity due to violence.

In all, assaults on women cost almost $6 billion every year. Because these estimates are based on rates of violence before the current economic crisis, the true cost may well be higher today

In other words: the bill proposes to cut $144 million over 5 years from services that seek to remedy a problem which, even with the current government involvement, will cost society about $30 billion over that same period.

Some might say that estimates about the cost of intimate-partner violence are notoriously unpredictable, that the federal government truly is broke, or that the proposed cuts really do reflect a consolidation of services that will result in more efficient use of funds. But even if they were right, that would not take away from the fact that domestic violence is a continuing, costly, and consistently underserved problem.

Cutting federal funds for dealing with it is not only bad news, it is a bad idea.

Why the Use of Steve Jobs As An Anti-Choice Political Stunt Is Flawed

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Steve Jobs' premature death has generated much online activity, some seeking to exploit his demise for political gain. In this category are articles suggesting that Jobs' status as an adoptee is a reason to restrict abortion access in general. The arguments put forward in this regard are flawed on two levels.

First, no individual circumstances can change the overarching reality that women and girls have abortions when they need them, regardless of the legal context. Restricting abortion access does not make the practice scarce, it merely makes it unsafe.

More than 30 percent of women in the United States will have at least one abortion before they are 45 years old, even though many live in states with few or no abortion providers. Most women who have abortions already have one child or more, and many refer to their desire to have time to parent as a key reason for needing an abortion. 

In fact, in my experience interviewing women around the world about pregnancy and child-bearing, abortion is the end rather than the beginning of their decision-making processes. Women talk to me about food for their children, time to play and concern with paying for their children's education. They talk about expensive birth control and child care and about limited health care options. They talk about how difficult it is to decide when and if to become a mother. And they talk about abortion as an option where other options have failed. 

They rarely, if ever, refer to the legality or availability of abortion services as a decision-making factor.  If a woman or girl feels she needs to terminate her pregnancy, she will find a way. I once spoke to a girl who had fired a gun into her abdomen because she felt too young to be a mother and abortion was illegal in her country.

It is also noticeable that abortion, in the United States, is more and more the recourse of women without financial resources.  In 2008, more than 40 percent of those having abortions in the United States were living under the poverty level, and this proportion is growing.  There is a reason for that: children are expensive and the United States provides few legal protections for parents. There is no federal law to protect paid parental leave or sick days, and there are no allowances for time off to breast feed. Federal law guarantees 3 months of unpaid extended sick leave to be used as parental leave, and only for those who are eligible, which excludes about 40 percent of American workers. There are no general provisions for health care--not even, in most states, for children. In 2010, almost 10 percent of all children (15 percent of children living in poverty) in the United States had no health insurance.

In short, though access to abortion services is becoming more expensive in the United States mainly because service providers are farther away, some women and girls see abortion as the only viable choice available to them.  In cases where women or girls might initially be inclined to carry a pregnancy to term and give the infant up for adoption, many would not be able to pay for prenatal care and to give birth--or even get time off for visits to the doctor and for the birth itself.  This in addition to the many very valid--and private--reasons women and girls might have to not want to carry a pregnancy to term, even if adoption were an easier and less costly option than it currently is.

Secondly, Steve Jobs' life experience doesn't work as an argument for limited abortion access, even by its own logic.

It is a fact that Steve Jobs was born before the legalization of abortion in the United States.  It has been suggested that Jobs' biological mother, faced with an unwanted pregnancy, contemplated having an abortion before she decided to carry the pregnancy to term and give the infant up for adoption. Her decision to do so was based on personal, and private, considerations.  This is as it should be.

Had Steve Jobs' biological mother decided to terminate her pregnancy in 1954 when she discovered she was expecting, she would have had to have an illegal and therefore potentially unsafe abortion.  And she might have died as a result, as more than half a million women worldwide continue to do every year because abortion access is illegal or severely restricted in their countries. Let us not wish ourselves back.

Gay Marriage: The Issue Is Respect

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Earlier this year, a student in a human rights seminar I was teaching declared her conviction that gay parents damage their children by virtue of being gay. I explained as gently as I could why this is a discriminatory notion, incompatible with human rights standards, and moved on. My student sat as if stunned for two minutes, then gathered her books and left the class.

She later confronted me outside the classroom, and I was astonished to see just how fervently she insisted that her opinion was both based on science and respectful of rights. Neither is true. As New York State joins the ranks of countries and other jurisdictions recognizing same-sex marriage, it's worth reflecting on rights and respect.

The fact is that thousands of human beings are subjected to violence across they globe simply because they are suspected of being gay. In Brazil alone, over 2,500 men were murdered between 1997 and 2007, ostensibly for being gay. In the United States, the It Gets Better Project has highlighted the sustained violence and bullying young people suffer just because they aren't straight. This month, the United Nations Human Rights Council for the first time condemned violence and other human rights violations based on a person's sexual orientation or identity.

Of course, those who oppose same-sex marriage in New York State and elsewhere are not saying they support violence against LGBTQ people. Nevertheless, the same basic proposition lies at the root of both: the notion that you are somehow a different -- lesser -- type of human being if you are not, or are not seen to be, straight, and that society is justified in rejecting you.

For too many people it is only a short leap from seeing homosexuality as offensive to justifying physical harm. In this way, for example, the ban on inter-racial marriage in this country coexisted with societal acceptance of violence against people of color. Many times, inter-racial couples suffered violence precisely because they dared to break the ban.

But perhaps the deepest-held notion is the one that was expressed so vehemently by my student: that all children brought up by LGBTQ persons are psychologically damaged. Fortunately, it is increasingly recognized that it is not exposure to diversity but rather to bigotry and prejudice that is damaging to kids. In 2008, the European Court on Human Rights held that France was not allowed to deny the adoption application of a women just because she was a lesbian. And in February, the High Court in the United Kingdom barred a couple from becoming foster parents because their anti-gay views were held to be potentially harmful to the children who would be in their care.

In fact, research shows that children with gay parents are just as likely to be well-adjusted as children with straight parents, and that the key to childhood adjustment is good relationships between parents and children and between the parents themselves.

Marriage, of course, does not guarantee good relationships. But where family leave and other benefits depend on marital status, children are disadvantaged if their parents are not allowed to marry. The vote in Albany this week is significant because it is another step toward guaranteeing children and adults the rights and respect they are entitled to.