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Wednesday, November 25, 2009

Giving thanks to and for women who know what's best:

This Thanksgiving I am thankful for, I am eternally grateful for, my mother, Ana Maria Teresa Amparo Irueste Alejandre. First diagnosed with in situ cancer the year I graduated from high school, she had a lumpectomy and underwent several months of radiation treatments. After several years of living cancer-free, a biopsy demonstrated she had invasive cancer. Multiple medical opinions all concluded a double mastectomy was the best course of treatment. After surgery came intense chemotherapy. Then radiation. Then reconstruction. While all of this was scary, neither of these malignancies would have been caught early enough to battle with a high probability of success without annual mammograms and monthly self-exams.

“Spotting sexism sounds easy, but the sheer commonness of it, coupled with its surprising diversity, makes it so that even hardened feminists could use refreshers.” – Amanda Marcotte –

Without any certainty that all of the residents of this great nation will enjoy the blessings of high quality, affordable, comprehensive and humane healthcare, the US Preventive Services Task Force (USPSTF) is telling women they don’t need mammograms until 50, and even then they should only get them every other year. Also, forget about breast self-examination, specifically, don’t expect a doctor or nurse to teach you how to properly do one. It seems finding a lump is not the same as early detection, and might mean it’s already too late, or worry you unnecessarily, because there is really nothing wrong. Not to be left out, the American College of Obstetricians and Gynecologists (ACOG) doesn’t want women to get pap smears until 21, unless already sexually active for more than three years, at which point they should get paps every other year, unless of course they’ve had three clear tests in a row, at which point they should only get one every three years. Again, here the idea is to avoid false positives. These tests, and the biopsies they can lead to, are expensive and anxiety producing. And there’s nothing worse than that.

Except cancer… But just we’re talking about just losing a few more women’s lives in exchange for reducing stress for hundreds. That’s just good utilitarianism, right?

And yet, I don’t remember there being a similar set of recommendations about prostate exams or other health issues impacting men. There were no press releases gender-neutral warnings against excessive medical testing, overtreatment, or whatever might feed a bourgeois culture of hypercondria, and further drive up the general cost of healthcare.

The simple fact is that women are the only ones explicitly being asked to sacrifice. The Stupak-Pitts amendment goes well beyond the Hyde amendment, which was already excessive, offensive, and spat in the face of Roe v. Wade, a US Supreme Court decision that has stood as the law of the land since 1973. With one in eight women affected by breast cancer, USPSTF’s decision to tell women not to be vigilant until they reach the age of 50 is one of the stupidest things I have ever heard. As a general rule, Americans avoid check ups, dentists, eye doctors, and wait until what ails them takes them to an emergency room, if they ever go at all. Women are more likely to engage in this neglect, to put their health needs last. Public health officials are struggling to prevent the spread of Herpes, Chlamydia, and Human Papilloma Virus, (HPV) for instance. HPV is responsible for 70% of cervical cancer cases diagnosed each year. On some college campuses 60% of female students are currently infected. And yet, ACOG feels it necessary to tell women to not get paps.

Shirley Chisholm, who made history in Congress and during her 1972 Presidential run, once said, “Prejudice against blacks is becoming unacceptable although it will take years to eliminate it. But it is doomed because, slowly, white America is beginning to admit that it exists. Prejudice against women is still acceptable. There is very little understanding yet of the immorality involved.” It is believed that approximately 140 million women around the world have experienced female genital mutilation. Add this statistic to the other realities placing women’s health at risk abroad and at home, and the picture for what we might expect in the future, especially for women from marginalized communities, seems extremely dire.

Beyond coming off as primarily patriarchal, ACOG and USPSTF recommendations seem completely void of cultural competency. Health decisions do not occur in a vacuum. And mixed messages from establishment professionals are not helpful when the average woman is already being bombarded and berated with conflicting cultural counsel. A Latina, for instance, inherits a tradition in which a giant party and ceremony celebrate her becoming a woman at 15. Similarly, a Bat Mitzvah tells a 13-year-old Jewish adolescent that she is a woman. And yet, there is no Latina or Jewish household that I have ever visited where it would be acceptable for a 15-year-old, much less a 13-year-old to be sexually active. No, no, sex is always evil and demonized. So much so, that even in this great progressive Obama Generation era we are living in, abstinence-only education is still the law of the land. In fact, Section 2954 of the Senate health reform bill released last Wednesday, funds it until 2014.

My friend Phatiwe, worked tirelessly for the Massachusetts Bureau of Public Heath, as the Special Project Coordinator for the HIV/AIDS Bureau for over five years to educate everyone, remove the stigma felt by those suffering, empower those on the margin, advocate justice to those with influence, and change public policies that needed changing. She graduated in 1999. She died from ovarian cancer in 2005. I do not pretend to speak for her now, nor do I wish to upset any of her loved ones by making mention of her in this essay. But I can remember very clearly conversations with Phatiwe about the impact of the AIDS pandemic on women and girls around the world. She made me think well beyond condom use and access to medicine. (She also made me fall in love with the Red Sox, but that is a story for another day). Phatiwe asked me to think deeply about the dehumanization that a woman suffers once identified as HIV positive within a social setting that placed all of her value in the baskets of sexual intercourse and motherhood. If girls were already seen as less than boys in an AIDS-free world, imagine a world where there are an estimated 33% more infected women than infected men overall, and in places like Sub-Saharan Africa where there are 36 infected women, between the ages of 15 and 24, for every 10 infected men. I once thought of abstinence-only education as prudish, and sexist. Thanks to Phatiwe, I realized it was misogynistic and acutely dangerous.

In the 1984, John Hughes classic, “16 Candles,” there is a scene where Jake (Michael Schoeffling) tells Geek (Anthony Michael Hall) that Caroline (Haviland Morris) is passed out drunk. His exact words are, “I could violate her in 10 different ways if I wanted to.” Jake comes up with a plan that involves Geek taking Caroline in the Rolls Royce so that he can pursue Samantha (Molly Ringwald). When Caroline wakes up the next day with Geek, she says, “I don’t remember what happened, but I think I liked it.” This is but one of countless examples of moments in which popular culture has suggested that having sex with a woman who is too inebriated to consent is not rape. It is. And everyone knows it is. On those same college campuses where 60% of female students have HPV, one in four women is the victim of rape or attempted rape. Throughout the United States, the likelihood that a woman will be raped is four times greater during the years between 16th and her 24th birthday. And since nationally 84% of survivors know their attackers, what follows is that an unacceptable number of young women have been exposed to, or acquired one or more sexually transmitted diseases because of rape.

Rape is an act of violence, not a form of sex. But to speak of the rape of women in disproportionate numbers during their teens and twenties, involves an admission that adolescents are objectified and sexualized by the very same society that then tells them they are not allowed to pursue protected, consensual sex. Cultural traditions dictate a point of transformation in which a girl becomes a woman, but public policy and worried parents shove abstinence-only education down her throat. In other words, a girl becoming a woman is not allowed to enjoy her own anatomy, but she is expected to allow others to enjoy it by looking, or by blaming herself for what she consumed, where she went, or what she wore when she raped. This same kind of patriarchal mindset exists in ACOG recommendations concerning pap smears, and USPSTF recommendations concerning breast exams. These may be full of complexities and contingencies, but at best, they reinforce the false belief many young people hold that no harm can befall them, and at worst, they suggest something profoundly disturbing and insidious, about women’s bodies: A woman is supposed to value the aesthetic of her breasts, of her reproductive organs, because society does, but is not allowed to expect regular and accurate exams for her health.

I am sitting in the middle of a pile of books filled with the words of bell hooks, Maxine Hong Kingston, Susan Moller Okin, Carol Gilligan, Betty Friedan, Alice Walker, Amalia Mesa-Bains, Gloria Anzaldua, Cherrie Moraga, Simone de Beauvoir, Gloria Steinem, Doris Lessing, Elaine Brown, Amanda Marcotte, Naomi Wolf, recalling a conversation I had recently with a twenty-something first generation American on the verge of taking her teenage sister to Planned Parenthood. Both women are dating other first generation Americans. All of the people involved are trying to please their immigrant parents. There is tension, cultural conflict, felt most acutely in this instant by the young women. Both love and respect their parents. They do not come from a household with an absent parent, or plagued by abuse of any kind, or suffering from a loss of dignity at the hand of poverty. They have survived racism and cross cultural conflicts with few scars. But their parents are upset with them. Both want to start taking oral birth control as their primary form of contraception. Their parents, like most, are not thrilled with the idea of their daughters having sex period, much less sex for the purposes of pleasure, not procreation, after “I dos” have been exchanged in a traditional wedding ceremony. In addition, like many immigrants that belong to communities of color, they’ve had negative experiences with medical professionals, and become sympathetic to conspiracy theories in which elites use injections and pills, distributed by nurses and doctors, to harm and humiliate.

It would be easier in one sense if these young women could simply reject their parents, label them old fashioned, or repressive, and simply prioritize their own desires. But it’s not that easy. It never is. And while the nostalgia of immigrants for times when people waited until their wedding night before they ever came to know one another physically, may seem idyllic and cheesy, or unrealistic and unfair, they invite us to think about something very basic and of paramount importance: Choice.

Each woman deserves the choice to follow the path her parents would choose for her; the choice to reject it; the choice to alter it by combining it with her own dreams and desires. Each woman deserves access to the data needed to make informed decisions, and the power to choose what works best for her. Each woman deserves the choice to have breast exams and pap smears on a schedule that works best for her, that keeps her healthiest. Each woman deserves the choice to have sex with whom she wants, when she wants, with a partner that she is attracted to, and that she consents to having sex with. If her partner is a man, or a woman, she deserves the right to determine how long to wait to have sex, and under what circumstances. If she chooses to wait until marriage before she is intimate with another person, then it is her right to marry the man, or woman, of her choice. And as the legendary Tupac Amaru Shakur once said, “Because a man can’t make one, he has no right to tell a woman, when and where to create one.” In other words, the decision of whether to use oral birth control or Depo Provera, prophylactics or another form of contraception, is a woman’s choice, as is the decision of whether or not to have a child, as well as when, where, and with whom. If you hold these truths to be self-evident, if you believe no government or social system has the right to erase the exercise of a woman’s freewill in school, at work, in life, in love, then you are a feminist. And that’s something else to be thankful, eternally grateful for.

“Women who grew to womanhood at the peak of contemporary feminist movement know that at that moment in time, sexual liberation was on the feminist agenda. The right to make decisions about our bodies was primary, as were reproductive rights… and yet it was also important to claim the body as a site of pleasure… We had sex. We did it with girls and boys. We did it across race, class, nationality… We embraced nakedness. We reclaimed the female body as a site of power and possibility… We were the generation of the birth-control pill. We saw female freedom as intimately and always tied to the issue of body rights. We believed that women would never be free if we did not have the right to recover our bodies from sexual slavery, from the prison of patriarchy… We were charting a journey from slavery to freedom. We were making revolution. Our bodies were occupied countries we liberated.” – bell hooks –


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