Oct 312012
 

As I’ve pointed out too many times before, in the aftermath of any weather disaster, women often face different needs than men.  In particular, people, mostly women and children, who are living in an abusive situation may be more vulnerable to violence because stress is often a trigger for acts of domestic violence as is feeling powerless as one might well feel if you have been flooded or burned out of your home, or you are cut off by water, no transit and no electricity.  And if you are the primary caregiver for children or elder relatives, fleeing an abuser is all the more complicated.

Compounding the problem, shelters and other facilities that might normally be available to help may also be without electricity and phones or have been flooded or be short-staffed and unavailable or less available to help and police may have a harder time responding to calls if the victim even has a phone (which as I write this a great many people in New York and New Jersey still don’t have).

If you know people who may be  particularly vulnerable to intimate violence in their lives and who have been affected by this horrendous storm, please do what you can to reach out to them and also, please consider making a donation to domestic violence shelters that may have been impacted as they may really be scrambling to provide additional services or rebuild.

And while we clean up here in the U.S. please be mindful that we were not the only country impacted by the storm and women in Haiti, still recovering from multiple weather disasters in the last few years,   are very vulnerable, particularly in refuge camps, where rape and sexual assault have been serious problems and where access to such basics as food for infants and feminine hygiene products may be hard to get.

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 October 31, 2012  Posted by on October 31, 2012 1 Response »
Oct 182012
 

When it comes to sexual violence during armed conflict, there is much we still don’t know, which, as the 2012 Human Security Report points out,  has important implications for how we address that violence.  The report’s analysis and conclusions about what we do and do not know however are deeply flawed.  The authors of the report state that they believe that the way we frame and perceive the problem is flawed in several ways:

First, it exaggerates the worldwide prevalence and intensity of wartime sexual violence by inappropriately generalizing from shocking victim accounts and statistics drawn from a relatively small number of the worst-affected countries.
Second, it systematically neglects domestic sexual violence in war-affected countries, despite the fact that its impact is far more pervasive than that of conflict-related sexual violence. It also largely ignores sexual violence against males in wartime.

As Megan H. Mackenzie points out, both of these assertions are highly problematic.  As is  the distinction the report makes between “conflict-related sexual violence” and “domestic violence”:

We make a distinction between the two major types of sexual violence that occur during wartime. First, there is conflict-related sexual violence, by which we mean that perpetrated by combatants—rebels, militia fighters, and government forces. Second, there is domestic sexual violence, which includes not only that perpetrated by intimate partners but also by other household or family members. The evidence we have indicates that the large majority of noncombatant sexual violence in wartime is made up of domestic sexual violence.

The insistence of the authors in making the distinction between “domestic” violence against women and “conflict-related” sexual violence is a critical fault in their analysis.  To begin with, as Gloria Steinem points out in an interview with Lauren Wolfe about why she spearheaded the Women Under Siege project  (of which Wolfe is the Director) with the Women’s Media Center, “sexualized violence” is a far better descriptor than “sexual violence”,

Because there’s nothing sexual about violence. Sex is about pleasure. Violence is about pain. Nature tells us what’s good for us by making it pleasurable, and what’s bad for us by making it painful. To get those things mixed up usually requires a childhood in which people we loved and depended on inflicted pain, and we came to believe we couldn’t get one without the other.

What we also need to be cognizant of however is that all violence is an attempt to gain power over an ‘other’.  That is true whether it is a U.S. drone attack over Pakistan, or the shooting of a young girl who dared to speak out against the Taliban.  It is true if it is fighting on the streets of Syria, or a street fight in New York or an honor killing in Iraq (a form of violence which reportedly increased after the U.S.invasion of Iraq).  It is true whether it is a rape by a U.S. serviceman in Japan or a murder behind closed doors in Omaha.

The point is this–the root cause of sexualized violence is an attempt to gain power over by the assailant, regardless of whether it is directly related to armed conflict or not and insisting that they are separate issues indicates a systemic lack of understanding that has very damaging implications.

It is also important to note that the common thread of the attempt to assert power over that is at the root of all sexualized violence makes it indeed quite difficult to separate the issues of conflict related sexualized violence and sexualized violence behind closed doors because all too frequently, military unrest itself leads civilians to feel powerless and vulnerable which leads to the use of “domestic” violence in an attempt to feel empowered.  In addition, when soldiers or other combatants are taught to hate and kill and to use violence to prevail in conflict, all too often those teachings follow them home in the aftermath of battle, those who commit sexualized violence as a tactic of war may well commit “domestic violence” as well–so where precisely would one draw the line between these realms?  It is, I think, necessary to make that connection (as opposed to asserting a distinction as the report does) and more useful to see it as varying manifestations of the root problem of the assertion of power over rather than as two separate problems.

The reports also makes a distinction regarding “strategic” rape that is deeply disturbing:

If mass rape is strategic—e.g., if it has been initiated as part of a top-down policy intended to terrorize civilians, or as part of a campaign of ethnic cleansing—the international community may have some immediate leverage that can be used to pressure the leaders of the government or rebel forces to stop. These may include threats to withhold aid to governments, to impose sanctions, or to push for indictments in the International Criminal Court.
If, as studies suggest, rape perpetrated by soldiers and rebels is not part of a top-down strategic plan, but is due to the fact that the military command system is simply too weak to stop the abuse, there is relatively little that the international community can do in the short term. In the longer term, however, bringing perpetrators of rape to justice may provide a measure of deterrence against sexual violence in future wars.

We have argued that some of the claims that sexual violence is deployed as a “weapon of war”are based on little more than anecdotal accounts. Pushing for policy initiatives on the basis of false assumptions is clearly a recipe for bad policy. It underlines yet again the need for reliable data—the sine qua non of evidence-based policy.

With respect, sexualized violence is ALWAYS strategic, regardless of  who perpetrates it.  As regards military conflict, granted, there aren’t too many examples of explicit top-down orders to commit such acts, but I would be hard pressed to come up with an example of military action or conquest that did not involve sexualized violence.  It has been a systemic part of of the violent quest for power over since the dawn of patriarchy.

But even without going back thousands of years and to bring it a little closer to home for most readers, one has only to look at the sorry history of the U.S. military in regard to sexual abuse, whether at bases around the world (as Cynthia Enloe has documented so thoroughly) or the ongoing epidemic of sexual abuse within the ranks that continues despite multiple commissions and lengthy reports and hand-wringing at Congressional hearings.

That said, the report does make some very valid points, namely that there is a lack of adequate data and that has important policy implications as does the incorrect interpretation and sensationalizing of data (they use a Nicholas Kristof piece as an example).

The report is also particularly critical of how the U.N. addresses sexualized violence which certainly in part is justified. I have always thought that it is unspeakably ironic that U.N. peacekeepers themselves have been accused of sexual violence.  However, while the U.N.’s work on this issue is very far from perfect, the reasons are myriad and far more complex than the  report’s distillation implies and to put it bluntly, what is the alternative?

There simply is not another global body that is doing anything remotely as comprehensive as what is being done by the U.N.  And it is notable to me that there is no attempt to address the complicity of the U.S. in dragging it’s political feet when it comes to implementing UNSCR 1325 (it took 10 plus years to put a National Action Plan in place in large part because that is something that was not acknowledged as important by the Bush administration) as well as our inability to ratify CEDAW.

In all, the report raises a number of important questions, but it’s analysis is limited and flawed and should be understood as such.

 

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 October 18, 2012  Posted by on October 18, 2012 Comments Off
Oct 152012
 

The theme of this year’s Blog Action Day, “The Power of We” is a concept that is crucial to feminist work.  All too often we find it necessary to talk about the problems of power over, the abusive usurpation of control which frequently defines and challenges our lives.  In addressing Power Over, we utilize multiple forms of empowerment–drawing on the power we have within ourselves and the power we create with community, working together.  The power of we.

While I’ve lectured and written about power numerous times, it seemed to me that the most appropriate way to observe and participate in this blog action and to write about the how the power of we informs feminist work was to ask a few of the many wonderful activists who are part of my “we” and who utilize this powerful concept in their work every day to share their thoughts about this topic.  Here is what they said:

Jill Miller Zimon is the Director of Partnerships for the Cleveland, OH based The Civic Commons and is also a member of the Pepper Pike, OH City Council.  She is also a writer:

I turned 50 over the summer and the only way I could conceive of celebrating was first, here in Cleveland, locally, getting together with 10 amazing female friends, and then, just this past weekend, with four girlfriends from college with whom I’ve been friends for over 30 years. Earlier this year, I was able to help celebrate another friend’s milestone birthday and we’ve known each other since we were four years old, and then I was able to spend another long weekend with another childhood female friend who I’ve known since we were in 7th grade. So I’d say that there is organizing and there’s organizing and in a woman’s life and in the scheme of building confidence and confidences, I cannot imagine having the trajectory I’ve had without both types of organizing.

Gloria Pan is a consulting campaign director for MomsRising and previously helped to launch the Mom’s Clean Air Force and Feminism 2pt0:

Like square pegs trying to fit into round holes, women today struggle to fit our lives into the societal infrastructure erected by men, for men. We’ve taken on the additional responsibilities of work on top of home, but without protections like guaranteed paid sick days, family leave and equal pay for equal work. It has become impossible. Yet from boardrooms to newsrooms, the voices of authority in public life continue to be male, and they will not speak for us. To achieve the societal changes women need, we must use the channels of social media to tell our stories, express our concerns and, above all, unite our voices into a crescendo that must be heard.

Attica Scott is the District 1 Representative on the Louisville, KY Metro Council and is the former coordinator for Kentucky Jobs With Justice and a former adjunct faculty member at Bellarmine University:

“The Power of We” is using our collective energy and gifts to transform institutions and systems and change public policy that destroys our natural environment and ignores the cries of young people, women, people of color and others who often feel powerless. “The Power of We” means committing ourselves to action that is inclusive and intentional and reflects and respects the whole person be they gay, living in poverty, a former felon, an elder, a person with disabilities or whatever reality they set at our feet. “The Power of We” means doing better than our best in order for everyone to feel part of our global society.

Gloria Feldt is a leadership speaker, the author of several books, most recently “No Excuses: 9 Ways Women Can Change How We Think About Power” and is the former President and CEO of Planned Parenthood.  In her work, Gloria encourages us to use our power to:

All social movements lose steam once they have won just enough that people find the doors open just enough that they personally can squeeze through. But that’s exactly the time when the power of we is critical to achieving the goals feminists envisioned before getting co-opted by the extraordinary successes we’ve had over the last 50 years. The three movement building principles I learned on the feminist frontlines are simple but not easy. They are necessary to keep on moving forward toward full equality. I call them Sister Courage: Be a sister–reach out to help another woman and ask for help when you need it; have the courage to state the problem or injustice; and put the two together into an organized plan. It’s how women got the right to vote. It’s how we got rid of “Help wanted male” job announcements and discriminatory lending practices. It’s how we got insurance to cover contraception–or legalization of contraception for that matter. It’s how we will rid society of sex trafficking. It’s the collective power that can change the world.

We are indeed powerful and that power becomes all the more empowering when we work together.  I invite you to add your own thoughts on the “Power of We” in the comments section.

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 October 15, 2012  Posted by on October 15, 2012 Comments Off
Oct 122012
 

Two Catholic guys and a woman walk into a bar behind a Black Christian guy and a Mormon guy, jostling each other and laughing. The woman turns to the  Catholic guys and in a quiet tone, asks the woman question.  What do they think of abortion? The men quit clowning around and quietly they answer.  Stop me if you’ve heard this one before.

Okay, I admit it, I had my finger on the remote control, thinking that the last fifteen or so minutes of the vice presidential debate weren’t going to be worth staying up for and once again, addressing how issues impact women had been missing in action as a topic of debate.  And then Martha Raddatz asked them what, as Catholics, they thought of abortion.

I really wish she hadn’t framed abortion  as a personal issue for a couple of Catholic guys. Frankly I don’t give a crap what their personal or religious beliefs are. What matters is their political stance on the subject. Not to mention that we really need to discuss reproductive rights as a whole, not just reduce it to the abortion question.

And I really wish that when they talked about Afghanistan and Iraq and Syria, etc. that Biden had pointed to the National Action Plan on Women, Peace and Security that Obama recently issued and the importance of CEDAW and 1325.  And imagine if equal pay was part of the economic discussion or women’s healthcare needs and how they will be met by each candidate.

It is especially infuriating that Biden has been a very strong supporter of both CEDAW and VAWA which has not had its funding re-authorized this year, courtesy of the GOP.  It truly speaks to the extent of our woman problem in this country that it is not deemed pc for him to be proud of his support for these crucial issues or to take Ryan and the GOP over the coals for refusing to support these measures.

It remains to be seen if the framers of the debates will deem the woman question asked and answered and whether the interests of women in any way figure into either of the remaining presidential debates.  I’m not holding my breath.

———-

Postscript:  All that said, I thought Martha Raddatz did a tremendous job of moderating, compared to Jim Lehrer’s sorry perfomance at the first presidential debate, it was a huge relief to see such competent moderating.

 

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 October 12, 2012  Posted by on October 12, 2012 1 Response »
Oct 072012
 

While most women readily undergo regular breast squooshing mammography radiation to screen for breast cancer, there are many misunderstandings about, and much we simply don’t know about the widely accepted test.  In The Big Squeeze:  A Social and Political History of the Controversial Mammogram, Handel Reynolds, MD provides a riveting look at the history of mammography that gives us a better understanding of what we do and don’t know about breast cancer screening.

The story of mammography is part science and medicine, but also in large part cultural, political and economic.  At the beginning of his narrative, Dr Reynolds notes that,

As mammography was aggressively promoted int he 1980s to 1990s, utilization rates rapidly increased.  As this occurred, the mundane mammogram became the little pink engine that could, and did, drive the growth of a vast screening-dependent secondary economy.

For many years, women in the U.S. were told to begin annual screening at age 40. In the last few years however there have been numerous reports that come to different conclusions about how often to screen and at what age to start screening.  But it is not widely known that this is hardly a new uncertainty.   The results of the first large study of mammography’s effectiveness, the HIP (Health Insurance Plan of Greater New York) which began in 1963 did not support beginning annual screening at age 40, and according to Dr. Reynolds,

It is important to note that the benefits of screening were seen only in women fifty to fifty-nine years old.  No benefit was demonstrated for women sixty to sixty-nine or forty to forty-nine.

While most of us are all too aware that there are many more cases of breast cancer than there were 50 years ago, what we fail to understand is that a significant part of that increase is due not to actual new cases, but that we are finding them.  In fact the first nationwide screening demonstration program, the Breast Cancer Detection Demonstration Project (BCDDP), which began in 1973 led to a 14% increase in the known incidence of breast cancer in 1974-75, according to Dr. Reynolds.

Concerns about radiation exposure from mammography are also nothing new. As early as 1976, Dr. John Bailar III of the National Cancer Institute (NCI) raised concerns about the risks of radiation-induced breast cancer from mammography which led to warnings about those risks being given to women considering screening and the NCI issued guidelines that said they could not recommend routine screening for women between the ages of 35-49.

But as Dr. Reynolds points out, radiologists have been heavily involved with the American Cancer Society (ACS) and 6 presidents of ACS have been radiologists. Hardly surprising then that  it was ACS that began to make assertions that up to 80% of women in the 35-49 year old age group fell into one or more high risk categories and therefore should be screened.

Dr. Reynolds also writes that the BCDDP study did not have a control group that did not undergo screening, and because of that, it could not answer the question of whether or not screening resulted in less deaths (which is the usual standard of whether such screening is effective).  That however did not stop ACS from  inferring that because the earlier HIP study indicated a mortality reduction in women over 50, it was also reasonable to assume that with improving mammography equipment, younger women would benefit as well and

In 1976…(ACS) adopted a position that women forty to forty-nine years old should be screened every one to three years.  At the time, it offered no scientific justification for this recommendation.  There was none. (emphasis mine)

Dr. Reynolds analysis of how mammography became widely accepted is quite enlightening.  He points to the blatant use of fear as a tool to convince women to get screened in the late 1980s with the American Cancer Society leading the way in telling us that breast cancer rates were rapidly rising despite the fact that the increased numbers of cases were  attributable in part to increased use of screening (as well as by women’s longer life expectancy–you are more likely to die of breast cancer if something else hasn’t killed you at an earlier age).  It wasn’t that the cancer wasn’t there before, it was that we weren’t aware of it or died of something else first.

ACS mounted a huge campaign around the use of the statistic that one in nine women would get breast cancer.  Yet an ACS spokesperson was quoted in the New York Times as saying that it was, “meant to be a jolt…It’s meant to be more of a metaphor more than a hard figure.” (emphasis mine).

As Dr. Reynolds notes, that sort of messaging led to women overestimating their own risk of getting breast cancer as well as overestimating the benefits of mammography and the all too common mis-perception that regular screening can keep you from getting breast cancer.

The book goes on to cover later studies that really brought into question whether there was any benefit to routine screening before the age of 50 and the very real risks of over-diagnosis and treatment for cancers that might not be life-threatening and to what extent screening really decreases fatalities as well as the problems of false negatives and false positives in mammography.  Towards the end of the book Dr. Reynolds takes a look at the problem of DCIS which in some cases would never be fatal but because we don’t know which cases might or might not become invasive, all cases are usually treated.   Dr. Reynolds suggests that we need to re-evaluate that approach because it puts so many women at risk for the complications of unnecessary treatment, suggesting that regular re-evaluation of such cases rather than immediate treatment may be appropriate.

This book is both fascinating and quite readable, and highly recommended.  It tells a necessary part of medical history that is much, much too relevant to anyone facing this disease or who knows someone who is (in other words, all of us).  That said, at the end of the book, Dr. Reynold tells us that we simply don’t know how much the recent drop in breast cancer deaths is due to screening and how much is due to better treatments.  Nor does he mention environmental factors or the role that the decreased use of hormone therapy may make in these rates.  Despite that, he asserts that,

Screening benefits women aged forty to forty-nine and those who are fifty and older.  The magnitude of the benefit however is greater for those over fifty.  With the battle for access essentially having been won, I believe that mammography should and will continue to be available to all women over forty who wish to be screened.

It is also necessary to note that for poor women and women without insurance, mammograms have not necessarily been available.  While I agree with Dr. Reynolds that mammograms should be available to any woman who wants to be screened, the data is far from clear as to just how beneficial non-diagnostic screening is.

A few additional thoughts:

1.  Concerns about the harms of radiation from mammography are as valid today as they were when they were first raised. Particularly in light of the concerns raised by scientists at the FDA about excessive radiation from GE mammography machines.

2.  This chart showing global breast cancer mortality rates is illuminating. The U.S. has lower rates than Canada and some European countries yet higher rates than some South American countries and Australia. While I’ve only been able to gather screening recommendations from English speaking countries, it is worth noting that both Canada and Australia recommend far less screening than is the norm in the U.S., yet one of them has a higher mortality rate than we do and one is roughly the same, leading me to truly wonder how we can say that routine screening is effective. See this map as well.

3.  According to The Telegraph (UK), the recent drop in breast cancer mortality in Europe is due primarily to treatment, not screening, a conclusion drawn because the drop applies to women under 50 as well even though most European countries do not have regular screening programs for younger women,

Professor Carlo La Vecchia, one of the study leaders from the University of Milan, said: “The fact that there will be substantial falls in deaths from breast cancer, not only in middle age, but also in the young, indicates that important advancements in treatment and management are playing a major role in the decline in death rates, rather than mammographic screening, which is usually restricted to women aged 50 to 70 in most European countries.

4.  According to a 2011 Health Day article that looked at the relationship between screening and breast cancer death rates in several European countries, it is not clear whether recent drops in death rates are attributable to screening or to better treatments. A WHO study found that the rates were similar regardless of screening.

5.  You may also want to listen to Uprising Radio’s Sonali Kolhatkar’s interview with Dr. Reynolds here.

What are we to make of all this?  Dr. Reynolds’ book provides some valuable historic context to our understanding and decision-making about mammography.  What I think is abundantly clear (and as Dr. Reynolds points out) is that policies about mammography have been the result of a far from perfect mix of science, medicine, emotion, politics and economic considerations.

It is beyond unfortunate that we need to be skeptical when it is radiologists who push mass screening–on the one hand it is their area of expertise. On the other, we live in a country where medicine is a for profit business and it is in their best interest to recommend their own procedures.  And as the recent Komen for the Cure dustup reminded us, there has been a real price paid for focusing on “curing” cancer rather than finding its cause and the enormous profitability of treating cancer has been one of the reasons. That has to change because the real truth is that  cancer cannot be cured, only treated, and what we need to do is focus on cause and prevention.  Until then, too many of us will keep dying of this disease.

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 October 7, 2012  Posted by on October 7, 2012 2 Responses »