Tag Archives: abortion/reproduction

Home Birth: How Dangerous is Too Dangerous?

We don’t prohibit all dangerous behavior, or even behavior that endangers others, including people’s own children.

Question: Is the limit of acceptable risks to which we may subject our own children determined by absolute risks or relative risks?

Case for consideration: Home birth.

Let’s say planning to have your birth at home doubles the risk of some serious complications. Does that mean no one should do it, or be allowed to do it? Other policy options: do nothing, discourage home birth, promote it, regulate it, or educate people about the risks and let them do what they want.

Here is the most recent result from a large study reported on the New York Times Well blog, which looks to me like it was done properly, from the American Journal of Obstetrics & Gynecology. Researchers analyzed about 2 million birth records of live, term (37-43 weeks), singleton, head-first births, including 12,000 planned home births.

The planned-home birth mothers were generally relatively privileged, more likely to be White and non-Hispanic, college-educated, married, and not having their first child. However, they were also more likely to be older than 34 and to have waited to see a doctor until their second trimester.

On three measures of birth outcomes, the home-birth infants were more likely to have bad results: low Apgar scores and neonatal seizures. Apgar is the standard for measuring an infant’s wellbeing within 5 minutes of birth, assessing breathing, heart rate, muscle tone, reflex irritability and circulation (blue skin). With up to 2 points on each indicator, the maximum score is 10, but 7 or more is considered normal and under 4 is serious trouble. Low scores are usually caused by some difficulty in the birth process, and babies with low scores usually require medical attention. The score is a good indicator of risk for infant mortality.

These are the unadjusted rates of middle- and low-Apgar scores and seizure rates:

homebirthoutcomesThese are big differences considering the home birth mothers are usually healthier. In the subsequent analysis, the researchers controlled for parity, maternal age, race/ethnicity, education, gestational age at delivery, number of prenatal care visits, cigarette smoking during pregnancy, and medical/obstetric conditions. With those controls, the odds ratios were 1.9 for Apgar<4, 2.4 for Apgar<7, and 3.1 for seizures. Pretty big effects.

Two years  ago I wrote about a British study that found much higher rates of birth complications among home births when the mother was delivering her first child. This is my chart for their findings:

Again, those were the unadjusted rates, but the disparities held with a variety of important controls.

These birth complication rates are low by world historical standards. In New Delhi, India, in the 1980s 10% of 5-minute-olds had Apgar scores of 3 or less. So that’s many-times worse than American home births. On the other hand, a number of big European countries (Germany, France, Italy) have Apgar<7 rates of 1% or less, which is much better.

A large proportional increase on a low risk for a high-consequence event (like nuclear meltdown) can be very serious. A large absolute risk of a common low-consequence event (like having a hangover) can be completely acceptable. Birth complications are somewhere in between. But where?

Seems like a good topic for discussion, and having some real numbers helps. Let me know what you decide.

Cross-posted at Family Inequality.

Philip N. Cohen is a professor of sociology at the University of Maryland, College Park, and writes the blog Family Inequality. You can follow him on Twitter or Facebook.

50 Years Later: Is the Birth Control Pill Patriarchy-Compliant?

If I have one thing to say about Holly Grigg-Spall’s new book, Sweetening the Pill: How We Got Hooked On Hormonal Birth Control, it’s that it brings together ideas in creative ways and comes out with conclusions that are new to me.

The book is an interrogation of the popularity of hormonal birth control in the U.S.  In one argument, Grigg-Spall begins with the fact that women’s bodies are a fraught topic. For hundreds of years, the female body has been offered as proof of women’s inferiority to men.  Feminists have had two options: (1) embrace biological difference and claim equality based on essential femaleness or (2) reject difference and claim equality based on sameness.

Largely, Grigg-Spall argues, the latter has won out as the dominant feminist strategy. Accordingly, all things uniquely female become suspect; they are possible traitors to the cause.  This includes ovulation, menstruation, and the mild mood swings that tend to accompany them (men have equivalent mood swings, by the way, they’re just daily and seasonal instead of monthly-ish).

Hormonal birth control, then, can be seen as a way to eliminate some of the things about us that make us distinctly “female.”  “Science is making us better,” the message goes.  By getting rid of our supposedly feminine frailties, “we are [supposedly] becoming better humans…”  A quick look at birth control pill advertising reveals that this goes far beyond preventing pregnancy.  Commercials frequently claim other benefits that conform to socio-cultural expectations for women: reduced PMS, clearer skin, and bigger breasts.  This Yaz commercial, for example, claims that the pill also cures acne, irritability, moodiness, anxiety, appetite, headaches, fatigue, and bloating.

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To add insult to injury, Grigg-Spall notes, advertising then frames consumption of the pill as liberation.  In this commercial for Seasonique, the pharmaceutical company positions itself as women’s answer to a mysterious oppressor.  “Who says?” is repeated a full eight times.

Others have criticized Grigg-Spall for, among other things, essentializing femaleness: utilizing  that strategy for equality that embraces women’s difference from men and asks others to do so as well.

I’m coming down on the side of “huh!?”  The Pill made an immeasurable difference for women when it was introduced as the first effective, female-controlled birth control method.  There’s no doubt about that.  Her book asks us whether our designation of The Pill as a holy pillar of women’s equality still applies today.  I think it’s worth thinking about.

Cross-posted at Pacific Standard.

Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

The Secret Life of Vintage Lysol Douche Ads

Every once in a while the internet is abuzz being horrified by vintage ads for Lysol brand douche.  The ads seem to suggest that women are repulsing their husbands with odorous vaginas caused by neglected feminine hygiene.  In fact, it only looks like this to us today because we don’t know the secret code.

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These ads aren’t frightening women into thinking their genitals smell badly.  According to historian Andrea Tone, “feminine hygiene” was a euphemism.   Birth control was illegal in the U.S. until 1965 (for married couples) and 1972 (for single people).  These Lysol ads are actually for contraception.    The campaign made Lysol the best-selling method of contraception during the Great Depression.

Of course, we’re not wrong to be horrified today.  Lysol was incredibly corrosive to the vagina; in fact, it’s recipe was significantly more dangerous than the one used today.  Hundreds of people died from exposure to Lysol, including women who were using it to kill sperm.  It was also, to add insult to injury, wholly ineffective as a contraceptive.

Here’s to safe, legal, effective contraception for all.

Via Buzzfeed and @CreativeTweets.

Lisa Wade is a professor of sociology at Occidental College and the co-author of Gender: Ideas, Interactions, Institutions. You can follow her on Twitter and Facebook.

Does Europe Have a Sex Selection Problem?

Excess under age-60 female mortality in less developed countries is estimated to add up to 3.9 million missing women worldwide (World Bank, 2011).  A large proportion of this is due to sex-selective abortion practices.  The practice occurs most commonly among poorer families in societies where boy children are given greater economic and social status than girl children. In such a context, the transition to smaller families can lead parents to choose boys over girls. Notably, female fetuses are most likely to be aborted when the first child born is a girl.

The table below shows the countries with the most skewed ratios at birth in the world. While there is naturally a slightly higher sex ratio of boys to girls — between 1.04-1.06 — ratios above that are considered to be altered by technology due to gender preferences for boy children.

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The reason we find this newest 2013 data of particular interest is that, despite the popular Western focus on Asia, the practice occurs in more European countries. Perhaps most striking is the central European country that ranks at the top of the list—Liechtenstein. This strikes us as odd, given that Liechtenstein has never made this list in the past. Perhaps this is a data collection error (in very small populations, as also in Curacao, the results can be skewed). But we are surprised that no journalists have picked up on the fact that the worst offending son-preference country in the world is now, allegedly, a European country.  We contacted the CIA to ask them about this possible data anomaly but have not yet heard back.*

On the other hand, if the Liechtenstein data is accurate, this would be a very interesting story indeed, especially since Liechtenstein has the most restrictive laws against abortion in Europe.  A quick scan of gender equity policies in Liechtenstein shows that women there were not legalized to vote until 1984, indicating that it is not the most gender egalitarian of European countries.

In any case, whether Liechtenstein’s inclusion in this disreputable list is a data error or not, the other European countries on the list are legitimate.  They have been high for many years, and a recent report on Armenia, for example, documents longstanding norms in gender preference.  The disproportionate focus on birth sex ratios in China and India no doubt reflects their status as the #1 and #2 most populous countries, which means a much greater overall impact in sheer numbers.  Nevertheless, our point stands.  Why has the disproportionate inclusion of non-Asian countries on the above-list gone virtually unmentioned by journalists?

Do Developed Western Countries Prefer Boys?

Americans often think of parental sex preference as a thing of the past, or a problem in developing countries. After all, the U.S. sex ratio at birth falls in the normal range, at 1.05. This is in spite of the curious American cottage industry in sex-identification home use kits, such as the Intelligender, the GenderMaker and the Gender Mentor.

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In surveys, American parents report an ideal of two children and equal preference for boys and girls. However, American gender preferences manifest themselves in more sneaky ways. A 2011 Gallup poll showed that, if they were only able to have one child, the highest preference was for a boy.  These results are little changed from the same Gallup question asked of Americans in 1941.

To return to a point made in an earlier post on skewed sex ratios, Americans may not be so different, after all, in their gender preferences from the countries in the above table.  The crucial difference, she noted, is that some Asian countries are more enabled to act on their boy preference than others. It appears we should now be including some European countries in that “enabled” group as well.

* Neither the United Nations, Population Reference Bureau, nor the World Bank have published 2013 statistics yet for comparison to the CIA data.

Jennifer Lundquist is an associate professor of sociology at the University of Massachusetts, Amherst who specializes in stratification and social demography.
Eiko Strader is a PhD student in sociology at the University of Massachusetts, Amherst who studies inequality in labor markets and the welfare state.

Why Male Pregnancy Matters

The reproductive health police are at it again, and this time they’ve got the gender and sexuality cops with them.  Despite the CDC reporting a decline in teen pregnancy across ethnic groups, public health and privately funded campaigns are popping up across the U.S. aimed at chastising, shaming, and blaming teenage mothers.

And now, the city of Chicago has gotten in on the act. Not satisfied with the traditional images of cheerleading teenage mothers with babies strapped to their chests, or wailing toddlers scolding their mothers for being too poor or too single, or even pop music icons who assure young women that motherhood ‘sucks’ even more than high school, the city of Chicago has decided to get creative. The Chicago Department of Public Health has created a series of posters featuring shirtless young men with apparently pregnant bellies – below the caption “Unexpected?”

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Ok, I get it. The campaign was designed to communicate the fact that most teen pregnancies are, yes, unexpected, and that teen fathers should bear an equal responsibility for said pregnancies. But as someone working at the interstices of narrative, health, and social justice, I am less concerned with wondering if teen pregnancy is ‘bad’, or even if shame and/or shock are effective motivators for behavior change (which I would argue they are not, check out Brené Brown’s eloquent argument). What concerns me is what other work such images are doing. In other words, what additional cultural stories is this campaign telling, and are those narratives socially just or unjust?

As this fantastic take-off from the Media Literacy Project shows, the primary problem with the Chicago campaign is its deeply trans-phobic narrative:

In the frame of the advertisers, the pregnant bellies in the ads are solely female while the rest of the body is solely male. The contrast is supposed to cause discord in the viewer, yielding feelings that the image is “disturbing” or “unexpected,” as the ads say. However, sex and gender are much more complicated than the advertisers understand. Transgender boys and men can become pregnant. Calling their bodies disturbing perpetuates a culture of ignorance, prejudice, and violence against transgender people.

The truth is, bodies which do not look traditionally ‘female gendered’ can and do become pregnant (consider the much publicized story of Thomas Beattie, for instance, a transgender man who bore three children) while bodies which do look traditionally ‘female gendered’ sometimes can or do not.

Philosopher Judith Butler asserted that gender is nothing more than a series of repetitive performances; behaviors which, in cis-gendered (not transgendered) people, are often so subconscious as to feel ‘natural.’ But simply consider that the gender-coding of many such behaviors have changed over time. Hairstyles, clothing, and work-home-balance are all easy examples. Requiring at the very least a working uterus, pregnancy is one type of public ‘performance’ that still appears ‘naturally female.’ Therefore, ‘male pregnancy’ can be a subversive act, as with the work of cyber-artists Virgil Wong and Lee Mingwei, where, as feminist science scholar Donna Haraway would say, one ‘queers what counts as nature.’

But that’s not what is going on here. As with the broadly comic absurdness of male pregnancy in films like Arnold Schwarzenegger’s Junior, this anachronistic Chicago campaign actually reinforces a traditional gender binary while essentializing pregnancy as a function of only cis-gendered female bodies. In doing so, the campaign defeats its own stated purpose. By looking at these posters, cis-gendered boys won’t feel like pregnancy can happen to them. Rather, they will scoff, or laugh at the ‘absurdness’ of male pregnancy, reassured that their (utterly and fixedly ‘masculine’) bodies are ‘safe’ from such conditions. More devastatingly, the cis-gendered general public looking at these images will have their own prejudices and expectations about male pregnancy reinforced: as something ‘unexpected,’ shocking, and ‘unnatural.’

Additionally, like other individual-level ‘shaming and blaming’/’shocking’ campaigns, this Chicago anti-teen pregnancy series deflects attention from more systemic understandings and structural changes: from finding funding for affordable and accessible reproductive health care, to anti-poverty work, to programs which support LGBTQ youth. While they may satisfy the need for a ‘moral panic’ among us middle-aged people as we ‘clutch the pearls and think of the children,’ what such anti-teenage pregnancy campaigns don’t do is actually increase the well being of our young people – be they male or female, cis- or trans-gendered.

Cross-posted at Adios Barbie.

Sayantani DasGupta is a faculty member in Narrative Medicine at Columbia University. She is the editor of Stories of Illness and Healing: Women Write their Bodies,  co-authored The Demon Slayers and Other Stories: Bengali Folktales, and authored Her Own Medicine: A Woman’s Journey from Student to Doctor.

Does Abortion Cause Infanticide?

Cross-posted at Montclair SocioBlog.

Does “the abortion culture” cause infanticide?  That is, does legalizing the aborting of a fetus in the womb create a cultural, moral climate where people feel free to kill newborn babies?

It’s not a new argument.  I recall a 1998 Peggy Noonan op-ed in the Times, “Abortion’s Children,” arguing that kids who grew up in the abortion culture are “confused and morally dulled.”*  Earlier this week, USA Today ran an op-ed by Mark Rienzi repeating this argument in connection with the Gosnell murder conviction.

Rienzi argues that the problem is not one depraved doctor.  As the subhead says:

The killers are not who you think. They’re moms.

Worse, he warns, infanticide has skyrocketed.

While murder rates for almost every group in society have plummeted in recent decades, there’s one group where murder rates have doubled, according to CDC and National Center for Health Statistics data — babies less than a year old.

Really? The FBI’s Uniform Crime Reports has a different picture.

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Many of these victims were not newborns, and Rienzi is talking about day-of-birth homicides — the type killing Dr. Gosnell was convicted of, a substitute for abortion.  Most of these, as Rienzi says are committed not by doctors but by mothers.  I make the assumption that the method in most of these cases is smothering.  These deaths show an even steeper decline since 1998.

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Where did Rienzi get his data that rates had doubled?  By going back to 1950.

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The data on infanticide fit with his idea that legalizing abortion increased rates of infanticide.  The rate rises after Roe v. Wade (1973) and continues upward till 2000.

But that hardly settles the issue. Yes, as Rienzi says, “The law can be a potent moral teacher.”  But many other factors could have been affecting the increase in infanticide, factors much closer to actual event — the mother’s age, education, economic and family circumstances, blood lead levels, etc.

If Roe changed the culture, then that change should be reflected not just in the very small number of infanticides but in attitudes in the general population.  Unfortunately, the GSS did not ask about abortion till 1977, but since that year, attitudes on abortion have changed very little.   Nor does this measure of “abortion culture” have any relation to rates of infanticide.

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Moreover, if there is a relation between infanticide and general attitudes about abortion, then we would expect to see higher rates of infanticide in areas where attitudes on abortion are more tolerant.

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The South and Midwest are most strongly anti-abortion, the West Coast and Northeast the most liberal.  So, do these cultural difference affect rates of infanticide?

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Well, yes, but it turns out the actual rates of infanticide are precisely the opposite of what the cultural explanation would predict.  The data instead support a different explanation of infanticide: Some state laws make it harder for a woman to terminate an unwanted pregnancy.  Under those conditions, more women will resort to infanticide.  By contrast, where abortion is safe, legal, and available, women will terminate unwanted pregnancies well before parturition.

The absolutist pro-lifers will dismiss the data by insisting that there is really no difference between abortion and infanticide and that infanticide is just a very late-term abortion. As Rienzi puts it:

As a society, we could agree that there really is little difference between killing a being inside and outside the womb.

In fact, very few Americans agree with this proposition. Instead, they do distinguish between a cluster of a few fertilized cells and a newborn baby. I know of no polls that ask about infanticide, but I would guess that a large majority would say that it is wrong under all circumstances.  But only perhaps 20% of the population thinks that abortion is wrong under all circumstances.

Whether the acceptance of abortion in a society makes people “confused and morally dulled” depends on how you define and measure those concepts.  But the data do strongly suggest that whatever “the abortion culture” might be, it lowers the rate of infanticide rather than increasing it.

* I had trouble finding Noonan’s op-ed at the Times Website.  Fortunately, then-Rep. Talent (R-MO) entered it into the Congressional Record.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

Health Care Costs, Greed, and “Socialism”

Cross-posted at Montclair SocioBlog.

The Washington Post has provided some data on medical costs across a selection of countries (Argentina, Canada, Chile, and India in grey; France, Germany, Switzerland, and Spain in blue; and the U.S. in red). The data reveal that American health care is very expensive compared to other countries.

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No wonder the US spends twice as much as France on health care.  In 2009, the U.S. average was $8000 per person; in France, $4000.  (Canada came in at $4800).  Why do we spend so much?  Ezra Klein quotes the title of a 2003 paper by four health-care economists:  “it’s the prices, stupid.”

And why are US prices higher?  Prices in the other OECD countries are lower partly because of what U.S. conservatives would call socialism – the active participation of the government.  In the U.K. and Canada, the government sets prices.  In other countries, the government uses its Wal-Mart-like power as a huge buyer to negotiate lower prices from providers.  (If it’s a good thing for Wal-Mart to bring lower prices for people who need to buy clothes, why is it a bad thing for the government to bring lower prices to people who need to buy, say, an appendectomy? I could never figure that out.)

There may also be cultural differences between the U.S. and other wealthy countries, differences about whether greed, for lack of a better word, is good.  How much greed is good, and in what realms is it good?  Klein quotes a man who served in the Thatcher government:

Health is a business in the United States in quite a different way than it is elsewhere.  It’s very much something people make money out of. There isn’t too much embarrassment about that compared to Europe and elsewhere.

So we Americans roll along, paying several times what others pay for medical procedures, doctor visits, and drugs.

Jay Livingston is the chair of the Sociology Department at Montclair State University. You can follow him at Montclair SocioBlog or on Twitter.

Public Opinion about Abortion 40 Years after Roe v. Wade

Yesterday was the anniversary of the landmark Roe v. Wade decision. On January 22, 1973, the U.S. Supreme Court handed down the landmark case establishing women’s right to an abortion (though not an unrestricted right).

The Pew Research Center released some data on current public knowledge and opinion about abortion in the U.S. They found that well under half (44%) of younger people — those under 30 — knew what Roe v. Wade was about. A quarter said they didn’t know, and a third thought it was about another issue. This was a much lower level of familiarity than older age groups:

Abortion is still certainly a contentious issue, but it may not be quite the galvanizing cultural flashpoint it once was. Indeed, fewer people seem to see it as a critical issue. A growing percent of respondents say that abortion isn’t all that important — now over half say so:

That seems to indicate a lessening of the intensity of the culture war surrounding abortion. That could mean less intensity in opposition to abortion (most respondents thought it should be legal, though many personally thought it was morally wrong), but it may also lead to less resistance to the types of restrictions on clinics that leave abortion technically legal, but so difficult to access that it’s a hollow legality.

Gwen Sharp is an associate professor of sociology at Nevada State College. You can follow her on Twitter at @gwensharpnv.