Involuntary Sterilization, Cowboy Doctors, and the West in Africa

J from Tales from the Hood sure knows how to cheer a girl up.  By sending her a story about someone bragging about participating in a non-consensual sterilization in Tanzania!

Now, this is not some big well known person, and there are lots of stupid people on the internet, posting about doing lots of terrible things.  So why does this warrant a post?  Well, maybe, because J felt the need to "share the love" with me, and now I want to share it with you, so we can stare open-mouthed together.  But also, because even though this is just one guy posting about doing stupid things in developing countries, I think his mindset is reflective of a far more common, and deeply damaging, mindset in aid workers: "We're here to help.  Therefore, we're helping."  And also: "We know better than the poor people (after all, they are poor, and we are not)."  Neither of those are true, as J and others have meticulously documented.  So, into the meat of our story.

The blog's author, Erik, is a doctor working in a village in Tanzania.  A Tanzanian doctor comes to his house at 9 pm, asking for help:

"Hello Dakatari, come on in." We never used each others name. Only Daktari. It's how it is done. The challenge was to use it in every single sentence.
"Daktari, I wonder if I could beg a little help from you this evening. We have a little bit of a problem, Daktari."
"Happy to help, Daktari. What's up?"
"Daktari, a woman has come in to the clinic tonight. She is pregnant and has been in labor for two full days. She has been with the village Traditional Healer for the whole day."

The Traditional Healer. Say no more. Straight away I knew this was not going to go well. Each village had a Traditional Healer/Witch Doctor who practiced ancient arts of medicine. These techniques included ritual skin cutting, herbs and randomly placed sticks through punctures. I'm sure that many of their methods worked, but the only ones we ever saw were the ones that didn't. In those cases the patients would be dragged to our hospital as a last resort. They were usually in septic shock, nearly dead or horribly late for treatment like our Sunday night patient.

The woman needs a C-section, and the Tanzanian doctor has an injured hand, so can't perform the surgery himself.  Eric is hesitant since OBGyn isn't his specialty, and he hasn't performed a C-section in 20 years, but he ultimately agrees.  The patient's health takes a turn for the worse during the operation:

"How's it going up there, doc?" I asked. Everyone who wasn't a Daktari, I called doc. It was simpler.
"Hmmmmmm..........." I thought he didn't understand my English. I spoke slower.
"How is she doing, doc?"
"Hmmmmmmm...................Well, Daktari, maybe she is not breathing. I cannot be sure," he said without an ounce of panic. I thought: that's a little nonchalant for what he's talking about.  

They begin CPR:

"Daktari, the epidural injection must have gone too high and paralyzed all her nerve function," I said as I started doing chest compression over her sternum.. I heard a rib crack with a loud POP under my hand and I winced.

"Yes Daktari. I believe that is correct," said Dr. M. She is a young woman and this is her fifth baby. She has a good heart."
Fifth baby, I thought. Holy shit. All I could think of was five orphans.
"C'mon, cmon," I said to no one in particular, "this cannot go down like this."

Supporting the right to choose without denigrating disabled individuals

Earlier, when we talked about Oklahoma's abortion legislation protecting doctors from legal action if they do not correctly report test results to mothers, RecoveringEconomist argued that those who supported the law under the guise that it protected disabled individuals were really misogynists in progressive clothing, since they did not support other measures to protect persons with disabilities.  That said, I've often felt members of the reproductive justice movement are in danger of falling into the same trap, saying there are other ways to protect persons with disabilities without actually doing anything about it.  If we really want to walk the walk, reproductive justice advocates need to both fight against laws restricting women's rights and actively work to strike out ableism and promote equality for persons with disabilities.  This Ain't Livin' has a great piece today on this very topic, arguing that protecting disabled individuals requires more information, not less.  I.e., instead of taking away women's right to make their own medical decisions by withholding test information, doctors should be giving women accurate accounts of a disability's implications and the requirements for raising a child with that disability.

People who receive a fetal diagnosis are provided with plenty of information about what it means for the pregnancy, but not a lot of information about what happens next, other than scaremongering about how much of a hardship it is to care for a disabled child. Lies about children with disabilities breaking up marriages. Horror stories. They are not provided with balanced and supportive information that informs them about how they could care for their child after the birth, the variance involved in diagnoses, the fact that sometimes a fetal diagnosis is wrong, that support is available. Despite best efforts on the part of the disability rights movement, many parents face a fetal diagnosis alone and terrified, and they never even get a chance to meet living people with the same condition; they’re told to terminate, not to research. Doctors tell parents of people like me that termination is the best option.
That’s not making an informed choice. That’s making a choice based on fear and misinformation, and it is wrong. I do not support that, and I do not think that anyone who supports reproductive rights should support that either. This is not decisionmaking, it’s ‘do what you’re told or you’ll get a defective baby.’

She also discusses how people in the reproductive rights movement have often resorted to ableist and hurtful language when discussing this particular law, including implying that being forced to have a "disabled" or "defective" baby is a fate worse than death.  I encourage you to go read the entire piece, and discuss below.

Don't wrap your misogynist beliefs in a blanket of faux-concern for the disabled

The Oklahoma Legislature voted this week to override the governor's vetoes on two laws restricting abortion rights, one of which would prevent women who have had a disabled baby from suing a doctor for withholding information about birth defects while the child was in the womb.

I find this law to be troubling in many ways; however, the primary reason that I have such a strong reaction to it is because it attempts to mask its primary goal of the oppression of women (and in particular, the oppression of low income/ low education women) with phony concern over children, and in particular, children with mental and/ or physical handicaps.

While I do believe that there are many pro-life individuals who are deeply and genuinely concerned with the well-being of fetuses, children, and the handicapped (e.g. this family), I believe that many people (and most legislators) who harbor pro-life beliefs do so as a means of punishing and oppressing women, especially women who deviate from conservative and religious beliefs of how "good" women should behave (e.g. "If you didn't want to have a baby with Down's syndrome, you shouldn't have had sex before marriage").

The reason I hold this belief is simple: if the true concern of these people, and these legislators, was to protect children (and in particular, disabled children), then they would be supporting a number of policy solutions that did not center around abortion. They would, in addition to abortion-restriction, pursue policies that would benefit children AND the mothers who care for them. If you really care about disabled children and you don't want them to be aborted, why not give women who conceive disabled children special allowances to take care of them? Why not have free, quality, government provided daycare? Why not increase funding for groups and programs that assist the disabled and the poor?

The fact that the majority of these "pro-life" individuals and legislators vehemently oppose these programs reveal their true intention, and it is in no way concerned with the well-being of children.

Questioning the power of the pill: Do we need more innovation in birth control?

Feministe has an interesting piece about an interview Laura Eldridge gave about her new book on birth control.  Eldridge is a critic of hormonal birth control, and argues that its side-effects have been downplayed and women led to believe they only have one reliable choice for family planning.  While I certainly agree that the pill may not work for everyone (and as someone who is generally suspicious of pharmaceuticals, taking such a powerful medication for so long makes me nervous), I also agree with Feministe that for many women, it's hard to overstate the immense power of the pill.  Birth control access, more than anything else, really changed the way we as women were able to live our lives, so I will go to the mat defending it, even if I acknowledge we need to have an open conversation about the pros and cons of different methods.

Femonomics reads the internet so you don't have to: bad science, working women, and football

Some crazy study has come out that shows that to maintain weight, women need to exercise an hour a day.  Oh wait, no it doesn't!  The study followed 34,000 women, who had a mean age of 54 at the start, over 13 years, and recorded exercise, start weight, and end weight.  1) There it is again: correlation is not causation.  Exercising a lot was correlated with not gaining weight (for women who had a "normal" BMI to begin with), but that could be because people who exercise a lot eat differently, have different genetics, or had different health habits early in life.  2) Did I mention these women started at 54?  Gaining weight in the 13 years between 54 and 67 is completely normal (whereas exercising an hour a day really isn't, especially for people in their 60s who may have health problems, see image).  Your body needs fat to synthesize estrogen, which is protective against osteoporosis and other diseases of aging.  After menopause, estrogen produced by the reproductive system naturally decreases (why hormone replacement therapy used to be the norm), so fat cells may be an important source of ongoing estrogen support.  We have no idea whether weight gain after menopause is good or bad for you.  We have no science that says this.  These studies...oh man.  As Gawker says, science is working overtime to make women feel bad about themselves, but not much else.

Beyond choice: The big picture of reproductive justice

Last night I heard four reproductive justice advocates speak at Barnard College.  Surprisingly, the evening's conversation only touched on the topic of abortion.  The four women, Aisha Domingue of Brooklyn Young Mothers' Collective, Mary Mahoney and Lauren Mitchell of The Doula Project, and Miriam Perez of Feministing and Radical Doula, have all been trained as doulas, and all work with women at various stages of their reproductive decision-making: pregnancy, abortion, childbirth, and adoption.  What this panel emphasized is that while abortion choice and contraception access continue to be key frontiers for the reproductive justice movement, there are other crossroads where women find themselves without agency over their own bodies, particularly childbirth.  Perez said she got into doula work after seeing the documentary Born in the USA.  "There was something about the way childbirth was being done in the usa that just appalled and horrified and motivated me," she said.  "I found we had technologized and medicalized and institutionalized it in a way that was not serving mothers."