health

This month’s guest column* by Christine H. Morton, PhD, a research sociologist at the California Maternal Quality Care Collaborative, draws on her research and publications on women’s reproductive experiences and maternity care advocacy roles, including the doula and childbirth educator. She is the founder of ReproNetwork.org, an online listserv for social scientists studying reproduction.

The ever-evolving history of the childbirth reform movement has new developments, which need to be incorporated into the older story which documents the shift from home to hospital birth; and the paradigm clash of midwifery and medical models of birth reflecting holistic and technocratic values, respectively. We need to incorporate the story of the doula, which I argue, is one of many efforts to bridge the divide – to provide, as Robbie Davis-Floyd has called it, humanistic care in birth, which is what most women desire.

History is happening now. In addition to the emergence of the doula in the past thirty years, more recently, we see efforts underway in maternal health policy (Childbirth Connections’ Transforming Maternity Care), among physician and nursing professionals (most especially around maternal quality measures, and maternity quality improvement) and resurgence among, for lack of a better word, ‘consumers’ or childbearing women, who seek greater access to vaginal birth after cesarean (VBAC). What are the goals of each stakeholder; how do they intersect and overlap, and come into conflict with one another? This is a big story, and we need to tell it!

I take a small slice of this larger historical backdrop to consider the interconnected history of childbirth educators and doulas, which will be the subject of my research presentation at the Lamaze-ICEA Mega Conference in Milwaukee.

To back up a bit, when I embarked on my sociological investigation of the doula role, I was interested in many aspects of this innovative approach to childbirth advocacy and support. What strategies and mechanisms enabled women with no medical training to insert themselves at the site where medical care is delivered to a patient in a hospital, and enact their self-defined role? Why did women become doulas and what did the work mean for those who were able to sustain a regular practice over time? How were doulas utilizing and leveraging the corpus of evidence based research which suggested their impact was as great, if not greater, than that of the physician, the culture of the obstetric unit, or the labor and delivery nurse? Where did doulas come from? What, in the history of childbirth reform, or childbirth education, or labor/delivery nursing, could help me understand how doulas emerged at this point in time in U.S. history?

Later, after learning that there were limited histories of childbirth education (by non-childbirth educators), and little research on the history of obstetric nursing, I had to take a step back and consider these factors as well. Why was the work and perspectives of women who support other women during childbirth an overlooked piece of historical research? Why did histories of women’s health reform efforts largely exclude childbirth reform? Why had there been no history of the women who were involved in childbirth education; in labor and delivery nursing; in the mainstream arena of birth care in the US? So as not to be accused of ignoring the scholarship that does exist in this area, I acknowledge my debt to Margot Edwards and Mary Waldorf; to Judith Walzer Leavitt, to Barbara Katz Rothman, Robbie Davis-Floyd, Margarete Sandelowski, Deborah Sullivan and Rose Weitz, Judith Rooks and Richard and Dorothy Wertz (I can make my full bibliography available to those interested). I have been inspired by these histories, but they focused less on the women (childbirth educators) who were making history and more on the larger cultural shifts in beliefs about medicine, technology, women’s bodies and reproduction.

When childbirth education per se was a topic of inquiry, the research focus tended to be on the primary sources of the male physician champions – Grantly Dick-Read, whose work informed the natural birth movement, and Ferdinand Lamaze (and his US counterparts – Thank you Dr. Lamaze author Marjorie Karmel and Elisabeth Bing) who formulated a method for accomplishing unmedicated, awake and aware childbirth. However, most of this scholarship makes unsubstantiated generalizations about what particular childbirth educators (of various philosophies /organizations) believed, and how they taught. There is surprisingly little in the way of empirical research – few scholars interviewed childbirth educators or conducted systematic observation of their classes over time.

So after completing my dissertation on the emergence of the doula role, I had the great opportunity to continue with my research interest through a research grant from Lamaze International to conduct an ethnographic investigation of childbirth education, with my colleague, medical anthropologist Clarissa Hsu. We talked to educators, observed their classes and analyzed our data.

We found that educators who were actively practicing doulas drew heavily on their direct labor support experiences as authoritative resources for stories and examples that supplemented the material they taught. Actively practicing doulas also included more curricular content on early labor than educators without such experience. Having real births to draw upon provided doula-educators a different type of credibility and authority than educators without such current labor support experience. These educators relied on other mechanisms to establish their authority, such as knowledge of the latest research on birth and use of more authoritarian teaching styles.

We found that the intersection of doula practice and childbirth education has significantly affected how childbirth preparation classes are taught, and this new infusion of practice and ideology is worth exploring. I encourage you to explore this with us, and welcome your thoughts.

*Note: this column was originally posted on the Science & Sensibility blog.

For this month’s column, I had the pleasure of emailing with Chris Bobel, Ph.D. about her new book which deftly tackles a taboo topic.

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You explore new feminist activism that focuses on menstruation. Historically, how have feminists viewed menstruation, and why menstrual activism now?

The issue of menstruation has not been a top feminist priority, though, since at least the 1970s, a few bold feminists have recknoned with socio-cultural and political dimensions of the menstrual cycle. I argue that the menstrual taboo–which impacts us all, even feminists–often puts the issue off-limits. In mainstream culture, the only menstrual discourse that gets any play is making fun of women with PMS. I studied menstrual activists who want to widen and complicate the conversation. Menstrual activism is part of an enduring project of loosening the social control of women’s bodies, moving women’s bodies from object to subject status–something absolutely foundational to addressing a range of feminist issues, from human trafficking to eating disorders to sexual assault.

What do you think of Kotex’s new ad campaign “Break the Cycle,” which lampoons traditional menstrual product ads?

The new campaign could be a game change, but I’m doubtful. First, the campaign only works as long as the menstrual taboo persists; otherwise, their frank talk doesn’t stand out, does it? While I can join in the joke of the industry poking fun at itself–and I love the message of “no more shame”–in the end, it’s the same, just repackaged.

Second, I resent this campaign for exploiting shame to sell product for nearly a centuray and then exploiting THEIR overdue pronouncement–“enough with the euphemisms, and get over it”–to sell product.

Also, you’ve got to wonder if not only Kotex but their whole industry is now pulling out all the stops to try to hold onto its market share as menstrual suppression drugs–like Seasonique and Lybrel–are gaining interest.

So, what do you think of pharmaceutical industry arguments that support these menstrual suppressants?

Their quasi-feminist arguments co-opt feminism to push drugs. Big Pharma is marketing suppression as a ‘lifestyle choice’, but what most don’t realize is that “menstrual suppression” is actually cycle-stopping contraception that does not only reduce or eliminate menstrual bleeding but also suppresses the complex hormonal interplay of the menstrual cycle. We don’t yet have adequate data to really show if this is a safe long-term practice for otherwise healthy women. Check out this position statement.

Furthermore, ad campaigns represent the menstrual cycle as abnormal, obsolete, and even unhealthy. These messages underscore that women’s natural functions are defective, dysfunctional and need medical intervention. This can lead to negative body image, especially in young women. How is this feminist? ‘Choice’ without good, fact-based information based on thorough medical studies isn’t real choice, and a campaign that exploits women’s negative attitudes about their bodies isn’t feminist either.

Your work uses menstrual activism as an analytical lens through which to view continuity and change in the women’s movement, from what some call the “second wave” of feminism through the “third wave.” So, given that the ‘wave’ distinctions are not without controversy among feminists, what do you see as setting third wave feminism apart? Is it truly unique, or is it merely a label that recognizes the next generation?

There’s a lot of continuity between the waves–mostsly in the tactical sense. Today’s feminist blogs are yesterday’s zines, which reflect earlier mimeographed manifestos; radical cheerleading recalls street theater and public protests, like early second-wavers at the 1969 Miss America pageant. Second-wavers practiced what third-wavers call DIY (Do It Yourself) healthcare when they modeled pelvic self exams. But, most third-wavers depart from most (but not all) second-wavers by troubling the gender binary. For example, the radical wing of menstrual activism movements reers to “menstruators”, instead of assuming that everyone who menstruates gender-identifies as a woman.

Tell me more about that!

Most assume that a female-bodied person, with breasts and a vulva, is a woman, and usually that’s true. We also assume that menstruation is a near-universal experience for women. Radical menstruation activists question these assumptions. Menstruation is not and has never been EVERY woman’s experience. Women don’t menstruate for lots of reasons, and they don’t menstruate their whole lives. Also, some transmen and intersex people DO menstruate. So, equating menstruation with womanhood is problematic. Saying “menstruators” makes room for more people, more experiences. This linguistic move is boundary smashing, inclusion-in-action and bodes well for feminism’s future.

But, you’ve written that menstrual activists are not successful at all attempts at inclusion.

The first face of the feminist movement may have been white and middle class, but poor white women and women of color across the class spectrum have always been there, often toiling in relative obscurity. This could be the case with menstrual activism, too. However, I’m a white, privileged academic, and this biases my world view. I looked for women of color doing this work and found a few. But, was I looking in the right places? Was I using the right language? One activists of color said that I was likely missing Black women because I wasn’t clarifying how race and gender intersect in menstrual health. Also, menstrual activism is risky business for all, and especially for women of color, whose bodies have been denigrated throughout history. Taking on the menstrual taboo can make others see you as nasty, gross, improper…and if you’re already struggling to be accepted and taken seriously, then why go “there”?

Well, I and many other women’s health activists appreciate that you ‘went there’!

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For more on this topic and her research, check out Chris’s new book — New Blood: Third-Wave Feminism and the Politics of Menstruation (Rutgers University Press, 2010), previewed in the Our Bodies, Ourselves blog and in a provocative article in the Guardian last fall.

Health posts are my thing, and today I cannot stop thinking about the health of the Gulf Coast…which clearly impacts the health of more living creatures than we can fathom.  News coverage may talk about bodies of water like they are distinct things, but ‘the Gulf’ is merely a cartographer’s distinction.  It’s hard to watch the live feed of the endless spray of oil shooting into the ocean.  It feels like watching a massacre, like a spray of machine-gun bullets ending life after life.  Calling this catastrophe a “spill” is like calling an amputation a “boo-boo.”    And, frankly, I can think of nothing more important to write about for this month’s column. 

So, allow me to compare our planet to a patient, a very ill patient who has suffered a severe injury and is receiving really crappy medical care.  Or, let’s take it to a more intimate-level: we can anthropomorphize one affected area, the Mississippi Spillway, as the vulva of the U.S.  One of my favorite sociologist bloggers, Mimi Schippers, Ph.D. (a.k.a. Marx in Drag), did just that in a post where she calls British Petroleum (BP) a pimp — and not the MTV/”pimp my ride”/bling-bling/Snoop Dogg kind of pimp.  No, we’re talking a stone cold, cruel, exploitative, abusive, criminal.  In the words of Dr. Schippers:

 BP and the rest of the oil industry are the johns and the federal government is the pimp.  Federal, state, and local politicians pimp us out to put money and power in their own pockets while, by paying the right price, Big Oil gets to take what it wants and needs.  And they-the pimp and the johns, do so with absolutely no regard for the needs or well-being of the body they use.  The body—the living environment, including the people—is, however, a breathing entity.  And though it appears as if it is just an object to be used, the people know what they are doing.  They strike a bargain that, for the moment, benefits themselves but sacrifices the rest.  You give me jobs, and I’ll give you whatever you want.  Invoking the vulva as metaphor suggests there is something feminine or female about this place and that masculine or male power is the problem.  But don’t let that confuse the issue.  This is about class and economics. 

Whether you prefer to see the U.S. government as an incompetent physician (allowing a patient to inch towards death) or as a corrupt police officer (being too kind to a felon), we have got to ramp up our demands for swift, safe, effective action.  And, perhaps, we need to think seriously about how to safely shut-down all of the deep-water drilling before the next tragedy.  All the money in the world cannot buy a healthy ocean.  Even if this torrent of BP oil is the last one we ever have to deal with, don’t think that we’re close to knowing how bad things really are..in the words of that 70’s BTO classic:

Here’s somethin’ that you’re never gonna forget. B-, b-, b-, baby, you just ain’t seen na, na, nothin’ yet!

I dedicate this month’s column to parents who are in the midst of crises which are well-articulated on the website A Heartbreaking Choice:

Pregnancy does not end happily for everyone. Sadly, some parents receive grim prenatal news that something is seriously or fatally wrong with their loved and wanted unborn baby. They have to make a decision about continuing or ending pregnancy. We realize that all parents make a loving choice, one they feel is better for their baby. Regardless of the fetal anomaly found, the decision to end a pregnancy is always a difficult one.

Although it is estimated that between 80 and 95 percent of parents receiving a severe prenatal diagnosis choose to end the pregnancy, those who face this nightmare often feel alone. There is very little in the way of support programs for them. With this site and the dedication of courageous parents willing to reach out, we hope to create a safe haven of encouragement, validation, hope and healing.

How many of us have thought about all that is involved with therapeutic abortions?  Parents in these situations have to navigate a medical system which is under the influence of a legal system which (in my humble opinion) has succumbed to a failure of the separation between church and state. It saddens and infuriates me that these mothers — especially those in their third trimesters — may be denied access to medical options which could best protect their physical and mental health. In this day and age of U.S. abortion policies, should we be grateful that any states allow any options at all?  Gratefulness is hard to come by in the face of so much suffering.  My prayers and love go out to all parents who face these heartbreaking choices.

Ads for menstrual products have been notoriously evasive, avoiding the dreaded ‘v word’ (vagina) and using blue liquid as a stand-in for the blood that is markedly absent in both linguistic and visual representation. Words conveying the reality of menstruation – blood, clots, cramping, etc – are absent, as are visual depictions of what actually happens during a period – or the fact that females bleed, often copiously, from that most dreaded “down there” (a euphemism that, as Feministing points out, “two out of three network censors still feel icky” about).

Yet, a more realistic (and humorous) representation of periods seems to be slowly seeping into popular culture. An example is the recent U by Kotex ad, the transcript of which is as follows:

How do I feel about my period? We’re like this [crosses fingers]. I love it. I want to hold really soft things, like my cat. It makes me feel really pure. Sometimes I just want to run on the beach. I like to twirl, maybe in slow motion. And I do it in my white Spandex. And usually, by the third day, I really just want to dance. The ads on TV are really helpful, because they use that blue liquid, and I’m like, Oh! That’s what’s supposed to happen!

(To see the video clip of the ad, go here: http://www.youtube.com/watch?v=FRf35wCmzWw)

Though this ad avoids the v word as well any specific reference to the product itself or why one should use Kotex (as pointed out here), it’s self-mocking tone pleasantly parodies the way menstruation has been characterized in the majority of ads. Periods, it reveals, are not a time one tends to want to dance joyously in a tight-fitting sheer dress or frolic along the beach in a white bikini. While the ad does play on the idea of menstruation as “the curse,” and thus perpetuates a negative rather than a positive (or neutral) view of this female biological process, it at least admits that periods often involve pain and inconvenience (not to mention no blue liquid whatsoever).

Though the NYTimes documents that three networks rejected the original ad, which did use the v word, even this de-vaginized version uses humor to mock our cultural shock and horror surrounding menstruation, moving away from ridiculous suggestions that bleeding, bloating, cramping, and/or menstrual headaches really make women want to dance, shop, or exercise (what else, after all, do women ever want to do?). And, though we have no specific references to female genitalia, at least there is an acknowledgment that periods for many (most?) are not all that fun.

Moreover, as reported in the NYTimes, “Visitors to the Web site, UbyKotex.com, designed by the New York office of Organic, part of the Omnicom Group, are urged to sign a ‘Declaration of Real Talk,’ vowing to defy societal pressures that discourage women from speaking out about their bodies and health. …For every signer, Kotex will donate $1 to Girls for a Change, a national nonprofit based in San Jose, Calif., that pairs urban middle school and high school girls with professional women to encourage social change.”

And, while the ad had to be “sanitized” for television (or, in other words no real mention of what a sanitary napkin or tampon is for, let alone a mention of where they go, was approved), the accompanying website is far more explicit in its anatomical and functional details, including a section entitled “challenging the norm” that aims to “start a new, healthier conversation about periods and vaginal care.” Thus, not only is Kotex partnering with a organization aimed at empowering girls and women, it is actually offering REAL information about menstruation and menstrual products – what a concept!

While the tv ad’s self mockery is certainly a fun and refreshing approach to a bloody subject, I wonder when/if the mainstream media will allow ads that admit – horror of horrors – that females have vaginas and this bodily reality is not disgusting, not a curse, not even a reason to boogey-down in celebration but rather nothing more or less than a bodily reality.

I am not saying that having a vagina is not cause for celebration (I personally rather like mine), but I feel whenever the body (or part of it) is showcased as something to uncritically celebrate, the flipside – where the body is denigrated and denied – is not far behind. Instead, I would like to see wider recognition and acceptance of the fact that menstruation happens, and does so often (for too often for my taste, in fact), that the body is not all pleasure and desire but also pain, inconvenience, and monotony.

As I am currently attending the National Popular Culture Association conference where I am presenting on a panel with three other women who are also menstruating, such concerns have been foremost in my mind. After seeing each other face to face for the first time after months of email organization and discovering are bloody synchronization, one of us joked “I know women are often in sync, but are we now so technologically advanced that we can sync via email?”

Our running joke was that we would announce our panel, a feminist analysis of Twilight, via sharing “You are about to hear an analysis of male, heteronormative, white privilege from four menstruating feminists.” In our banter, Robert Pattinson’s now rather infamous claim that he is “allergic to vagina” was a recurring point of reference as well. Though I feel Pattinson meant this as a joke and is likely not the misogynist some have suggested, I feel in contrast that US culture more broadly is allergic to vagina – to the word vagina – let alone to the fleshy, bloody, and yes, toothless, bodily reality.

Alas, as Gloria Steinem wrote in her 1978 piece, if males menstruated it would likely be a sort of bragging right, a competition over who could bleed the most. Yet, as it is female’s bodies that require the use of pads, tampons, and diva cups no such celebratory bragging rituals occur. Rather, even within the self-aware mockery of the way menstruation is rendered invisible and monstrous (such as in the above Kotex tv ad) it is still something that cannot be named, let alone visually represented. This, indeed, makes me blue.

Mammograms have been on my mind.  What do ya’ll think of this honkin’ YouTube video going around?!

Coco Chanel has often been quoted as saying, “A woman who doesn’t wear perfume has no future.” If perfume staves off doom, then perhaps that’s what inspired this otherwise-inexplicable new ad by GlaxoSmithKline for its HPV vaccine:

As you can see, it leads with a blue-eyed, fair-skinned, made-up (and apparently affluent) young woman lounging on an antique sofa on the first floor of a mansion. But softly shimmering lights and fairy-like chimes distract the waif from her book. She dreamily follows the golden twinkling lights up an impressive staircase, where she gazes with a beatific smile upon a champagne-colored perfume bottle magically floating in mid-air. As the bottle rotates to reveal the words “CERVICAL CANCER“, the young woman’s expression switches from bliss to frowning concern. Enter the narrator’s voice:

Maybe it’s unfair to get your attention this way, but nothing’s fair about cervical cancer. Every 47 minutes, another woman in the U.S. is diagnosed. But, there are ways to prevent it. Talk to your doctor.

Unfair? I would have said “insulting.” As in, maybe it’s insulting to assume that the best way to attract a young woman’s attention to a serious health issue is to dupe her into thinking she’s watching a perfume commercial? But, if you want to talk ‘unfair’…Maybe it’s unfair that there hasn’t been a public health campaign to educate teens, women and men about sexually-transmitted HPV (human papillomavirus), which can cause not only cervical cancer but also other serious cancers in men and women? Maybe it’s unfair that the only public “education” about the HPV epidemic has come in the form of pharmaceutical ads that continue to narrowly brand and market HPV vaccines as “cervical cancer” vaccines?

The ad finishes by presenting a GlaxoSmithKline website — which troubles me, as a sexual health researcher, because it does not offer visitors a comprehensive HPV education. But that may have been too much to hope for, given that their HPV vaccine (Cervarix) received FDA approval for use in girls and women (ages 9 to 26) just this past October.

So, skip this ad and website if you’re looking for a more neutral source of information about HPV vaccine options, and visit the CDC instead. And those who’d like a more thorough STD/STI education should check out the American Social Health Association and other website resources which are not funding by pharmaceutical companies.

Note: while GSK has disabled adding comments to their series of new ads, you may rate not only this ‘perfume’ ad but also their ‘front porch‘ and ‘night out‘ ads with the start-ratings you feel they deserve. And, for more on the mis-marketing of HPV vaccines, read my article, “Why Men’s Health is a Feminist Issue,” in the Winter issue of Ms., on newsstands now.

(Originally posted on Ms. blog, cross-posted at Sociological Images and AdinaNack.com)

This is Alison Piepmeier, recovering well from brain surgery, and planning to be back on Girl with Pen really soon.  In the meantime, I’m delighted to introduce you to this month’s guest columnist, Eliza McGraw, writer, mother, and great friend of mine.

Earache

I’m here in Charleston, South Carolina visiting my pal Alison Piepmeier, whom you all know from her blog here on Girl with Pen.  Theoretically, I am helping her, Walter, and Maybelle out, given Alison’s recent brain surgery.  And I am bunking with the baby and did just now make some pumpkin muffins, but I am not sure that I am helping as much as I am just, as always–we have been friends since 1994, when we met in graduate school, I just have avoided putting my education to the same kind of productive use that Alison has–enjoying being with Team Biffle-Piepmeier.

To be here for the week did, however, entail a thorough job of organization on my part.  I live in Washington, D.C., and am a freelance writer.  I also am the primary caregiver, driver, cupcake-maker, room parent, tutor and hockey mom to my 6 and 8-year-old children.  My days are happily complex so the list on instructions I left behind–also known as “the matrix”–included such entries such as “Wednesday–bring in a green food for St Patrick’s day,” “Thursday:  put Simon’s lacrosse shorts in backpack,” “Friday is P.E. day–Macie
in sneakers.”  It had a long list of contact information for the many family members, friends, and neighbors who knew I’d be away, permission slips for various pickups, and a refrigerator roll call so my husband Adam would know what I had made to eat.

On Monday, I received an email from Adam inquiring when the pediatrician’s office opened, since Macie (my 6-year-old) had an earache.  We’re not an earachey kind of family, as a rule–no tubes, no audiologists–so I was concerned.  Macie has also wound up in the hospital more than once, so any time she develops the slightest sniffle, I get a little anxious.  Also, it was only day two.  Things were already falling apart already?

Adam is an architect, and while it’s not as if he were expected in the OR momently, he was supposed to be at work with roll of drawings spread out on the desk (my mental image of architectural design), not heading out to the pediatrician’s.  If you looked at the matrix, there was no mention of “Take Macie to pediatrician.”  (If there had been, I would have written, “Remember insurance card and to stop for bagel on the way
home at bagel shop on Connecticut Avenue.”)

Even knowing that Adam, eminently competent and adaptable, had Earache 2010 covered, I felt like something was a little off all day as I played with Maybelle, went to the grocery store with Alison, and generally existed here in Charleston, 539 miles from the situation room at home.  When I called and heard Macie crying in the background (over Adam’s shouting from the front seat “She’s fine!  We’re going to get medicine now!”) I experienced that sensation that makes you realize why people say hearts “sink.”  Even once I received the update that Macie was at my mom’s and tucked under the same animal-themed blanket I used to curl up with when I felt sick (nosebleed stains, 1970s brown and orange zebras) while watching Mulan, I felt like I should have been with her.

But as the day wore on–hearing Macie’s voice be a tad bossy about which of the previews she deigned amusing enough to watch reassured me that her health was stabilizing–I realized I only sort of felt that way.  I missed her, and hated to think of her in any kind of pain.  But I was glad to be here, with Alison, Walter, and Maybelle.  I learned that is possible to be in the right place, even if that place is not with my own children for a certain painful moment, the one thing even I never planned for.

Last post I talked about the marathon boom, and how it’s being driven by women  http://girlwpen.com/?p=1821. Not coincidentally, I think, within the marathon community there has been a controversy about the boom, and whether or not the “slow” runners (those who take anywhere from four to seven hours to finish the race, thus running from a 10-minute to a sixteen-minute mile pace) really count as serious runners (a sixteen-minute pace is, after all, as slow as or slower than walking). See the New York Times article about the controversy: http://www.nytimes.com/2009/10/23/sports/23marathon.html?emc=eta1 Faster runners believe that running a marathon entails running a marathon–running the entire length at a fast pace, racing rather than merely participating.  Those in the slower group argue that participation is the point, and that speed is beside the point.  They run just to finish, and to have a good time.  As marathon numbers have swelled, primarily driven by the slower runners, the more competitive runners feel like their efforts are demeaned by those who participate but, for instance, stop to have lunch along the route, and that the marathon has become a social event rather than an athletic competition.  From the competitor’s perspective, the idea that “anyone can run a marathon” detracts from their distinctiveness as serious athletes.

An historical perspective that the debate has not incorporated suggests that these two conflicting attitudes, the competitive and the participatory, have a long cultural history that earlier split along gendered lines due to the gender role expectations of the early twentieth century.  According to historian Susan K. Cahn, in the U.S. in the 1920’s, women physical educators advocated an inclusive, participatory model of sport where the object was not to win, but enjoy oneself and better one’s health through participation.  This was a deliberate counter to the competitive sport model practiced by male athletic leaders, for whom winning was the bottom line http://www.amazon.com/s/ref=nb_sb_noss?url=search-alias%3Dstripbooks&field-keywords=Coming+on+Strong&x=11&y=18.  Of course there were women who were very competitive, and men who just wanted to participate, but the dominant attitude was that competition was for “real” athletes, while those who participated were wanna-be athletes at best.  This historical perspective raises interesting questions today:  what counts as athleticism?  Is participation enough?  Is sport a democratic, inclusive institution, or one based on the principles of competition, which necessarily involves exclusion?  Both?

I would argue that there is a third alternative we might consider as well.  While the competitive model of sport involves an internal focus while training, concentration on one’s breathing, pace, heart rate, etc., based around improving one’s performance, and the participatory model tends to involve an external focus, concentration on one’s surroundings or companions and enjoying the activity, there is an approach to sport than incorporates both of these ideas and that has links to the idea of sport as a form of spiritual practice.  I’ll call this the immersive model of sport–one in which sport is approached as a vehicle through which, as Professor Shirl James Hoffman puts it in the foreword to Sport and Spirituality http://www.amazon.com/Sport-Spirituality-Introduction-Ethics/dp/0415404827/ref=sr_1_1?ie=UTF8&s=books&qid=1267635442&sr=1-1, we “shape our spirits and create alternative realities and states of consciousness” (xi).  Sport experienced as an immersive practice can involve competition–training hard to perform your best–but it can also involve the joy of sheer participation, an appreciation of the body in movement, a way to step out of the ordinary frenzy of our daily lives filled with the barrage of things to get done and instead experience pure absorption into the activity itself, and a suspension of all other distractions.  Known as a “flow” state, this mode of sports participation can incorporate the best of both the competitive and participatory models, and avoid some of their pitfalls.  I’ll elaborate on this model of sport participation in my next post.

Last week, the NYT reported “Merck: Studies Boost Gardasil for New Uses“; this week the CDC’s Advisory Committee on Immunization Practices (ACIP) met to discuss these new results. It will be interesting to see what, if any, changes result from new clinical evidence that (1) the vaccine is effective in preventing anal precancers in males and (2) the vaccine is effective in women 27-45 years old.

Those who’ve followed HPV research for the past decade were not surprised by the findings of either study. What has surprised me is how little attention ‘male’ Gardasil has attracted since receiving FDA approval last October. Writing a feature article for the Winter 2010 Ms. magazine gave me the opportunity to more deeply explore this topic and hopefully raise awareness — not only about Gardasil, a.k.a. the “cervical cancer” vaccine, but also about the full range of male HPV-related cancers that it might also prevent. 

So, this month’s column is inspired by my desire to respond to some of the interesting questions, comments and accusations that I’ve received via the blogosphere (like WashingtonCityPaper and HugoSchwyzer) in these first days following the publication of my article. I’ll start by acknowledging that my article’s title seems to have pushed more than a few buttons: apparently not everyone wants to know “Why Men’s Health is a Feminist Issue.” One comment asked “Why does the burden for sexual health need to fall, yet again, to women?” My response: It’s a burden for only girls/women to be responsible for sexual health, so prioritizing equal access to STI/STD vaccines results in a more fair sharing of this ‘burden.’ From the opposite side, a comment criticized this angle as being self-interested: “…when feminists speak of male health issues, it is usually in the context of the way they affect women.” To that, I reply: if you read the full article, you’ll see that boys/men have plenty of reasons to care about having access to this vaccine that have to do with protecting their own health, regardless of whether or not they ever have a female sexual partner.

This leads to another trend in responses: What’s in it for men?  Or, as one comment put it, “The only reason for males to get the vaccine would be to prevent HPV in women.” Really? How about the variety of serious HPV-related male cancers (oral, penile, anal, and others) that are (1) on the rise, (2) often fatal due to lack of accurate testing/screening, and (3) in the U.S. likely result in more combined deaths in men than cervical cancers in women? (See my Ms. article for an overview of these stat’s or, if you love charts check out p. 4 of the American Cancer Society’s 2009 report).

And, media coverage of Gardasil would not be complete without questions/concerns focused on whether or not Gardasil does more harm than good. For the record: I have not taken a pro-vaccine or anti-vaccine stance on Gardasil or any other vaccine. But, I speak in favor of equal access to vaccines, support the conducting and media coverage of medical studies that reveal the full range of potential health costs and health benefits of any vaccine,  and argue for funding public health campaigns about HPV and other sexually transmitted epidemics. And, though some blog comments reveal confusion over the possibility of being “required” to get the Gardasil vaccine, I’m not aware of any current U.S. vaccination policy that does not allow for ‘opting out.’ (Note: as of December 14, 2009 Gardasil was no longer required for female green card applicants.)

A less popular theme, though one that intrigues me, came from those who took the angle of “What’s in it for big pharma?” One comment hypothesized, “…you can’t help but suspect Merck’s money motive is playing a role in the push for expansion to men.”  And, I reply, what PUSH? If money was their motive, then wouldn’t they have updated the Gardasil.com website to encourage male consumers? Visit that site prior to March 1, and you’d think that it was still only approved for girls/women.

I’ll end this post by expressing my thanks to all of the journalists and blog authors who are raising awareness about this topic, including Ms.‘s own Executive Editor Katherine Spillar on the Huffington Post. I also send out my gratitude to blog readers who add insightful, thoughtful, sociological, and truly feminist comments like Annie‘s. In my opinion, to be feminist is not to be pro-women, it is to be pro-equality and pro-justice (not to mention anti-sexism, anti-racism, anti-homophobia, anti-ageism…you get my drift). I don’t know if the pro- and anti-vaccine folks will ever see eye to eye, but there’s absolutely nothing to lose and everything to gain by being pro-HPV-education.