Oct 30 2009

Pill does not cure gender inequality

There’s a very illuminating leader in The Lancet last week about maternal mortality and the fact that despite sustained global campaigning efforts there has been little progress on the Millennium Development Goal to reduce maternal deaths by 75% by 2015.

The article makes some good suggestions for why this has been; vertical disease programmes have seemingly been based on straightforward interventions while maternal health programmes do not rely on ‘a pill'; maternal health progs have been limited and not taken into account the interactions with other health issues (e.g. HIV/AIDs and maternal deaths); there has been a paradigm shift within maternal health from vertical interventions to health systems strengthening which has not been matched with a funding shift; etc.

But one thing that was not mentioned, and only alluded to by reference to a ‘continuum of care’, is the impact of the status of women, views on female sexuality and reproductive autonomy which arguably are greater indicators of maternal death than skilled birth attendants (although in fact these things are inextricably linked).

For example, Sierra Leone has one of the worst maternal mortality ratios in the worst (either 1st or 2nd together with Afghanistan). Over 90% of women are also subjected to female genital mutilation in Sierra Leone (UNICEF).

Similarly in South Africa where there is particular interaction between maternal deaths and HIV/AIDs there is also endemic sexual violence where it is estimated that women born in South Africa have a greater chance of being raped than learning to read.

Now we cannot wait for female emancipation around the world to bring down maternal mortality, but we have to take an approach to tackling women’s health problems which recognises societal influences, culture and the centrality of sexual and reproductive rights to saving women’s lives.

A WHO study found that about 40 per cent of the healthcare infrastructure across sub-Saharan Africa is operated by faith-based groups. I have heard much higher estimates than that. This would inevitably have an affect on women’s (as well as men’s) sexual and reproductive rights, access to information and access to services.

This picture was taken in a Catholic run health centre in Kenya. It is a HIV/AIDs prevention poster in which a sticker has been put over the phrase ‘Use a Condom’.

This picture was taken in a Catholic run health centre in Kenya. It is a HIV/AIDs prevention poster in which a sticker has been put over the phrase ‘Use a Condom’.

To reduce maternal deaths, women need to get married and have kids later, have less children therefore use family planning, be well nourished and free from disease, have access to primary healthcare as well as emergency obstetric care (which is culturally appropriate and in their language), have access to safe and legal abortion, and be educated in their rights, their right to healthcare, their right to information and – very simply – have the right and ability to say no or yes to sex and insist on condom/contraceptive use.

Drug treatment of post-partum haemorrhage or sepsis may fit nicely into our drug delivery programmes, work well with our partnerships with pharmaceutical companies, and definitely help save lives. But it is a drop in the ocean without women themselves having bodily integrity.

Oct 24 2009

Freshen Breath the Unconventional Way

Pongwiffy: A Witch of Dirty Habits was one of my favourite children's books. Says a lot.

Pongwiffy: A Witch of Dirty Habits was one of my favourite children's books. Says a lot.

I guess it is something that they are still inventing things that surprise you. You think you have everything you ever wanted, every consumer good imaginable and then something pops up and you are left open-mouthed.

This is how I felt recently when I came across (no pun intended) vagina fresheners. Yes, I’m afraid you read that right. Mints that feed into the Va-jay-jay to give it a tangy flavour.

I’ve linked before to this study which shows that having a low opinion of one’s fanny-fu-far is bad for women’s sexual health (for Americans: fannies are ladies front-bottoms and we snigger whenever you use the word, heh). And yet we have to put up with jokes about fishy smells and frankly creepy, unnecessary products designed to feed off women’s insecurities.

As well as poonanie mints people have invented deordorising tampons, vaginal deodorant (is it just me or do fragrances called ‘tropical rain’ and ‘island splash’ seem inappropriate?), wipes (links to blog asking if vag wipes are a sign of politeness) and douching (this is a link to the Science Museum, ftmfw). All of these things are invented and marketed to make you feel like you need something other than soap and water to be clean and healthy. You don’t.

This impacts on women’s health because if they always think that the pink clink stinks then they are less likely to notice changes which may signify infection or seek help and advice (similarly vibrator use actually increases sexual health). Plus being self-conscious of your wookie effects your enjoyment of oral sex which instead should be savoured.

There is nothing peculiarly smelly about women’s bits. Any enclosed area that gets sweaty gets wiffy – male as well as female.

So back off with the fish jokes, everyone knows the hairy clam tastes of milk and honey.

Oct 20 2009

The myth of the computer science gene

This is a great slideshow on a topic I have written about a few times; computer science, women’s brains and gender differences in what are perceived to be ‘male’ subjects.

Slide 21 is particularly helpful for the intelligence debate…

People need to realise that the diagram below works for women and men. Oh and how it does.

Nerd Venn Diagram

Nerd Venn Diagram

Previous posts on female/male intelligence and women and open source software.

Oct 11 2009

Vagina Dentata Dresses: On sale at Top Shop

New Top Shop designer Christopher Kane came up with this lovely number.

croc dress

I’ve actually seen someone wearing this in the street and now pretend that they are secret fans of my blog :)

Oct 11 2009

While everyone is on the subject of HPV…

It is distasteful to see a number of anti-vax headlines (which have subsequently been taken down) reporting the tragic death of a 15 year-old girl after she had received the cervical cancer jab. Of course we learnt soon after that Natalie Morton had a malignant chest tumour but that was after the vaccination programme had taken a hit.

None of this furore really leads to a conducive atmosphere in which we can talk about possibly extending the vaccination to boys, but I’ll give it a go.

This week the British Medical Journal published a study into the cost-effectiveness (or not) of extending the HPV vaccine programme to boys as well as girls. Of course, cervical cancer is not the only cancer associated with HPV 16 and 18, which the Cervarix vaccine covers, but also vulvar, vaginal, and oropharyngeal, anal, and oral cancers.

The vaccine would therefore not only have direct health benefits for males but also to indirect health benefits (for sexual partners) through reduced transmission of HPV.

To be clear (unlike the Sunday Express) this was research done in the US on Gardasil not on Cervarix which is being rolled out in the UK. There has however, been similar research in the UK by the Joint Committee on Vaccination and Immunisation which lead to the current recommendation that the vaccination programme should only cover girls (cost-effectiveness of vaccine to girls here).

The BMJ research continued that:

Given currently available information, including boys in an HPV vaccination programme generally exceeds conventional thresholds of good value for money, even under favourable conditions of vaccine protection and health benefits.

Put simply, there would not be enough benefit from boys being vaccinated to make the extension to the programme value for money. What is interesting is that it does highlight where a pure cost-effectiveness analysis can miss important social policy aspects.

The British Medical Association voted at its last Annual Representative Meeting (ARM) for the vaccine to be rolled out to boys as well as girls. The arguments did not rest only on the effectiveness of the extended coverage but also on the impact that limiting the vaccine to girls – namely, that both men and women should take responsibility for eradicating HPV from the population rather than women taking sole responsibility.

This is not just a political point or an abstract notion of ‘fairness’, it is also a public health one. Due largely to the risk of pregnancy, women routinely take more responsibility for sexual health then men (I won’t go into it here but this still has implications for lesbian and gay people). Therefore, gender discrimination and inequality impacts on sexually transmitted infections when for example, women are not in a position to insist on condom use. This is not just the role of sexual or public health education, our systems and programmes need to support the principle of men and women taking responsibility for sexual health matters.

This is why the 1994 International Conference on Population and Development in Cairo spawned the ‘Cairo Consensus‘ which acknowledged the need to increase male responsibility for family planning and recommended expanding services in ways that protect the reproductive health of both men and women. However, cost is always going to be a barrier.

Before I’m accused of being in the pocket of Big Pharma on this one (er, unlikely) it is important to acknowledge the well-founded concerns regarding Merck’s aggressive marketing of Gardasil in the US and the suspicion that Merck would be behind any extension to the vaccination programme. Believe me the last thing I want to do is contribute to Merck’s profits.

I am not arguing that Cervarix should definitely be rolled out to boys as well as girls, simply that (rather ironically) focusing on evidence-based medicine can be overly simplistic if it fails to take into account important social factors and the cumulative impact of focusing sexual health interventions on women and girls. I also acknowledge the economic need to ration health care and that cost-benefit analyses are important but necessarily cannot factor in every eventuality.

Vaccine policy based on QALYs alone? Unfortunately society’s a bit more complicated than that.

This is cross-posted on The Lay Scientist.

Oct 5 2009

New Site. New Blog. Same subject matter…

I thought I’d cleverly launch my new site by guest blogging somewhere else. I’ve helped hijack The Lay Scientist which is run by my good friend Martin Robbins who is too busy being lofty and writing for the Guardian. I’ve cross-posted the article below – but this is by way of an explanation for why it sounds like I’ve never written about vaginas before….

Waiting for clitoromania

I’m very excited to be guest blogging at The Lay Scientist and have to say its a bit like being in someone else’s flat without them being there. I obviously don’t do that too often and am just managing to keep myself out of Martin’s knicker drawer.

I thought I might start as I mean to go on, by writing about vaginal orgasms. Call me an attention seeker.

I was sent a study from the Journal of Sexual Medicine by the fabulous and recommended Dr Petra Boynton and have to say that, however angry it made me, I will be forever in debt to Prof Stuart Brody for introducing the word ‘clitoromania’ into my life.

Needless to say, the study is more than a little Freudian. Feminists have frequently had a problem with Freud, mostly on the basis that he was talking bollocks (heh), but also because he was often hugely simplistic and lacking in evidence. Somewhat like our new friend Prof Brody.

Dr Petra makes some excellent points about the flaws in the methodology of this study, notably that it was a questionnaire which was asking the female participants to estimate and recall such things as partners’ penis length, duration of penetrative sex and what they had been taught about female orgasms. Questionnaires asking for estimation and recall may return interesting information on attitudes but does not lead to very credible factual information. For example, you may be likely to say that your lovely partner has a larger than average cock because you’re a nice person not because its true.

But I can’t shrug off the feeling that Prof Brody has an agenda here, most notably because of his reference to women’s studies courses (codeword for hairy-armed, feminist, lesbians):

Many North American university courses, including women’s studies courses, promulgate texts that falsely claim that vaginal orgasm does not exist, is very rare, or is essentially the same as clitoral orgasm.

Really? Do they really? Really, do they? There is no evidence offered to support this statement or indeed most of the statements made in the discussion of this paper which specifically do not follow from the evidence reported by the survey.

There is an illustrious history of ‘scientific’ fascination in female sexuality and genitalia; from hysteria (meaning literally disturbances of the uterus, hence hysterectomy) to the widespread myth (for I’m afraid it is a myth) of the vagina dentata. The problem is how bad science, and bad science reporting, can be irritating but also damaging – to health, sexual satisfaction, and relationships.

This study generated the headlines “Women’s ultimate fantasy: Size not foreplay“, “Wait. Size Matters, After all?”, “The elusive orgasm” and “Oui, la taille du sexe, ça compte’ (roughly translates ‘Yes, the size of the sex counts’, but check out the less than supportive accompanying picture).

So there’s pressure to orgasm, to have multiple orgasms, to not take too long and now according to this study, have the right sort of orgasm. Listen Stuart Brody – back off.

It is a concentration on “doing sex right” which leads to the medicalisation of male and female sexual ‘dysfunction’. I don’t deny that sometimes drugs and treatments for sexual dysfunction are necessary and beneficial to individuals but often, and certainly historically, we are being told that there is a right and wrong way to have sex and if you’re not doing it right then you have to be corrected.

Humans, together with other animals notably the bonobo (great article, doesn’t link to animal porn. Honest), have sex for pleasure not simply procreation. By sex, I don’t share Brody’s fixation on heterosexual penetrative sex (believe me it is a fixation, see here, here, here) I would include oral sex, same-sex sex and all number of sexual practices which I’m not going to list here because you all have access to the internet.

Focusing on heterosexual penetrative sex is therefore frankly boring, unrealistic and makes us less adventurous than our ape cousins.

Instead let me recommend this study to you, which is also survey-based but is explicitly collecting data on attitudes, on the health impacts of women having positive attitudes towards their genitals. Debby Herbenick the lead researcher draws attention to how our culture portrays women’s genitals as dirty and in need of cleaning and grooming and how this impacts on sexual health and satisfaction.

Although the point of science is to check for biases and strive as far as is possible for objectivity, it still takes place – and importantly is reported – within a cultural context. A cultural context which is full of inequality, prejudice and discrimination.

This is why when you read the headline “scientists say size does matter” followed by a story of a flawed study that certainly doesn’t prove penis size increases the prevalence of vaginal orgasms; stop and think – I wonder why? When you do, you would have taken your first step on the path to feminism 😉

Naomi Mc blogs as Vagina Dentata. She was dragged by our over-centralised economy to London from Scotland and finds it to be “not that bad”. She’s a human rights activist and hearts epidemiology.