Recent Resources for Feminists
DifferenTakes #37: Ten Reasons Why Prisons are Bad for Reproductive Freedom Print E-mail



DifferenTakes is an investigative series of issue papers, published by the Population and Development Program at Hampshire College, providing alternative information and analysis on a wide range of reproductive rights, population, environment and social justice issues.  We are launching a special series of DifferenTakes focusing on 'Reviving Reproductive Safety' in movements for women's health and reproductive justice. 

We are pleased to send you the seventh in the series, "Ten Reasons Why Prisons are Bad for Reproductive Freedom" by Eesha Pandit.  This issue explores how prisons and the criminal justice system in the U.S. have specific consequences for women's reproductive freedom.  We are also planning to develop a poster version of this article and will be in touch when it is complete.

- Betsy Hartmann and Amy Oliver
Co-editors, DifferenTakes
Available in
[pdf version] | Poster (Legal-size and ready to download)

NO. 37 ~ Fall 2005

Ten Reasons Why Prisons are Bad for Reproductive Freedom

By Eesha Pandit

The nightly news is ridden with gruesome tales of increasing crime in our communities. Daily, battles are fought and lost in the ?war on crime? and the ?war on drugs,? both of which are pseudonyms for the criminalization of poverty. Are our communities stronger and healthier as we become increasingly dependent on systems of incarceration to solve social problems? The answer is an emphatic no. Further, prisons and the criminal justice system at large have specific consequences for women?s reproductive freedom. Here are 10 reasons why women?s health and reproductive rights advocates should think critically about prisons, their impact on women and their role in our society.

1.      Prisons devastate families and communities.

The U.S. has the largest number of people in prison in the world, and women are the fastest growing prison population.  Since 1980, the number of women incarcerated has risen by almost 500%.[1] Family ties and relationships are inordinately strained when a mother is incarcerated. About 78% of women in prison have children, but they are often incarcerated in federal prisons out of state or in state prisons in remote towns.[2] Less than half of these women are able to see their children and families. Furthermore, incarcerated women are at a high risk of losing their children. According to the Adoption and Safe Families Act of 1997, a woman loses her parental rights to a child who has been in foster care for 15 of the previous 22 months. Thus, a great majority of women who must place their children in foster care during their incarceration will lose them.[3]

Such facts raise larger questions about what effects prisons have on the social fabric of our communities. Prisons impact children, partners, wives, mothers and community members. Women often bear the burden of supporting households in which a partner is incarcerated.  Children of inmates are at risk of educational failure, joblessness, addiction and delinquency.  Much of this devastation is caused by the so-called ?war on drugs? and mandatory minimum sentencing. The drug war does not promote and protect family values, as many would have us believe.[4]  Between 1986 and 1996, the number of women in prison for drug law violations increased by 421 percent.[5] The vast majority[6] of women are incarcerated for relatively minor, non-violent crimes.  Instead of incarceration, these women need access to drug treatment, education and decent jobs.

2.      Prisons pose a particular threat to women of color and poor women.

Women of color are the fastest growing prison population in the country today[7] and most come from underprivileged and under-resourced environments.  Almost half of all women in prison report that they have been sexually assaulted during their lifetime.[8] Victims of sexual assault are more likely to be forced into homelessness and poverty, which often precede drug use, prostitution and committing economic crimes.  Women of color and poor women are least likely to have access to the necessary treatment and counseling for sexual abuse. Instead of receiving such care, they are incarcerated and treated as criminals and not victims of a system that has failed to protect their rights.[9]

Once these women serve their sentences they are further denied access to the public services and support that they need to prevent themselves from winding up in prison yet again. Anyone who has been convicted of a drug-related felony is prohibited from receiving cash or food stamps and living in public housing.[10] Thus, many women ex-prisoners are unable to provide for themselves and their children, continuing the cycle of punishing women not for crimes they commit, but for their poverty.

3.      Prisons perpetuate the criminalization of sexuality.

Discrimination and oppression in society at large make certain communities more vulnerable to state violence.  LGBTQ people often face increased violence from law enforcement officials, which jeopardizes their reproductive and sexual health. Until very recently, it was criminal for LGBTQ people to engage in sexual activity. Such legislation stems from the state?s desire to control sexual activity in certain communities. Sex itself is not criminal ? unless you are poor, LGBTQ, and/or a person of color. Likewise, sexual abuse by prison guards is often attributed to the hypersexuality of female prisoners, particularly women of color. The demonization of (female and queer) sexual deviance is commonplace in our culture, and because of our reliance on prisons, this translates into increasing numbers of women and LGBTQ people in prison.[11]

4.      Prisons are detrimental to women?s overall health.

Women in prison are subject to some of the worst health services known to exist. The recent exposé ©n the New York Times regarding the now infamous Prison Health Services Company only scratches at the service of human rights abuses perpetuated against prisoners in the United States.[12] This violence affects the lives of women in very specific ways that often fly below the radar of mainstream prison reform activists.

Women are often denied very basic health care rights while in prison. Women in the California prison system are denied access to necessary medical diets, basic hygiene products like soap, shampoo and toothpaste, as well as essential medication.[13] Women suffering from treatable diseases and mental illnesses are often denied medical treatment and access to health care and gynecological and reproductive services.[14] Often such negligence causes exacerbation of their illnesses and leads to unnecessary, expensive and dangerous medical procedures that could have been avoided with proper and preventative care. In extreme, but not entirely uncommon cases, this form of medical neglect results in death.

5.      Prisons restrict reproductive choice.

Prisons function in several ways to prevent women from exercising control over their reproduction. The extreme medical neglect in the criminal justice system jeopardizes women?s right to make their own reproductive choices by endangering their health and fertility. Often, the failure to screen for and treat sexually transmitted infections and cervical cancer leads to infertility and preventable hysterectomies.[15]

Further, detention centers, jails and prisons often interfere with a woman?s right to an abortion. They require women to bear the cost of the abortion as well as security and transportation to a clinic. Often, a court order is required before women are taken to a clinic, causing such a long delay that the abortion is no longer possible when the necessary permissions are granted.[16]

Women who are pregnant at the time of their detention face a lack of adequate and available prenatal care. They report difficulty in accessing health care services and obstetricians. They are denied prenatal vitamins and the appropriate diet and work assignments. If they suffer from a drug addiction, they are denied the requisite medication to prevent unnecessary miscarriages and stillbirths.[17]

6.      Women in prison face sexual abuse.

Women in prison face the threat of sexual violence on a daily basis. Seventy percent of guards who are responsible for monitoring women prisoners are men. These guards are responsible for supervising women prisoners throughout the day, including in the showers and bathrooms. A very high degree of rape, sexual assault, groping during body searches, and extortion occurs. To prevent women from reporting their abusers and to punish those who may have spoken out, guards use threats of physical assault and sentence extension and deny women visitation by their children and family members.[18]

7.      Prisons negatively affect pregnancy and motherhood.

Law enforcement officials, judges and elected officials nationwide have sought to punish women for their actions during pregnancy, which may affect the fetus they are carrying.  Women can be charged with child abuse, fetal homicide or drug trafficking if they test positive for drugs during pregnancy. Often women are tested for drugs without their knowledge. While in prison, the active endangerment or neglect of a pregnant woman can result in the termination of her pregnancy. Often the women themselves are held accountable and further punished for these outcomes.[19]  Women and children?s advocates agree that women should engage in healthy behaviors that promote the birth of healthy children, yet they realize that a woman?s substance abuse problem involves complex factors that must be resolved with treatment and social services, not incarceration. Thus, prisons violate a woman?s privacy rights, criminalize a medical and social problem and offer nothing to help women have healthy babies.[20]

Furthermore, irrational security measures dehumanize and endanger women during childbirth. In most states, it is standard practice to shackle all prisoners during transportation to medical facilities and during the medical visit. Pregnant women are routinely shackled during active labor and after they give birth; they are often restrained while they are giving birth as well. Illinois is the only state whose legislature has banned this practice.[21]

8.      Prisons foster and perpetuate the injustices inherent in the criminal justice system.

With more that two million people behind bars, the U.S. has become the world leader in incarceration. Although women are currently less than 10% of the prison population, since 1995 women have been entering prison at a faster rate than men. Given such an alarming trend, it is crucial to understand the changing role of prisons in the larger criminal justice system to understand the challenges a system of mass incarceration poses to reproductive freedom.

Prisons and jails render women?s reproductive rights expendable, even though the courts define these rights as essential. Women of color and poor women are increasingly vulnerable to such violation of their rights because access to resources and freedom from discrimination are key factors in obtaining reproductive autonomy.  The criminal justice system?s reliance on incarceration points to a broader contention between women and the state. State authority takes diverse and shifting forms that pose very difficult challenges to women trying to exercise control over their reproduction.[22]

9.      Prisons do not make us safer.

Currently, activists that address the issue of state violence work in isolation from those that address domestic and sexual violence. Women of color and poor women who suffer disproportionately from both state and interpersonal violence are marginalized as a result.[23] The mainstream anti-violence movement has sought to protect women from domestic violence and battering by advocating for more involvement of police agencies. For communities of color and immigrant communities, this strategy is at times wholly ineffective because these communities face disproportionately a threat of violence in the home from the very same law enforcement authorities that are charged with their protection.  In situations like these, home raids can take place at any time on tenuous legal grounds and women are left no recourse in the face of violence from both batterers and law enforcement officials.[24] Clearly, we need to re-evaluate the role of prisons and mass incarceration in our society. If prisons are not serving the purpose of protecting the members of our society from violence and instead are jeopardizing women?s rights and health, then the burden falls on each of us to challenge the injustices perpetuated by this system. 

10. There are alternatives to prisons.

Many believe that we need new approaches and strategies to deal with violence in our communities. In order to come up with workable solutions, the first step is to let go of our desire to discover one single alternative system of punishment that would play the same role as the current prison and jail system. The prison system is deeply entrenched in the social, cultural, and economic practices of the United States. We need to explore community based responses to violence that don?t rely on the criminal justice system. Many ask: what about violent offenders? We need to call into question our analysis of violence as individual acts perpetrated solely by individual people, to the exclusion of examining it as a phenomenon symptomatic of larger structures of power and oppression. These are starting points. From here we can move forward to create structures that not only end violence, but advance freedom and human rights.


Resources:

Amnesty International Women?s Human Rights Program

www.amnestyusa.org/women/womeninprison

Critical Resistance: Beyond the Prison Industrial Complex

www.criticalresistance.org

Drug Policy Alliance

http://www.drugpolicy.org/drugwar/

Incite! Women of Color Against Violence

www.incite-national.org

Human Rights Watch Prison Project

http://www.hrw.org/prisons/

Justice NOW

www.jnow.org

The National Center on Institutions and Alternatives

www.ncianet.org/ncia

Prison Activist Resource Center

www.prisionactivist.org

Prison Legal News

www.prisonlegalnews.org

Prison Moratorium Project

www.nomoreprisons.org

The Sentencing Project

www.sentencingproject.org

Eesha Pandit is Associate Director of Programs at the Civil Liberties and Public Policy Program at Hampshire College.

is Associate Director of Programs at the Civil Liberties and Public Policy Program at Hampshire College.References

[1] Bureau of Justice Statistics as of June 30, 2003.

[2] Not Part of My Sentence: Violation of the Human Rights in Custody: Impact on Children of Women in Prison, Amnesty International Report, 1999. 

[3] Nkechi Taifa, ?Roadblocked Re-Entry: The Prison After Imprisonment,? www.opensocietypolicycenter.org/pdf/roadblocked.pdf, last visited November 13, 2002.

[4] Gardiner, Gareth S. and Richard N. McKinney, ?The Great American War on Drugs: Another Failure of Tough Guy Management,? Journal of Drug Issues No. 21(3), 1991, pp 605-616.

[5] ?What?s Wrong with the Drug War?: Mandatory Minimum Sentencing,? Drug Policy Alliance, http://www.drugpolicy.org/drugwar/mandatorymin/, last visited August 19, 2005.

[6] Seventy percent of women are incarcerated for relatively minor, non-violent crimes.  See endnote 4.

[7] See endnote 1.

[8] ?Factsheet: Women in Prison,? The Sentencing Project, http://www.sentencingproject.org/pdfs/1032.pdf, last visited March 8, 2005.

[9] Gilfus, Mary, ?Women's Experiences of Abuse as a Risk Factor for Incarceration,?

http://www.vaw.umn.edu/documents/vawnet/arincarceration/arincarceration.html, last visited June 30, 2004.

[10] Allard, Patricia, ?Life Sentences: Denying Welfare Benefits To Women Convicted Of Drug Offenses,? The Sentencing Project, February 2002.

[11] Davis, Angela, Are Prisons Obsolete? Seven Stories Press, NY, 2003, pp 60-83.

[12] Zielbauer, Paul von, ?As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence,? New York Times, February 27, 2005.

[13] Chandler, Cynthia, ?Death and Dying in America: The Prison Industrial Complex?s Impact on Women?s Health,? Berkeley Women?s Law Journal, Vol.40, 2003.

[14] See endnote 2. 

[15] Barry, Ellen, ?Women Prisoners and Health Care: Locked Up and Locked Out,? in Kary Moss, ed., Man-Made Health Care, Durham: Duke University Press, 1996.

[16] Roth, Rachel, ?Do Prisoners Have Abortion Rights?? Feminist Studies, Vol. 30, No. 2, 2004.

[17] See endnote 13.

[18] See endnote 2. 

[19] Chandler, Cynthia and Carol Kingery, ?Speaking Out Against State Violence: Activist HIV-Positive Women Prisoners Redefine Social Justice,? in Silliman, Jael and Anannya Bhattacharjee, eds., Policing the National Body, South End Press, Boston, MA, 2002, p19.

[20] Paltrow, Lynn M., ?Punishing Women for their Actions During Pregnancy: An Approach That Undermines the Health of Women and Children,? Center for Reproductive Law & Policy, 1996, http://www.nida.nih.gov/pdf/darhw/467-502_paltrow.pdf, June 24, 2003, last visited August 26, 2005.

[21] See endnote 2.

[22] Roth, Rachael, ?Searching for the State: Who Governs Prisoners? Reproductive Rights?? Social Politics, Vol. 11, No. 3, 2004.

[23] ?Gender Violence and the Prison Industrial Complex,? Joint Critical Resistance ? Incite Statement, http://www.incite-national.org/involve/statement.html, last visited August 26, 2005.

[24] Bhattacharjee, Anannya, Whose Safety? Women of Color and the Violence of Law Enforcement, Justice Visions Working Paper, American Friends Service Committee and the Committee on Women, Population and the Environment, Philadelphia, 2001, http://www.afsc.org/community/Whoseexec.pdf, last visited August 29, 2005.

DifferenTakes #36: Beyond the Hype: What You Should Know About the Seasonale Birth Control Pill Print E-mail
 
 
DifferenTakes is an investigative series of issue papers, published by the Population and Development Program at Hampshire College, providing alternative information and analysis on a wide range of reproductive rights, population, environment and social justice issues.  This summer we are launching a special series of DifferenTakes focusing on 'Reviving Reproductive Safety' in movements for women's health and reproductive justice. 

We are pleased to send you the sixth in the series, "Beyond the Hype: What You Should Know About the Seasonale Birth Control Pill" by Amelia Bucek.  This issue explores the "designer contraceptive" Seasonale, its aggressive promotion as the pill that limits menstrual bleeding to four times a year, its marketers' problematic depiction of menstruation and women's liberation, and its potential health risks.

- Betsy Hartmann and Amy Oliver
Co-editors, DifferenTakes
^^^^^^^^^^^^^^^^^^^^^^^^^

Beyond the Hype: What You Should Know About the Seasonale Birth Control Pill

By Amelia Bucek
A Publication of the Population and Development Program at Hampshire College * No. 36 * Summer 2005

Since the first birth control pill was released to the American public in 1960, oral contraception has evolved considerably. Within today's burgeoning and increasingly specialized pharmaceutical industry there are dozens of varieties of birth control pills available. Many of these are advertised as offering more than just fertility control.[1] Dubbed "designer contraceptives," these pills cater to specific issues completely detached from contraception. Whether the allure is convenience, acne treatment, or a reduction in water retention, focus on the gimmick attached to the pill overshadows all other concerns associated with the contraceptive. The niche marketing of these pills translates to an expanded customer base and increased profits for contraceptive manufacturers. The deregulation of prescription advertisements in 1997, which allows pharmaceutical companies to advertise alternative uses for the pill directly to consumers, hastened this practice. Media attention to designer contraceptives has also facilitated this growing market. One of the most celebrated and criticized pharmaceuticals in this field is Seasonale. 

What is Seasonale?

Seasonale is an extended cycle oral contraceptive pill, which differs from the standard pill in its method of prescription. Oral contraceptives are customarily dispensed in 28-day packs containing 21 active pills with hormones and 7 placebo sugar pills. The break in hormone intake for one week every month causes the body to think ovulation has occurred, resulting in the shedding of the uterine lining. This outcome is technically called a withdrawal bleed, but is also known as a period since it mimics the monthly occurrence of menstruation. Seasonale promises to limit this bleeding to just four times a year. Women prescribed Seasonale take active pills for 84 consecutive days, followed by 7 days of placebo. Periods are thereby reduced from an average of 13 a year to 4, creating the specialized purpose of Seasonale: menstrual suppression.

Selling Doctors on Seasonale

After testing Seasonale on 1400 women in 47 cites nationwide, the FDA approved the pill in September 2003.[2] In its initial marketing of the product, Barr Pharmaceuticals aggressively targeted physicians. Questionable mingling of reproductive health education and manufacturer profits was evident in audio conferences sold for $99 a piece to educate healthcare providers on extended use contraception. These corporate-sponsored listening sessions could also be used as credit toward professional nursing requirements.[3] In early 2004, Barr unleashed a 250-person sales team that sought out 28,000 physicians (20 times the number of women they tested for the safety of their product) throughout the U.S. in order to spread the word on Seasonale.[4] This profit-driven approach proved to be quite successful. In February 2004, 5000 prescriptions for Seasonale were written each week and by March sales totaled $17.7 million. Seasonale had become the fourth top selling oral contraceptive.[5] Only eight months after its release, over 120,000 prescriptions had been written, with 7,000 being added weekly.[6] After significant buzz had been created throughout the medical community and spread to the patient population, Barr launched a $50 million ad campaign in June 2004.[7]

Advertising Seasonale to Consumers: PMS, Liberation, and Health

The Seasonale campaign included television spots, two-page ads in magazines as diverse as Vogue and US News and World Report, as well as a trendy website all promoting the Seasonale mantra, "Fewer Periods. More Possibilities." [8] The overall theme of the ads is that it is fun and attractive to get fewer periods a year and the decision to suppress menses is easy and obvious. One television commercial pictures a woman in a bright white space, wearing a red polka dot dress, responding happily to a voice-over informing her that it is now possible to limit her monthly periods to just four a year. She then proceeds to spin around as all but four of the polka dots (representing menstruation) fly off her dress. Thus, menstruation is deemed as frivolous as a fashion decision. Some versions of this ad feature multiple women, all dressed in white, who pick up the red dots and throw them around like Frisbees. The ads try to equate Seasonale with a crisp and clean sense of carefree fun.

The marketing and media coverage of Seasonale paints a very negative picture of menstruation, which serves to further imply that the pill is a constructive addition to a woman?s life. In research sponsored by Barr on women's attitudes toward their periods, the company claimed that more than half of the women surveyed felt "messy, fat and unattractive" during their periods. However, as the National Women's Health Network (NWHN) points out, this data was misconstrued. In actuality, only one third of the women reported menstruation made them feel unattractive and Barr neglected to disclose the 68% of respondents who experience a positive sense of health during menses.[9]

Such faulty reporting on the negative effects of menstruation is eerily similar to the wave of media attention given to premenstrual syndrome in the 1980s. In fact, PMS is widely cited as a reason to take Seasonale, and as was the case in the late 20th century, the alleged problems caused by menstruation are often overblown and quite dubious. For example, one Boston Globe piece on extended cycle pills was titled, "No Chocolate Cravings\ No PMS or Bloating\ No Fatigue or Moodiness\ What if Having Your Period Was a Choice?" [10] Readers are led to presume that all menstruating women experience these symptoms and that even chocolate cravings necessitate pharmaceutical treatment. Journalists writing about Seasonale also claim that the menstrual cycle causes women to miss professional, social, or family-oriented events,[11] keeps them from participating in summer activities,[12] and makes them ineffective leaders.[13]

Even more troubling is the way these damaging, broadly applied stereotypes are used to depict menstrual suppression as the road to feminist liberation. Candace Bushnell, creator of the HBO series Sex and the City and Seasonale's celebrity spokeswoman, summed up this idea by saying, "When you think about what women can accomplish with 13 periods a year, think about what we can accomplish with only four. We have come a long way, but we've only just begun." [14] By alluding to the feminist movement in her speech, Bushnell places menstruation as an obstacle on par with institutional forms of sexism that hinder women?s possible achievements. Instead of offering a critique of the social structures that impede women's progress, the blame is turned inward and placed on the menstruating body. She implies that if only women could stop menstruating, they could achieve so much more. Barr Laboratories also hired a doctor to attend a media briefing on Seasonale to make similar claims, asserting that the drug could improve high school girls'  test scores.[15] Although there is no proof of the accuracy of this statement, the message is clear: if women want to excel in school, employment, and life in general, they should limit their periods.

An interesting component of the "feminist" argument for Seasonale is the hypothesized role of menstrual suppression in maintaining women's health. There is a school of thought, led by Dr. Elsimar Coutinho and Dr. Sheldon Segal, authors of Is Menstruation Obsolete? (1999), that firmly believes women are becoming ill due to regular menstruation.[16] Simply put, the rationale is that historically, Western women's main function in society was to procreate. Consequently, they were pregnant or breast-feeding, in other words not menstruating, for the majority of their reproductive lives. The conclusion is then drawn that the woman who experiences infrequent menstrual cycles is more natural and healthy than the woman whose menstrual cycle occurs monthly. Regular menstruation is deemed unnatural and a threat to women?s wellbeing.

Menstrual suppression is offered as a compromise to fix this biologically unnatural turn of events. It is hailed as a "radical rescuing [of] the ovaries and endometrium from modernity." [17] This approach simultaneously argues that women's bodies were designed for a life of serial pregnancy, and not much else, as it also alleges that if women try to exceed these roles, their reproductive health will falter. Thus, the only way to be a successful modern woman and retain your health is to suppress your menstrual cycle. In a New Yorker article, Malcolm Pike of the University of Southern California illustrates this rationale by claiming that:

The modern way of living represents extraordinary change in female biology. Women are going out and becoming lawyers, doctors, presidents of countries - the world is not the world it was. And some of the risks that go with the benefits of a woman getting educated and not getting pregnant all the time are breast cancer and ovarian cancer, and we need to deal with it.[18]

Although women's health advocates firmly deny any reduction in cancer risk due to menstrual suppression,[19] Seasonale is offered as a means of returning women to a more biologically natural state of infrequent menses that will allow them to lead healthier, more enriching lives. However, such assumptions about women's nature are far from empowering. They frame the female body that does not participate in compulsive procreation as pathological, and rely on the notion that women's bodies are most healthy when symbolizing a social function focused on reproduction. Therefore, even though Seasonale is marketed as an aid to women's empowerment, it also frames women's liberation as biologically unnatural and unhealthy.

10 Health Concerns You Should Be Aware of Before Taking Seasonale

While proponents of menstrual suppression advocate on behalf of Seasonale for its health benefits, there are several health issues related to the pill that paint a far less optimistic picture of extended cycle contraception.
      1.    Seasonale does not protect against STDs. The focus on the designer purpose of menstrual suppression relegates Seasonale's role in fertility control to the back burner, rendering promotion of safe sex while taking Seasonale all but forgotten.
  1. The extended cycle regimen of Seasonale exposes women to a 23% increase in annual hormone intake. This may translate to an increased risk of side effects already attributed to the birth control pill, such as stroke and heart attack.[20]
  2.  There has been no long-term research undertaken to study the effects of extended cycle oral contraception. Physicians and journalists attempt to downplay this fact by referencing women who have skipped the placebo pills to manipulate their periods for years.[21] However, personal experimentation is no substitute for scientific study and has no effect on the safety of this practice.
  3. The research conducted to test Seasonale was only conducted on women over the age of 18. Even though 1.2 million girls aged 15-19 currently use oral contraceptives, the effects of an extended cycle pill are unknown for this age group.[22]
  4. Seasonale was only tested on women who had previously been using 28- day oral contraceptives. No research on the effects of Seasonale has been performed on women who have never used birth control pills before.[23]
  5. Significant breakthrough bleeding can occur between scheduled periods while taking Seasonale. In December of 2004, the FDA took action and officially admonished Barr for excluding information about the possibility of substantial breakthrough bleeding in their advertisements in order to make Seasonale appear safer.[24]
  6. Abnormal changes in menstrual flow are often early warning signs of other physiological problems. Suppression of this function can mask symptoms and delay attention to a variety of disorders.
  7. The expected loss of monthly menstruation would also remove a common marker of pregnancy. Women who become pregnant while taking Seasonale may not become aware of their condition until much later than the average woman, thereby reducing their options for abortion.
  8. Promotion of menstrual suppression may cause or promote a negative view of the menstruating body. The National Women's Health Network warns that if menstrual suppression is aggressively advertised as the preferred and natural way for the female body to function, young girls especially will acquire a negative body image.[25]
  9. Positive physical effects linked to monthly menstruation such as lowered risk of heart disease, bone health, sexual desire, increased immunity, and a cyclic reduction in blood pressure, would be lessened with the use of an extended cycle pill. [26]

Conclusion

Despite the health concerns and the media manipulations associated with menstrual suppression, an extended cycle oral contraceptive may be the right choice for some women. Those who experience extremely painful periods or women who have conditions exacerbated by the onset of monthly menstruation might find Seasonale to be the relief they have been looking for. Others may simply prefer to bleed less frequently for their own personal reasons. Regardless of the impetus to use Seasonale, it is pertinent that both physicians and manufacturers ensure that women have access to all of the health information necessary to make an informed decision. Women also deserve new contraceptive methods that are developed in an environment that places their needs and safety above the profit margins of pharmaceutical giants.

Amelia Bucek recently graduated from Hampshire College. Her senior thesis evaluated the media reaction to Seasonale as the latest installment in a long history of defining, and redefining, women's nature through menstruation.

References

[1] Stephens, Anastasia. "How to Never Have a Spot, Period, or Baby Again," The Independent, 20 January 2002.

[2] "Shares rose 8.35?" Drug Store News, 10 September 2003.

[3] Kemper, Carol A. "Seasonale: A Revolutionary contraceptive," Infectious Disease Alert, October 2003.

[4] Fried, Jennifer. "Ending Your Monthly Cycle. Period" Chicago Sun Times 2 December 2003; ?Event Brief of Barr Conference Call,? Disclosure Wire, 8 September 2003.

[5] Hardy, Katrice. "Sales are Booming for Virginia-Developed OC," Knight Rider, 15 May 2004.

[6] Gettelman, Elizabeth. "Seasonale may make monthly periods obsolete. But at What Psychological Price?" The Washington Post, 8 June 2004; Hardy, Katrice, "Sales are Booming for Virginia-Based OC."

[7] Gettelman, Elizabeth. "Seasonale May Make Monthly Periods Obsolete."

[8] However, as of this writing, the website, www.seasonale.com, has been reduced to just a couple of pages, perhaps for renovation.

[9] National Women's Health Network, "Fact Sheet on Menstrual Suppression," www.womenshealthnetwork.org, April 2004.

[10] Scott, Megan. "No Chocolate Cravings\ No PMS or Bloating\ No Fatigue or Moodiness\ What if Having Your Period Was a Choice? It's Up To You," Boston Globe, 22 August 2000.

[11] Brunk, Doug. "Extended-use OCs Pose Educational Challenge," Internal Medicine News 36, no.21, (1 November 2003): 1.

[12] Nissman, Cara. "A Better Pill to Swallow? New Contraceptive Reduces Periods, Raises Questions," Boston Herald, 3 August 2003.

[13] Van Buskirk, Audrey. "No Flow: A new form of birth control raises questions about how to be a natural woman," Santa Fe Reporter, 21 October 2003

[14] Gettelman, Elizabeth. "Seasonale May Make Monthly Periods Obsolete."

[15] National Women's Health Network, "Fact Sheet on Menstrual Suppression."

[16] Coutinho, Elsimar. Segal, Sheldon. "Is Menstruation Obsolete" (New York: Oxford University Press, 1999).

[17] Gladwell, Malcom. "John Rock's Error," The New Yorker, 13 March 2000.

[18] Ibid.                                                                                   

[19] National Women's Health Network, "New Version of Oral Contraceptive Pill" www.womenshealthnetwork.com, 5 September 2003.

[20] Gettelman, Elizabeth. "Skipping Periods: The Pros, The Cons, The Science," The Washington Post, 8 June 2004.

[21] Stein, Rob. "Experimental Pill Puts Menstruation on Hold," The Washington Post, 3 March 2003.

[22] Gettelman, Elizabeth. "Skipping Periods: The Pros, The Cons, The Science."

[23] Karen Hoffman. "Foes Raise Red Flag Against Suppression of Menstruation," Pittsburgh Post Gazette, 24 June 2003.

[24] "FDA Warns Barr Over Commercial," Asia Africa Intelligence Wire, 31 December 2004.

[25] National Women's Health Network, "New Version of Oral Contraceptive Pill."

[26] Rako, Susan. No More Periods? The risks of menstrual suppression and other cutting edge issues about hormones and women's health (New York: Harmony Books, 2003), 14, 45, 124.
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Amelia Rokotuivuna: Fijian feminist for peace, justice & equality, August 7 1941 - June 2 2005 Print E-mail
Women's GlobalNet #276:
Activities and Initiatives of Women Worldwide June 26, 2005


FIJIAN FEMINIST WHO FOUGHT FOR PEACE, JUSTICE AND EQUALITY IN THE SOUTH PACIFIC

Amelia Rokotuivuna August 7, 1941 -June 2, 2005

On June 2, 2005, a woman of extraordinary energy, passion and ability who dedicated her life to promoting peace, democracy and social justice,died in Suva, Fiji, at the age of 63.

Amelia Rokotuivuna was a community leader far ahead of her time, who grew up in the Fiji mining town of Vatukoula and went on to become head girl of Adi Cakobau School, Fiji's most prestigious college for girls.
She was a founder of the Fiji YWCA, joining Australians Ruth Lechte and Anne S. Walker in 1962 to begin the programmes of an activist organization that worked for peace and democracy in a multi-cultural Fiji.  In 1967, she attained a diploma in social administration and development from the University of Swansea in Wales, returning to become
General Secretary of the Fiji YWCA in 1973.

For the next two decades in this position, Amelia led the fight on issues such as equal rights for women, a nuclear-free Pacific, political reform and multi-culturalism. She advocated for those without a voice,reminding the great and powerful of their obligations to the poor and disadvantaged.  Referring to her charismatic leadership of the Y during
those years, Dr. Wadan Narsey, formerly an economics lecturer at the University of the South Pacific (USP) and regular columnist with the Fiji Times, wrote: "As an Indo-Fijian non-Christian male, I found myself on YWCA committees on issues such as economic justice, constitutional reform, the anti-nuclear movement and numerous other important issues of
the time."

In furtherance of her anti-nuclear beliefs, Amelia took centre stage at the non-governmental meeting held parallel to the first United Nations world conference on women in Mexico City, 1975, speaking out against nuclear testing and raising the awareness of the world regarding the continuing abuse of the Pacific and its peoples by nuclear powers.

The Fiji coups in May 1987 demonstrated the real character of Amelia.
Never was her fearlessness and true grit more splendidly displayed.  She defied many of her own people to commit to a multicultural, tolerant and caring vision of Fiji.  Amelia, among others, was imprisoned briefly for her beliefs.

From 1992 to 1995, Amelia worked as Programme Secretary for Advocacy for the World YWCA in Geneva. At the time of her death she was President of the Fiji YWCA Board of Directors and a lecturer at USP.

Amelia leaves behind a son, Peceli, who continues her work as a community activist, brothers Apisalome (Mudu) and Sevuloni, sister Veniana and their families, and the family of sister Manaini (dec.). She will be sorely missed by family and friends alike, but her life spent in the search for peace, equality and justice in Fiji and the South Pacific
will be forever cherished and celebrated.

Written by Anne S. Walker, AM, with excerpts from eulogies by Fiji Senator 'Atu Emberson Bain and Ratu Joni Madraiwiwi, Vice President of Fiji.

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International Women's Tribune Centre
777 United Nations Plaza
New York, NY 10017, USA
Tel:  (1-212) 687-8633
Fax: (1-212) 661-2704
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Web: www.iwtc.org

DifferenTakes #35: The U.S. Occupation and Rising Religious Extremism: Print E-mail

The Double Threat to Women in Iraq

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DifferenTakes is an investigative series of issue papers, published by the Population and Development Program at Hampshire College in Amherst, MA, providing alternative information and analysis on a wide range of reproductive rights, population, environment, peace and social justice issues.

We are pleased to send you our 35th issue, "The U.S. Occupation and Rising Religious Extremism: The Double Threat to Women in Iraq" by Anissa Hélie who has worked since 1984 with the organization Women Living Under Muslim Laws. This issue critically examines how both the U.S. occupation and Islamic extremism threaten women's rights and lives.  It draws attention to the problematic tendency of many progressives in the West to romanticize the Islamic insurgency in Iraq and Islamic fundamentalist movements in their own countries while ignoring their negative impact on women.

- Betsy Hartmann and Amy Oliver
Co-editors, DifferenTakes


The U.S. Occupation and Rising Religious Extremism: The Double Threat to Women in Iraq

By Anissa Hélie
A Publication of the Population and Development Program at Hampshire College • No. 35 • Summer 2005 Download in Word Format

On February 8, 2005, the international feminist and anti-militarist network Women in Black (WIB) launched an urgent appeal for the immediate liberation of Giuliana Sgrena, an Italian journalist and WIB activist, who had been kidnapped in Iraq by a militant Islamist group (and who was later shot by U.S. forces as she was en route to safety).[1] Three days after the appeal, various WIB groups around the world had mobilized, holding 463 silent vigils across several continents. While this was an impressive display of both the efficiency and strength of women’s global solidarity, the incident remains just a snapshot of the mounting acts of violence against women in Iraq.

With about 140,000 troops currently deployed and a mounting death toll,[2] the U.S. occupation of Iraq raises numerous issues, ranging from allegations of war crimes to the backing of a new Iraqi government based on tribal, ethnic and religious affiliation – a fact likely to have long term implications for the region. However, the Iraqi context is marked not only by the U.S. occupation, but also by the rise of an extremist Islamist armed insurgency that is targeting women. The left needs to avoid romanticizing forces that, despite their claim to be primarily opposed to U.S. imperialism, in fact pursue a fundamentalist agenda in Iraq. The left also needs to heed and challenge the steady incursion of the Muslim religious right in the West.

Mounting Violence Against Women
The ongoing trend of violence against women in Iraq should be seen in the broader context of human rights violations perpetrated by U.S. forces against detainees and civilians, including children. Indeed, the dehumanization of anyone identified as ‘Arab’ or ‘Muslim’ post 9/11 and a culture of institutionalized racism within the US army[3] have led to many acts of brutality. There is serious evidence, corroborated by Amnesty International and Human Rights Watch, that jailed Iraqi women have suffered abuse and torture at the hands of the U.S. military.[4]

The breakdown of society in Iraq provoked by the U.S. occupation has also had a detrimental impact on women. The current security situation is so poor that parents are reluctant to send their daughters to school unaccompanied and large numbers of teenagers have now abandoned pursuing their studies. Threats of sexual violence and murder have also led professional women to quit their jobs. Iraqi women and girls (some of them as young as nine years old) are abducted for both ransom and trafficking purposes.[5]

Widespread violence also affects women’s political participation: following the 2003 murder of Akila al-Hashimi (one of only three female members of the Governing Council), many activists were forced to retreat from the public sphere. Yet a recent survey on “post-war” Iraqi women shows how much they continue to value access to political and legal rights. This study, undertaken in January 2005 by the Washington DC-based Women for Women International in collaboration with the Iraq Center for Research and Strategic Studies, is another example of women’s international solidarity.[6]

In addition to the destruction of basic infrastructure, an overwhelming lack of security, and violence at the hands of U.S. occupation forces, the emergence and rise of religious extremism pose new threats to Iraqi women’s lives.  In a move that goes beyond seeking to impose a rigid gender ideology, fundamentalist armed groups specifically target women in order to induce fear and helplessness among ordinary citizens. This is often a prelude to imposing an Islamic state. The work of Women Living Under Muslim Laws (WLUML) shows there is a pattern in Iraq that has been repeated in many other contexts: violence against women as a form of political intimidation is one of the strategies extreme-right religious forces systematically employ.[7]  As they seek to secure political power, fundamentalists of various creeds (whether Hindu, Muslim, Christian, etc.) often begin by intimidating, persecuting, abducting and murdering women as well as minorities. Religious, ethnic and sexual minorities are especially at risk.  Fundamentalist forces then move toward terrorizing all other citizens who may oppose their authoritarian theocratic project.

For example, an extremist group in Iraq called Mujahideen Shura (council of fighters) warned it would kill any woman who is seen unveiled on the street. The recent case of Zeena Al Qushtaini has shown this is not an empty threat. Zeena, a women’s rights activist and businesswoman known for wearing ‘Western’ clothing, was kidnapped and executed by Jamaat al Tawhid wa’l-Jihad, another armed Islamist group. Her body was found wrapped in the traditional abaya which she had refused to wear when she was alive. Pinned to the abaya was the message: “She was a collaborator against Islam.”  Muslim extremists have already moved on to assassinating male and female hairdressers whom they accuse of promoting ‘Western’ fashion.[8] They also specifically target trade union leaders as well as gays and lesbians.[9]  Religious minorities are also under attack, such as Christians in the Northern city of Mosul – with women from the Christian community singled out in a rape campaign.[10]

Given their political project and the violent tactics they employ, how can such militant groups gain any legitimacy in the West? It is necessary to reflect on the nature of the language used to refer to these increasingly powerful political actors.

Romanticizing “Resistance”
Western mainstream media and human rights organizations tend to describe these militants’ acts of violence using terms such as “insurgency.” There is also a tendency within some leftist and feminist circles to label Muslim extremists - who kill, rape, kidnap women and girls and openly target civilians - as “the resistance.” This is highly problematic in that the word “resistance” has a revolutionary, heroic connotation that leaves unchallenged the political agenda pursued by fundamentalist factions in Iraq. In the U.K., leading voices from the left further romanticize the Iraqi “armed resistance against imperialism,” even comparing it to independence struggles in Vietnam and Algeria.[11] It is worth remembering that there are plenty of unarmed civilians, as well as groups of every political affiliation, that reject the U.S. occupation yet do not engage in violence or human rights violations. Islamist fighters should not be confused with national liberation movements.

The “resistance” label is politically misleading in the Iraqi context, at least as far as Muslim fundamentalist groups are concerned. It is inadequate because the emphasis is narrowly placed on a rejection of U.S. occupation. Despite the anti-imperialist claims made by the leaders of armed groups, it seems very unlikely that if or when U.S. troops withdraw, persecution of women or religious and sexual minorities will stop – because what is really at stake is a theocratic agenda. Referring to “resistance fighters” is also dangerous because it valorizes and glorifies Muslim right-wing militants. It renders invisible the authoritarian nature of extreme-right movements that use religion, culture and ethnicity to impose their project of society onto people.

What we have in Iraq is violence.  What we have is a struggle for power, with various forces using extremely violent means – and different discourses.  Some use dialectics of “democracy” and “importing freedom,” while others use the “resisting imperialism” rhetoric.

The current situation in Iraq sadly illustrates the knee-jerk thoughtlessness with which some progressive constituencies in the West adopt a language that blurs complex political realities. Even more worrisome is the increasing tendency for left-identified individuals and groups to lend support to right-wing Muslims on the basis of their (alleged) anti-imperialist stand. Growing numbers of activists embrace short-sighted strategies, insisting for example that the Western “antiwar movement must not lose sight of the fact that its main enemy is at home­and any resistance to that enemy deserves our unconditional support.”[12] What is alarming about this statement is the immediate allegiance to unconditional support, without regard to the ideologies, practices, and acts of violence of those groups.

In Muslim contexts, as elsewhere, there are progressive and reactionary voices. Somehow, these political standpoints become blurred as segments of the Western left seem to adopt the strategy of “the-enemy-of-my-enemy-is-my-friend,” even though Khomeini’s post-revolutionary Iran should have taught us that it is indeed misguided to confuse anti-women, anti-minorities, anti-diversity voices with those of feminists or progressive advocates.  This ideological confusion is not lost on Muslim fundamentalists – who are anything but politically naïve. In fact, their soft-spoken leaders actively take advantage of a misplaced white guilt to expand their hold on the West. The bloody hands threaten and the educated intellectuals charm: such is the division of labor for these extremists.

Aware of the reality of racism and in an effort to befriend the oppressed, a “Muslim perspective” on just about anything is sought by progressive forces in the West, from playwrights to academics or (often self appointed) community leaders. Conservative voices, it seems, are seen as the most authentic. Liberal ones, somehow, lack the sweet perfume of exoticism. Hence, dangerously rigid standpoints are offered as the “true” expression of all Muslims. Space for dissent becomes monopolized by fundamentalists, at the expense of secular, feminist, and pro-democracy advocates.

Three recent examples highlight this point. In Ontario, Canada, so-called “moderate” fundamentalist groups lobbied to introduce Shari’a (the interpretation of Muslim jurisprudence that in some countries has condoned penalties like whipping, amputation and stoning to death) so that the “Muslim community” can resolve family conflicts without interference.[13]  There are similar pressures in Manitoba and Quebec, as well as in Europe and Australia. Despite the fact that laws framed with reference to religion have proven to be extremely detrimental to women’s rights in numerous contexts, the “multicultural” argument leads many on the left to blindly support an oppressive agenda.

In a less naïve and more strategic move, the U.K. Labor government, as it introduced its new Equality Bill in February 2005, decided to prioritize discrimination on the basis of religion and disregard discrimination on the basis of sexual orientation – for fear that “Muslims might feel offended if they were ‘lumped together’ with homosexuals.”[14] One can only wonder how British gays and lesbians from the Muslim community will appreciate the sacrifice of sexual rights on the altar of religious freedom.

Finally, the last European Social Forum (ESF), held in London in October 2004, was – in the tradition of the larger World Social Fora - meant to bring together large numbers of activists committed to debate issues such as “imperialist globalization, religious sectarianism, identity politics and fundamentalism.”  Sadly, ESF organizers took pride in inviting a number of extremist Muslim leaders. At the same time, they actively discouraged more progressive initiatives - such as a proposed panel including speakers from various feminist groups and international networks (WLUML, WIB, Women Against Fundamentalism, Catholics For a Free Choice and Act Together). While the Muslim Council of Britain and other similar endeavors could boast access to all available facilities in the several panels they organized, the feminist panel’s request to obtain translation facilities was turned down. One wonders whether it was because the feminists’ focus on "unholy alliances" between the left and Muslim extreme-right forces was deemed too threatening.

Building Real Solidarity
 These are not isolated incidents, and warnings about such alliances on such a broad scale have been circulated by international feminist groups.[15] Fundamentalism’s proponents seek support from progressive forces by appealing to the very ideals the left stands for, such as equality, anti-racism, and freedom of expression. At this time in history when one can witness extreme-right offensives gaining ground (whether in the U.S. with the Christian right, in India with the Hindutva forces, or in Iraq, Bangladesh and elsewhere), the need for international solidarity becomes all the more urgent.  To avoid lumping together cultural and religious identities and to recognize that not all those born in Muslim contexts happen to be believers, or choose to define themselves primarily on the basis of their faith, would be a good start.  Indeed, with fundamentalists building coalitions across cultural and religious divides,[16] we ourselves – as progressive people and as feminists of various horizons - should devise common strategies of resistance to groups who practice violence and oppression toward women and people in general. This is a matter of priority and an opportunity to further strengthen our global solidarity.

Anissa Hélie is a feminist historian by training and an activist by choice.  In 2005 she was a recipient of a research/teaching Ford Foundation Fellowship at the Five Colleges, Inc. in Amherst, MA.  She has worked with a wide range of women’s groups and human rights groups in various countries, focusing on issues of sexuality, fundamentalisms and reproductive rights.  She has been involved with Women Living Under Muslim Laws since its inception in 1984.


The Population and Development Program
CLPP • Hampshire College • Amherst • MA 01002
413.559.5506 • http://popdev.hampshire.edu
Opinions expressed in this publication are those of
the individual authors unless otherwise specified.


[1] Scahill, Jeremy. “No checkpoint, no self defense,” AlterNet, March 28, 2005. http://www.alternet.org/story/21613

[2] American Friends Service Committee. "Wage Peace" Movie (2 mns).  http://www.afsc.org/iraq/movie.ht

[3] Rockwell, Paul. “New Revelations about Racism in the Military - Army Reservist Witnesses War Crimes,” The Black Commentator, April 7 2005: issue 133.
http://www.blackcommentator.com/133/133_think_racism_military.html

[4] Amnesty International. “Iraq: Decades of Suffering, Now Women Deserve Better,” February 22, 2005. http://web.amnesty.org/library/Index/ENGMDE140012005

See also: “U.S.: Investigate Rumsfeld, Tenet for Torture,” Human Rights Watch, April 24, 2005. http://www.hrw.org/english/docs/2005/04/24/usint10511.htm

[5] Firmo-Fontan, Victoria.  “Abducted, Beaten And Sold Into Prostitution: A Tale From Iraq,” The Independent, July 26, 2004. http://www.countercurrents.org/iraq-fontan260704.htm

[6] Women for Women International. “Windows of opportunity: The pursuit of gender equality on post-war Iraq,” January 2005, released March 2005 (36p). http://www.womenforwomen.org/Downloads/Iraq_Paper_0105.pdf

[7] www.wluml.org

[8] Burns, John F.; Mahmoud, Mona; Worth, Robert F.  “A haircut in Iraq can be the death of the barber,” New York Times, March 18, 2005.

[9]  Osborn, Mark. “Iraqi Union leader murdered. ‘Resistance’ targets trade unions, women, lesbians and gay men,” January 12, 2005. http://www.workersliberty.org/node/view/3532

[10] Associated Press. “Iraqi Christians Keep Low Profile,” November 13, 2004. http://www.foxnews.com/story/0,2933,138375,00.html

[11] “Tariq Ali talks to Socialist Worker about empire and those who fight against it,” Socialist Worker Issue No. 239, March 26 2005 – April 12 2005. http://www.swp.ie/socialistworker/2005/sw239/socialistworker-239-9.htm

[12] Smith, Sharon. “The Right to Resist Occupation - The Anti-War Movement and the Iraqi Resistance,” CounterPunch, Jan 21, 2005. http://www.counterpunch.org/smith01212005.html

[13] Right-wing Muslim groups are making use of the Arbitration Act 1991. See the Canadian Council of Muslim Women’s  website: www.ccmw.com

See also: “Canada: Support Canadian women’s struggle against Shari’a courts,”.WLUML, March 7, 2005. http://www.wluml.org/english/actionsfulltxt.shtml?cmd[156]=i-156-180177

[14]  Cracknell, David. “Discrimination bill snubs gays to save Muslim vote,” The Sunday Times, February 27, 2005.  http://www.the-times.co.uk – See Appendix.

[15] “WLUML statement to the World Social Forum - Appeal Against Fundamentalisms,” January 21, 2005. http://www.wluml.org/english/newsfulltxt.shtml?cmd[157]=x-157-103376

[16] Whitaker, Brian. “Fundamental union – When it comes to defining family values, conservative Christians and Muslims are united against liberal secularists,” The Guardian, January 25, 2005. http://www.guardian.co.uk/elsewhere/journalist/story/0,,1398055,00.html

A decade-plus after the fact: Acknowledging the feminized face of HIV/AIDS Print E-mail

Refer Feminist Research: Corea, Gena. The Invisble Epidemic: The Story of Women and AIDS (New York: Harper Collins Publishers Inc., 1992, and at the time widely acknowledged as the female  equivalent of Randy Stilts' classic, And the Band Played On .... , plus in December of 1992 was listed in The New York Times Book Review "Notable Books of the Year".

In other words, a decade-plus of neglect which largely accounts for research into the highly promising protective measure of microbicides still being in its infancy in 2005, even as the feminized face of HIV/AIDS becomes more and more obvious. Under which rock have the the below mentioned  "experts" been hiding since 1992?
===========================
 Pakistan Saturday June 11 2005-- Jamadi Al Awwal 03, 1426 A.H.

Women: more vulnerable to HIV

HIV/AIDS is rapidly becoming a woman's epidemic. Approximately 14,000 people become infected with HIV every day, half of them women
Bobby Ramakant

Global HIV data -- tragically -- confirms what women's health, rights, and social justice advocates have said for a decade. The social, economic, and sexual vulnerability of women -- particularly young women and girls -- harms their health and increases their risk of HIV and other sexually transmitted diseases (STDs). Existing prevention strategies have largely failed to address this vulnerability, focusing on abstinence, mutual monogamy and male condom use -- none of which are easily controlled by women. The faces of HIV and AIDS in the world today are increasingly those of young women, many of whom are married, many of whom contracted the virus during adolescence.

Predictably, HIV/AIDS is rapidly becoming a woman's epidemic. Approximately 14,000 people become infected with HIV everyday. Half of them are women. A vast majority of women had only one mode of exposure to HIV -- sex with their male partners. Women are biologically more vulnerable to STD including HIV/AIDS. Women are twice as likely as men to contract HIV from unprotected intercourse. Vaginal membranes are exposed to infectious fluids for hours after sex; younger women are at greater risk because the immature cervix is more vulnerable to damage and infection. STDs often go undetected, and therefore untreated, in women. They increase women's vulnerability to HIV and if untreated, can lead to infertility, ectopic pregnancy, infant mortality and cervical cancer.

Gender inequalities prevent many women from being able to protect themselves. Millions of women lack the social and economic power to insist on HIV prevention measures, such as condoms, abstinence or mutual monogamy. Male and female condom use requires the tacit cooperation, if not outright participation, of the male partner. HIV risk escalates among adolescent girls because of their physical vulnerability and susceptibility to rape, forced marriage, trafficking, economic dependence and coercion. Violence, coercion, and economic dependency render millions of women of all ages unable to "negotiate" condom use or to abandon partners who put them at risk. Millions live in societies that permit them no role in sexual decision-making, condone male infidelity and assign to women the burden of shame and stigma associated with infectious disease.

But there is always hope that not only gender inequity might change for the better, and women and men will recognise, appreciate and respect the rights of each other, but women will have more meaningful roles to play in decision-making, and will be empowered enough to access, afford, use and negotiate the use of STD/HIV prevention options with their partners. This struggle will indeed be a long one.

Some dedicated advocates, scientists and donors are working to develop microbicides -- gels, tablets, or other intra-vaginal products a woman could use to reduce the risk of getting HIV through sex. Microbicides are substances that can substantially reduce the transmission of HIV and other sexually transmitted infections (STIs) when applied vaginally and, possibly, rectally. Epidemiological models suggest that a microbicide with 60 percent efficacy could avert 2.54 million HIV infections worldwide over three years.

However, microbicides are still being researched; it will require significant political will, public investment and popular demand before they become available. Microbicides are at different stages of research in a number of countries. They could be produced in a variety of forms: gel, cream, film, suppository, sponge or vaginal ring. Some would enable women to become pregnant without risking infection, while others would also be contraceptives, offering women a dual protection method.

Many studies have reported that women who perceive themselves at risk for HIV had little success in asking their husbands to use condoms. While condom promotion has encouraged men to use this protection with sex workers and casual partners, most men still refuse to use condoms with wives or regular partners. No wonder HIV cases are increasing rapidly among married, monogamous women in countries like India. Microbicides will certainly help these women to protect themselves from STI/HIV.

Many women want to get pregnant -- for their own reasons and/or to achieve the status and security that, in many societies, they can only attain through motherhood. Since condoms are contraceptive, women now have to choose between childbearing and HIV prevention. Microbicides offer a ray of hope here too, being developed into two variants: contraceptive and non-contraceptive, which will make it possible for a woman to conceive without exposing herself to the risk of HIV transmission.

Microbicides must be safe for all potential users -- women and men, pregnant women, HIV-positive women, adolescents. They must also be compatible with condoms and other barrier methods. Potential mechanisms of microbicide action include: killing or inactivating the virus by disrupting the surface membrane (surfactants), boosting the vagina's natural defences (acidifying agents), or preventing the virus from binding to its target cells (adsorption inhibitors), blocking replication of the virus once it has entered cells.

There are about 60 possible microbicides in the pipeline. Six potential products are likely to enter the phase of large-scale multi-centric clinical trials soon to assess effectiveness in prevention of vaginal transmission of HIV. These products include the surfactant (Savvy), the acidifying agent (buffer gel), and the adsorption inhibitors (PRO 2000, dextrin sulphate, carageenan and cellulose sulphate).

There are also some barriers to widespread support for microbicides. Morally conservative and patriarchal social norms make it difficult to confront the reality of a sexually transmitted epidemic. A culture of silence around women's sexuality enhances the stigma associated with seeking information or interventions about self-protection.

Much progress has been made on microbicides, but many challenges remain. Badly needed is a significant increase in investment from both the public and private sectors.

Another challenge is to involve men and try to address the unequal power equation between a man and a woman, thereby increasing the understanding of each other's need, and collectively demand: HIV prevention must address women's needs and vulnerabilities. Women need education, economic opportunity and social support, and gender equality in order to protect their health and rights. Women need HIV and STI prevention tools they can control. Women need microbicides.

The writer is a key correspondent for Health and Development Networks,
Thailand, and volunteers as AIDS Care Watch campaign coordinator for South Asia
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