Women, Republicans and the rhetoric of 'choice' By Alexander Sanger
The Guardian, April 20, 2012

 "What we want is women to be able to make their own choices […] We want women to make their own choices in healthcare … Women don't need anyone to tell them what to do on healthcare. We want women to have their own choices, their own money, that way they can make their own choices for the future of their own bodies."

 I couldn't have said it better myself. But to my surprise, these were not the words of Hilary Clinton or Michelle Obama. Rather, they were uttered by Representative Michele Bachmann, on Sunday's Meet the Press during a segment about Obamacare. And while I am sure these words made her press secretary cringe, they made me take note of the way the notion of "choice" has recently crept into Republican talking points.

 Like Representative Bachmann, I do believe in the inherent right of all women to make their own decisions and control their bodies. Bachmann is not the first anti-choice politician to recently wade into the vernacular of choice and bodily integrity.

Last week on the Daily Show, correspondent Al Madrigal took a closer look at Oklahoma state senator Constance Johnson's proposed amendment to the state's "personhood" bill that would effectively outlaw the deposit of sperm anywhere outside of a woman's vagina. When Madrigal interviewed Senator Ralph Shorty, the architect of the Oklahoma "personhood" bill, Shorty explained that he could not add Senator Johnson's "Every Sperm is Sacred" amendment because "it would be a huge free choice issue. Basically, a government is telling a man what he can and can't do with his body."

 Lately, the notion of choice has even extended beyond bodily integrity to (gasp!) the decisions women make about their professional lives. Responding to criticism about her lack of work experience, Ann Romney went on television last week to champion a woman's right to choose to work or stay home, stating that we need to respect a woman "in all those choices that they make."

 Romney, Shorty and Bachmann hit the nail on the head: we should respect the choices that women and men make about their bodies and their lives. If you support a woman's right to choose, that includes her right to choose to work, to take contraception to delay pregnancy, to end an unintended pregnancy and to abstain from sex altogether. All of these are decisions that women have the right to make – as Senator Shorty suggested – without government interference. And none can be supported in isolation. 

The word "choice" resonates throughout the entire political spectrum. It has to do with liberty and freedom, the basic principles of democracy that modern-day Republicans defend day in and day out – as long as it doesn't have to do with sex or reproduction. The problem is that Republicans, sensing the loss of moderate women because of their attacks on Planned Parenthood funding, are now overzealous in the usage of the word "choice", but acutely selective in applying its principles when it comes to women. I am pretty sure most women would agree that you can't have it both ways. Women know that they are better at making choices for themselves than any government ever would be.

 http://www.guardian.co.uk/commentisfree/cifamerica/2012/apr/20/women-republicans-rhetoric-choice

The World Health Organization (WHO) recently held a technical meeting to evaluate whether to change its advice regarding couples at risk of HIV using hormonal contraception. There has been evidence indicating that hormonal contraception puts couples at increased risk of acquisition of HIV, transmission of HIV and progression of HIV. The WHO group decided to leave its guidelines as is, i.e. not recommending against hormonal contraceptive use but added the following:

"Some studies suggest that women using progestogen-only injectable contraception may be at increased risk of HIV acquisition, other studies do not show this association. A WHO expert group reviewed all the available evidence and agreed that the data were not sufficiently conclusive to change current guidance. However, because of the inconclusive nature of the body of evidence on possible increased risk of HIV acquisition, women using progestogen-only injectable contraception should be strongly advised to also always use condoms, male or female, and other HIV preventive measures. Expansion of contraceptive method mix and further research on the relationship between hormonal contraception and HIV infection is essential. These recommendations will be continually reviewed in light of new evidence."

The quality of the clinical trials that the WHO reviewed were considered, by the WHO, to be low. This is scandalous. Given the many university-led trials on this issue, why can't the WHO and the scientists agree on how a trial on this vital issue should be carried out. Hopefully, they now will.

The WHO statement was met with some sharp criticism for not going further in warning and discouraging women from using hormonal contraception. See http://www.avac.org/ht/d/sp/i/42152/pid/42152.

For the WHO statement, see: http://www.who.int/reproductivehealth/topics/family_planning/Hormonal_contraception_and_HIV.pdf

In case you missed this:

http://www.slate.com/articles/news_and_politics/human_nature/2012/02/the_komen_fiasco_how_to_drive_planned_parenthood_out_of_the_abortion_business_.html

One of the most under-reported stories of 2011 was the prevalence of prenatal sex-selection in countries in Eastern Europe and in former Soviet Union Republics like Albania, Armenia, Azerbaijan and Georgia. The Council of Europe reported that these nations have sex selection ratios at birth of 112 for the three "A's" and 111 for Georgia (i.e. 112 males are born for every 100 females), far above the norm of 105-6. This level is the same as India. China is at about 120. The imbalance in the sex ratio is caused by both the selection of a male embryo for implantation in assisted reproduction and sex selection abortion.
The results were set out by the Council of Europe Report: "Population imbalances, which are likely to create difficulties for men to find spouses, lead to serious human rights violations such as forced prostitution, trafficking for the purposes of marriage or sexual exploitation, and contribute to a rise in criminality and social unrest."
Unnoted by the Council of Europe is the long term population decline in three of these countries. Albania's population has fallen 7.7% in the past decade. Armenia's and Georgia's have fallen as well, both from emigration and smaller family size, while Azerbaijan's, with its Muslim majority and tradition of larger family size, has been rising. In fact, much of Eastern Europe and the nations of the former Soviet Union are seeing absolute population declines from both emigration and smaller family size. China faced similar pressures with its One Child Policy, which forced many parents to chose a male heir, since they would have only one child. But Korea, with no One Child Policy and India similarly, ended up with imbalanced sex ratios, though smaller than China's. Lack of perceived economic opportunity leads parents to curtail family size. Note the decline in childbirths in the US during the current economic difficulties.
The sex selection disease has not spread yet to Western Europe or the Western Hemisphere, but it is something that policy makers need to keep an eye on. Laws against revealing the sex of a fetus, in effect in India, do little good. A broader cultural change is needed. Korea showed that this could be done, when that country reversed its sex ratio problem through cultural messages on valuing girls. An interesting twist is in Japan where parents having one child prefer girls.
There are profound human biological forces at work in childbearing. Children are the parents' future in more ways than one. This must be understood and respected, even as we strive to help parents see the alternatives.

It is expected that President Obama will soon sign a “megabus” spending package for fiscal year 2012 (H.R. 2055), which includes funds for international family planning and reproductive health programs. Essentially the funding is the same as the previous budget, neither a cut nor a raise. A raise was sorely needed but was not to be, despite heavy lobbying by us at IPPF and success in the Senate. The House remained opposed and wanted deep cuts. The compromise was level funding.

The State Department and foreign operations bill section of the bill includes a total of $610 million in bilateral and multilateral family planning and reproductive health funding. Comparable FY 2011 funding totaled $615 million.

The bill includes $35 million for a U.S. contribution to the UN Population Fund, a $5 million reduction from the amount appropriated last year. The bill continues the requirements that UNFPA maintain U.S. funds in a segregated account, none of which may be used in China or for abortion, and mandates a dollar-for-dollar reduction in the amount provided to UNFPA by a sum identical to that spent by UNFPA in China.

The funding bill does NOT reinstate the Global Gag Rule, something the House wanted but the Senate resisted. The Senate in fact wanted to prohibit the President from reinstating it. This too, alas, is not in the bill.

Presentation by Jacqueline Sharpe, President of IPPF, Nov 26, 2011, London

Alex Sanger is an ideal volunteer, fully committed to our vision, richly endowed with all the qualities that enable him to make effective contributions to IPPF, generous both with his time and financial resources.

Alex learned about unmet need in the lap of his grandmother, Margaret Sanger, who founded the birth control movement 90 years ago and travelled extensively throughout the world to lay the groundwork for assembling the international group that created IPPF in India in 1952.

Alex was not always a volunteer. Until 2000 he was the CEO of Planned Parenthood of New York City, PPNYC, one of the largest affiliates in the international family planning community. With a budget of over $20 million dollars, PPNYC serves a diverse population of over 75,000 New Yorkers with innovative medical and educational programs, and millions more through its extensive advocacy initiatives.

As a volunteer, he is currently member of the IPPF/WHR Regional board, and the chair of International Planned Parenthood Council, which is fully dedicated to fund raising for IPPF. As such, he travels extensively using his remarkable oratorical skills to motivate individuals – both millionaires and less endowed regular citizens as well – to support our fellow citizens who are vulnerable and don’t have access to contraception unless IPPF helps them. He walks the talk and uses very creative techniques. For instance, recently, when he sold his apartment, he included in the deal a generous donation to IPPF.

A prolific writer, he is the author of the book Beyond choices: Reproductive Freedom in the 21st Century, and is frequently featured with articles in major newspapers and in websites and blogs. Recently Alex published key articles in defense of our movement when one of the most radical candidates for President of the United States made some blatantly false accusations that had wide repercussions.

Alex cares about every aspect of our work. In the last few years - working closely with the staff in a very respectful way as always – Alex headed a real estate committee of the IPPFWHR Board. Numerous hours were dedicated to major and minor decisions, and detailed - and humorous – reports kept the whole board in the loop. Carmen and her staff were extremely grateful for his guidance and support – and for the state of the art coffee machine he donated to the new office. He is also a great cook, annually contributing the best brownies to the pot-luck lunch of the WHR office, when staff feast on the culinary excellence of their peers who represent the diverse cuisine of the whole region.

Ideas, financial donations and even food: we are honored to make Alex Sanger the recipient of the individual Volunteer Award.

Reproductive Health in the Sacred Valley of Peru - July 2011

The Sacred Valley of Peru, outside of Cusco and the gateway to Machu Picchu, but so much more, is one of the last indigenous bastions of Peru. The people speak Quechua, an ancient Inca language, and make their living by farming and livestock. Men, women and children work the farms on the valley floor and high on ancient Inca terraces that climb the Andean peaks up to 4,000 meters or more. They dress in traditional clothes and live in mud brick dwellings, which the higher you go, the fewer amenities like electricity and water they have.

I spoke to some of the local women through a translator. Rosario is 47, farms and has 6 children from 27 to 14. Her first five were delivered at home; her sixth she delivered in the local hospital, because she was having a difficult pregnancy (risks in pregnancy increase with the number of deliveries). Just before she entered the hospital, her husband had an accident and injured his foot so badly that he was unable to work their farm. Because she, and her children, were now responsible for the farm without his help, she decided to have a tubal ligation after her delivery. She wanted more children but sacrificed for her living children and husband, whom she had to feed.

Her method of birth control between pregnancies? Achank’aray, a local herb grown high in the Andes. The indigenous women collect it and boil it to make tea. One cup a day prevents pregnancy. When Rosario was ready for her next child, she stopped taking the tea. As for sex ed, this is commonly done by the grandmother. Herbal recipes are passed down from generation to generation. There are no herbal contraceptives, alas, for men. There is, however, one plant that lessens male aggression. If a husband is abusive or violent, then the local women wash his underwear in a plant called tuberculo. Alternatively, they put it in his drink. After two days the husband’s libido and aggression are markedly lessened.

I then met an extended family: Mercedes, age 62 with her daughters and daughters-in-law, Florentina, Isidora and Isabella. They all live in the same small house, in the valley. Mercedes, age 62, had 8 children ages 38 to 19. These children have 2, 3 or 4 children each. Florentina, age 25, a daughter-in –law, has just two, ages 7 and 2. She does not want any more children and uses birth control injections every three months from the local health facility. She pays 10 Soles per injection, or around $3. She gets headaches as a side effect but continues, since she cannot afford to educate her children. While the tuition is free, the school uniforms, books and school supplies are not. My gifts of pens and paper were most welcome.

Isidora, age 35, a daughter, has 4 children, ages 12, 10, 7 and 4, all delivered at home except the last. She too uses injections for birth control.
Isibella, age 37, another daughter, has 3 children, ages 16, 8 and 4. She says she does not use contraception.

I passed on to a pair of women waiting to take batches of barley to the Sunday market in Pisac. Regina, age 37, has two children , ages 16 and 12. She uses the calendar method for birth control, since injections are too expensive. She lives too low in the valley to find the herbal plants.

Her friend, Modesta, age 43, had four children. After the delivery of her fourth at the local health facility, the doctor pressured her into having a tubal ligation, even though she wanted more children. She says she feels constantly sick, since she is not getting her monthly period and toxins are building up inside her body. She is angry.

None of the women tell their husbands they are on birth control. Machismo is a reality of life. Men want children and equate birth control with their wives having extra-marital affairs.

While hardly a scientific sample, these women represent the challenges of poor women in Peru. Traditional methods remain in use, but many have changed to modern methods despite the costs and side effects. The number of children per woman is declining. The concept of unwanted children is virtually unknown, rather, women want many children to farm the land. Women alone are responsible for birth control and have to use it surreptitiously. None mentioned abortion. Nor was there any infant mortality.