Your Vagina does not Need Feminine High Jinx Products to Stay Healthy

Lolling in front of the TV one evening, I sat bolt upright when a commercial for a “vaginal wash” appeared on the screen.   The product contains “LactoPrebiotic” to “help maintain a healthy pH balance to fortify natural defenses”. They recommend women “use it every day as an important step towards good feminine health”.  Shades of perfumed, daily panty liners, here we go again.  A healthy vagina should have a “light and fresh scent”.

I assumed LactoPrebiotic was an invented term.  But no, there is such an animal.  WebMD explains,

“Probiotics are “good” bacteria that help keep your digestive system (my emphasis) healthy by controlling growth of harmful bacteria. Prebiotics are carbohydrates that cannot be digested by the human body….The primary benefit of probiotics and prebiotics appears to be helping you maintain a healthy digestive system (again, my emphasis).”

Their marketers have extrapolated benefits from one body system to another.

I found an article examining one of these “daily care for intimate skin” products, including a detailed examination of the ingredients.

I am horrified that these products continue to find a place on the market.

We know how to look after our vaginas; and countless articles have been written about maintaining good vaginal health.  Even this recent article mentions avoiding douching; but it neglects to warn women away from other vaginal cleansing products.  There is plenty of good advice, but also some missed opportunities.

Normal Vaginal Fluids

Vaginal fluids are normal.  Mucus produced in the cervix comes out through the vagina throughout the menstrual cycle indicating the most and the least fertile times in the cycle.  Vaginal lubrication is produced by the Bartholin glands.  Female ejaculate, a clear fluid that is projected from the urethra, is not strictly speaking vaginal but may be perceived as such.

Women who are aware of their normal vaginal fluids will likely be aware when these fluids look, smell or feel different.  Over the counter (OTC) products encourage women to self treat when there is a perceived problem.  I often see ads for OTC yeast treatments; and recently one for Bacterial Vaginosis (BV) came across my TV screen.  The latter surprised me, because the treatment for symptomatic BV is antibiotics.

The other issue I have with self treating is that there are several Sexually Transmitted Infections (STIs) that produce similar symptoms, like irritation and unusual discharge.  If a woman has had unprotected sex with a new partner, male or female, she would be well advised to have a swab taken to diagnose the problem.  If she has chlamydia or gonorrhea, she will need to take antibiotics.  Her partner(s) should also be treated.  Untreated chlamydia or gonorrhea can result in Pelvic Inflammatory Disease (PID) and eventual infertility or ectopic pregnancy.

I acknowledge that a woman who has had yeast infections in the past and is well aware of the symptoms may choose an OTC medication; but symptomatic BV requires an antibiotic.  It has also been linked to PID.

Bayer has a product that claims it can “permanently beat Bacterial Vaginosis”.

They say it restores the pH balance in the vagina.

There is no guaranteed prevention for BV.

Women coming to the sexual health clinic where I worked would frequently return with symptoms of BV.  I followed the research closely for years as scientists looked for a way to encourage and maintain the vaginal production of the necessary lactobacilli.  They did, however, discover some reasons why women may produce fewer of these bacteria critical to vaginal health.

“Vaginal douching or other washing practices are frequently cited as a cause of disturbance of the vaginal flora leading to the onset of BV. In a prospective study, douching was associated with loss of protective H2O2-producing lactobacilli and acquisition of BV. A case-control study…investigated associations between vulval washing, vaginal washing, and douching and BV… Use of bubble bath, antiseptic solution, and douching was more common in women with BV…”

Vaginas should smell like vaginas

Lysol was once used as birth control (nope, didn’t work) but also to help women practise “complete feminine hygiene”.  For decades, women were told they needed to stay fresh, clean and essentially cover up their natural odours.  But being aware of our personal odour is what helps us to monitor our vaginal health.  My feminist cohorts were railing about this issue from the early 1970s.  Have we come a long way, or are we still stuck in the rose bushes hoping we’ll smell like one?

 

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Birth Control: is it in you?

At a recent meeting of the Sexual Health Network of Ontario, health care providers came together to examine and extol the virtues of the Intra Uterine Device (IUD).  The IUD is a plastic device wrapped with copper that is inserted into the uterus.  I have always been a proponent of this method of birth control, especially for women looking for an alternative to hormonal methods.

The IUD had to overcome a terrible reputation from the bad old days of the Dalkon Shield.

I remember the Shield well.  I was a very young married woman when I had one inserted.  I complained to my gynecologist that I had ongoing pain on one side which lasted several days a month.  It felt like there was a plumb line attached to my ovary.  It wasn’t until returning from overseas that I had it taken out – or rather dug out – because that’s what it felt like.  The little claws were embedded in my uterus.

It was a deadly device.  The Dalkon Shield’s strings acted like a wick, drawing bacteria into the uterus, causing infections – and in nearly two dozen cases in the US – death.  The deaths in developing countries continued as “developed” countries offloaded their products abroad.

However, in the early 1980s, long after the discredited Shield had tarnished the reputation of all IUDs, new research indicated that the newer copper IUDs were both safe and effective and, in particular, did not cause ectopic pregnancies.  It also became clear that they functioned as a true contraceptive by creating an unfriendly environment in the uterus which repelled sperm.  This opened the door to women who had worried it was an abortifacient.

Copper IUDs

Copper IUDs are 99 – 99.8% effective.  In those rare cases where pregnancy occurs with an IUD in place, the pregnancy can continue as long as it is not ectopic.  Statistically, pregnancy outside the uterus is more likely with an IUD; but given its high effectiveness rate, the risk is very low.  A copper IUD can usually be removed if there is a pregnancy; but that would increase the risk of miscarriage.

A woman with average or no cramps and average bleeding is a good candidate.  She can expect a 10 -20% increase in cramping and bleeding with a copper IUD.  Counselling has changed over the years with regard to multiple partners.  Health care providers were concerned about untreated Sexually Transmitted Infections (STIs) causing Pelvic Inflammatory Disease (PID) with an IUD in place.  However, now STIs can be treated without removing the IUD; although, clearly, a woman with more than one partner is encouraged to use condoms.

Adolescents and women who have not been pregnant can also use the IUD.

Copper IUDs can also be used as emergency contraception up to seven days after unprotected intercourse.

There were a number of questions asked during the presentation; for example, the reason why some IUDs can stay inside the uterus longer than others.  Copper IUDs vary in the number of years they can stay in place: 3, 5 or 10 years.  The main difference between one copper IUD and another is the quantity of copper used.  Although Nova-T is a five year IUD, one practitioner said that they do not use it beyond 30 months because, after that point, they have found an increased risk of pregnancy.  10 year IUDs are larger and more difficult to insert and may cause more cramping on insertion.

The only contraindications to the use of a copper IUD include allergy to copper or other components of the IUD, pregnancy, endometriosis, an abnormally shaped uterus, very heavy bleeding or cramping; or active Pelvic Inflammatory Disease. There are a few risk factors, like perforation of the uterus with insertion, but perforation is rare and the uterus often repairs itself.

Intra Uterine System (IUS)

This progestin-releasing device can assist women with severely heavy bleeding as well as women with endometriosis .  By three to six months, most women who use Mirena (the first IUS on the market) experience dramatically reduced bleeding.  About one third of women will stop having periods after 12 months.

Because it uses the synthetic progestin levonorgestrel, it causes similar effects to Depo Provera which also uses a synthetic progestin; i.e., changes in the cervical mucus and uterine lining, making it harder for sperm to reach the uterus.  And similar to Depo Provera, there may be side effects, including:

  • bleeding and spotting between periods
  • heavier bleeding during the first few weeks after device insertion
  • headache/migraine
  • nausea
  • bloating
  • breast tenderness or pain
  • weight gain
  • changes in hair growth
  • acne
  • depression
  • changes in mood

As always, it is important that health care providers explain fully what a woman may expect.

I learned about some newer IUS devices aside from the more commonly known Mirena: Jaydess, a smaller, low-dose version, good for three years; and Kyleena, which releases the lowest dose of hormones for the longest amount of time.  Mirena has the highest dose of progestin of the three and is approved for five years, although data indicate it is effective up to seven.

The IUS can cause spotting for two to six months.  During the presentation, I had noticed two Orthodox Jewish women and a Muslim woman in attendance.  I made a comment about my birth control counselling at clinic regarding spotting.  Because there may be religious strictures about having intercourse in the presence of blood, I always made sure that women for whom this was an issue were well informed.

Speaking of blood, there was an interesting discussion around using a menstrual cup with the IUD.  Because of the suction on the vaginal walls with a cup, to avoid expulsion it is best to gently break the suction before removing the cup.  Another precaution would be not to use a menstrual cup for two months after an IUD insertion because the risk of expulsion is highest in those first two months.

The copper IUD is an excellent choice for women who want long-term, safe and effective contraception, but prefer not to use hormones.  Make sure that your health care provider has plenty of experience with insertion.

 

 

 

 

 

Do it Yourself Swabs

I was approached by a med-tech start-up company regarding their self-collection device for at-home screening “to prevent cervical cancer and Pelvic Inflammatory Disease (PID)”.  The Eve Kit’s promo video and Indiegogo funding campaign explains the device and their motivation for designing it.

Violeta Cobo, Territory Manager, said that “HerSwab™ (the device that collects the sample) has been approved for self-collection of cervico-vaginal samples” by Health Canada.  The device is to be launched in late 2016.

The promo video raised a number of questions for me.

The device was registered with Health Canada for “safety, efficacy and intended use”, but as I explained to Jessica Ching, co-founder and CEO, the term “approved” is open to interpretation.

But that was only a quibble.

How exactly did they intend to test for cancer, HPV and “STIs which could cause PID”?  Was the device a Pap test?  An HPV DNA test?  A swab for chlamydia and gonorrhea?

Ms. Ching explained that the device is not a Pap test.  It can sample for either HPV or gonorrhea and chlamydia depending on which test the woman prefers.  To detect HPV, the device collects the sample from the upper vaginal canal.  The lab uses PCR amplification to test for high-risk strains of HPV.

However, because Pap tests use cytology when they sample from the cervix, I expressed some concern in case the self-sample result was inaccurate.  A meta-analysis concluded that self-sampling and physician sampling were equivalent; but studies are ongoing.

Regarding the self-sample for chlamydia and gonorrhea a small study (189 women) found their swab for “easy, comfortable” and “suitable for diagnosis”.

As to what happens after diagnosis, Ms. Cobo responded:

“When a patient gets a positive result, she gets referred to one of the doctors we are going to work with. The doctor will follow up with her and prescribe treatment or refer to a screening visit (in case of HPV) if needed.  She could also grant us permission to share the results with her family doctor if she has one.”

However, when I asked about the availability of those doctors, Ms. Ching admitted that to date there were very few with whom they have been able to partner.  The ideal, she added, would be to eventually offer follow-up across the country; however, one of the rationales for the product is precisely the dearth of health care providers.

Do women want to do it for themselves?

The promotional material for the $85.00 kit argues that women find testing “awkward” and that they may not have time to see a health professional.  They also see at-home privacy as a plus.

I asked Ms. Ching about research they had done into whether and why women would prefer at-home testing.  They did focus groups with 20 women and spoke with 50 others from whom they gathered anecdotal information.  She also mentioned focus groups conducted by the Dalla Lana School of Public Health and St. Michael’s hospital and commented, “Our informal findings did mirror the findings of other published studies”.  A CMAJ commentary asks whether the time for self-testing in Canada has come.

The CMAJ commentary poses the question from a public health point of view about women at risk in Canada who might truly benefit.

In Australia, self-testing will be available in 2017 – to targeted women.  For me, this is the real public health issue.  In Australia,

“Women who don’t normally get pap smears – including indigenous women, victims of sexual abuse and those who avoid the test for cultural or religious reasons – have the highest rates of cervical cancer.  These are the women who, from 2017, will be able to collect their own tissue samples in world-first changes to the country’s screening program”.

Targeted self-testing strikes me as an improvement on the selling points of awkwardness, privacy and time constraints.

In Canada as in Australia, the women who get cervical cancer are not screened regularly and/or do not have follow-up and treatment for abnormal Pap tests.  They are poor, marginalized and Indigenous.  The Canadian government’s response has been expensive vaccinations for girls (and in some provinces, boys) against HPV.  Women’s health advocates would prefer to see better access to screening and follow-up through Pap registries; and improved access to health care, especially in remote areas.  According to the CMAJ commentary, some pilot testing of self-sampling has already taken place for these high-risk women.

The value of health professionals

 As someone who worked in a sexual health clinic as a counsellor for three decades, I have one more issue.

When a woman came in for testing, I explained the Pap test, what it was for and how it was done.  In fact, I often accompanied her to the examining room to translate (Spanish, French and occasionally very inadequate Portuguese) and in some cases, to hold her hand, especially when there had been past sexual trauma.

Counsellors use an intake sheet which covers not just medical, but also sexual history.  We find out if the woman has a history of sexual abuse, if she has been having unprotected sexual activity, if it was vaginal, anal or oral, if she understands the difference between the Pap test and STI testing.  We find out which STI she should be tested for depending on her risk factors.  We tell her about contact tracing in case we find a reportable STI.  We explain that HPV is very common and that only certain types may lead to cervical cancer unless the abnormal cells are treated.

These conversations are critical in helping a woman take control of her health in a way that DIY testing cannot.

Given the cost and limitations, it remains to be seen what role self-testing might play in this country.

 

 

 

Chickens coming home to roost

If you have a cervix, read this.

In 2013, I wrote a blog on new provincial and federal cervical screening guidelines (https://springtalkssex.wordpress.com/2015/01/08/confused-about-pap-tests-july-2-2013/) partly because women’s health advocates were worried that these updated policies were putting women at risk in order to save money.  There was no risk, in my opinion, in delaying the initial Pap or from the longer interlude between screening tests.  But there certainly was a risk: not informing women of the difference between cervical screening and Sexually Transmitted Infection (STI) testing.

Because most Human Papilloma Virus (HPV) infections resolve on their own, research indicated that earlier and annual testing did not decrease sickness or death from cervical cancer.  Even high-risk HPV infections that cause cellular changes on the cervix tend to resolve on their own without treatment.  Cervical cancer develops when there is persistent infection with a high-risk type of HPV in the presence of co-factors like a suppressed immune system.  Pap testing (and/or HPV testing) indicate when treatment is necessary to prevent its development.

When Cancer Care Ontario (CCO) published fact sheets to inform the public about the new guidelines, I contacted them to point out that they also needed to provide information about the importance of STI testing.  It was obvious to me at the time that there would be repercussions.

I had been selling the annual Pap as part of sexual health education classes for years.  Suddenly, young women (including trans men with a cervix) were being told they didn’t have to start till they were 21 (Ontario) or 25 (federally); and they didn’t need to have a Pap every year.  So, of course, many stopped having internal exams until they were told they had to.

Young women, in my experience, especially those whose annual Pap test coincided with – and in some cases were dependent on – their birth control pill renewal, had no idea what was going on during their internal exam.  Despite the efforts of sexual health educators in the classroom to distinguish between the Pap test (checking for abnormal cells on the cervix) and STI screening (swabbing the cervix and inside of the vagina) when they arrived at clinic for their exam, counsellors had to take the time to explain it again. It is not clear if Physical Education teachers and family physicians today consider it important to educate about this important difference.

So what’s the big deal?

The importance of the distinction becomes clear when we look at the statistics.  According to the lead researcher of a recently published article on this issue (see below), over the past 10 years, chlamydia and gonorrhea rates in Canadians rose by 72 and 53 per cent, respectively, especially for chlamydia.  The highest number of cases of chlamydia are diagnosed in young people between the ages of 15 – 24.  The increase in diagnoses was in part due to Public Health Units encouraging an increase in testing in the early 2000s.  The urine (NAAT) test (v-e-e-ry appealing to men) also brought in more young people for testing.  One of the suspected behavioural reasons for the increased number of cases was less condom use among older adolescents and young adults who made the switch from condoms to hormonal contraception without being tested first.

Untreated chlamydia, which is commonly asymptomatic, can do serious damage to the Fallopian tubes.  Moreover, untreated STIs which provoke an increase in white blood cells at the site of the infection, make it easier for HIV to enter the bloodstream.

Here come the chickens

St. Michael’s Hospital in Toronto raised the alarm about a decrease in testing in their recent study (http://www.sciencedaily.com/releases/2015/10/151015144701.htm).  The lead researcher said, “…we found that women weren’t visiting family physicians as often for Pap tests, causing a drop in STI screening as well.  Female patients were also less likely to be screened for syphilis, hepatitis C and HIV under the new guidelines…”

When I contacted Cancer Care Ontario to complain about the lack of information on the importance of ongoing STI testing, the woman I spoke to thought it would be confusing to try to explain the difference between the various types of testing.  Prior to writing this blog, I re-visited the CCO web-site looking for what I hoped would be updated literature.  There is still no mention at all of STI testing.

The takeaway for readers with a cervix is this: if you have had unprotected sexual activity, whether you have symptoms or not, see your health care provider even though it is not time for your Pap test.  They will look at your genitals; they will test you for chlamydia and gonorrhea and any blood-borne infections you may have been exposed to.

As for me, I guess it’s time to contact CCO medical directors encouraging them to read the St. Michael’s study.  I wonder if they still think it’s too much for women’s brains to handle.

Read more here:

Cancer Care Ontario information on screening: https://www.cancercare.on.ca/cms/One.aspx?portalId=1377&pageId=9550

“Pink Viagra” approved in US: Big Win for Big Pharma

Is Addyi coming to a drugstore near you?

With the Canadian purchase of Sprout, the company that convinced the US Food and Drug Administration to approve flibanserin (now marketed as Addyi), Canadian approval may not be far behind.  Does this medication really “even the score” with men by increasing women’s sexual desire?

The New View Campaign (http://www.newviewcampaign.org/) has been arguing for years that female sexual dysfunction was manufactured to pave the way for a medication to treat it.  The Journal of Medical Ethics agreed in their commentary, “Hypoactive sexual desire disorder: inventing a disease to sell low libido” (http://jme.bmj.com/content/early/2015/06/28/medethics-2014-102596.short).

But female sexuality and desire are complex.  Back in 2004, a CME (continuing medical education) guide was written to help doctors integrate the “New View” approach.  They included a section on the medicalization of male sexual problems and a similar history for women, including an account of the search for a female medication akin to Viagra, which had already begun by the late 1990s.  The CME detailed a step by step response to this medicalization.  They began by explaining that women’s sexual problems may be due to:

  • sociological, political or economic factors
  • problems relating to their partner and relationship
  • psychological factors
  • medical factors

Clearly, no medication is going to address all of these issues.

The big sell for a female equivalent to Viagra began with faulty research, which soon became medical gospel.  The New View Campaign repeatedly criticized the oft quoted 43% figure, which was said to represent the total prevalence of sexual dysfunction for women 18 – 59.  Where did this figure come from?  The researchers, including two authors paid by Pfizer, asked 1500 women to answer “yes” or “no”, if they had experienced any of seven problems – for example, lack of desire or difficulty with lubrication – two months or more in the past year.  If they answered “yes” to even one of these questions, they were popped into the sexual dysfunction category.

There is no clear biological indicator for abnormally low desire because desire is entirely subjective.  In order to be diagnosed with female sexual interest/arousal disorder, one must report “significant distress” which is also highly subjective.  Given the above list, what woman has not had life experiences that tamp down her desire or ability to lubricate?  Just had a baby?  Don’t touch me.  In a loveless relationship?  You don’t need lube or a pill.

There were already two failed attempts to get the FDA to approve flibanserin despite their widely publicizing the (manufactured) need for it.  The FDA cited lack of effectiveness (4.4 satisfying sexual experiences vs. 3.7 for women taking a placebo: a whopping difference of 0.8%).  There was also concern about side effects (e.g., dizziness, nausea, fatigue, insomnia).  In fact, many women discontinued participation in the clinical trials because of these side effects.  And for women who like a glass of wine before sex, forget about it.  Flibanserin’s concentration – and accompanying side effects – increases with alcohol.  There is a similar increase if she is using oral contraceptives or other common medications.  Moreover, a woman would have to take a daily pill without expecting any change for weeks, as is the case with anti-depressants.

The International Business Times agrees “it is more like an antidepressant and works by changing brain chemistry over time, in a similar way to serotonin and dopamine. While male Viagra is taken before engaging in sexual activity to increase blood flow to areas of the body to help treat erectile dysfunction, Flibanserin is to be taken daily to improve sexual desire over time.” (http://www.ibtimes.co.uk/female-viagra-addyi-approved-us-what-flibanserin-how-does-it-work-1516090)

What’s a drug company to do?

The third attempt was preceded by the creation of Even the Score (http://eventhescore.org/the-problem/), backed by pharmaceutical companies – a brilliant marketing ploy.  They argued that medical sexism was withholding medication from women whose sexual desire was perceived as less important than men’s.  Co-opting feminism is an old game, but one which, in this case, was very effective.  They won the American round.

It remains to be seen if Canadian women will fall for the same ploy.

Don’t believe the hype.

Read more:

Drug Facts Box: http://www.informulary.com/informulary-drug-fact-boxes/addyi-for-women-distressed-by-decreased-sex-drive

Reducing pregnancies for teens and poor women = reduction in poverty: reductio ad absurdum?

This New York Times article http://www.nytimes.com/2015/07/06/science/colorados-push-against-teenage-pregnancies-is-a-startling-success.html?partner=rss&emc=rss&_r=2  asks the following question: “If teenagers and poor women were offered free intrauterine devices and implants that prevent pregnancy for years… would those women choose them?” The answer?  A “resounding yes”, which they deem a “startling success”.

Pregnancies to teenagers and “unmarried women who had not finished high school” plunged, especially in the poorest areas of the state, allowing them time, according to the article, to “gain a foothold in an increasingly competitive job market”.  It was seen as a poverty reduction strategy.

I wish I had been a fly on the wall during the counselling sessions that led these young and poor Colorado women to choose long-acting contraceptives.  Were they fully briefed on the side effects and potential risks?  Did they discuss Sexually Transmitted Infection (STI) prevention?  What was the overall vision of poverty reduction in Colorado?

During my sexual health clinic days, there were women who chose – and continued to use – Depo Provera, a contraceptive injection that lasts for three months.  They did so after I had fully informed them of potential side effects and risks of the progesterone-only method.  Some adolescents who came to the clinic were good candidates for the copper IUD and it worked very well for them.  After a clinic counselling session, when young teens or disadvantaged women opted for a method of birth control that worked for them; or they chose to end a pregnancy realizing that their circumstances would not allow them to raise a child at that time, they were making informed choices.  I recognized then as I do now, that reproductive control and poverty, while linked, are not the only elements in the equation.  After reading the article, I wondered about other measures proposed to reduce poverty in Colorado; and what will happen when the private grant to fund this experiment runs out.

Teenage pregnancy and pregnancy for low income women are complex issues.  Factors that result in unplanned pregnancies to teenagers include lower economic status, sexism, racism, prior sexual abuse and ongoing abusive relationships.  The absence of the social determinants of health can result in risk-taking behaviours, like smoking and unprotected sexual activity.  With regard to sexual abuse, for example, without the benefit of comprehensive counselling, young women run the risk of future sexual assault and abusive, controlling partners.  Some exploitative male partners will refuse to “allow” them to use contraception; or they may refuse to use condoms.  When one has little control in one’s life, reproductive control is not even on the table.

For younger and poor women, while it may not be prudent financially, emotionally or even physically to continue a pregnancy, if poverty itself were eradicated, part of the burden to the state would be eliminated, while still allowing funding to provide parenting support.

I imagine some ideological detractors of the Colorado experiment might accuse them of eugenics, deliberately limiting births to racialized and poor women.  I do not subscribe to this point of view.  However, one must acknowledge the history of eugenics practices in North America and abroad that will inevitably make some people skeptical of the motivation behind this poverty reduction experiment.

And yet, research is conflicting on the relationship between teen pregnancy and poverty.  According to Statistics Canada, “women from disadvantaged backgrounds are more likely to end up disadvantaged even if they delay childbearing. And while teenage childbearing continues to be a significant indicator of lower socioeconomic outcomes, the effect is smaller than originally believed” (http://www.statcan.gc.ca/pub/75-001-x/2008105/article/10577-eng.htm).

While I agree that delaying pregnancy is a tool towards poverty reduction, let’s be frank: only the redistribution of wealth will eradicate poverty.

The second issue in terms of the counselling process is STI prevention and treatment.  Like women who use oral contraceptives, women who use IUDs, injections (and implants in the US) may not see the need for condom use.  I would like to know if they discussed and offered testing and treatment for STIs like chlamydia, the rate of which is especially high in older adolescents and young women.  Because there are no symptoms of chlamydia in the majority of cases, without testing, women may contract Pelvic Inflammatory Disease which, if undetected over time, may lead to infertility – not a recommended form of birth control.

A Public Health map of Toronto that plots adolescent pregnancies follows the same geographical trajectory as STIs in the city, which, in turn, follows the curve representing its poorest neighbourhoods.

And who is at higher risk for poverty in Toronto?  Recent immigrants, Aboriginal people, those who are disabled, elderly and alone, racialized or children (http://www1.toronto.ca/City%20Of%20Toronto/Social%20Development,%20Finance%20&%20Administration/Strategies/Poverty%20Reduction%20Strategy/PDF/povertyinTO.pdf).

Poverty reduction, like unplanned pregnancy to young and poor women, is also complex.  There are no magic wands, but there are proven tools.  If we take the lead from developed countries where there is more economic equity, we see that a higher minimum wage and/or guaranteed income, a fair tax system where the wealthy and corporations paid their fair share and increased services, results in a profound reduction in poverty.

In the meantime, contraception and birth control, including post-coital options and abortion, should be freely available to all as a public health service.

Additional reading

The hidden epidemic: A Report on child and Family poverty in Toronto, November 2014

http://www.torontocas.ca/app/Uploads/documents/cast-report2014-final-web71.pdf

Poverty causes Teen Parenting, Not the other way around

http://rhrealitycheck.org/article/2013/04/29/poverty-causes-teen-parenting-not-the-other-way-around

Good Practices in Anti-poverty Family-focused Policies and Programmes in Developed Countries

http://www.un.org/esa/socdev/family/docs/egm12/PAPER-RICHARDSON.pdf

Detoxifying society

If people are still reading these blogs in say, ten years, I hope they will have to look up the meaning for FHRITP and “hate fuck”.

The FHRITP acronym has been used to publicly humiliate female journalists during live TV spots.  “Who would you like to hate fuck” was one of the posts of the Dalhousie dentistry students’ “Gentlemen’s Club” Facebook page.  These examples of hateful male bonding seem to be the topic of the week.

The Dalhousie students were sent to a restorative justice program rather than being summarily expelled. On the same day that I read the report, detailing the comprehensive process of rehabilitating the male dentistry students (http://www.dal.ca/content/dam/dalhousie/pdf/cultureofrespect/RJ2015-Report.pdf) I listened to a CBC interview on the sexualized atmosphere in the military and the way different countries were addressing it (http://www.cbc.ca/radio/thecurrent/the-current-for-may-22-2015-1.3083305/seeking-worldwide-lessons-on-reforming-military-sexual-misconduct-1.3083331).  The CBC interview focussed on finding the best mechanism for pursuing complaints of harassment and sexual assault of women, men and LGBT people in the military.  But when asked about prevention, one participant said that just being able to check “inclusion” off a list was inadequate; there needed to be enforcement.

Quite right.  But I generally associate prevention with education.  The word was not mentioned in either the interview on the military or in the Dalhousie report, although the Dalhousie report does describe “the way forward”:

“…addressing climate and culture is about doing the things we do differently, not just doing different things.”  They expect that “…the ways forward on culture and climate issues within the Faculty… will also be informed and shaped by the recommendations of the Task Force on Misogyny, Sexism and Homophobia … at the end of June 2015.”  I hope they are right.  Because part of a good university education is the preparation of young adults to take their place in society.

Unfortunately, we live in a society that is toxic – and unsafe – for women and LGBT people.

Inclusion and respect seem to exist only on paper.  The expression of deep hatred towards the “other” is based in the distortion of human sexuality where we commodify sex and objectify people.  I addressed some of these issues in an online magazine article on how this affects girls (http://www.cwhn.ca/en/networkmagazine/hypersexualization).  Their self-objectification starts young, when they are encouraged by societal norms, reinforced by media, to buy into their objectification and the accompanying loss of power.

When we see strong women break down because their hard earned power has been attacked, it is both shocking and distressing.  In the wake of the recent FHRITP incident, CBC women reporters assailed their harassers in a video where they related their personal stories of dealing with sexism (https://www.facebook.com/thenational/videos/10152868931477686/?pnref=story).  One reporter asks why no one steps forward.  In a recent TV interview, a female comedian also asks: why does no one step forward when we are sexually harassed on stage?

The answer is that critical mass has not yet been reached.

Addressing society’s negatives, like racism, misogyny and homophobia begins in the home.  Media literacy can take place in front of any screen, unpacking the prancing women of Victoria’s Secrets’ lingerie ads, the overt misogyny of music videos and the every-day cultural normalization and trivialization of violence against women.  Before girls become imprisoned as objects in their own minds, this work needs to continue in the schools.  For example, the 2015 revised Ontario Health and Physical Education Curriculum addresses stereotypes, harassment and consent at multiple grade levels.  With good teacher training and comprehensive lesson plans, perhaps we can, at last, have some positive expectations for their – and our – future.

What I hope will emerge is a generation of young people who respect one another, who have no desire to discriminate on the basis of gender or sexual orientation, who are empathetic and brave.  They will stand up to the Neanderthals who have not yet absorbed the basic values of equality and respect.  This is the generation of young people who will turn rape culture on its ass and kick it to the door.