Why Birth Control Shouldl Not Be Covered by Health Insurance: A Pro-Women’s Rights Take

On Tumblr earlier today, I posted a short piece against health insurance coverage for birth control. Mind you, I was not opposing birth control as such, or the idea of women who can’t afford it, getting birth control paid for. What I was saying, was that birth control is not a health issue, and therefore should not be covered through health insurance.

So why is it not a health issue? I acknowledge that it is, in some cases. For example, some women use birth control to prevent premenstrual symptoms or to lessen the risk of ovarian cysts. However, most women use birth control for its intended purpose, which is contraception. And while the right to prvent pregnancy, is a women’s right, it is not a health issue.

So what is it? It’s a matter of reproductive justice and of sexual liberty. Women (and men and people of all genders for that matter) have a right to consensual sex however they please, and this is the reason most people use birth control, and have every right to do so. Making sexual rights about health, however, distracts people from the real point of the discussion, which is that people of all genders have a right to do sexually as they wish as long as they obtain consent from the other people involved. Too often, liberals and feminists, indeed, use tragic examples of the health uses of birth control to draw attention to the need for coverage, but these needs can easily be met without having to admit that every woman has a right to birth control.

Then there is the thing that contraception should not be covered by insurance. The reason behind this is more based on what insurance is for, which is to cover the costs of unforeseen risk. Birth control is, however, there to deal with in most cases a calculated risk. (I know that in cases of rape and incest, this is not true, but these make up the minority of birth control uses.) Women know whether they want to get pregnant, so when they purchase health insurance, their need for birth control is known to them. Besides, we have insurance systems to cover relatively small risks, while in the case of birth control, 99% of all American women have used it in their lifetime, if we have to believe Sen. Gillibrand, which I do. That’s such a substantial number that it’s not something insureable.

On my Tumblr, people commented that men get Viagra paid for through the health insurance industry, too. I at first found this a valid argument, but my husband, with whom I discussed my Tumblr post and its responses, reasoned otherwise. He said that erectile dysfunction is not natural, while getting pregnant after unprotected sex is. I am not sure I agree with this logic, which is based in what it’s meant to be a functioning human.

However,the Viagra comparsion goes awry in one respect, which is what I mentioned above: erectile dysfunction is much less common, and much less calculable, than pregnancy after unprotected sex. Therefore, even if you reason that it’s not a medical problem and therefore doesn’t need health insurance coverage, it could still fulfill the other principles insurance is based on, and people may for example opt to buy additional coverage for this purpose.

Note, again, that I never said that women should have to pay for birth control out-of-pocket just because it’s not an insureable risk or a health matter. My husband proposed, and I agree with this, that there should come some kind of low-income fund, which would pay for birth control for women who can’t afford it otherwise. After all, I am totally for birth control to be affordable to all women.

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Sign the Petition Against Gay Death Penalty in Uganda

Tomorrow, the Ugandan Parliament will vote on a gay death penalty bill. This is horrible. Gay people are already in danger of the death penalty, but this bill could make it even worse. AVAAZ has created a
petition to sign against this bill. The site is not very accessible, so don’t blame me for not having signed it myself. I am just passing this on for everyone who is opposed to homophobia like I am.

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13-Year-Old Girl Latest Victim of “Corrective” Rape

In South Africa, a 13-year-old girl is the latest victim of “corrective” rape. “Corrective” rape involves the raping of lesbians in order to “cure” them of their sexual orientation. The goveornment condemns this crime, but I wonder whether they will genuinely act upon it. It is obviously at least as serious a crime as other forms of rape. Probably more so, because a hate crime is involved, too. Maybe I’m too cynical, but my inclination is that the police won’t do much with this presumed epidemic of “corrective” rape. Gay rights may be human and constitutional rights according to the government spokesperson, but there are probably more important things on the police’s mind.

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It’s Okay to Be Questioning

Questioning is in a sense a sexual orientation, although it may also not be one, since someone who is questioning is, for whatever reason, unsure of what gender(s) they are attracted to, if any. It can also mean being unsure of whether one is asexual or sexual. Being questioning is developmentally typical in early adolescence, although most people assume they’re straight and sexual because it’s the “default” sexual orientation. Being “bi-curious” and similar things are forms of being questioning, but they are not really inclusive.

There is much stigma associated with being questioning. Most people assume that you must somehow know your sexual orienttion, but are either afraid of coming out (if you are presumed to be queer), or “it’s just a phase” (if you’re assumed to be straight). In my own case, I was told that I only identified as first lesbian, then pansexual, and finally as questioning, because I wanted to be different in a way other than blindness.

I want to make this really clear: it’s okay to be questioning. It doesn’t even mean you’ll ever find otu your sexual orientation – you may not. If you do ever find out your sexual orientation, it doesn’t mean that you were “faking” when you were questioning. Being questioning also doesn’t mean that, if you’re in a relationship, you do not love your partner. Sexual orientation, after all, has to do with what gender(s) you are generally attracted to, rather than the gender of your current partner – which may not have been relevant in why you fell in love with them.

I identify as questioning. I am aware that I possess some straight privilege due to being in an opposite-sex relationship, but I do encounter a lot of the stigma I described above when trying to come out as questioning. I have internalized some of this, but I am learning that, as I said, it’s totally fine not to know your sexual orientation.

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Ugandan Asylum Seeker Allowed to Stay in UK Awaiting Case Review

According to PinkNews.co.uk, Ugandan asylum seeker B.N. is allowed to stay in the UK to await her case review. Previously, she was denied asylum because a judge ruled she is not a lesbian. This was based on stereotypes about what a lesbian should be like, such as the fact that she did not read gay media. I commented then that, whether B.N. is a lesbian or not, she is in danger because she is publicly known as one. This is further reflected in an Ugandan MP’s comment that B.N. can return to Uganda if she “repents”.

Besides, even from a mostly anti-immigration point of view, a person from an anti-gay nation who dares to be open about her sexual orientation, is likely highly acculturized and therefore relatively useful, insofar as you should really say such about people, to a European country. If you want only the most successful immigrants, you should effectively still admit B.N. to the UK. In any case, I hope the judge reviewing her case will be sensible enough to grant het the asylum she deserves.

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GOP Knows Best Whether You Were Raped

Over at Feministe, there is an excellent post summarizing the anti-reproductive rights proposals made in H.R. 3, the so-called No Taxpayer Funding for Abortion Act. Most strikingly, the Republican Party, who obviosuly sponsors this bill, seeks to redefine rape for the purposes of abortion access. Only victims of “forcible” rape will be able to obtain an abortion through taxpayer-funded insurance. This term is not defined, but it is assumed that a victim cannot have been asleep, intoxicated, unconscious, or otherwise not fighting against the rape. I’m not sure whether spousal rape is considered “forcible”, but, knowing the Republicans, probably not. And, of course, if a woman doesn’t report the rape for whatever reason, she cannot access an abortrion.

This is pure and simple misogyny. I am only a recent pro-choice “convert”, but it is bills like this that have contributed to my shift in opinion. It is unbelievable that the GOP thinks they know better when a woman was raped than that woman herself.

And, of course, the entire bill is utterly classist. Women who are able to pay for their own abortions, get them, but people who need Medicaid or even taxpayer-funded private insurance, are denied abortions in virtually any case. Healthcare for everyone, oh well.

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Suicide Among LGBT People: Review and Recommendations

There is a long report in the most recent Journal of Homosexuality on suicide, suicidal behavior and suicidal ideation among lesbian, gay, bisexual and trans people. The report starts by defining the sexual orientation and gender identity minorities described in thsi paper. The authors are aware that gender identity and sexual orientation both run on a fluid continuum, and that hence LGBT is not the right term. However, they use it anyway because it is used overall in the research community. That makes me wonder whether no-one wants to change the terminology used in research papers to more accurately reflect the reality of sexual orientation and gender identity minorities.

The authors follow by examining the rate of suicide, suicide attempts and suicidal ideation among LGB people. It is thought that gay and bisexual males are more likely to commit suicide or to attempt suicide than heterosexual males, whereas lesbian and bisexual females are more likely to have suicidal ideation than straight women do. The fact that gay or bisexual men are more likely to attempt suicide, contrasts with findings in the genral population, where women are more likely to attempt suicide. As for age at suicide attempt, this varies across studies. Some studies say that adolescents are most likely to attempt suicide, while others report that suicide attempts are more evenly distributed over the lifespan. A potential explanation may be that suicide attempts are more linked to the age at which LGB people start to identify and disclose their sexual orientation than to chronological age.

Mental illness is one of the most significant risk factors for suicide attempts in the general population. Indeed, LGB people, particularly adolescents and bisexual men, are more likely to have a mental disorder than straight people. This, however, does not explain fully why LGB people are more likely to attempt suicide: when controlling for mental disorders, one study found that LGB people were still two to three times more likely to attempt suicide than straight people.

Another risk factor for suicde attempts and mental disorders is discrimination. Several studies found a relationship between parental rejection and school bullying or violence because of sexual orientation and suicide attempts among LGB adolescents. IN LGB adults, experiences with discrimination and harrassment were also correlated to suicde attempt. There was, however, an interesting racial disparity between Whites on the one hand and Latinos and Blacks on the other, where White LGB people were more likely to have mental disorders, while Black and especially Latino people were more likely to attempt suicide. The explanation for this might be that Latino/Black people are more likely to attempt suicide because of social stressors rather than mental illness.

Instituttional discrimination is also a factor in the increased rate of mental illness among LGB people. In states which do not provide protections from discrimination based on sexual orientation or that have constitutional amendments prohibiting gay marriage, there are elevated rates of mental disorders as compared to those in states with more equality. Poor health insurance, for example due to the lack of coverage for same-sex partners, may also lead to elevated rates of untreated mental illness.

Lastly, HIV/AIDS is also a possible risk factor for suicde attempts, but data on this are inconclusive. It is suggested that substance abuse and other mental disorders may be more relevant predictors of suicide attempt among HIV-positive men than is the virus itself. However, rates of suicide attempts among HIV-positive persons have decreased since there are better antiretroviral treatments available.

There are several protective factors against suicide among LGB people. Among adolescents, family connectedness, support from other adults, and school safety protect against suicide attempts. In adults, connections to an LGB community help. It is also suggested that intimate relationships protect against suicide attempts, but that has not been studied.

The authors go on to discuss suicide risk among transgendered people. One study reports an alarming 80-fold increase in suicide deaths among trans individuals as compared to the general popluation. Another study found that trans people were more likely than any comparison group – heterosexuals, gay and lesbian people, and cis people matched on age, relationship status and several other variables -, except for lesbian females, to attempt suicide. Several risk factors are being reported among trans people for suicde attempts, among them mental disorders and discrimination, particularly rejection by parents in adolescence and on-the-job discriminination and harrassment in adults.

The researchers make many recommendations to improve mental health services, suicide prevention services, and public policies relevant to LGBT individuals. With regard to mental health programs, they encourage furthering of LGBT-specific programs and interventions in mental health and substance abuse services. There areseveral guides to LGBT care, but none provide specific guidelines on suicide prvention. It is recommended, lastly, that DSM-V be revised to make it clear that sexual and gender identity minorities are not per se mentally ill.

There are very few suicide prevention programsspecifically for LGBT people. The only one mentioned in this study is the Trevor Project. It is recommended that interventions, education and awareness related to suicide among LGBT people be increased.

Lastly, several public policy changes are recommended. It is recommended that LGBT groups and allies advocate for:

• Better access to health and mental health services through non-discriminiation policies;
  
• Explicit protection against school violence and bullying based on sexual orientation or gender identity;
  
• Improvements in discriminatory legislation related to factors contributing to suicde or mental health problems;
  
• Inclusion of sexual orientation and gender identity questions on surveys relevant to health and mental health.
  

The authors conclude that, although many questions related to suicide among LGBT populations are as yet unanswered, there appears to be little doubt that a broad national effort will be needed to encourage and fund the needed research, raise awareness of the problem among LGBT and suicide prevention leaders, and develop
the interventions, prevention strategies, and policy changes through which suicidal behavior and suicide risk in LGBT populations can be reduced./P>

Reference

Haas AP, Eliason M, Mays VM, Mathy RM, Cochran SD, D’Augelli AR, Silverman MM, Fisher PW, Hughes T, Rosario M, Russell ST, Malley E, Reed J, Litts DA, Haller E, Sell RL, Remafedi G, Bradford J, Beautrais AL, Brown GK, Diamond GM, Friedman MS, Garofalo R, Turner MS, Hollibaugh A, Clayton PJ (2011), Suicide and Suicide Risk in Lesbian, Gay, Bisexual, and Transgender Populations: Review and Recommendations. Journal of Homosexuality, 58(1):10-51. DOI: 10.1080/00918369.2011.534038.

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Prospective Study Finds Increased Psychopathology among Persons Sexually Abused as Children

When reading the study I’m going to review here, one would almost say “Oh, duh!”: it is logical and common sense that childhood sexual abuse (CSA) leads to psychiatric disorders. What is new about this study, however, is that it is prospective rather than retrospective. The presence of abuse was ascertained using a forensic medical registry. Unlike what the title suggests, not all subjects were followed up after 43 years: all cases of CSA between 1965 and 1995 were collected. Psychiatric pathology was also ascertained using a state registry of public mental health contacts that detailed the persons’ diagnosis. The sexual abuse victims were compared to a sample of the general population.

Sexual abuse victims were over three times more likely to have contact with public mental health than were the general population controls. This held true for both males and females. They were also more likely to suffer from all types of disorders except for eating disorders. The reason there was no significant correlation between CSA and eating disorders, may be that only those treated by the public mental health system were counted. The most significant risk correlation was found for PTSD, alcohol and drug abuse, and personality disorders. Female sexual abuse victims were significantly more likely to suffer from most disorders than controls, while non-psychiatric complaints were more likely to occur in males. Of note is that three sexually abused males had a diagnosis of pedophilia, compared to none in the control group. However, significance could not be calculated.

When comparing diagnoses in childhood versus adulthood, both remained significantly higher among the CSA group. In childhood, PTSD, conduct disorder and known drug abuse were the most significant, while in adulthood, other disorders and known substance abuse were more likely to occur.

When examining abuse characteristics, it was found paradoxically that mental health contact, diagnosis of a clinical disorder, and diagnosis of a personality disorder, were significantly associated with older age at abuse. On the other hand, most clinical disorders were significantly associated with younger age of abuse. I do not understand this paradox, although it was concluded that psychopathology is not associated with younger age at abuse.

Those who were raped rather than victimized to non-penetrative abuse were more likely to have contact with mental health services and be diagnosed with most disorders. Having multiple offenders was also a significant risk factor for mental health contact and diagnosis of psychopathology. However, whether the perpetrator was related or not, was only significantly correlated with psychosis, where people abused by a non-relative were more likely to develop a psychotic disorder.

Reference

Cutajar MC, Mullen PE, Ogloff JRP, Thomas SD, Wells DL, Spataro J (in press), Psychopathology in a Large Cohort of Sexually Abused Children Followed up to 43 Years, Child Abuse & Neglect. Published online: October 2, 2010. DOI: 10.1016/j.chiabu.2010.04.004.

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Family Environment Predicts Outcome in Women Physically Abused as Children

I started reading research articles again. In the most recent issue of Child Abuse & Neglect appeared an interesting article on the variables influencing adult outcome for women who experienced childhood physical abuse (CPA). The authors interviewed 290 women living in a community in the northeastern U.S., who had lived for at least ten years of their childhood in a two-parent home. The two-parent home was chosen to increase homogeneity among the women. For the same reason, all women had to be at least second-generation U.S.-born. Blacks and those with an alcoholic parent were oversampled due to their underrepresentation in community settings. However, there was no significant effect of either of these factors on the presence of abuse.

Of the 290 women, 84 met conservative criteria for CPA. CPA was defined as resulting in at least some injury and not merely used as corporal punishment. I wonder how many CPA cases were missed when women perceived their abuse as punishment. However, since the prevalence of CPA was high compared to other studies rather than low, this is likely not considered interesting. What this did show, according to the authors, is that living in a two-parent household is not a protective factor against CPA.

Severity of abuse was assessed using a seven-point scale that assesed whether abuse occurred at all, whether it occurred at least weekly, whether the mother was the perpetrator or there were multiple perpetrators, whether the abuse lasted for more than one year, and whether injury was severe. When predicting adult outcome, however, severity was not more useful than a dichotomous measure of whether CPA had occurred or not. This is not saying that severity is not important. Rather, they may be the specific dimensions of severity measured that were not significant. This finding needs to be replicated.

Other variables that were assessed where the quality of the family environment and childhood stresses. The quality of a family environment was measured using nine items for each of the following four dimensions: conflict, cohesion, expressiveness, and organization. I could not make out how childhood stresses were measured.

Adult outcomes were measured with a variety of scales, measuring self-esteem, depressed mood, life satisfaction, satisfaction with social support, social adjustment, and the presence or absence of a psychiatric disorder or alcohol problem.

As I said, severity of abuse did not predict adult outcome better than whether abuse occurred at all, so when adding family environment and childhood stress into the model, the authors used the dichotomous measure of CPA. As the authors expected, family environment contributed significantly to adult outcome. Particularly, conflict, cohesion and expressiveness were correlated with all seven measures of mental health. When childhood stress was added as a variable, family environment remained a significant predictor of the women’s outcome. Childhood stress alone was not a significant outcome predictor.

Reference

Griffin ML, Amodeo M (2010), Predicting Long-Term Outcomes for Women Physically Abused in Childhood: Contribution of Abuse Severity versus Family Environment. Child Abuse & Neglect, 34(10):724-733. DOI: 10.1016/j.chiabu.2010.03.005.

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Intellectually Disabled Man to Visit Sex Worker at Taxpayer Expense

In today’s Daily Mail, there appeared an interesting opinion piece on taxpayer-funded sex for a man with intellectual disabilities. The man apparently needs to visit a prostitute in order to enhance his independence or dignity, as the article words it. He will be traveling to Amsterdam to see the sex worker, because, according to the article, he apparently needs a holiday, too. Of course, that is nonsensical: sex work is illegal in the UK and legal in the Netherlands, so that’s why he needs to travel here.

I have mixed feelings about this case. First of all, I think sex work ought to be legalized in the UK so that people don’t need to travel abroad to visit a sex worker. Secondly, yes, I do feel that disabled people have a right to access sex workers if they cannot get sexually satisfied any other way. I am not so sure whether I think this sex should be taxpayer-funded, but am not radically opposed to the idea.

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