Wednesday, May 28, 2008

Rant: Gynecology, choice, "annual exams", and the medical establishment

For those readers of this blog who are made squeamish by feminism, medicine, or vajayjay talk, I suggest you look away now. Consider yourselves warned.

Recently, I read a post on feministing asking how women felt about getting their "annual exams". I didn't weigh in on the topic, because where I live now, and where I lived before, "annual exams" aren't annual, and include only a pap smear, rather than the breast exam and everything else that seems to happen in the States. Also unlike the U.S., here these exams are usually done by your family doctor, rather than a gynae specialist. what this discussion reminded me of, though, was a pro-feminist framing of gynae care I'm not sure I am comfortable with. I'm not sure I can agree that gynae care is entirely feminist--while being healthy is certainly pro-woman, I'm not sure viewing the female reproductive system as something that needs to be checked once a year to remain healthy, or the pap smear as a pre-requisite to a birth control prescription is feminist. The first reminds me enormously of the medicalization of birth, with all the patriarchal control of female reproductive organs and disconnect between a woman and her own body and health (after all, what other body system needs so much checking out once a year?). Requiring a pap before prescribing birth control smacks of medical paternalism to me--even in the highly legalized medical environment in the U.S., surely a woman ought to be able to sign a waiver and get her birth control anyway (there are some places that offer this option, but from what I have heard they are in the minority). I think it is likely, too, that this insistence on intimate exams may actually prevent some women from getting hormonal birth control--this insistence will not force unwilling women to get gynecological exams, it will cause them to use other (potentially inferior) methods of birth control.

Combine this climate of control and medical paternalism (of which there is a long history with regard to women's bodies) with the fact that often women are not in charge of their gynae exams--take this and this as examples from the medical blogosphere and the feminist blogoshpere respectively that make my toes curl in their shoes--and you have a pretty ugly scenario.

In Australia, around 61% of women go for their pap smears every two years as recommended. That means 39% don't. To try to raise this number the government is paying doctors extra for treating women who have not been tested for a while (but you can guarantee that that extra money is not being passed on to patients). In a country the size of Australia, you can guarantee some of the problem is access and choice--when you're dependent on a rural health service that covers a wide area, well, it might take a bit longer to get to a doctor. Like anywhere, though, some women's reluctance will have to do with what doctors call "anxiety or embarrassment", which I believe is meant to cover everything from anxiety and embarrassment right up to fear and trauma. While the medical approach is that these women should "get over it for their own sake", I am a little disappointed to note the actual level of care being offered--I'm going to talk about the Australian model, because I've done some research about it.

In Australia, around 2% of the ordinary non-liquid paps are inconclusive (usually because they contain blood or mucus), requiring the woman to come back for another test 6-12 weeks later. While there is a more effective test, the cost of this test is not covered by the Australian government (unlike most other medical testing), and even where it is performed an ordinary pap must be performed anyway. In a traumatised woman, the additional testing, expense, and discomfort may be the barrier between getting successful health care, and not getting it, but it is much easier to trot out the line about how "women with cervical cancer should have come in for a smear" than actually address this problem.

HPV testing could be offered as an alternative to traditional pap smears, meaning women did not have to get tested so frequently, but again, this is not covered by the Australian government, and therefore does not actually help many women.

And then there is collection method. Blind sweeps, and self sampling (either with the traditional method, as this midwife offered, or with the newer mechanisms) can offer women an non-traumatic way to collect the necessary samples. The Australian cancer screening program., however sees 'no evidence' to support the use of this approach. I guess the women in this study who would use this approach but did not get regular pap smears are not enough evidence. As this paper says, self sampling could bring the participation rate in cervical screening to near 100%, but cynically I have to wonder if it is easier and cheaper to blame women for getting cervical cancer.

My point is this (and yes, I have one): I do believe that being healthy, and having a healthy reproductive system are feminist objectives. I also believe that choice, knowing one's own body, and questioning the patriarchy are feminist objectives, and given the above it is clear that (at least in Australia) choice is being restricted (and may pose a barrier to the health of up to 39% of women). I am all for taking care of our bodies, and I am grateful that (largely thanks to the feminists who went before us) gynecological care has advanced enough that women are allowed to get pap smears these days. Having said that, the fact that the medical patriarchy is denying birth control without a pap smear, or constricting womens choices about what kind of pap smear they have (financially, practically or informationally) quite frankly makes me think that too much gynecological care isn't feminist. Until women everywhere can get care in the way that works best for them, until the blaming of cancer victims for "not coming in for a pap" stops, until women are seen as intelligent beings and allowed to decide for themselves about the risks associated with birth control, I can't quite see the "annual exam" as feminist.

Monday, May 26, 2008

Rant: Religion and the food industry: There's what in my yoghurt?

Recently I hit the grocery store needing a mid-afternoon something to fill the hole. I don't know what it is about me, but I eat all the damn time. Honestly, if I am not the original argument for "size is genetic" I don't know who is--like I say I eat all the time, and I (like my parents, who eat differently to me) am short and on the stocky edge of normal. I like to eat protein in the afternoon, because it fills the hole and keeps me out of the candy jar at work (because my already-awful teeth need me eating that stuff like I need another chronic illness). I was also in the mood for something sweet, so I checked out the mousse type selections in the yoghurt fridge. I read the ingredient list, and discovered to my horror, that Nestle mousses include halal gelatine.

Now, giving Nestle the benefit of the doubt, I contacted them to enquire whether the gelatine was from animal sources, and indeed it is--beef gelatine. After this, The Partner conducted a survey of all the products in that fridge--and despite mostly being yoghurt, many of them had gelatine in them. Upon my understanding of all this, I have investigated gelatine as an ingredient, and will not be ingesting anything that contains it in the future.

There are two larger issues at play, here, though. First of all, what the fuck are all these companies doing putting an animal product in yoghurt in the first place? Yoghurt is supposed to be a healthful, vegetarin food, and should be primarily dairy. Bulking these foods out with gelatine is at best making the foods less healthful, and at worst sneaking meat into what should be vegetarian products. I knew the food companies weren't above dirty tricks, but I am significantly unimpressed that yoghurt isn't yoghurt anymore.

The second issue is the use of halal gelatine. I am a firm supporter of religious tolerance. I support everyone's right to live their spiritual life in any way they choose. I do not, however, support any kind of cruelty done in the name of religion or culture, to humans or animals. I do not support customary-rights whaling, I do not support bullfighting as a protected cultural practice, and I do not support halal or kosher slaughter, which I (and the British Veterinary Association) believe to be cruel.

Now, yes, arguably any slaughter is cruel (and it certainly seems especially unnecessary to thicken yoghurt which should be thickened by straining and no other method), but as someone who would truly struggle to meet their nutritional needs without meat, I would at least like my meat products to come to me with as little attached cruelty as possible. I buy free range eggs and chicken, and I try to stick to fish products and (even better) vegetarian options as much as possible (but it won't always be possible). And I believe putting animal-based halal gelatine into anything consumed by a population that would almost certainly deem the method of slaughter cruel is unethical. Certainly, it makes it easier for the food giants--they do not have to deal in multiple suppliers, and their food is suitable for a larger market; but easy and ethical only rarely go hand in hand, and in this case they don't. The food suppliers ought to label more clearly that their food is not suitable for vegetarians, and not suitable for those who support what research shows to be humane slaughter.

As for me? I'm now sticking to Tamar Valley yoghurt. Sure, it costs me $8 for a six pack, but it tastes amazing, doesn't have gelatine of any stripe in it, and leaves me feeling fuller (perhaps because it isn't bulking out the product with gelatine) than any other kind of yoghurt. And as for gelatine? It's off my list.

Monday, May 19, 2008

Rave: The reclamation of my own body

I've decided I need to write more in this blog, as a space for the things I can't put on any of my professional blogs. I shall try not to ignore it for nearly a year in future.

Being an avowed feminist, and getting more avowed by the day, I've been thinking a lot about the mind-body dichotomy and how it plays out where I can see social ideals exerting controls over women's bodies, through food and fat, through sex (and rape), through fashion, through forced childbearing or denial of the right to bear children, through sports, and ultimately through murder (to name just a few).

For me, personally, my body has been a source of discomfort for as long as I can remember. Because I cannot run fast or catch a ball, and I grew up in a society that values sports above all else, my body and its failings have made me an object of school ridicule since I was small. I do not fit in to an idealized beauty standard, and this has been readily apparent to me for a long time. And in my early adulthood, I suffered the bodily betrayal of chronic illness; pain, dependence, weight loss and gain due to illness and medication, loss of control in general (the illness with which I am diagnosed has particularly socially unacceptable symptoms, being intestinal in nature). And of course the usual stories of sexual harassment and the like that all the women I know could tell, well, I can tell them too.

I'm not saying all or any of this for pity, but because I want to demonstrate how from the time I went to school, my body has been a source of embarrassment, shame, inconvenience, pain, and discomfort. Until I left my teens, I walked with a hunch to make myself smaller and less obvious. I wished I could be like that Roald Dahl story, and just be a brain in a jar, because nothing good came of having a body.

Recently though, I have begun to realise the joy I take in my body. Now, for those of you whose minds have already hit the damn gutter, I'm not even going to talk about sex--partly because it too bloody obvious, partly because it is fraught and I don't want to get into it. Instead, I'm going to talk about other things:
  • Discovering swimming at 13, and realising I could swim further than pretty much anyone I knew, but that that didn't matter because it was good to just move through the water and be tired afterwards.
  • Discovering the gym at 14, and learning to enjoy group exercise in a way where I was my own master, and where I did not have to be able to run or catch a ball.
  • Playing basketball in girls-only physical education in Finland, where all that mattered was that everyone was having a good time.
  • Learning to climb and be the master of my own destiny, and getting bloody strong along the way (oh, and meeting my husband wasn't bad either).
  • Lifting weights, and changing the shape of my body, not in a way that pleased society, but in a way that pleased me.
  • Taking up running on the treadmill with a goal in mind, and being surprised at how fast I could run without even trying
  • All the other gym classes -- step, where I was particularly talented and could learn anything; boxing aerobics, where I was quick and my aggression didn't matter, pilates and body balance where I learned to concentrate on what my body was doing and how small changes affected it, deep water running, where I could do great cardio without joint pain and most recently and importantly...
  • ...body jam, where I dance. I've always loved to dance, but I've never had any faith that I didn't look stupid or pornographic. It's taken a year of jam, but I simply don't give a flying fuck anymore what I look like. I don't care that some of the moves are sexual. I enjoy moving, and I am moving not for anyone other than me. It's about how I feel, rather than how I look (though I've been told that my dancing is pretty damn pleasing to the eye, these days).
It's taken doing the jam thing (for a year!), and losing my shame about moving my "child bearing hips", "thunder thighs" "boobies" and all the other parts of me that attract less attention for me to look at all of these experiences and stand up and recognise the joy I take in them. The brain in the jar scenario doesn't allow for any of these joys, and finally I am choosing to focus on the joy in all of it, rather than feeling slightly embarrassed and apologetic.

This is not, of course, to say that I love the way my body looks, or that the creepy jerk staring at my chest in the gym/elevator/train doesn't make me want to hide (or smack him), or that pain and illness don't make me curse my body as a bastard traitor that isn't playing the game. It's just that that isn't the dominant narrative anymore; it's no longer about what my body can't do, or what it is, but about what it can and does do. I've reclaimed my body.

I can't help but wonder, though, if I wouldn't have come earlier to this if physical education at school had been better rounded, and exposed me to other things than running and catching balls (and after all, the majority of us are not great at these things or sports heroes wouldn't be worshipped the way they are), and perhaps I might have come to the joy in simple movement earlier. It wouldn't have completely ameliorated all the other baggage, but knowing my body did one good thing just for me might have helped along the way. If I have daughters who are as hopeless at sports as I am, I'm certainly going to do my damndest to expose them to other types of movement...just in case.