Health Behavior and Health Education – Page 3

Shame Won’t Make You Healthy. Really.

Some of you public health and social marketing gurus have likely already come across the recent slew of ads in Georgia, published by an organization called Strong4Life, that are ostensibly part of an effort to curb childhood obesity. A lofty goal, indeed, but a misguided approach, the criticisms of which have already begun. The images are pictures of overweight and obese children with a variety of captions, including “It’s hard to be a little girl if you’re not,” and “Fat may be funny to you, but it’s killing me,” and “Fat prevention begins at home. And the buffet line.”

Shaming rarely works as a strategy for behavior change. It’s been shown in efforts ranging from drug use behavior to HIV-prevention goals and marketing campaigns. If you click on the images in the Strong4Life campaign you get taken to video spots of these children, who seem burdened by sadness and depression (which can be both causes of and side effects of being overweight – exacerbating these emotional states does not help in weight loss endeavors). Recognizing if one is at an unhealthy weight is an essential step towards healthy weight loss, but the children do not appear buoyed by information, support, and new ideas on ways to be healthy. They seem downtrodden and embarrassed, the very characteristics that a shaming and body-bullying culture easily pounce on and cultivate. The video of Bobby, which portrays a mother who appears shamed by her son’s question doesn’t make me want to hit the gym or eat a platter of vegetables. Instead, the voyeuristic quality of the mock confessions feels more than a bit exploitative and it triggers a gut reaction of sympathy and protectiveness, making me want to yank the camera from the hands of Strong4Life. It’s like they took a message from the Jillian Michaels’ school of adding insult to injury, splashing in an additional dose of fear and intimidation, and expecting that this will result in a lifelong substantial increase in meaningful self-esteem.

The well-developed criticisms of this campaign point out that not only does shaming and negative marketing not induce healthy behavior change, but that these ads do nothing educationally. One girl near-tearfully admits that she gets made fun of at school because she’s fat, and the video slams down a tag line of “being fat takes all the fun out of being a kid” before fading out. While the Strong4Life campaign has a “Get Started” tab offering facts about nutrition and screen time and physical activity, the impact of the original image has already been made. Advertising relies on quick one-liners, on stark imagery, and emotional reactions. In this case, what we see is a tag line reiterating that this girl is not a normal kid, a solitary image of an overweight girl connected to an emotional plea on her part of loneliness and victimization. It’s powerful all right, but not empowering. The ad emphasizes fat loss, heightening the importance placed on size, instead of cultivating an interest in healthy lifestyles and appreciation of the fact that people come in different sizes and can be equally healthy. Critics of the appreciation-of-all-sizes approach say it borders on supporting obesity, which I see as short-sighted. Very high weight status can certainly indicate other problems, like diabetes, early heart and respiratory problems, and difficulties engaging in physical activity. But it’s also essential to make sure that the message that larger sizes are universally unhealthy is quashed, and it’s vital to promote instead that appreciating people of all sizes is essential – and more importantly, that valuing people regardless of size is a priority. This is a topic that deserves that kind of nuance. I would welcome ads that excitedly show kids engaging in active lifestyles, enjoying sports and enjoying healthy, full diets – creating characters in ads that viewers want to emulate, as opposed to characters that viewers are meant to distance themselves from or who are meant to be repelling, is not only good business sense but inclusive and supportive. These ads further emphasize and underscore the cultural norm categories of “normal weight kids are normal” and “overweight kids are not normal and therefore not ok” – this certainly won’t help curb teasing or bullying in this arena. And since we do know that consistent, positive social support is one of the key factors in healthy behavior change, it’s obvious why public health experts met this series with skepticism. And here’s what else we know – healthy lifestyle changes significantly decrease mortality, regardless of baseline body mass index. Changes in fitness level are what alter all-cause mortality, not changes in BMI.

The response that these ads are cultivating “important conversation” is somewhat moot. It may get people talking, and it hopefully it will encourage media platforms with a larger audience than this blog to come out with constructive, evidence-based, supportive tips and strategies for a healthy lifestyle – but the fact remains that these ads are contributing to the negative, body-shaming noise that fuels so much of popular media and it remains that the effect can be really damaging and counter-productive at the outset. Individuals who ultimately are successful at losing large amounts of unhealthy weight (or who more consistently use condoms, for example) do so not merely because someone called them fat (or because they knew someone who became infected with HIV) – this has happened many times over to individuals seeking or needing to enact behavior change. The change happens because they not only begin to see themselves as deserving of these changes, but also because they become helpfully informed with concrete action steps that help move them through behavior change, are supported and consistently cheered on, and because they know what to do if they feel themselves slipping.

The bottom line is that discussions about healthy living need to happen to prevent long-term chronic health problems, and these conversations do need to happen early. But they shouldn’t start with shaming, embarrassment, or the putting on display of children who have weight problems and asking them to broadcast what’s so horrible about it while telling them that their love of the buffet is what got them to this point. We can do better.

Sebelius Caves, Girls Pay the Price

By now, I’m sure you’ve all heard that Kathleen Sebelius, the Secretary of Health and Human Services, has blocked the recommendation of the Food and Drug Administration that the over the counter (OTC) drug Plan B, commonly known as the ‘morning after pill,’ be made available without a prescription for girls of all ages. It is currently available without a prescription to girls ages 17 and up, and requires a prescription for girls ages 16 and below.

It is worth noting that this is the first time a Secretary of HHS has overruled the FDA. This is not insignificant. The purpose of HHS is to promote the health, safety, and well-being of Americans. The FDA is an obvious component of this. While the FDA is an agency of HHS, the purpose of the FDA is to promote and protect public health, through the regulation of OTC and prescription medications, vaccines, food safety, medical devices, and more. They do this through clinical trials and testing, which is how we come to know of drugs’ side effects as well as how significantly they aid in the relief of what they purport to treat. The FDA recruits researchers who understand both the purpose of and execution of this research. Attempts have been made to loosen the regulations of the FDA; for example, some terminally ill patients have petitioned the FDA to allow them to access experimental drugs after Phase I of a trial – the FDA has denied these requests due to the lack of research regarding a drug’s long-term effects post- Phase I. The FDA is not without criticisms; they have been accused of being both too hard and too lax on the pharmaceutical industry. Members of the FDA have also expressed feeling pushed to present certain results. Scientists at the FDA complained to Obama in 2009 that they felt pressured under the Bush administration to manipulate data for certain devices, and the Institute of Medicine also appealed for greater independence of the FDA from the powers of political management.

The commissioner of the FDA, who is a physician, reports to the Secretary of HHS. Sebelius’ job is not one of medicine or research, and requires a background in neither. It does require a background in politicking, which is exactly what we’re seeing here. The purpose of pointing that out, and of articulating that this is the first time a Secretary of HHS has overruled an FDA recommendation, is that Sebelius’ refute would not be based on differing scientific results, or research that opposes the FDA’s recommendations – because there is none. The override has different drivers, and the assumption floating out there – for good reason, since there is little alternate explanation – is to appease social conservatives and the anti-abortion contingents.

Plan B is not the abortion pill. It is the equivalent of an increased dose of a daily birth-control pill, and has no effect on already established pregnancies – it prevents pregnancy from occurring. Scientists within the FDA unanimously approved the access of the drug without a prescription for girls of all ages, after an expert panel put the recommendation forward. It is, to quote a USC pharmacist, one of few drugs that is so “simple, convenient, and safe.”

The conservative Family Research Council claims that requiring a prescription will protect girls from sexual exploitation and abuse – I fail to see how requiring a girl to get a prescription will protect against sexual violence, especially since girls may be attempting to get Plan B because sexual violence has already occurred. This comment is also a flagrant indication of misunderstanding of sexual violence and abuse – a young girl is not likely to disclose to an unknown physician that she is being sexually abused or assaulted and that’s why she needs a prescription for Plan B. Make no mistake, this ban is a victory for anti-abortion rights activists. If a girl cannot prevent a pregnancy from occurring, she is subsequently faced with trying to terminate an existing pregnancy (again – that could have been prevented!). Given how reproductive and abortion rights have been systematically chipped away at for the past few years, this girl who did not want the pregnancy and tried to prevent it from happening but was denied because she is shy of 17 years, will be in an even worse position. This is what anti-abortion activists are counting on – that once she is pregnant she will have to carry to term.

Plan B can prevent abortions from happening. HHS, with its mission of protecting the health and welfare of all citizens, should do everything they can to protect the health of girls’ reproductive development, which includes the prevention of unwanted pregnancy at its earliest stage. The girls under the age of 17 who need Plan B the most are the ones who also need it to be as easily accessible as possible. Much like requiring parental permission for abortions for girls under the age of 18, this ban actually can put girls at risk. Many girls will not have the family support, financial means, or healthcare to manage a pregnancy; some girls may face parental and familial abuse if they have to admit to needing to prevent a pregnancy with Plan B. What if a girl is a victim of sexual assault within her family? Should she be forced to deal not only with this trauma, but also have to determine how to prevent herself from being forced to carry a fetus to term as a result of this tragedy? Most girls under the age of 17 do not have easy access to clinicians and hospitals on their own, nor are they able to navigate our increasingly complex healthcare system on their own, which they would not only need to do to access Plan B, but would need to do within 72 hours for the pill to be effective. Girls whose bodies are not ready for pregnancy, girls who were victims of assault and rape and incest, girls whose futures will be dramatically changed and opportunities truncated – they all become casualties of this ban. Before we start sex-shaming and proclaiming that they shouldn’t have had sex if they didn’t want to deal with the consequences, let’s remember that these girls were not miraculously impregnated. Whether consensual or not, a boy was involved. This is a gendered issue – the girls are the ones who will have to deal with the lack of access to Plan B, physically, mentally, and emotionally.

Originally, advocates in 2003 successfully petitioned Plan B to be available OTC for girls 18 and up (after having been available with a prescription since 1999), but a judge overruled that decision and lowered the age to 17 after he deemed the decision had been made politically, not for scientific reasons. It appears that history is repeating itself.

Feminism in Zambia: Finding an Unexpected Champion

Our last guest post this month is by Stephanie Reinhardt. Stephanie is a Program Officer with Jhpiego and is currently working to support HIV/AIDS and maternal health programs in east and southern Africa. Growing up in San Francisco and joining forces with Larkin Callaghan at the age of 4 has left her overly opinionated and easily distracted by all the exciting things around her. Hey look – a baboon just walked by my office window! When she’s not bouncing around the globe, she’s very busy procrastinating.

Gabriel, a Zambian taxi driver who works outside an overpriced hotel in the capital Lusaka, drove me to a township on the outside of town last week. We started with the usual conversation.

“Where are you from?” he asked.

“California,” I responded, “though I’m starting to feel like Zambia is my second home”.

I’ve been to Zambia six times in the past four years supporting public health programs run through Jhpiego, an affiliate of Johns Hopkins. After some discussion about various locations in the US he had learned about from other passengers, he jumped into his favorite story about American history to see if I knew it as well.

After slowing his taxi to traverse a particularly rough patch of potholes, Gabriel looks at me and said, “Well, you know about the Gremich sisters?” (Upon further research, I learned the correct spelling of Grimké sisters). I shook my head no, which gave Gabriel the green light to dive into his story:

“During the time of slavery in America (perhaps in California, or Texas or wherever), there were two sisters who wanted to put an end to slavery.”

I jumped in to briefly describe (with my best recollections from high school) the divisions between the north and the south that eventually led to the civil war, which I explained, for future reference was on the east coast of America, so I would guess that the Grimké sisters were probably from a state like New York. (Turns out they were from South Carolina, but later joined abolitionist circles in Philadelphia, New York and New Jersey.)

Gabriel gave me a polite nod, but the civil war was clearly not his target conversation. With the eagerness of a school kid sitting in the front row, he continued his story, which he credited to a book he had read called, No Fear of Trying. Gabriel’s eyes grew large as he told the story of these sisters’ amazing bravery to publicly speak out against slavery. He looked at me and repeatedly tapped the top of the steering wheel with his palm to emphasize the profundity of this story. “These were the first women to speak at a podium…to men. Women did not do that at that time.” He described the message of equality and freedom that they took all the way to the US government. “People thought that women should not give public speeches to men. Lots of people threatened them and told them to stop, but these women were so brave, ” he continued. I was nodding in agreement, but apparently not giving the reaction he wanted. “Isn’t that amazing?” he exclaimed. “It’s great!” I responded.

Despite a few factual inaccuracies (that the Gimké sisters final speech ended slavey, and this all took place in the 1950s), Gabriel’s story is pretty spot on. The Grimké sisters grew up in South Carolina with all the advantages of a privileged class awaiting them. Unlike many other northern born abolitionists, the Grimké sisters had seen slavery first hand and felt compelled to not only put an end to the practice, but to put an end to racial and gender discrimination – an idea radically progressive for their time. They promoted extremely advanced messages for both racial and gender equality. Angelina Grimké letters demanded “educational reform, equal wages and an end to other forms of discrimination against women.”

What fascinated me most about Gabriel’s story was not that I was previously unaware of this significant historical biography (I am never shocked by the amount of information I don’t know or frankly, don’t remember). Rather, I was completely taken aback by his emotional response to this story. He loved these women for their bravery to stand up to men and wanted to share it with anyone who got in his cab.

Zambia is not a country known for its progressive gender relations. Women unfortunately still live very much as the mercy of their husbands, cultural laws and the State. As explained in a 2002 OMCT report on violence against women in Zambia:

Women in Zambia currently face many obstacles to the realisation of their human rights including high rates of violence against women in the family, in the community and by the State, discrimination in the application of customary laws relating to family and inheritance rights, low levels of representation in political and other decision-making structures, a lack of access to education and employment opportunities, poor health care services and the limited availability of affordable contraception.

The 2007 Zambian Demographic Health Survey (DHS) included an assessment of women’s empowerment by asking questions on employment and decision-making. While great variations exist with regard to education level and location, overall 37 percent of men think that decisions about how to spend the wife’s cash earnings (if she has employment outside of the home) should be made mainly by the husband. These views extend to a woman’s body as well – 46 percent of men think that the husband alone should make the decision on the number of children to have. Only 64.8 percent of currently married women responded that they are the primary decision makers or make joint decisions with their husbands regarding their own health care.

So, given this context, I was baffled. I wondered if I had stumbled into the cab of an outspoken Zambian male feminist. As Gabriel’s taxi approached our destination, I probed him on his thoughts on women’s rights in Zambia. “Oh,” he responded, “we have learned a lot from Americans. Everyone is equal here.” Then he dropped the famous development buzz word “gender” and it was all over. “Yes, we have learned gender is important, so now we are all equal.” Ack.

I was hugely disappointed. My image of this Zambian male taxi driver in a superhero outfit championing women’s rights quickly vanished. I thanked him for the ride and started to get out of the car. As I was about to depart, he pulled out a small piece of paper and said, “You work in health? Can I ask you a question?” I nodded, and he continued: “My wife has decided that we should only have three kids, and so we want to stop now that we have three. Can you look at this list and tell me what you would recommend?” On the piece of paper was a list of family planning methods that they had received from their local clinic. I sat with him and explained the differences between some of the short term methods and the long term methods. I also described the vasectomy process should he be interested in the procedure. I explained that if his wife wants no more kids, a long term method, such as an IUD might be best, as it offers protection for 5-7 years. He smiled and responded, “Great, thank you. I will tell my wife this information and see what she wants to do.”

Maybe we have our champion after all.

Looking for More Attention? Drop Some lbs.

At least that’s what Skinny Water is promising in their latest advertisement, which I spotted yesterday. The ad shows a woman facing a throng of cameramen snapping her picture, elegant earrings dropping to the top of the headline which says: “Skinny Always Gets the Attention.” Take a look:

big skinny — Thinspiration, thanks to Skinny Water

A close-up, to see all the text:

close skinny — Close-up, for good measure.

Below the headline and photo of the various flavors, it also says “Zero calories, Zeor sugar, Zero Carbs, Zero Guilt.” With all that’s not in this water, you might wonder what it does offer. The website tells me that depending on the flavor of water, they’ve added vitamins B3, B5, B6, B12, C, A, and E. They’ve also thrown in magnesium, folic acid, calcium and/or potassium.

Despite trying to market itself as healthy, Skinny Water is instead perpetrating the cultural message that the best – nay, only – way to ensure that you get attention is by being skinny. This of course positions them well to try to push their product on those women who have been pulled into this lie. This ad tells us that the best way to skinny is not through healthy food choices and exercise and an understanding of what “skinny” means for our particular body type and shape, but essentially through fasting – which is what zero calorie drinks are the equivalent of.

In fact, Skinny Water is doing precisely the opposite of what a health-conscious company and product should be doing. Promoting the idea that those who are skinny deserve attention more than those who are not creates communities that support harmful diet-related behaviors and disordered eating for the goal of a wispy appearance . Not to mention reinforcing the ever-present undercurrent of disapproval of those who are overweight – or even normal weight! – and do not bow to the hierarchy of beauty that says those who are thin are the best. It’s just one more item in the laundry list of products that tell women their size and appearance are what is most important and will attract loyal friends and fans.

In defiance of that, let’s use our brains to remind ourselves why Skinny Water is wrong. While the website details the added vitamins and dietary minerals of each drink, it’s far better to get your needed supplements through a healthy diet rich in cruciferous and dark and leafy vegetables, fruits, whole grain and lean proteins. Washed down, in fact, by regular old water that keeps you hydrated and helps your body process and absorb nutrients. Skinny Water is telling its buyers that by adding these vitamins and minerals to their product, one can cut out food entirely and survive on a calorie-free but vitamin-rich manipulated water diet. Don’t be fooled! (I know you aren’t. Hopefully, you’re equally horrified.) For example, the“Power,” “Sport” and “Fit” drinks are all fortified with calcium, magnesium, and potassium – to help activate metabolic enzymes, keep your blood regulated, and support strong bones and teeth. Do you know what else can do that? Bananas, yogurt, kale, almonds and cashews, and quinoa. Frankly, there seems to be little difference between the “Power,” “Sport” and “Fit” drinks despite the claim that they each support different “goals” of the drinker – which lends support to the conclusion that these are madly marketed products that don’t substitute a healthy, well-rounded diet and instead are capitalizing on the now-entrenched notion that women care more about being skinny than anything else.

Summer’s Eve has Bad Marketing. And the Product is Terrible for You.

In light of all the on-point criticism of the ridiculous feminine hygiene ads and how they portray a woman’s relationship with her reproductive organs, I think we should point out a couple things.

First, douching is actually not good for you – it disrupts the balance of good versus not so good bacteria, which maintains a certain acidity level and in turn is key to a healthy vagina. Douching can destroy this careful equilibrium, causing an over-growth of the bad bacteria. This can lead to yeast infections and bacterial vaginosis; both of which are uncomfortable and cause symptoms that are more disruptive than the non-existent issues one thought they were getting rid of in the first place. More dangerously, douching can actually force unhealthy bacteria up into the uterus and ovaries, which if untreated can lead to Pelvic Inflammatory Disease (PID). This, more disturbingly, can cause infertility issues. While this may be rare, why risk the possibility by doing something that is unnecessary at best, but very damaging at worst?

The Summer’s Eve website has an “education” section, which does point out that some regular discharge is normal and offers some good snippets about the importance of wearing 100% cotton underwear. However, in their advice about yeast infections, they include “don’t sit around in a wet bathing suit,” “eat berries and yogurt often,” “don’t wear tight-fitting, non-breathable clothes,” and “eat less sugar,” concluding the list with “use pH-balanced washes formulated for the vaginal area.” Up to that last point, the list was fairly on target. In fact, the list I’ve gotten from my gyno every year has read very much the same with the exception of that last line. In fact, their advice has always been along the lines of: “do not use washes formulated for the vaginal area, even if they say they are pH-balanced, because your body balances that pH like a pro on its own.”

Summer’s Eve says their products have been dermatologist and gynecologist tested – I would be interested in what that test entailed, but also would be remiss to not point out that “tested” does not in any way necessarily equate with “approved.” I can test drive a Mercedes and it tells you nothing about what I think of it (I’d like one). Look, the American College of Obstetricians and Gynecologists as a body of physicians do not recommend douching. I am more inclined to trust them than a Summer’s Eve label.

Interestingly, the site does admit that the vagina is like a “self-cleaning oven.” This begs the question – why do I need this?

Women and their reproductive organs have thrived for thousands of years. Those reproductive organs have done a remarkably efficient job of cleaning themselves all those years without the “help” of douching projects. It doesn’t take a genius to deduce that these people are trying to tell women that their vagina is supposed to smell like a Laura Ashley store. It’s not. It should look and smell the way it has for centuries. Vaginas have spawned babies for generations without the help of branding and perfume, and it seems the marketing efforts could be better spent educating men and women that the vagina isn’t supposed to be the fertile ground of daisy chain making and delicate blossoms.

Your vagina is the foundation of your holistic health as a woman. Summer’s Eve is a masking product, not a health product.

Bottom line – if something seems off down there, swabbing it to make it smell like a bouquet is not the right course of action. Seeing your gynecologist is.

Abortion Isn’t That Simple, Mr. Douthat

Ross Douthat, one of the NY Times conservative columnists whose pieces I occasionally force myself to read, wrote an article yesterday about sex-selective abortion. In short, he claimed that the reason 160 million women were “missing” (that is, the reason they were so outnumbered in many countries like India and China, as well as other nations in the Balkans and Central Asia) was because they were “killed” via sex-selective abortion. In his words, the women weren’t “missing,” they were “dead.” (He also claims that the author of the book he cites, Mara Hvistendahl of the book “Unnatural Selection: Choosing Boys Over Girls, and the Consequences of a World Full of Men,” appropriates the issue to one of patriarchy, of greater social issues and inequities – which I agree with. He then says that “the sense of outrage that pervades her story seems to have been inspired by the missing girls themselves, not the consequences of their absence,” saying that she is more upset by the idea of abortion itself than she is about the issues surrounding abortion. Don’t you think that’s for her to decide? And doesn’t it seem she’s already decided what she thinks based on her book?)

Douthat, however, manages to contradict the crux of his argument near the start of his column.

He begins by saying “female empowerment often seems to have led to more sex selection, not less.” He then quotes Hvistendahl as saying “women use their increased autonomy to select for sons,” because male offspring bring higher social status. In countries like India, sex selection began in “the urban, well-educated stratum of society,” before spreading down the income ladder.

If this were the case – if in fact women had become truly empowered in their respective lands – culturally, politically, economically – then why would they be aborting based on the opposite – that men in their communities are still holding the cards? Are they imagining that men still hold positions of power and wealth in their countries, or are they living the ramifications of that painful reality everyday? Women do have some increased autonomy in many of these regions. But guess what? This autonomy has likely served to highlight the still very real inequities and disparities that exist in their communities, which contributes to the rates of sex-selective abortion. If women see which sex has the higher status, and one of the few autonomous decisions they can make is to choose the sex of their baby – they are likely going to choose the one with more status. This upsetting power dynamic shows just how far away true empowerment is for many of these women and their communities. If they felt their children would have the same opportunities if they were female than if they were male, the sex selection abortion Douthat decries would actually decrease. It is not the responsibility of the female fetus to ensure she is treated with the same respect and equality as the male fetus. Douthat seems to really care about female fetuses – but seems less interested in addressing the massive social, political, and economic issues that create so many difficulties for them once born. (His colleagues Paul Krugman and Nick Kristof seem to have handles on that. Too bad they were off yesterday.)

It seems that Douthat wants to push for the feelings of regret and remorse about abortion itself, separate from the issues surrounding it. Does sex-selection abortion sadden me? Yes. Does aborting a fetus that indicates it will have Down Syndrome sadden me? Yes. You know what else makes me sad? That a woman cannot afford a baby because she is single and has no familial or community support; because she has an abusive partner (homicide is the number one cause of death for pregnant women); because she has a low-wage hourly job that offers no maternity leave which could help her stay well while carrying the baby if needed; because she has no health insurance meaning she can’t access quality pre-natal care to make sure her baby would be healthy since we are systematically closing down those facilities that offer services for women who are uninsured (and also help provide birth control to prevent pregnancy!); because she has no way to pay for day care and she may have to quit her low-wage job to care for her baby; because she would then have no money for all the supplies, food, and developmental tools her baby would need to thrive which can lead to malnutrition, behavioral problems, child depression; because she could then become part of the 29.9% of families in poverty that are headed by single women, and her child could become part of the 35% of those in poverty who are under 18 years of age – the poverty rate for households headed by single women is significantly higher than the overall poverty rate.

We’ve cut child welfare services that aid women by the tens of millions in the past few years. Georgia alone cut over $10 million in Child Welfare Services. We’ve also cut subsidies that support adoption agencies – the organizations that help women find families that may be able to care for her baby were she to carry it to term – and who make sure these families are actually fit to do so! TANF (Temporary Assistance for Needy Families) provides women and families with aid so that children can be raised in their own homes or with relatives, instead of being placed in foster care and becoming wards of the state. How much have we cut from TANF? 17 of the poorest states, with some of the highest poverty rates in the nation, have already stopped receiving funds.

Birth control, one might say? Sure – birth control is expensive, so if she doesn’t have health insurance, she isn’t likely to be able to afford birth control (hey, Planned Parenthood can help with that, too! Seeing a pattern?) And if her partner refuses to wear a condom? If she is in an abusive relationship, if she fears leaving her partner, if she relies on her partner for added economic security – she’s much less likely to argue with him about the condom use. Or even feel that she has the agency to begin a negotiation discussion at all.

These facts make me sad. And all of these facts might lead a woman to decide she can’t have a baby. And many things not listed here may lead a woman to decide that she will not have a baby. And that she will have an abortion. Is it my decision? No. It’s not. It’s not yours or Ross Douthat’s, either. Again, Douthat represents the contingent of pro-lifers who want to make it seem like pro-choicers are cheering the performing of abortions right and left. What we are cheering is the right for women and respect of women to make their own decision based on their very specific personal circumstances. And given the fact that the medical establishment has not agreed with the pro-life camp in claiming that fetuses before a month into the third trimester can feel pain (reacting to stimuli does not equal pain, to reiterate, and pain without a cerebral cortex is seen by physicians as not possible), which has most recently become the pro-life camp’s wildly off-base rationale for preventing a woman’s right to choose, and given the fetus’ place of residence in the woman’s uterus as a part of her body, not as a human, these issues that Douthat sees as “sideline” are actually very much at the center of the argument. Bottom line – it’s the woman’s body. It’s the woman’s choice. She will be the one carrying it, she will be the one birthing it. No one else. So why should anyone else decide?

Additionally, it is not a crime for a woman to not want children. Since she is able to give birth, it is her decision as to when and how that will happen. Everything about her life and future will change once she has a baby. So she needs to be sure she is ready for that. How can one disagree with that? Douthat may not like it, but “the sense of outrage that pervades his story” (see what I did there? 😉 ) seems to me more rooted in his anger and frustration with his opinion not being considered by women in these decisions and not being able to control what a woman decides to do about what is going on in her body.

All of the things I listed – the job issues, the healthcare issues, the family and community issues, the issues that arise when a child doesn’t have access to food, clothing, and developmentally appropriate stimulation – are the causes. So why don’t we start figuring out how we can mitigate those facts and issues instead of attacking the effect – the abortion – which is a decision women come to after weighing all of those facts and issues just discussed. Douthat’s fear tactics of talking about female fetuses strewn across Indian hospitals is scary imagery. So is this:

And this:

homeless4 — Photo via Captain Hope's Kids Blog

And this:

philippines — Photo property of streetkidnews.blogsome.com

Want less abortions? How about providing health insurance, that covers both birth control and pre-post natal care? How about equal pay for equal work, so women are more financially and economically secure, providing them with the resources to stay out of poverty and keep their children out of it, too? How about child care in work environments, helping women who cannot afford day care can stay in their jobs and remain a part of the economy? While we’re at it, how about great public schools and clean community centers, so women know their children are being intellectually fed and socially stimulated in safe environments that help keep them out of more dangerous and potentially life-threatening social circles? How about comprehensive sex education so men and women know how to protect themselves not only from pregnancies but from diseases that can endanger a fetus and create complications during birth and cause health issues for them and their children – creating more expense, particularly if one has no health insurance.

Let’s talk then. And how about you follow me on Twitter?