A few weeks back I did an interview with Leslie Botha regarding the distribution of Depo Provera to women in developing countries. Recently Leslie shared with me an email she received from someone working in a family planning clinic in Karnataka, India. He described how he was providing the Depo Provera injection to women and finding that, after they stopped using it, they were not experiencing menstruation for up to nine months. He asked for advice – “what is the procedure to give them normal monthly menses….is there any medicine?”
I have written previously about one potential problem of providing women with Depo Provera – the possibility of continuous spotting and bleeding that would not only be distressing with no warning that this might happen and no medical support, but could also be difficult to navigate in a place with poor sanitation or with strong menstrual taboos. As women in developed countries are so very rarely counseled on side effects of hormonal methods of contraception, it seems unlikely women in developing countries receive such information. As we know, some women will instead experience their periods stopping entirely during use of the shot and, as we see from this email and from the comments on other posts written for this blog, long after use.
In this context I find it interesting that the Gates Foundation’s programs for contraception access have a very public focus on Depo Provera. The method was mentioned again by Melinda Gates in a recent TED interview and when she was interviewed as ‘Glamor magazine Woman of the Year’ the shot was front-and-center of the discussion of her work. Yet the Foundation also funds programs that provide support for menstrual management and sanitation. Continuous bleeding from the shot, or cessation of bleeding altogether, would seem to be an important connecting factor between these two campaigns.
Much has been written on the menstrual taboo in India and how this holds women back. In the US we have come to embrace menstrual suppression as great for our health and our progress as women. We see menstruation as holding women back in a variety of ways. However, in India could lack of menstruation also be seen as a positive outcome? Instead of dealing with the menstrual taboo with expensive programs that provide sanitary products and education, might suppressing menstruation entirely be seen as a far more cost-effective solution? It may seem like a stretch, but I am surprised this has not been brought up during debates about the need for contraceptive access in developing countries. Yet of course, the menstrual taboo may well extend to absence of menstruation – a woman who does not experience her period might also be treated suspiciously or poorly.
When Melinda Gates says women “prefer” and “request” Depo Provera I always wonder whether that’s after they’ve been told how it works (perhaps described as a six-month invisible contraception) or after they’ve had their first shot or after they’ve been on it for two years and then, via FDA guidelines, must find an alternative? How much follow up is there? As the self-injectable version is released widely how will women be counseled? Gates argues that the invisibility of the method is part of the draw as women do not have to tell their partners they are using contraception, but what happens when they bleed continuously or stop entirely?
It seems to me like there might be a real lack of communication – both between medical practitioners and their patients, drug providers and the practitioners, and those who fund these programs with everyone involved. It is often argued that the risks of pregnancy and childbirth in developing countries justify almost any means to prevent pregnancy – including the use of birth control methods that cause health issues. How much feedback are groups like the Gates Foundation getting on women’s preferences if they seem to be so unaware of the potential problems, even those that would greatly impact their wider work?
Guest Post by Jennifer Aldoretta
Women currently comprise approximately 46% of the workforce and 50% of college graduates in the United States. But if we look at the statistics for women holding “powerful” positions, we notice a stark difference: women make up 18.5% of Congress, 20% of the Senate, 18.2% of the House of Representatives, and a measly 4.2% of both Fortune 500 and Fortune 1000 CEOs. A slightly higher 28.2% of US businesses are owned by women, but when we look at technology startups founded by women, the number plummets to an estimated 5%.
As a female founder of a technology startup, this divide has been cause for much contemplation and reflection over the past months. Why am I such a small minority? What effect will this have on the success of my company? And, most importantly, what can I personally do to help change this trend? In light of the recent criticism of comments made by Paul Graham (a prominent figure in the startup community) about female founders, I felt compelled to write about my personal experience as both a female founder and a woman in tech. For the record, I feel that Graham’s comments were taken out of context (and I am hopeful for his upcoming essay about female founders), but the situation did bring up an important conversation.
I recently studied a list of eight characteristics of a successful startup CEO, and I noticed something interesting: each one of these characteristics was one that a woman and a man are equally capable of possessing. It is not any more likely that a man will be passionate about his company; it is not any less likely that a woman will have vision; and a woman is not any more likely than a man to be adaptable.
There are many variables at play that contribute to the current divide between men and women in startups and technology. Differences in upbringing—including the toys we played with, the way our parents do or do not perpetuate gender stereotypes, and our social interactions with other children—are a huge deterrent for many otherwise capable women. Somehow, I defied those odds. I had wonderful parents who refused to let me dumb myself down and helped me to define my self-worth by my abilities and not my appearance or my gender.
Despite defying those odds, I continue to come back to one characteristic that I feel can make or break the success of a female startup founder: self-confidence. Before you form a snap judgment and accuse me of claiming that women have no self-confidence, allow me to explain. I’m not saying that women lack self-confidence. However, the type of confidence required for a female founder to convince a room full of powerful men (because it’s almost always all men) that her company is worth something is a very special breed of confidence. It’s not the type of confidence that I grew up with, and it is something that I have struggled with as a founder. This confidence is also one that boys likely did not grow up knowing. It is a confidence that a founder must learn, foster, and perfect. While male founders must also develop this breed of confidence, the women who manage to break through the gender gap and become successful founders must be fearless and possess this confidence in a way that no male founder will experience. And if you’re a non-white female, you can probably expect that to be compounded. As a female startup CEO, my confidence, my passion, my vision, and my expertise must oftentimes exceed that of my male counterparts to have the same effect, and in some cases, may even be counterproductive. I received my degree in mechanical engineering. In college, I was belittled and put down by male classmates when I was more capable of performing stereotypically “masculine” acts (like using tools or taking the lead on a group project). As a founder, I have been asked completely inappropriate questions about my personal relationship with my male cofounder. Yes, all of these things have actually happened. Luckily, experiences like these are not a daily occurrence, but they have still had a profound effect on me.
The second week of July began with a post at The Daily Beast titled ‘Are Tampons Anti-Feminist’ and ended with my own post for Dame ‘5 Facts About Menstrual Suppression.’ In between there was ‘Not Everything is a Feminist Issue for Chissakes,’ and ‘I Do Not Think Tampons Are Anti-Feminist, for Chrissakes.’ Meanwhile, towards the end of that week, women were having their tampons and pads confiscated by security guards at the Texas Senate as they entered to protest the proposed ban on abortions after 20 weeks. It was a perfect storm for a debate around menstrual shame.
With notable foresight the first article mentioned ends with, “For women who can’t break the silence, there are other ways to protest. Just ask DiFranco. “I didn’t really have much to say/the whole time I was there,” she sings in “Blood in the Boardroom,” “so I just left a big brown bloodstain/on their white chair.”” Later, women at the Texas Senate shared responses that were similar to this statement (“No tampons allowed? Guess we’ll just have to bleed all over the seats” and “Maybe it’s time for a bleed-in”), although there were an equal number remarking on their feelings of humiliation and horror at having their tampons and pads exposed in public.
Somehow, along the way, these threads of discussion were merged – if we’re considering tampons as anti-feminist, or menstrual shame culture as anti-feminist more accurately, then surely what we’re saying is that women should just bleed all over their furniture and clothing, right? Right?
Texas native and high-profile feminist writer Amanda Marcotte weighed in on the debate: “I used to joke that anti-choicers would start considering bans on menstruation,” she wrote.
I would argue that between menstrual shame culture and the pharmaceutical industry we have a “ban on menstruation” of a kind already.
When asked why it was necessary to keep tampons and pads “private” anyway and why it was that confiscating them in public was being discussed as a power move on the part of the Senate employees, she responded with:
“I’m not afraid to be a urinating human being, but I also don’t just go pee on the street corner. One can want to go about without blood on their clothes and not be ashamed of being female. I promise.”
And then, after some attempts at reasoning, “Convinced. I am going to pee freely now, and anyone who says no is just down on me for having a urethra.”
Never mind that they weren’t confiscating toilet paper, available and publicly displayed in the Senate bathrooms.
Elsewhere she suggested that those who were questioning our acceptance of the menstrual hygiene industry’s messages were just “weirdos.”
Marcotte: “I just want once to make a tampon joke without the weirdos who think women should bleed freely for “feminism” coming at me.”
Response: “Do these people have jobs? Or couches?”
Marcotte: “I have no idea. I just assume it’s part of that crunchy fake feminism that thinks women should give birth in ditches, too.”
I don’t think many women are going to argue that we bleed on our couches and clothes because, considering the statistics on division of housework, it’s definitely women who are going to have to clean that up. And if doing laundry isn’t anti-feminist, well, I don’t know what is.
Elsewhere the writer of ‘Not Everything is a Feminist Issue…’ Erin Gloria Ryan, another high-profile feminist writer, when directed to re:Cycling as a source of knowledge on the issue responded with “Ill read it (the blog) aloud at my next fun social gathering filled with normal people.”
Whether it’s from lack of awareness of the history of oppression of women via their bodies or whether it’s just another symptom of the corporate/capitalist feminism that dominates the mainstream, these are the women considered to be representative of the whole.
I relay the details of this interesting week not to depress, but to galvanize.
I, for one, am proud to be a weirdo, an abnormal person, a crunchy feminist, a fake feminist, oh and a miserable enemy of uteri everywhere, a bitch, and a…err…fish.
A couple weeks ago, I received the following ‘thanks, but no’ to a proposal I sent to a reproductive justice conference,
Dear Chris Bobel,
Thank you for submitting your proposal, “How Menstruation Matters to the Reproductive Justice Movement”…..Our staff has spent the last few months evaluating proposals and building an initial workshop list. We were inspired by the volume of quality proposals that we received. All of them helped us in the planning process.
At this time, however, we are not accepting your proposal for the 2013 conference.
As I typically do, I immediately headed to the deep dark brooding place of self-recrimination. That’s where I go. But as I set afoot on this well-worn path to my special ugly place, I did something I don’t usually do; I paused, lifted my head and looked around.
As I did, I wondered, if just maybe, the rejection was not the result of the deficits in my proposal, but rather, a reflection of the broken link between menstrual awareness and the broader movement for embodied autonomy.
In other words, maybe the rejection was not as much about me (and my failings) but more about the world around me, and ITS (meaning OUR) failings as a culture to see how a certain bodily reality is part of a larger whole. Maybe the fact that a team of progressive reproductive justice activists and scholars saying NO THANKS to an opportunity to make the essential linkages between the menstrual cycle across the lifespan and reproductive justice is an indication that WE still have SO MUCH WORK TO DO to help people see this crucial connection.
I know I am not alone in feeling like the spotted elephant on the Island of Misfit Toys (seasonal reference: DONE!). Sister menstrual warrior Laura Wershler recently wrote the following when I this blog post-in-progress:
Caring about menstruation and the menstrual cycle makes me almost a freak in the pro-choice world. I get ignored or criticized a lot because people don’t want to ask or answer some of the questions I keep trying to pose about choice around non-hormonal contraceptive methods.
So what’s a freak to do? We could stamp our feet and curse those who don’t see what’s pretty obvious to us, but that won’t raise the awareness.
This is on us.
Yes. Rejection stings, but maybe this time, I can take something away far more productive than the usual self-flagellation. Maybe this time, I can take it in as a clarion call, a motivation for a deeper commitment to help others make the menstrual connection, to, spread the #menstruationmatters message (thanks again Laura Wershler).
This means more conference proposals (and a thicker skin for more rejections). More writing. More blogging. More teaching. More radio interviews. More everything.
Who’s with me?
Throughout the contraceptive realm, LARCs are being heralded as the best thing since Cinderella’s glass slipper with little acknowledgement that for many women LARCs are more like Snow White’s poisoned apple.
Nov. 25 to Dec. 1, 2012, was LARC Awareness Week, billed by the California Family Health Council as “a chance to increase awareness about LARCs as a safe, effective, and long-acting birth control method.” Women were invited to contribute video messages on the theme Why I Love My LARC.
This catchy acronym stands for long-acting reversible contraceptive, and the push is on for many more women to choose this form of birth control. Make no mistake, it’s all about control: What the doctor puts in, only the doctor can take out. Ergo, it’s 99% effective. You can quit taking your pills, rip off your patch, or NOT show up for your next Depo-Provera shot. But if you hate the side effects caused by your IUD or implant, you’ve gotta go see a health-care provider to have it removed.
I’ve challenged the Contraceptive Choice Project study that praised the effectiveness of LARCs over the pill, patch and ring. I took issue with the ACOG recommendation that LARCs are the best methods for teenagers. Now there’s more hype with LARC Awareness Week.
According to the awareness campaign, LARCs include the ParaGard (copper) IUD, Mirena (progestin) IUD and Implanon, a non-biodegradable flexible rod, also containing progestin, that is inserted under the skin and left for up to three years. (Here’s a story about the rods going missing in women’s bodies.) Read the patient information about Implanon. Would you agree to have it inserted into your body?
Women who hate Implanon are speaking out. So are women who don’t love their ParaGard or Mirena IUDs. On YouTube, a video by a women with Mirena issues has over 6000 views; Why I Love My LARC, posted 8 days earlier, has about 100.
The old-school LARC – Depo-Provera – is not on the campaign’s list of LARCs, though it is heavily used in the United States. Holly Grigg-Spall recently reported that “one in five African American teens are on the Depo shot, far more than white teens.” Hmm. Will they all be switched to other LARCs when, or if, they come back for their next shot? Perhaps Depo is not on the list because women can discontinue this contraceptive without clinician intervention. But it’s probably because Depo causes bone density loss – and because this LARC is not a lark. Women are sharing their Depo stories on another re:Cycling post: Coming off Depo-Provera can be a women’s worst nightmare. You can find more bad news about this LARC than any other.
What about getting your LARC removed if you hate it instead of love it? One re:Cycling blogger shared what happened when she wanted her ParaGard IUD removed:
I HATED the thing but the nurse who was supposed to take it out tried to talk me out of it for a good 20 minutes. Finally I was like ‘”Why do you want me to keep this item in my uterus so badly?” And she said, “I just don’t want to see you get rid of your very effective birth control.”
This is not the only reason why women who end up hating their LARCs will be discouraged from rejecting them. The Affordable Care Act requires all health plans issued on or after August 1, 2012 to provide no-charge access to FDA-approved LARCs. What’s it going to take to convince health-care providers to remove an expensive contraceptive – provided for free – that was supposed to last for three to 10 years?
Maybe a YouTube video about Why I Hate My LARC will help make it as easy to get rid of one as it now is to get one.
I admit, I didn’t know that this is National Women’s Health Week until I received a reminder in my inbox from a U.S. FDA mailing list, letting me know about the Food & Drug Administration’s role in promoting Women’s Health. They’ve published a brochure (available in both HTML and PDF versions) commemorating 100 Years of Protecting and Promoting Women’s Health.
Society for Menstrual Cycle Research members and other women’s health advocates and activists will want to look through the list of the accomplishments the FDA claims responsibility for and lists as unequivocal improvements in women’s health.
For instance, we’ve had many discussions at re:Cycling about the FDA approval of the pill in 1960 as one holding mixed benefits for women, and not always the best choice for women’s health. The brochure also asserts that in 1970, “FDA initiated the first package insert written for consumers to explain to women the benefits and potential risks of oral contraceptives.” That happened in 1970, but Barbara Seaman, Alice Wolfson, and the other founding mothers of the National Women’s Health Network had more to do with its initiation than the FDA.
And here’s another inspiring quote from the FDA brochure:
1980: Making Tampon Use Safer
Problem: In 1980, there were 814 confirmed cases of menstrual related Toxic Shock Syndrome (TSS) and 38 deaths from the disease.
Response: FDA began requiring all tampon packages to include package inserts educating women about the risk of TSS and how to prevent it. In 1997, there were only five confirmed menstrually-related TSS cases and no deaths. The tampon package inserts with TSS information continue to be used today.
Sure, the FDA is proud of those safety rules now, but in 1982 the agency asked the industry to come up with their own voluntary standards because they did NOT want to regulate tampon safety. After years of pressure and organizing from Boston Women’s Health Collective members Esther Rome and Judy Norsigian, activist Jill Wolhander, researcher Nancy Reame, and others to standardize tampon absorbency ratings, the FDA finally enacted regulations in 1989, by court order. Nine years after 38 women died from a tampon-related illness.
Just last year, the FDA could have made another decision that would almost certainly save women’s lives, by removing birth control pills containing the synthetic progesterone drospirenone from the market, but instead the advisory panel voted by a four-person margin that the drugs’ benefit outweighed the risks.
You know what else isn’t on the list? Emergency contraception, a.k.a. the Morning After Pill and Plan B. The agency hemmed and hawed and delayed unconscionably for years, until finally approving it for limited over-the-counter availability in 2006 — a year after Susan Wood walked out of the FDA Office of Women’s Health for good over what she believed to be “willful disregard of scientific evidence showing Plan B to be safe.”
Celebrating organizational achievements that advance and protect women’s health is a fine thing. I’m glad Frances Kelsey withheld approval of Thalidomide in 1960, and for the most part, I’m glad the FDA is on the job. But while we’re celebrating women’s health and reminding everyone to be active, eat healthy, and get preventive health care (if they are so fortunate to have access to health care), let’s also celebrate the activists and advocates that keep agencies like the FDA in line.
Research by SMCR members Tomi-Ann Roberts and Nicki Dunnavan garnered a lot of attention this week. Stories showed up at Live Science – Why Why Women Should Bring Their Periods ‘Out of the Closet, popular ladyblog Jezebel – Your Period Is a Time for Deep Lady-Bonding, and the Daily Mail - Women, start talking about it. Period! Roberts and Dunnavan surveyed 340 religious and non-religious women about their experiences and attitudes about menstruation. As the Daily Mail reported: ”U.S. researchers say women across the world need to be more positive about menstruation – and that means talking about it in public.”
There’s been lots of public discussion about contraception, some might say too much! The birth control/medical insurance coverage brouhaha hit a boiling point last week with Rush Limbaugh’s egregious comments about Sandra Fluke, and the heated debate rages still. Maureen J Andrade at OpenSalon writes that Birth Control Is Not a Women’s Issue: It’s a Human Right, while Asma T. Uddin and Ashley McGuire, blogging at the Washington Post, insist It’s about religious liberty, not birth control. A group of crafters has come up with a unique protest action: sending “interfering” male government members a knitted or crocheted uterus, vagina or cervix, while feministing.com has invited readers to Talk About Birth Control For REAL.
Back to women’s experience of menstruation, Enith Morillo in Menses’ non-sense: Menstruation and the Muslim Woman’s “Red Tent” and Carolyn West in Menstruation – Celebration or Taboo?, explore different cultural menstrual traditions.
In response to Rick Santorum’s recent assertion that birth control only costs “a few dollars” and therefore there shouldn’t be such a big fuss about denying insurance coverage, Mother Jones published a birth control calculator this week that estimates your lifetime costs for birth control, based on your current age. The calculator asks you to enter your age and then select your preferred method. Options include the pill, IUDs, Implanon, injections, the patch, the vaginal ring, and surgical sterilization. (It doesn’t specify sterilization for women or for men, but given the context of the current debates, I’m assuming the calculator estimates only the cost of female sterilization.) It also fails to take into account that, in reality, most women use more than one method throughout their reproductive years.
Now, I know that aside from the cost of reference books, charting supplies, and perhaps a course or two to get started, using Fertility Awareness Methods is free, but condoms and spermicide aren’t. And as NPR reported on Tuesday, it can be difficult or inconvenient to get those methods covered by health insurance. Diaphragms and cervical caps aren’t cheap either, and they both require physician visits to be properly fitted. Diaphragms last a long time, but they do need to be replaced every few years. It’s been a while since I needed one, but I’m pretty sure that my health insurance covered the cost of my diaphragm, although I had to pay out-of-pocket for the accompanying spermicide gel. In my student days, I got both at my school’s Student Health Center, covered by the student health insurance fees that we were required to pay whether we used the student health center or remained on parental insurance.
I’ve written before about my bewilderment at the diaphragm’s disappearance, but I’m increasingly frustrated that the current political debates about the pill are contributing to the apparent erasure of all non-hormonal methods of birth control. The pill has become synonymous with birth control in some quarters, without consideration of the profound implications of that swap for women’s health.
I am not opposed to the pill, by the way. I want it to be available, I think it should be covered by health insurance, and I want it to be safe. But I also want women to have complete, accurate, accessible information about all of their birth control options. And let’s get all of them covered by health insurance.
It seems like everyone has something to say about the nature of women and the meaning of menstruation. Even Col. Muammar el-Qaddafi, the recently deposed and still at large dictator of Libya, took it upon himself to opine on the topic. I am not able to judge the accuracy of the translations I have read since so many of those who write about Qaddafi find it hard to resist taking shots at his many peculiar characteristics, but here’s an excerpt from his magnum opus, The Green Book, a three-volume manifesto covering a wide range of subjects, including the nature of men and women, education, politics and the Libyan constitution. The translation comes from a site called Kawther Salam.
“Female is women, and male is man. And women according to the saying of gynecologists, “She menstruates or becomes ill each month, and men do not menstruate because they are male, man does not get sick monthly with “period”. This periodic disease means, every month there is bleeding so the woman because she is female is under a natural monthly disease of bleeding. And when the woman does not menstruate she becomes pregnant . . . and man does not become pregnant and therefore is not naturally affected with these diseases which infect women, because of being females. A woman after that gives breastfeeding to the child… the natural breastfeeding is two years. Therefore breastfeeding means that the woman accompanies her child and her child accompanies her, therefore her activities are paralyzed and she is directly responsible for another human being whom she helps in all biological functions, and without her he dies, and men do not become pregnant and give breastfeeding.”
In light of the starkly negative view of women and menstruation implicit in this passage (presuming the translation accurately captures the tone), it will be interesting to see how the newly emerging political and social structures in Libya frame the menstrual ecology of the country. Those readers familiar with menstrual values and practices in countries and cultures like Libya are encouraged to comment so as to enrich our understanding.
Raise a glass – today is Margaret Sanger’s birthday. Learn about her and her work at the Margaret Sanger Papers Project.