A Michigan woman is suing the U.S. Conference of Catholic Bishops (USCCB), claiming the bishops’ anti-choice directives are negligently affecting the medical care delivered at Catholic-owned and -sponsored hospitals.
Filed by the American Civil Liberties Union (ACLU), the lawsuit, believed to be the first of its kind, argues that patients’ lives are put at risk by unnecessarily denying pregnant women in crisis proper medical care.
In 2010, a then-18 weeks pregnant Tamesha Means showed up at Mercy Health Partners in Muskegon, Michigan, in the middle of having a miscarriage. Her water had broken and she was experiencing severe cramping. Mercy Health, a Catholic-sponsored facility, told Means there was nothing it could do for her and sent her home. Means came back the next day, this time in more pain and bleeding and was again told the course of action was to wait and see.
It wasn’t until Means, a mother of three, returned to Mercy Health a third time, this time suffering from a significant infection as her miscarriage persisted untreated. In response, the hospital gave Means some aspirin to treat her fever and prepared to send her home. Before the hospital discharged Means for a third time, she started to deliver. It wasn’t until then that the hospital decided to admit Means and to treat her condition. Means eventually delivered a baby who died within hours of birth.
Mercy Health is required to adhere to the “Ethical and Religious Directives,” a set of rules created by the USCCB that govern the delivery of medical care at Catholic-run hospitals. The directives prohibit a pre-viability pregnancy termination, even in cases when there is little or no chance that the fetus will survive, and the life or health of a patient is at risk. The rules also direct health-care providers not to inform patients about alternatives inconsistent with the directives, even when those alternatives are the best option for the patient’s health.
According to the ACLU, that is exactly what happened to Means at Mercy Health, where attorneys claim the directives are put above medical standards of care. According to the complaint, at no point in the three times Means showed up at the hospital did anyone tell her that she had little chance of a successful pregnancy. The ACLU also alleges that the hospital, as a direct result of the bishops’ directives, failed to tell Means that her health and life were at risk if she tried to continue the pregnancy, and that the safest course of care for her was to end it. “They never offered me any options,” said Means in a statement. “They didn’t tell me what was happening to my body. Whatever was going on with me, they discussed it amongst themselves. I was just left to wonder, ‘What’s going to happen to me?’”
The lawsuit alleges that because she received neither the information nor the care appropriate for her condition, Means was unable to direct her course of treatment, and suffered unnecessarily. “A pregnant woman who goes to the hospital seeking medical care has the right to expect that the hospital’s first priority will be to provide her appropriate care,” ACLU Deputy Legal Director Louise Melling said in a press call. “Medical decisions should not be hamstrung by religious directives.”
According to the ACLU, Means’ story is not unique. In support of their complaint, attorneys representing Means point to research showing that other patients have been denied information and appropriate care at hospitals bound by the bishops’ directives. “The best interests of the patient must always come first, and this fundamental ethic is central to the medical profession,” Kary Moss, executive director of the ACLU of Michigan, said on the call. “In this case, a young woman in a crisis situation was put at risk because religious directives were allowed to interfere with her medical care. Patients should not be forced to suffer because of a hospital’s religious affiliation.”
But, according to the ACLU, patient care does suffer, significantly. The group’s research shows that over half of OB-GYNs working in Catholic-sponsored hospitals have run into conflicts with the directives. In one example, a doctor describes a miscarrying patient who was gravely ill and who was carrying a fetus that had no chance of surviving. Even though this patient had sepsis and a 106-degree fever, the hospital’s policy would not allow the doctor to treat the patient by terminating the pregnancy until the fetal heartbeat ceased on its own. In another example cited by the ACLU, a cardiologist was reprimanded for telling a patient with signs of a potentially fatal condition that if it worsened, the American College of Cardiology and the American Heart Association would recommend terminating the pregnancy in order to save her life.
Because this lawsuit is believed to be the first of its kind, there are a lot of unanswered questions, like whether or not the bishops can be sued for negligence in this way, and the effect, if any, a ruling on the issue would have for other Catholic-owned and -sponsored hospitals.
More importantly, though, the lawsuit forces a look at the question of what role, if any, religious doctrine should play in the delivery of medical care. And it does so in the venue of negligence and malpractice claims, which is far more patient-centered than any intellectualized debate about medical ethics, religious faith, and the First Amendment. Notably, Means’ attorneys don’t claim that her constitutional rights were infringed on in any way. Instead, they argue the bishops are negligent in putting forward directives they know will endanger patients’ health and conflict with professional standards of care. In some ways, it’s a much more straightforward claim to make, and one that, presuming the lawsuit is allowed to move ahead, will require the bishops to defend the directives on the merits and against claims they violate the standard of care for pregnant patients. With Catholic-owned or -sponsored institutions making up a significant percentage of health-care providers in this country, these are questions that need answers.
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In August, reporter Annamarya Scaccia took an in-depth look at how Swarthmore College and other U.S. higher education institutions have been mishandling sexual assault cases. This is a follow-up to that piece.
Three months have passed since Swarthmore College introduced its centralized reporting system as part of its new Interim Sexual Assault and Harassment Policy—a carefully manicured reworking of campus procedures currently under investigation by the Department of Education’s Office of Civil Rights (OCR). Released with its 2013-14 Student Handbook, Swarthmore’s updated policy aims to rectify the many issues exposed in two federal complaints alleging the school has mishandled sexual assault cases on campus.
With this provisional doctrine, Swarthmore has implemented a sweep of administrative changes informed heavily by a third-party consultant report including a restructured Title IX team, extended Title IX and sexual misconduct training, and refined sexual misconduct definitions. These adaptations, claims the liberal arts institution, are Swarthmore’s attempt to “take clear and definitive steps” addressing the concerns raised last semester by members of its student body.
But for one freshman, a revamped process meant to ensure students are safe on campus and receiving the professional help they need has become an officious charge in order to compensate for past mistakes.
Like her fellow first-year peers, Anna Livia Chen was required in late August to attend the student-led Acquaintance Sexual Assault Prevention (ASAP) workshop as part of Swarthmore’s orientation for incoming students. Implemented in the mid-1980s, the ASAP workshop serves as a comprehensive overview of sexual assault issues and prevention. This year’s seminar, updated per the liberal arts school’s new policy, focused on consent and its real-life applications.
But Chen opted not to participate. As the Mountain View, California, native explained to her residential assistant, she wasn’t emotionally ready to tackle the subject of sexual assault given her own experience as a childhood sexual abuse survivor. Hearing survivor testimonials—a standard part of the workshop—would be triggering for her.
Neither Chen nor her RA thought her case would need to be shared with Swarthmore’s interim Title IX coordinator, Patricia Flaherty Fischette. Per the new system, Fischette is supposed to receive all information pertaining to any sexual assault and harassment incidents learned of by college employees or any of the six student groups identified as required reporters, such as RAs or ASAP facilitators. (The college’s Worth Health Center, Counseling and Psychological Services, and religious advisers are considered confidential resources that do not have to report.) According to Jenni Lu, news editor of Swarthmore’s the Daily Gazette, by ordering reporters to share cases with the Title IX office, the southeastern Pennsylvania institution is attempting to direct survivors to sources it deems professionally trained so students feel they’re receiving “the adequate help that they need.”
“They’re afraid that if all survivors are doing is approaching their friends, their peers, people who necessarily haven’t gone through extensive training to deal with this, they may not actually be getting the help that they need,” Lu told RH Reality Check. “They really are trying to keep victims’ safety in mind.”
Nancy Nicely, Swarthmore’s secretary of college, echoed as much in an email statement to RH Reality Check: “Our goal is to not only meet the letter and spirit of the law, but to ensure that our policies assure the safety of our students, provide meaningful support to victim/survivors, and enable us to respond with the highest levels of fairness, compassion, and respect for privacy.”
In Chen’s case, the sexual abuse she experienced happened when she was a junior high school student in California, and wouldn’t fall under the tenets of either Title IX of the Education Amendments of 1972, which prohibits sex and gender-based discrimination in federally funded schools, or the Clery Act, which requires the collection and disclosure of information about crime on and near campuses. And, to this extent, the lawyer who helped Swarthmore draft its new sexual misconduct policy, Gina Maisto Smith of Pepper Hamilton LLP, told the Philadelphia Inquirer in August in regards to an unrelated case that schools are required by law to investigate past events of sexual assault and harassment on campus if “that threat becomes current”—which Chen’s was not.
But the ASAP facilitator who contacted Chen about organizing a private ASAP session was concerned. Since Chen was a minor when assaulted and a minor at the time she told her RA (she was 17), the facilitator felt Fischette should know. Complying, her RA gave Fischette the “most pertinent details,” stressing that Chen “was no longer in any danger whatsoever” and had “all the support” she needed from her family, friends, and therapist back home.
Fischette should have been the end of the line—or so Chen was told. But upon receiving Fischette’s report of the case, Swarthmore’s general counsel disagreed. The firm, which is now informed of all sexual misconduct cases sent to the Title IX coordinator, according to Chen, determined Chen’s minor status was cause enough for Swarthmore’s Department of Public Safety to report the abuse to the Pennsylvania Department of Public Welfare’s ChildLine and Abuse Registry. (Swarthmore’s interim policy states any college employee who suspects abuse of a child they’ve interacted with during their employment must make a report to Public Safety, but doesn’t offer specific guidance.) It was a decision that would drag the still unresolved case out over a month and cause Chen to start unraveling at the seams. (Neither Fischette nor Nicely responded to RH Reality Check’s phone calls seeking verification.)
“So much of my time was being drained by having meetings with various administrators and resources, not to mention the emotional energy it took. I had no time for self-care, which is something that I desperately needed with everything that was going on,” Chen said. “I am still frustrated that this process got to a point where it overtook my life in the way that it did.”
Much like she did with Swarthmore’s administrators, Chen stressed to Child and Youth Services (CYS) of Delaware County, which received Public Safety’s report, that she didn’t want her case pursued, and wouldn’t go into any more detail. However, according to Chen, on October 10—the day of her 18th birthday—CYS informed her it was legally required to notify the police with the information they had on file, including Chen’s California address. (Chen said she was surprised to learn that CYS had her home address, as she explicitly told Public Safety that it wasn’t to be disclosed in its report.)
“One of the most upsetting things about my experiences is that nothing ever went as we were told it would. The amount of information that I shared with my RA or the actions that we took in cooperating with the reporting policy probably would have been very different if we had known that it would ultimately result in my case being reported to the Child Sexual Abuse Hotline,” Chen said. “All of this goes to show that the biggest problem with the required reporting policy is the lack of transparency. People are not being informed about what will happen once they adhere to the new policy and the chain of events is triggered.”
“The more the college becomes OK with saying they aren’t perfect, the less students will be upset about said imperfections. Humility is a great quality,” she added.
Chen said she still hasn’t heard from law enforcement. As for administrators, Chen is working on scheduling a meeting with the players involved to discuss her concerns as well as policy and practice changes to help avoid a case like hers from occurring again. “The story isn’t fully closed, but the official case according to the school is closed,” she told RH Reality Check.
If you ask Eddie Zhang, a recent Swarthmore alumni and a support person for many survivors involved with the federal Title IX complaint lodged in May against the institution, Chen’s situation is illustrative of a “very amplified [form] of paternalism” on the administration’s part. This direct pipeline between survivor and administrator, he said, removes responsibility from the student through the notion that authority figures are better equipped to address sexual assault. This, in turn, can prevent immediate observers from helping victims. And it also assumes that those identified as authority figures and trained resources are “doing their job,” he said.
“To say that somebody who hears of an assault should then report because then the victim or survivor can receive ‘the help they need’ would be farcical if it weren’t tragic,” Zhang told RH Reality Check. “I think there’s a lot of merit to lateralizing support systems, whereby more students have some degree of training and responsibility to assist immediately, rather than having as the only option deference to the paternalistic implementation of ‘support’ that the college has to offer.”
“The belief that sexual violation is something that only [professionals] can handle is a structural reinforcement of the social isolation of survivors,” he added.
This perceived interventionism is also seemingly coupled with systematic complications. As the interim reporting policy stands, it doesn’t allow much room for discretion, Lu said, as required reporters are obliged to reveal “essentially everything that they know,” including the student’s name. It can also place a heavy burden on the student, she said, by having them determine what cases are “relevant, ongoing, or potentially harmful to the school environment.”
“They’re putting a lot of trust in those students and I think that they’re hoping that, because they’re putting trust in the students, students will reciprocate that and put trust in the system,” Lu told RH Reality Check. “It’s a hard thing to ask of the students because, in the past, that’s been the big issue—students haven’t trusted the school, but [the administration] has been working really hard on centering this view of the reporting system around [the Title IX coordinator].”
That fragile trust, though, wavered earlier in late August when the school removed student Mia Ferguson—the driving force behind the complaint against the institution—from her RA role for withholding a sexual assault survivor’s name she learned about prior to taking up her post. From the college’s perspective, as an RA, Ferguson was mandated to give this information as it was pertinent to an ongoing investigation. But the 19-year-old junior didn’t see it that way—she wouldn’t break the confidence of the person who came forward before she took the position. It’s an incident that created confusion on campus as to what exactly constituted retroactive reporting, Lu said.
The retroactive reporting clause, however, was clarified in a campus-wide email distributed by Fischette on September 2, according to a Daily Gazette article written by Lu. In particular, any required reporter must share all information and names, if known, regarding incidents of sexual misconduct, no matter when they’ve learned about the assault. And, said Lu, the college has made clear that “basically 100 percent of the time” the survivor’s name is an important detail to be revealed.
Chen’s experience aside, Lu said it’s too early to tell how the new reporting policy is shaping up because “it’s not something that’s openly manifested out in public.” Lu did notice, however, a recent uptick in reports of sexual misconduct that had occurred in years past, all of which are posted to The Daily Gazette’s news blotter. While she said the student paper is not “privy” to how or why those reports are filed, she theorizes it may be a mix of retroactive reports shared by required reporters and students coming forward of their own volition.
“[The administration] has really been trying to show students that they want to start with a new sense of openness that has been lacking in the past,” Lu said. “It’s hard to say that it’ll be successful just because people have naturally been really mistrusting in the past—and for good reason. It will take a while.”
Image: MHM55 / WikiMedia Commons
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Since its debut on September 20, the documentary After Tiller has captivated audiences and sparked thought-provoking discussions about later abortions and the physicians who provide them. The film has been screened at this year’s Sundance Film Festival and in 25 cities across the globe, but it has likely never been more highly anticipated than it was at its November 20 debut in Wichita, Kansas, the city that Dr. George Tiller called home.
There are many reasons why After Tiller is a must-see film. The feminist and reproductive health communities have provided much commentary about it since its release. But even more important are the perspectives of people outside these communities, for whom the film may provide an introduction to the myriad reasons why women seek abortions later in their pregnancies.
In Wichita, the film was shown to a packed house at the Orpheum Theatre. There were metal detectors at the door and security was ever-present, but the crowd appeared to be largely pro-choice and there were no disruptions of any kind. The film was followed by a panel discussion, featuring the movie’s co-producers and directors—Martha Shane and Lana Wilson—along with Julie Burkhart from the South Wind Women’s Center, which is housed in the facility where Dr. Tiller practiced, and Scott Stringfield, the medical director from Choices, the crisis pregnancy center located next door to South Wind.
The post-movie discussion was polite, with members of the audience seeming to go out of their way to respect the dissenting opinion found among them. People in attendance included Dr. Tiller’s patients, neighbors, staff, and fellow parishioners from his church, including the man who was with him when he was shot and with whom his last words were spoken. For this audience, viewing After Tiller provided something even more than philosophical and moral musings about a complex subject matter. It provided yet another step toward healing for this community so intimately aligned with the film’s namesake, their doctor, their hero, and their friend.
Before the event, RH Reality Check spoke by phone with one of the film’s co-directors and co-producers, Martha Shane, about the film and what it meant to host a screening in the city where Dr. Tiller practiced, and where he was killed by anti-choice terrorist Scott Roeder in 2009.
RH Reality Check: Does showing this movie in Wichita hold a special or particular significance for you? What do you hope the effect of showing this movie in Wichita will be?
Martha Shane: I think we always have felt that it would be important to show the film in Wichita. Dr. Shelley Sella [one of the four remaining providers in the nation who openly provide third-trimester abortions since Tiller's death] talks in the film about the climate of hatred existing in Wichita, that she felt it contributed to Dr. Tiller being murdered. As filmmakers, I don’t think we hold a particular goal for what we’re trying to achieve there, but I do imagine it will be an emotional screening. I feel that it is important that we share the film with the people who knew Dr. Tiller so well.
RHRC: People in the pro-choice movement revere their abortion providers, particularly those physicians providing later procedures. Here in Wichita, Dr. Tiller was certainly viewed as a hero to the women he helped, to the pro-choice community here, and to those who knew and loved him as a person. After spending so much time with these doctors, do you personally view them as heroes?
MS: It’s complicated. That’s not how I talk about it in the film. The question we asked the doctors when we interviewed them was, “What gives you the courage to continue doing this work?” They would say that it isn’t about courage, that it’s about stubbornness. I think that there is definitely a sense of courage in these doctors who provide this service to women.
You know, both Lana [Wilson, the film's co-director] and I knew that we were pro-choice when we set out to make this film, but we didn’t know much about third-trimester procedures, so that has been a learning experience for us. It was interesting to us that one of our film editors said that while he was working on this project, he would try to distinguish his personal moral line with these abortions, and he said every time he thought he found the line, he then heard from a woman in the footage that would make him truly reconsider. I was personally floored by the desperation of the women we encountered while making the film.
RHRC: What of the criticism that this is not a “balanced” documentary? You said in an interview on GRITtv that you determined there’s already been enough coverage of the anti-abortion rhetoric. You said that you chose consciously to focus on the women and the “gray area” found even within the clinic. Tell me more about this gray area. What effect does highlighting this area have on the movie, and what effect could it have in the way we talk about abortion?
MS: We observed that the news media in their coverage of abortion only focuses on people who are on one side or another, but the vast majority of people are in the middle ground when it comes to this issue. The film shows the doctors themselves struggling with the complexity of their work. So the question becomes: How do we decide to provide these later abortions for these women? What moral calculus should be used? The film allows its viewers to wrestle with these issues for themselves. We hope that by embracing the complexity that we can change the way that abortion is spoken about in public.
RHRC: In Kansas, the threat to abortion comes not only from violent assassins, but also from our anti-choice, extremist legislature. Does the political element of abortion enter into the film at all?
MS: Our film follows Dr. [LeRoy] Carhart through the 20-week abortion ban in Nebraska. When we approached him about the film, he said that he had been trying for years to get legislators to come to the clinic to hear these women’s stories, but they would never come. I think it was a large reason why he chose to participate in the film. While none of these doctors chose their work for political reasons, it has become an inescapable reality for them.
RHRC: While you are here, you are scheduled to be at a fundraiser for the South Wind Women’s Center. This clinic doesn’t perform the later procedures that are featured in your film. Do the stories of the women who have non-medically necessary first- and second-trimester abortions contribute something to the discussion? What happens when there is no “gray area” and it is simply a matter of choice? Does this “gray area” allow for women who simply feel unable to proceed with a pregnancy due to a personal choice and their individual personal circumstance?
MS: I try to talk about the complexity of the issue. These women who seek first- and second-trimester abortions contribute so much to the discussion, considering one in three women have an abortion in their lifetime. The complexity is seen in every woman’s decision to have an abortion. It is a decision that each of them thinks through deeply. I think this is particularly underscored in the third-trimester procedures, but it equally true in first- and second-trimester abortions.
Dr. Sella said in a panel discussion we were on that with gay rights there have been situations with legislators, when a family member came out and it affected their personal point of view. If a legislator’s daughter had an abortion, he might not ever know. I mean, people have a right to privacy. Everyone shouldn’t have to tell their story, but if people put their story out there and talk about it, it contributes to the understanding of the issue.
RHRC: Will there be physicians willing to do this work in the future? What does the future of third-trimester abortions look like?
MS: There is a new provider who is working with Dr. Sella and Dr. Susan Robinson in Albuquerque. She’s 35 years old. They are excited about her involvement. They do hear from medical students interested in providing these procedures, but what they are most concerned about is the procedure remaining legal. The loss of legality is the biggest threat.
Our post-theatrical plans for the film are to bring it to medical schools and show it to the students. We are hopeful that it might encourage the students to demand that their schools continue to teach abortion procedures. We also hope that it would create a more supportive atmosphere for their peers who do this work in the future, by showing that they are not monsters.
RHRC: Have you had anyone share any personal change of heart with you as a result of viewing this film? What other kinds of feedback have you received from your film?
MS: At the screenings we’ve attended, we’ve had some people say that they consider themselves very “pro-life,” but that they didn’t realize how complicated the issue is. I think that it can be the beginning of thinking more deeply about the issue. That type of conversation has happened many times. I think it is definitely affecting people.
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Emily Spangler is a 15-year-old high school student and one of RH Reality Check‘s youth voices.
Being a teenager who wants to promote acceptance and equality and change the world is not necessarily easy. It can be quite stressful, especially when the world you see is not going in the direction you would like it to be going in. Still, raising your voice on certain issues is natural for some, like it is for me. I’m an advocate for empowering women to be engaged in the political process and to have their voices heard on issues that affect them. Someday, I want to make a bigger impact on this world and to be elected to public office. But I recognize that for others, activism not only requires courage and sacrifice, but can actually be dangerous.
Under the threat of violence—and even after surviving an assassination attempt—Pakistani teenager Malala Yousafzai continues to stand up for the rights of girls to education and equality. In so doing, Malala shows us that no matter what age we are or where we come from, we all have the power to use our voices for the issues we care about.
Thank you, Malala.
On October 9, 2012, Yousafzai was shot in the head. The Taliban targeted her for spreading so-called Western ideas, most notably the right to education for women. Yousafzai survived the assassination attempt and, undaunted, continues to serve as an activist for the rights of women and girls. In the wake of the attack, global leaders have joined her in promoting and emphasizing the importance of access to education in Pakistan. For example, United Nations Special Envoy for Global Education and former British Prime Minister Gordon Brown presented a petition to Pakistani President Zardari to ensure education for all.
Earlier this year, Yousafzai spoke before youth leaders at the United Nations and called for worldwide access to education for every girl. She was nominated for this year’s Nobel Peace Prize and though she did not win, she became the youngest nominee ever.
At 16, Yousafzai is already an accomplished young woman and the world is looking forward to her next steps of activism and courage. Her story is unique, but she is also one of many activists around the world. She is a voice for many women in Pakistan, and her fearless actions have had an impact on the world. Her actions are a prime example of what raising your voice for an issue one is passionate about looks like. She has inspired others, including me, to raise their voices on issues that are near and dear to their hearts.
Although many activists are not threatened to the extent that Yousafzai was, it is important to remember that no matter where you come from, how old you are, or what your background is, your voice can have an impact on the world.
Back here in the United States, my generation has an advantage. When we want to raise our voices, modern technology is often available. No longer are we limited to writing to our local newspapers or giving speeches in our communities, because many of us also have access to social media websites, online news outlets, and forums where community speeches can go viral. It is easier now than ever to have our voices heard by a range of people around the world and for our messages to get across.
We can also host online discussions, which engage a broad audience, on websites like Twitter, Tumblr, and Facebook. We are capable of meeting other activists online and connecting with them. We have the world at our fingertips and keyboards, although we may not always realize it. There are so many different ways for our voices to be heard with the growth of online resources.
People of my generation: Your voice was given to you, and it should be put to use. By speaking out, we inspire others to have their voices heard as well. One can inspire a fellow peer, another activist, classmates, or a whole generation. Online or offline, your voice does matter.
Malala showed our generation that in order to have a sustainable future, we need to raise our voices. Issues in education, health care, the environment, and other areas are at stake unless we each take responsibility to create change. And thanks to Malala we know change is possible, even with the efforts of just one girl at a time.
Image: The New York Times / YouTube
The post Thank You, Malala Yousafzai, for Inspiring Us to Activism appeared first on RH Reality Check.
Alcohol is often cited as the reason why certain sexual risks were taken, be it sleeping with a stranger or forgoing birth control. Stroll across a college campus on any given Sunday afternoon and you’re likely to hear somebody say, “I can’t believe I did that, but I was so wasted!” When it comes to condom use, however, a new study finds that expectations of what alcohol might do and partner type have much more to do with women’s decisions about condom use than whether they were drinking or even how much they drank.
These researchers chose only to study women because they wanted to look beyond gender differences and do a systematic analysis of what affects young women’s sexual decisions. It’s worth noting that the study does not suggest that women are on their own in the choice to either get drunk or use condoms. We shouldn’t forget that young men were involved in each of acts of intercourse reported in the study, and they too were (or should have been) part of the decision-making process. Of course, all of our efforts to increase condom use—drunk or sober—should be aimed at men and women.
Now, back to the study at hand. The year-long research project that followed some 500 young women in their first year at a university in the Northeast. Researchers asked them about a variety of health behaviors, including substance use, diet, exercise, sleep, and sexual behavior, as well as psychosocial adjustment. Researchers focused on students who had had sexual intercourse at least once during their first year in school. In monthly surveys, students were asked about their most recent experience of vaginal or anal intercourse, including what their relationship with the partner was like, how long they’d been in the relationship, how much alcohol, if any, they had consumed before having sex, if they’d smoked marijuana beforehand, and if they used a condom or any other birth control method. Participants were also asked how often they consumed more than four drinks at a time (categorized as heavy episodic drinking) and how often they smoked marijuana. Finally, researchers used a variety of scales to measure participants’ expectations relating to alcohol and sexual risk, their level of impulsivity, and their propensity for sensation seeking.
The results are based on responses from 297 women and 1,856 reports of intercourse. (Since women were only asked about the two most recent events in a given month, each participant could report on no more than 24 events total.) Despite all of the focus on binge drinking on college campuses, only 20 percent of the events involved any drinking, only 13 involved heavy episodic drinking, and only 6 percent involved marijuana use. While this study looked to analyze these events in much more detail, I think it’s important for us to take a moment to note that most sex among these first years happened largely without the influence of alcohol or pot.
Women were more likely to use any kind of substance during intercourse events with new partners rather than established partners. In particular, alcohol use was more common with relatively unknown casual partners (acquaintances and strangers) than with friends, and more common with friends than with ex-boyfriends. Marijuana use, however, did not differ across casual partner types.
The participants used condoms in 61 percent of intercourse events. Condom use was less common in events involving romantic partners (58 percent) than in events involving casual partners (72 percent). Specifically, women were least likely to use condoms in events involving established romantic partners (55 percent) and most likely to use them in events involving friends (74 percent) and acquaintances (79 percent). This is not surprising, as many women switch from condoms to other long-term methods of contraception as relationships become more serious.
What may be surprising, however, is that drinking in and of itself did not affect condom use. In fact, when researchers looked only at the relationship between alcohol and condoms, they found that events involving alcohol were more likely to involve condoms. Condoms were used in 70 percent of events involving drinking and 59 percent of events that did not involve alcohol. This does not mean, however, that tipsy girls are more likely to reach for the rubber. It goes back to relationship type—both condoms and alcohol are more likely to be used with casual partners.
There are two prevailing theories about how alcohol affects sexual decision making. The first is called “alcohol myopia theory.” (Yes, researchers have basically turned “beer goggles” into a legitimate topic of academic study.) As the authors explain it, this theory suggests that alcohol changes the way we process information. We can still process cues such as arousal that make us want to have sex, but we can’t adequately think through those more complex ideas such as the possibility of sexually transmitted infections or the fear of future rejection that might make us more cautious. Under this theory, women would be less likely to use condoms if they were drinking alcohol. The recent study, however, found otherwise:
After controlling for partner type, we found no associations between drinking and condom use, contrary to what might be predicted by alcohol myopia theory. Even in situations involving heavy drinking (four or more drinks), during which we might expect disinhibition to lead to decreases in safe-sex behavior, we found no evidence of decreased condom use across this sample of women.
The researchers did find, however, that in events during which women did use alcohol, condom use decreased as the number of drinks increased. They concluded that only extremely high levels of drinking reduce the probability of condom use.
There is a second theory about alcohol and sex that the findings of this study do support. Expectancy theory says that individuals’ behavior after drinking is driven by their beliefs about alcohol’s effects on behavior. Essentially, how you behave while drunk is a self-fulfilling prophecy—if you think you are going to take more sexual risks because of alcohol, you probably will. Researchers used a six-point scale to measure women’s expectations and found that those women who believed alcohol use increased sexual risk-taking were somewhat less likely to use condoms in events involving alcohol. This suggests we need to address expectations with women before they drink.
In my peer sex educator days, I wrote a workshop called Bedspins, which explored sex and alcohol. The basic premise was: We’re not going to tell you not to drink, we’re not going to tell you not to have sex, and we’re not even going to tell you not to drink and have sex at the same time, but you do have to think about it, preferably before you get blitzed. In one of the activities, I handed out index cards with either an S (sober) or D (drunk) on the back and had participants finish this sentence based on their assigned sobriety or lack thereof: “On Friday night I went to this party and met this really cute guy/girl. We started talking, and ____.” Not surprisingly, people were more likely to end the story with sex if they thought they were drunk at the time. I always liked to sneak in one card about mind-blowing sober sex just to buck expectations. This was 20 years ago, but clearly we still need to challenge the same assumptions because whether it is serving as a motivator of risky behavior or an after-the-fact excuse for it, expectations set the stage for actions.
That said, the researchers noted that in their sample of college-age women, “strong alcohol-sexual risk expectancy beliefs were relatively uncommon.” Only 13 percent of women in the study scored above a three on the six-point scale.
I think there’s a lot of good news in this study. For the most part sex was happening without alcohol and with a condom. Condoms were also more likely with new or casual partners, which seems to suggest that when women do forgo them it is part of a conscious decision based on the state of their relationship and possibly other birth control methods. Given the high rates of serial monogamy in college, however, I might suggest even more condom use, but in general I think this study gives us a view of young women making responsible sexual decision and I hope we all give them credit for it.
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This week, Mother Jones released an important story about how the European version of the drug Plan B emergency contraception would carry a warning telling women over 165 pounds that it’s less effective and women over 176 pounds that it likely won’t work at all. The story was a success from a policy perspective, as the FDA immediately responded by saying they will look into including similar warnings on American packaging.
Unfortunately, what could have been a clean victory for public health was sullied by the fact that many in the press have no idea how to handle a story about women and weight without bringing it back to fat-shaming. As reported at Think Progress, many headline writers around the country used the words “overweight” or “obese” in their headlines, even though the story is not actually about judgment calls about whether or not a woman weighs “too much” and it’s especially not about how much body fat she has. Because of this, the stories ended up delivering a pointless dose of shame alongside important health information, which may have made them less effective in getting the point across.
Because of that, I put together a quick guide on how reporters and editors can present stories about health care and weight that avoid fat-shaming. I’ve certainly failed at times to be as mindful as I can, but a little more diligence can help improve the quality of health care reporting.
Make sure your facts are straight! One of the major problems with using “obese” or “overweight” in the headlines for the Plan B story is that the package warning wasn’t about that. The warning is about women who weigh over 176 pounds. A woman who is over 6 feet tall can weigh that without coming close to the medical definition of “overweight.” Simply verifying that the story was about absolute body weight and not about other measures could have helped avoid this error. The word “heavier” was the best choice for headlines, because it was swift and accurate.
Not every story about weight needs to come back to the “obesity epidemic.” Not every story about weight and health is about how Americans weigh too much and need to lose weight. Obesity’s effects on health is a common news item, but as this Plan B story shows, there are other stories out there about how your weight affects your health care that aren’t about gaining or losing weight, or about dietary/exercise issues at all. Make sure your story focuses on the important issues—in this case, the limits of Plan B emergency contraception—and not about adding to the growing pile of stories chastising women about their weight.
Be mindful about what art you use. This story was about emergency contraception and package labeling. There was no need to use, as some outlets did, pictures of women standing on scales. (At least no stories I have seen used a picture of the headless fat person, something to be avoided at all costs because it’s so dehumanizing.) The illustrations insinuate the story is about weight management, when in fact it’s a story about drug efficacy. Pictures of the pills in question, of pharmacies, or even of women looking worried because they (presumably) had unprotected intercourse were all better options.
Only use the terms “obese” and “overweight” in the scientific sense, and reference whose definition you’re using. People throw those words around as if they were moral judgments or something you can just tell by looking at someone. Remind yourself that they are medical terms used by public health officials and should only be used in that context. To make sure that your audience is clear about this, reference whose definition you’re using when describing what counts as “overweight” or “obese.” Is it the CDC’s? WHO’s? There’s a lot of internal debate in the medical community about these terms, so make sure you’re clear which definition you’re using. If you’re not speaking in medical terms, avoid completely.
BMI is better for measuring populations, and doesn’t work for individuals. The Plan B story had nothing to do with BMI, and thankfully some reporters were careful to point that out. But overall, there’s a tendency in the media to treat BMI as if it’s a useful measure for assessing an individual’s body and health. It’s really not, in no small part because there’s so much individual variation regarding body type, genetic tendencies for certain nutrition-related disease, and muscle-to-fat ratio. The BMI might be a good way for public health officials to create understanding about what’s going on in a general population, but it’s not a useful way to render any judgment about a single person’s body. Avoid using it to talk about individuals altogether.
Do not marginalize people based on their weight. As the Mother Jones reported Molly Redden noted in the original story, 166 pounds—the weight at which current formulations of emergency contraception starts to lose effectiveness—is the average weight of the American woman. Beyond the shaming and the inaccuracy, this points to why using terms like “obese” and “overweight” are such a bad idea. The implication is that the story only affects a small number of women when really the story has widespread public health implications. Instead, write it with the people whose bodies are being discussed in mind as your primary audience. After all, as the Plan B story shows, they’re the ones who have the most vested interest in your piece. Why wouldn’t you write directly to them?
Weight and health care is a tricky subject, because there’s no way to completely separate the two topics, but there’s also so much shame built into the discourse about weight. It might feel overwhelming at times, but with these few simple suggestions, some of the major landmines can be stepped around. It’s important to do so, and not just because sensitivity is important in and of itself. It’s also because articles that come across as judgmental or shaming are unlikely to be read by people who need the information the most. And isn’t getting good health information into the hands of people who need it the whole point?
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Not long after the white puffs of smoke blew through St. Peter’s Square in March to announce his election as head of the Roman Catholic Church, Pope Francis set many a progressive heart aflutter, especially with regard to his oft-stated concern for the poor of the world.
The release on Tuesday of Evangelii Gaudium, the pope’s manifesto for the renewal of the church, has set off a pandemic of swooning among liberals, particularly because of the pope’s welcome critique of so-called “free market” ideology and the gaping income inequality it creates. Overlooked is the internal inconsistency of the document, in which exclusion of the poor from full participation in society is rightly portrayed as an evil, while exclusion of women from full participation in the church is defended as necessary.
When it comes to inequality of the sexes, Pope Francis enthusiastically embraces Rome’s status quo, using his great treatise on his dream of a kinder, gentler church to sanction the exclusion of women not just from leadership, but from performing the most holy of its rites: celebration of the Mass.
“The reservation of the priesthood to males…is not a question open to discussion…,” Francis writes.
While, in the same document, the pope also reiterates the church’s rejection of abortion as a moral choice and implicitly condones the marginalization of LGBTQ people, it is his blessing of a male-only priesthood that is arguably the most damaging, for it renders the church as a model justification for the view of women as subhuman—a view that lends cover to the rapist, the pimp, the bigot, and the chauvinist whose works the pope decries, even as he advances stereotypes about the “feminine genius” that women have to offer in acts of compassion and intuition.
As Sister Maureen Fiedler observes, Pope Francis “seems to think of women as a different species of human.” And it is from this “othering” of women from rest of humanity, I believe, that the church’s cruel and sometimes murderous denial of women’s reproductive prerogatives stems.
For Catholics, the Mass is a mystical, not just a representational, rite. The priest is believed to be the conduit, a channel of God’s grace, for the transformation of bread and wine into the actual body and blood of Jesus Christ. That’s an awesome power to have—rather god-like, in fact.
The church’s denial of priestly ordination to women is based on a trumped-up piece of theology known as the “natural resemblance” rationale. Simply put, since Jesus was a man, then only men can be priests. Fiedler, explaining and rejecting this theory, suggests that “to say that only males may image Jesus sacralizes masculinity.”
Put another way, Gloria Steinem, speaking at the National Press Club last week, quipped: “When God looks like the ruling class, the ruling class becomes God.”
Re-branding the Church
Despite its tortured logic with regard to the rights and role of women, both as human beings and as members of the Roman Catholic Church, Evangelii Gaudium (“Joy of the Gospel”) is a papal tour de force, both as a piece of literature, and for the institution Pope Francis puts forth as the church of his dreams.
The most radical changes called for by the pope in his exhortation have little to do with the critique of capitalism that has grabbed the headlines, but rather a proposed shift in the power dynamic of the existing hierarchy—he envisions a less centralized power structure—and a purge of corruption (described as “spiritual worldliness”) in the Vatican bureaucracy. But it is the change he seeks in the church’s image, which he has already set about by famously refusing to live in the sumptuous setting occupied by his predecessors, that has dazzled journalists and commentators.
In Evangelii Gaudium, the pope’s language is vernacular and, in its English translation, at least, pleasing in cadence. It is quite a departure from the prose that ordinarily fills official Vatican documents. In it, Francis speaks of himself in the first person, and admits certain faults of the church. In confirming the church’s opposition to abortion, for instance, Francis states:
Precisely because this involves the internal consistency of our message about the value of the human person, the Church cannot be expected to change her position on this question. I want to be completely honest in this regard. This is not something subject to alleged reforms or “modernizations”. It is not “progressive” to try to resolve problems by eliminating a human life. On the other hand, it is also true that we have done little to adequately accompany women in very difficult situations, where abortion appears as a quick solution to their profound anguish, especially when the life developing within them is the result of rape or a situation of extreme poverty. Who can remain unmoved before such painful situations?
Such an admission of the church’s shortcomings in tending to the needs of the desperate pregnant woman would have been unthinkable by this pope’s recent predecessors; in doing so, Francis casts himself in a more favorable light while doing nothing to change the doctrine that robs women of their full agency, and hence, their full humanity. It is also a doctrine that can rob a woman of her life.
The entire document, in fact, advances little change in the substance of church teaching, and more a change in style and tone. It is, at its essence, a blueprint for winning converts to the faith, and reeling in disaffected Catholics back to the church. It is a survival playbook for a church abandoned by its European flock, and losing substantial numbers among its North American constituency. In Latin America, the church faces steep competition with evangelical Protestant sects, and in Africa, it’s competing with those sects and with Islam. The stern and condescending Father-knows-best condemnations of Popes John Paul II and Benedict XVI—who launched a holy war against Latin America’s native Liberation Theology movement—proved to be deeply alienating.
A nice pope who seems to be of the people, who writes in an accessible style, who appears to understand the difficulties faced by those wriggling under the boot of global capitalism can only help the church’s predicament. And so Francis recasts the church’s social teaching on ministering to the poor in the language of progressive economists and the Occupy movement, and challenges unnamed Catholic politicians and business leaders (Rep. Paul Ryan [R-WI], House Budget Committee chairman and former vice presidential candidate, comes to mind) to abandon “trickle-down theories which assume that economic growth, encouraged by a free market, will inevitably succeed in bringing about greater justice and inclusiveness in the world.”
Such theories, Francis writes, pointedly, have “never been confirmed by the facts.”
Yet, in his defense of the faceless poor, Francis seems to miss the fact that women are more likely than men to be in poverty, and that is because of the very kind of structural inequality that his church models for the world as an image of holiness.
Doing Well by Doing (Some) Good?
I do not mean to suggest that the pope is insincere in his call to defend the poor. I believe that he is. And his pronouncement certainly does put those Catholics who advance the cause of Ayn Rand and the fortunes of the Koch brothers in an uncomfortable position. If that helps to save the Supplemental Nutrition Assistance Program (SNAP), a.k.a. food stamps, from the chopping block, that’s all to the good. If the bishops put more of their diocesan budgets into to bringing real services and comfort to the poor, that would be outstanding. But it would be naive not to note that Francis’s call to serve the poor also serves the pope’s obvious effort to rebrand the church, still suffering the moral bankruptcy of its child-abuse scandal, as a force for good.
So, too, does the pope’s admonishment, apparently aimed at members of the Curia (the Vatican bureaucracy), to avoid going on “witch hunts” of those deemed doctrinally impure. Although again, the pope declines to provide examples, it’s hard not to think of the Vatican’s 2012 attack on the Leadership Conference of Women Religious for facilitating the spread of “radical feminist ideas,” when reading those lines. The bishops and the Vatican lost big in the court of public opinion on that one, when it was revealed that American Catholics like their nuns much better than they do their prelates.
Francis cites the withholding of the sacrament of Communion from the impure—as has been done to punish pro-choice Catholic politicians—as not particularly helpful. He urges priests to stress the joy of the Gospel in their homilies, and advises them not to deliver sermons that comprise lists of obligations.
In an interview given earlier this year to the Jesuit journalist, Rev. Antonio Spadaro, Francis suggested that church officials stop harping on church teaching that opposes abortion and condemns homosexuality. He didn’t suggest that any change was warranted to those doctrines; just that it was not really helping the church to keep emphasizing them. (Interestingly, Wisconsin Gov. Scott Walker [R], who is Roman Catholic, recently told a press gathering organized by the Christian Science Monitor that while he is anti-choice and personally opposed to marriage equality, he preferred to talk about fiscal issues.)
“Exclusion, Mistreatment and Violence”
In the section of Evangelii Gaudium titled “The Inclusion of the Poor in Society,” Pope Francis throws this bone, without irony, to women in poverty:
Doubly poor are those women who endure situations of exclusion, mistreatment and violence, since they are frequently less able to defend their rights.
All women, of course, “endure situations of exclusion” from the leadership of the church, and that very exclusion sows the seeds of their mistreatment both within the church and in the greater society. A powerful message, marginalizing women as creatures unworthy of respect and incapable of authority, is inherent in the very image of the church’s leadership.
Women are to content themselves with whatever grace trickles down to them via the transformative powers invoked by the male priest.
The Roman Catholic Church, with its own nation-state, temporal power around the world, and command of media attention, is arguably the most visible religious institution in the world. Any entity that treated any other class of people as the church treats women would rightly, in the 21st century, be a pariah institution. But since it’s women we’re talking about, it’s all right. And the sad thing is, I don’t think the pope even sees the internal contradiction in his words.
Surely you can give the pope some props for his comments on the evils of free-market economics, one liberal male friend said to me, when I expressed my disgust at the kudos raining upon the pope with the publication of his magnum opus. Wow, said another, you’re really going to lay into him for not making changes yet on the position of women in the church?
So here are my props on economics section of the pope’s treatise. This from Evangelii Gaudium, is just terrific:
Just as the commandment “Thou shalt not kill” sets a clear limit in order to safeguard the value of human life, today we also have to say “thou shalt not” to an economy of exclusion and inequality. Such an economy kills.
But by that same logic, an honest person must then say “thou shalt not” to a theology of gender exclusion and inequality.
Such a theology kills.
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