New Pornography Regulations In LA: Are They Addressing the Right Problem?

@RHRealityCheck

On January 25, the mayor of Los Angeles signed regulation that requires the use of condoms by all performers in adult movies filmed within the city’s borders. The regulation conditions the issuance of film permits for adult movies on compliance with existing California worker safety rules, which already require barrier protection for workers exposed to blood and other potential contaminants (including semen). The ordinance spells out what these state safety rules mean in the context of the adult film industry, and requires producers to pay enough for film permits to finance workplace safety inspections.

Public health advocates have not surprisingly celebrated the regulation. Adult film producers have equally predictably been less enthusiastic, citing safe sex films as being less popular with viewers and actors alike, and threatening to move their filming elsewhere. This would not be too hard since the ordinance applies only to Los Angeles City and not to the broader Los Angeles County.

But there are other reasons the ordinance may not be as effective as one might hope.

The first is that fewer adult movies are filmed and produced professionally than was the case ten years ago. Over the past decade, free internet sites driven by home videos and other amateur content have taken over a growing slice of the porn image and film market. While it is clear that these sites are not posting free content for philanthropic reasons—indeed, online porn is said to be worth $5 billion a year—it is equally clear that the majority of US-produced porn content streamed online is not and will not be subject to filming permits.

As a corollary to this, the ordinance will not be very effective at influencing the overall depiction of sex in imagery and media. This outcome is all the more lamentable because encouraging condom use is so important. Let’s look at the facts.

Fact number one: young people in the United States act particularly clueless about the cause-and-effect links between unprotected sex, the spread of sexually transmitted infections (STIs), and unplanned pregnancies. In the United States, about half of the 19 million individuals newly diagnosed with an STI every year are between 15 and 24 years old. In addition, about 800,000 girls and young women between 15 and 19 years old get pregnant every year, mostly unplanned. Only about 60 percent of sexually active high school students say they used a condom during their last sexual encounter.

Fact number two: frighteningly few teenagers and pre-teens in the United States receive effective information and guidance about sex, despite the fact that 9 out of 10 kids in public secondary schools will receive some form of sex education at least once during their time from 7th to 12th grade. This is partially due to the fact that the federal government has invested several billion dollars in abstinence-only programs since 1997, including $5 million in the 2012 federal appropriations bill alone. Abstinence-only sex education teaches sexual abstinence until marriage as the only viable option for teenagers to avoid STIs and pregnancy. Under this logic, condoms are not only ineffective but also immoral because they “make” teenagers have sex. (Study after study has proven abstinence-only sex education to be ineffective at best and harmful at worst).

Fact number three: the internet is where kids go for the information they feel they need, including about sex. Successive Youth Internet Safety Surveys have shown that children between 10 and 17 years old are increasingly exposed to sexual content on the web, and, in fact, that to a growing extent they seek this content out. This is not surprising. Teenagers will always be curious about sex, and the availability of internet viewing on portable computers and other mobile devices such as MP3 players makes it easier for them to seek out sexual content in privacy.

The scary bit is that those children and adolescents who depend on the internet for information about sex—that is, those who do not receive effective sex education at school or at home—are more likely to be influenced by what they see. Already a desk study commissioned by the US Department of Health and Human Services notes that the general effects of pornography on the viewer include more permissive sexual attitudes, including a heightened tolerance for unprotected sex.

Which brings us back to condom use in pornographic movies and imagery. We cannot really prevent children from seeking out or inadvertently being exposed to explicitly sexual content online, including from porn sites. And we cannot mandate parental support for comprehensive sex education or even just an understanding attitude towards sex. As a result, if most online porn content depicts unsafe sex as the norm, a scarily large proportion of teenagers will see it as such.

We are not, however, as powerless as the Los Angeles City ordinance. We can think of creative ways to support adult content that features safe sex—for example, government-sponsored awareness campaigns or guidelines for amateur porn, potentially supported by financial incentives. And, by mandating comprehensive age-appropriate sex education in all schools, we can make sure that no teenager will have to depend on the internet for information on sex.

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.

Sexual Harassment: Not Really About Sex At All

@RHRealitycheck

This week, a national study found that sexual harassment affects about half of the students in grades seven to 12. Some might see this as an indication that there is too much talk about sex in our schools. They would be wrong. Others have chalked it up to teenage hormones and suggested that we leave well enough alone. They would be equally wrong.

Sexual harassment is nothing new. In 2008, a study found that just over a third of middle and high school students had been sexually harassed. The National Coalition for Women’s and Girls Education put the percentage at almost 90 in 1997. And, indeed, discrimination based on gender has been an actionable offence under Title IX of the Education Amendments since 1972, and since then the courts have applied Title IX to various types of sexual harassment.

But the motivation for sexual harassment seems to be shifting. Bill Bond, a school safety expert for the National Association of Secondary School Principals, notes that attempts to exploit fellow students sexually have become less common, and that now students seem to use sexual remarks to degrade or insult someone else.

This sense, that sexual harassment nowadays is more about hostility than about sex, was validated by the study published this week as well as by the study published in 2008. Both concluded that most sexual harassment in middle and high schools in the United States is directed at girls and at children suspected of being gay or lesbian.

Where straight girls are targeted, the harassment is generally about their level of sexual activity, which is either deemed too much (they are “sluts”) or too little (they are “prudes”). In the case of youth who are thought to be gay, it is the mere fact that they might even want to have sex that is “wrong.”

In other words, the more frequent type of harassment suffered by children today—and the one they report as affecting them the most negatively—is expressing hostility at children who do not fit into some preconceived notion of what “normal” sexuality is. Normality in this connection apparently means that girls must display a level of sexual activity that can go unperceived (neither too much nor too little), and that everyone should be straight.

Or to be a bit more blunt about it: sexual harassment in middle and high schools today is motivated by either misogyny or homophobia. Neither has to do with sex. And neither would be helped by treating sexual harassment between children as a result of overactive hormones to be dismissed.

In fact, the solution is just the opposite: active and broad engagement about sexuality and sex roles. Because misogyny and homophobia are fuelled by ignorance and fear. And ignorance and fear can be fought with knowledge.

Unfortunately, broad knowledge-building is not generally the objective of sex education in US middle and high schools. At best, sex education deals with sexuality as a matter of biology: how do male and female bodies engage in (heterosexual and procreative) sex. At worst, the message is that all sex is bad unless you are married and want to procreate. These types of sex education do not transfer much needed tools to our children as they grapple with their evolving sexuality. Indeed, by ignoring (or vilifying) sexuality altogether, limited sex education may instead feed the fear that expresses itself as sexual harassment.

Comprehensive sex education, on the other hand, provides the broader knowledge our children need and want. At its best, comprehensives sex education engages children on their own level of comprehension in a conversation about what sexuality means, how to relate to ourselves and each other with respect, and how to make responsible and informed choices about our sexual and reproductive lives. Comprehensive sex education not only combats the fear and stereotypes that fuel sexual harassment, it also works in terms of delaying the age of sexual initiation and lowering the number of teenage pregnancies.

All children have a right to comprehensive sex education. Giving them the information they need and are entitled to has obvious benefits for their reproductive and sexual health. It is also a way to reduce the chances that they will subject their peers to sexual harassment.

How Not to Address Teen Pregnancy

This past weekend, New Zealand found itself in the midst of a loud public debate over the case of a  teenager who procured an abortion with the support of her school counselor, without  informing her parents. The parents were angry, and much was said about the ethics, propriety, and legality of the situation.

The main issue was not whether abortion should be legal there (it is) or whether the state may be justified in limiting access (it  does).  The question was whether parents have a right to interfere with (or at least know about) their daughter’s decision.  New Zealand law says they don’t.  In the United States, over 40 state legislatures and the Supreme Court have come to the opposite conclusion.

In the United States, as in New Zealand, the arguments for parental involvement laws include an assertion that they contribute to lower teenage pregnancy and abortion rates, and that they improve family communication.  There is no evidence to support this. The clearest documented impact in the United States of these laws has been an increase in the number of minors traveling outside their home states to get abortions in states that don’t mandate parental involvement or  have less restrictive laws.

Moreover, the American Academy of Pediatrics has noted that parental involvement laws don’t  promote family communication, though  they  increase the risk of harm to the adolescent by delaying access to appropriate medical care.  In fact, most teenagers who seek abortions—in particular younger teens—voluntarily seek their parents’ involvement, regardless the law.  And research has shown that adolescents who are strongly opposed to informing parents for fear of a negative or coercive response tend to predict family reactions accurately.

A stronger argument for parental involvement is that an abortion is a serious medical procedure, and the child should be able to count on her family for support. This is indisputable.  What is under dispute in the recent debate in New Zealand—and what should be under dispute in the United States—is whether these laws help increase that support, or whether they can have the opposite effect.  Just because the US Supreme Court has said that parental involvement laws are constitutional doesn’t mean they are helpful either in preventing pregnancy -- or in helping a young girl who finds herself pregnant.

Many American politicians decry the US teenage pregnancy rate, which is roughly three times the rates in  Germany and France, more than four times  the Netherlands rate, and 50 percent higher than New Zealand’s. 

There are good reasons to seek to prevent teenage pregnancy. First of all, early pregnancy can have adverse physical health consequences.

And having to care for  a child affects access to education, employment, and public life for the young mother—and perhaps for her baby as well. Changes in the mother’s life from an unplanned pregnancy can be surprising and even oppressive. And teenage pregnancies are more often than not unintended.

There are plenty of good answers to what to do about high teenage pregnancy rates. They include ensuring that teenagers both know how to prevent pregnancies (scientifically based sex education) and have access to the means to do so (modern contraception).  There are also more intangible factors, such as positive body image for girls, policies that promote gender equality, and greater openness about sex. Studies have shown that countries that score high on all of these points tend to have lower levels of teenage pregnancy and in many cases abortion.

The United States has a long way to go to ensure access to age-appropriate, comprehensive sex education and modern contraception, and US teens could certainly use support in developing positive notions of their bodies, gender equality, and healthy sexuality.

But rather than investing in these areas, state legislatures are marching forward with more and more legal restrictions on access to information and abortions, including parental notification or consent,  and mandatory waiting periods and sonograms.  These laws are heavy in government intervention and  don’t deter teen pregnancies.   

US legislatures would be better off considering what policies would best protect the rights of the pregnant girl to have the health information and services she needs, to be consulted and heard in matters that concern her, and to have her best interests protected by the state. These questions were raised this weekend in New Zealand.  It is high time they are raised in the United States as well.

Access to Abortion in Ireland—A Key Human Rights Issue

(Originally published by the National Women's Council of Ireland)

Last week, Human Rights Watch launched our most recent report on women's rights -- "A State of Isolation: Access to Abortion for Women in Ireland". The report was based on interviews and research we conducted in Dublin, Cork, London, Birmingham, and Washington DC in mid 2008. And though the word "abortion" features prominently in the title, the report is about much more than abortion.

It is about the thousands of women who face crisis pregnancies every year in Ireland. And above all, it is about a government that actively sabotages their health.

Through our interviews with women who had traveled abroad for abortions, with medical practitioners, and with social workers, we documented the consistent obstacles women and girls face to independent and responsible decision-making about their pregnancies. They are not allowed to access the services they need within Ireland, they are aggressively discouraged from seeking the care they need abroad, and they cannot trust that the advice they receive is accurate or complete. Indeed, at the most basic level, the report is about information.

And to demonstrate just how important information can be, I want you to imagine a woman with a crisis pregnancy.

Perhaps she is one of the girls who got pregnant as a result of sexual abuse. Perhaps she is a married woman with 3 existing children and cannot afford to feed a fourth. Perhaps she is a student. Or a refugee going through an asylum procedure. Or perhaps she feels that something is not quite right with her pregnancy, health-wise.

Either way, she is a woman who believes she cannot and must not carry her pregnancy to term. But where can she turn?

Often, she may not know. The government has made sure that information about the termination of pregnancies remains difficult to access -- even information about how to get information about the termination of a pregnancy.

Those who provide accurate information about abortions abroad cannot advertise broadly and are prevented, by law, from supporting their patients in seeking care.

Meanwhile, those agencies who claim not to provide information about abortion remain unregulated, and therefore free to harass women and girls who are already in distress with harrowing medical claims many of which are completely inaccurate.

In many cases, the agencies that provide accurate information are indistinguishable from those that don't.

Worse still, women who depend on maternity hospitals and GPs for support also cannot be sure to get full information. Despite an exception in the law, clarified by the Supreme Court, that women have a right to an abortion within Ireland if their life is threatened by the pregnancy, there is no official protocol on when abortion might be legally performed in Ireland. Mostly doctors are reluctant to guess, and some, as a result, actively discourage pregnant women with complicated pregnancies from seeking full information about their health status: they can't do anything about it anyway.

Some might say: if the government's intention is to discourage women from having abortions, it looks as if their policy is working.

They would be wrong. Thousands of women and girls travel abroad for abortions every year. They are not prevented by the misleading or scarce information from seeking abortions. They are preventing from seeking abortions in a timely manner. This has a detrimental effect on their health, both physically and mentally.

Abortion, as a medical procedure, is safest when provided within the first 8 weeks of the pregnancy. And the longer a woman with a crisis pregnancy has to wait for the services she needs, the deeper her distress and ordeal. If the woman is suffering through a pregnancy with fatal fetal abnormalities or that has been the result of rape or incest, this is in some cases even more true. By stalling women's access to the care they need, the Irish government is complicit in their distress.

In other words: the government contributes directly to undermining women's health, dignity, and human rights. Because though decisions related to abortion are complicated and deeply personal, they are also a question of human rights. And the Irish government has an obligation to provide women with the support and information they need to navigate those decisions.