They qualified as a doctor (BMBS) in 2015 from the University of Nottingham, going on to begin speciality training in Obstetrics and Gynaecology in 2017. They previously studied Psychology (BSc), also gained at The University of Nottingham. They are currently working towards an MSc in Reproductive and Sexual Health Research at the London School of Hygiene and Tropical Medicine.
Emma’s pronouns are she/her or they/their. They are comfortable with the gender label ‘woman’. However, they are conscious of this having been strongly ‘externally’ imposed through a life-time of social conditioning. For example, Emma attended an all-girls secondary school in North London and still has the pink baby name band she was given at birth. If they had grown up in the fearless post-feminist, gender-stereotype-free utopia they would like to try to bring about, maybe this label would not be so appropriate…
According to the World Health Organisation (WHO), 6 out of 10 unintended pregnancies and 3 in 10 of all pregnancies worldwide end in abortion. Lots of people choose to get abortions and it is a very common experience.
MAKING ABORTIONS ILLEGAL DOES NOT STOP PREGNANT PEOPLE FROM SEEKING AND HAVING THEM.
Pregnant people seek abortions even where it is difficult and/or illegal to access them. Amnesty International points out that abortion rates are 37 per 1000 people in countries where they are prohibited (for example illegal or only available in rare circumstances) and 34 per 1000 where abortions are broadly allowed by law. These rates are very similar, suggesting that making abortions illegal does not stop people from needing, seeking and having them. Criminalising abortion can however, make it more dangerous. The WHO lists unsafe abortion (e.g. where it is illegal and not available from a healthcare facility) as the leading cause of (preventable) maternal death.
THERE ARE TWO TYPES OF PROCEDURES FOR AN ABORTION:
One is medical – where someone takes medication to end a pregnancy. The other is surgical, which involves a procedure to remove the pregnancy from the womb.
We have already seen that abortion is common worldwide. We also know that people of many religious faiths choose to have abortions. Many people oppose abortion on religious and/or moral grounds. But having access to legal abortioncare does not take away an individual pregnant person’s right to decide if abortion is spiritually or ethically okay for them.
ABORTION IS ALLOWED IN THE UK UP TO 24 WEEKS OF DEVELOPMENT.
Having an abortion is sometimes equated to ‘killing a baby’. Up to 24 weeks of development, a foetus may have some features which can look human-like. But up to this point, a foetus cannot feel pain. These collections of tissue also do not function as organs in a fully developed human would – to the point where a foetus at this stage would not be able to sustain itself outside of the womb.
ACCESS TO ABORTIONCARE IS A SOCIAL JUSTICE ISSUE.
Criminalising abortion disproportionately affects people who have been socially marginalised – for example by reason of race or income. Access to good, safe and legal healthcare – including access to abortioncare – is needed by everyone who can get pregnant and is an important part of reproductive rights.
Abortion Rights – organisation campaigning for access to safe, legal abortion in the UK.
We Trust Women – Campaign from the British Pregnancy Advisory Service to decriminalise abortion in the UK.
Planned Parenthood – US based organisation that provides and campaigns for reproductive rights.
Women on Web – an online based, international abortion service.
***Content warning: This article contains mentions of eating disorders, weight loss, and calorie counting***
On 6th April 2022, the UK government brought in new rules which means that many restaurants, cafes and take-away businesses will now have to print the calorie content of the food they serve on their menus.
BEAT, the UK’s Eating Disorder charity, described itself as ‘disappointed’ about this move – saying that it will increase anxiety and unhealthy behaviours for people with eating disorders such as anorexia and bulimia.
As someone with a medical degree and experience of working to support those with eating disorders, I’m with BEAT on this one.
Furthermore, I believe that focusing the conversation around healthy eating on calorie counting is potentially harmful for many people, not just those with established eating disorders.
Calories – a measure of the amount of energy food contains – are a pretty limited way of understanding how healthy or nutritious a certain food is. A healthy diet contains a range of some food groups and a limited amount of things like saturated fats, salt and some types of sugars. Knowing the calorie content of a meal tells you nothing about this type of information however.
It also ignores the important social and pleasurable part food can play in our lives. I cannot imagine having dim-sum with my family in Chinatown or going out with friends for a Sunday pub lunch and being able to keep track of the calorific content. It just wouldn’t be an enjoyable experience.
To demonstrate how limited and how unhealthy it can be to focus on calories alone, I’ve mocked up a week’s worth of daily menus that would be below my recommended calorie intake, but I would definitely not consider to be a ‘healthy’ diet.
Each day’s worth of meals contains no more than 2,000 calories, what NHS online says is generally the ‘recommended intake’ for women (immediately after stating that an individual’s actual food energy requirement is based on lots of variables!).
As you can see, despite coming in at just less than 2,000 calories every day, this is a staple diet of saturated fats and sugars. It’s all vegetarian so is – at least distantly – mostly plant-derived, although contains no fresh fruit or veg. As a day’s worth of food, I think you’d be left pretty hungry too.
Just to be clear, I’m not saying that there’s anything wrong with any of the food items that I’ve included. I don’t believe any food is ‘good’ or ‘bad’ in and of itself and most of them are things that I love and often choose eat. Even if something is fatty and/or full of carbs, there are times when the best thing for your body and mind is to eat it.
I am saying that these foods all need to be eaten alongside other types of food, to be part of a varied diet. Calorie counting does not encourage this. This type of food promotion is potentially very unhealthy and ultimately misleading.
*** n.b. This is intended to give people some idea of how contraception works, for educational purposes. It is not medical advice. I would STRONGLY encourage anyone thinking of starting contraception to talk this through with a healthcare professional, who can give you detailed and individualised advice***
A big (and varied) type of contraceptives are ones that rely on hormones. A hormone is a chemical that is made by one part of the body and is carried by the blood to another part of the body, where it has some sort of effect. Insulin is a type of hormone – produced in the pancreas, it helps our bodies store the sugars that we eat for when we need them later. People with uteruses also make special hormones that control their fertility cycle – when they release an egg from their ovaries and when their period comes.
Remember, people with uteruses can’t get pregnant all the time – but for a few days when they are ovulating, which is just a fancy word for when they have released an egg. If this egg meets a sperm before it deteriorates and is shed with a period, then it can implant (‘dig into’) the uterus and eventually develop in to a baby.
So hormonal contraception is only for people with uteruses to take. And it affects their cycle, so there isn’t this a bit where they are capable of getting pregnant. Exactly how that happens depends on what kind of hormones are in a particular type of contraception, and how they are delivered in to the body (more on that later). But they can do things like stop ovulation from happening, help keep a layer of mucus over the entrance to the womb so sperm can’t get in, or keep the lining of the uterus (the endometrium) very thin, so an egg can’t implant and grow there.
A very simple way of getting hormones in to the body is swallowing them as medicines – the contraceptive pill. There are two main types – the combined pill and the progesterone only pill. They need to be taken regularly (sometimes every day) at about the same time of day, to work.
Pills are usually available from a doctor – for example a GP, or one you could see at a sexual health clinic. In the UK, you can also get the progesterone pill from some pharmacies without a prescription, by talking to the Pharmacist instead.
Which pill to choose can depend on a few things, like whether or not certain illnesses are common in your family. It’s a good idea to make an appointment with a healthcare worker who can talk you through this if you’re considering the pill, so that they can go through this with you.
‘Birth control pills’ were some of the earliest types of contraception available that also worked really well. Because it can be tricky to remember to take them though, there are lots of other ways of getting contraceptive hormones in to the body without having to remember to take them every day.
Hormonal IUSs (‘intrauterine systems’) are small plastic devices that are put in the uterus. They contain hormones, which they slowly release into the body over 3-5 years (depending on what type). Because it stays in the body for a long time, you don’t have to remember to take it and it is *very* unlikely to fail as contraception.
The same can be said of the hormonal implant. This is a rod, about the size of a match, that is made from slightly bendy material and also contains hormones that are slowly released in to the body over several (three) years. It is usually placed in the arm, just under the skin. People that have them can usually feel them through the skin, but don’t notice them all the time.
As they last for several years, the implant and the IUS are sometimes described as ‘long-acting’. They are also described as ‘reversible’ because if and when they are removed from the body, they no longer have an effect and that person is likely to be able to get pregnant again. Because they go inside the body, they need to be put in and taken out by a healthcare professional – usually a doctor or a nurse.
Hormonal injections are also given by healthcare professionals and not something you can give yourself at home! This is where a dose of hormones is injected in to the body and lasts for several weeks (eight to 13, depending on the type of injection). If you want to keep using them as contraception, you need to be able to keep going back for appointments to have another one after this. They aren’t reversible, but do wear off if you stop having the injections.
Last but not least, there are two types of hormonal contraception that you don’t need to remember every day and you can give yourself at home – although you would still need to talk to a doctor or nurse to get them in the first place.
The first is a vaginal ring – a flexible ring that is inserted in to the vagina. The muscles that make up the walls of the vagina then hold this ring in place. It is usually kept in for three weeks then removed for several days, before being re-inserted. A user can put it in and take it out themselves, much like they would a tampon!
Another hormonal device that someone can set-up themselves in the contraceptive patch. This is a big plaster-like device, that releases hormones through your skin. It is removed and replaced every week – for as long as you need contraception for.
So – there are lots of different ways of getting hormones in to the body! These can be really popular because they tend to be very effective, especially if they are released by a means where you don’t have to remember every day.
Hormonal contraception doesn’t create a barrier between a penis and a vagina during PIV sex, so it isn’t a kind of protection. This means that, although it can make it very unlikely that you will get pregnant from this type of sex, it doesn’t stop STIs (sexually transmitted infections) from being passed from person to person. For this reason, some people might choose to use something like condoms as well as hormonal contraception. Even though condoms are also contraception, they don’t work quite as well at preventing pregnancy as the methods we’ve described here.
One negative aspect of hormonal contraception is that it can have side effects – it can effect the body in unpleasant and unwanted ways. Lots of people seem to report that they have negative effects on mood, for example.
Not all of the side effects are bad – some can be welcome, for example they can cause good skin changes, or make periods less heavy.
And of course bodies work differently – one person can get on really well with a particular type of hormonal contraception, whilst another doesn’t at all.
Because healthcare professionals try to help lots of people, then can sometimes forget these individual responses. You know your body best though. If you are ever struggling with the side-effects of any type of contraception, it’s completely your choice if you want to stop using it – even if a doctor or nurse thinks that it’s ‘good’ or suggests that you should try it for longer and ‘see how it goes’. Ultimately it’s your decision. It’s fine to ask for a second opinion (ask to see another health worker) if you feel you aren’t being listened to. It’s your body, after all!
We sometimes think of protection – things that make it less likely to pass infections from person to person during sex- as synonymous with contraception – things that stop people from getting pregnant.
But when we think about it, we know that not all types of sex can lead to pregnancy…
Condoms are, of course, are both. They create a barrier between a penis and a vagina during penetrative PIV sex. This means that sperm can’t get in to the vagina, the uterus and ultimately can’t meet an egg. In this way, condoms that go over the penis can reduce the chance of pregnant.
In creating a barrier between one person’s body parts and another during sex, it also means that there’s less chance of passing infections from person to person too! That’s because there’s less direct contact, as well as less fluids (like semen, blood or mucus) from one person touching another. This greatly reduces the chance of an STI (sexually transmitted infection) from being transferred. So condoms are also protection.
When we think of condoms, we often think only of external condoms – ones that fit over the penis like the ones in the image above. But you can get internal condoms too. These are made of the same thin material, but are inserted into a vagina.
They act as contraception for penis-in-vagina (PIV) sex, preventing sperm from getting in to the vagina. But they can also be used as protection in PIV and other types of sex involving the vagina, creating a barrier between the vagina and fingers, mouths, tongues, sex toys used by another person, or anything else that might potentially transfer an STI from one person to another.
Similarly, external condoms are also a type of contraception, but can also be used as protection in other types of sex involving a penis – such as anal or oral sex.
Condoms are often made from latex, but some people have allergies to this material. So lots of brands make condoms that are latex-free. This includes condoms made from animal products – but it’s worth noting that although these act as contraception, they are known to be less effective as protection. That’s because they contain microscopic holes, too small for sperm to pass through, but not for some STIs to cross.
One type of protection that is not a form of contraception is a dental dam. This is a sheet of plastic, similar to that condoms are made of, that can be placed over a vulva for oral sex. Again, it’s creating a barrier between one person’s body parts and another’s during sex.
Dental dams can be a bit trickier than condoms to get hold of, at least in the UK. They tend not to be available in supermarkets and chemists like external condoms. They can sometimes be picked up at sexual health clinics, or ordered online. Because they can be harder to get hold of, sometimes people make their own using an external condom and cutting it to create one flat sheet.
Protection is designed around genitals because those are the bits of our bodies that are good at passing on STIs. Bits of our bodies like our hands are covered in relatively tough skin that makes a strong barrier against fluids. Some people use protection like plastic gloves or finger cots (‘finger condoms’) if there is a break in their skin from things like eczema though, or if they have cuts and they are using their hands in sex.
We can see that just as sex isn’t limited to PIV sex, protection isn’t just limited to condoms for penises!
Even though it’s an *extremely* common experience – there are estimates that 800 million people in the world are having a period every single day – this is one of the topics that often gets the most ‘yucks’ and discomfort in schools.
In my experience, people often have misconceptions about periods in the UK. Despite this, I find that there’s a tendency to talk about period stigma as a purely foreign problem – often only acknowledging problems in low income countries. Unicef recognises that period stigma is a global issue.
As someone who regularly talks to young people about menstruation, it seems sadly alive and well in the UK. Often, just bringing out (completely new and unopened) tampons and other period products is enough to evoke palpable – and audible – signs of discomfort in the classroom. I firmly believe that the way to tackle this is to talk to all people about periods – whether they have them or not themselves…
Firstly, let’s start with the basics – what is a period?
It’s bleeding through the vagina from the uterus, usually for a few days, most often once a menstrual cycle (more on variations and problem periods later). The bleeding is the lining of the uterus being shed. It’s made up of clots, tissue and blood – so is very different to the ‘fresh’, bright red blood you might get from veins or arteries from a cut.
Usually (but not always) people use something to manage this bleeding. Different types of period products include:
Pads: Either disposable or reusable material that is attached to underwear and soaks up blood. Disposable pads are widely available. They usually contain some sort of plastic to make them waterproof and are single use – i.e. they are thrown away after being used. Reusable pads are made from fabric and can be washed and reused. At least in the UK, they can be a bit harder to get hold of. Some brands sell them online, or independent makers sell them through websites life Etsy.com. If you are craft savvy, you might like to make them yourself.
Tampons: These are cylinders of cotton wool-like material. They are inserted into the vagina. The walls of the vagina keep them in place, where they can absorb blood. They are removed by pulling on a little ‘string’ attached to them. Concerns about tampons getting stuck, lost or causing harm seem quite common. Although people do sometimes find they can’t remove a tampon, this doesn’t seem to happen very often. Even if it does, the vagina is a closed ‘space’ and a healthcare professional should be able to remove it using special tools (I have had this job at one point). Like anything that is inserted in to the body from outside (including food) there is always going to be some risk of infection with inserting a tampon. Again, this isn’t very common, especially if tampons are removed and changed regularly and you make sure to wash your hands before removing or inserting one.
Period Cups: Shaped a bit like an egg-cup without a stand and made from a squishy but solid material. They are inserted in to the vagina, where they sit underneath the cervix (entrance to the uterus) and collect blood. They can then be emptied and washed – rinsed out in between uses and sterilised (e.g. in boiling water) in between cycles. They usually have a little ‘pull’ on the end that can be used to remove them – a bit like the string on a tampon. Along with fabric pads, they are another type of reusable period product.
Period Disks: They work in a similar way to period cups – but are shaped differently. They are a flattish ‘disk’ shape, rather than a ‘cup’ shape, but are still inserted in to the vagina, where they sit and collect blood. They don’t have the little ‘pull’ piece, and sit a bit higher up in the vagina.
Pants: These are shaped and worn like regular underwear. But the ‘gusset’ (the bit that sits underneath the vagina in people with vulvas) is made from absorbable material, to soak up period blood. As with reusable pads, these are washed and then reused.
Freebleeding: Some people don’t use any particular product when they are menstruating – bleeding ‘freely’ on to their clothes. This can be by accident, or it has been used as a political statement.
Busking it: Sometimes people use anything to hand, such as tissues or cloth, to soak up period blood. One reason for this might be period poverty – the inability to afford period products. It is thought that millions are affected by this, even if high income countries like the UK.
How do people choose which period product to use? People are different – and what is good for some, isn’t for others. Also, your needs and your cycle might change over time or in different circumstances. For example, personally I like to use a period cup during the day because it can be reused and is fine to take swimming. But at night I prefer period pants, as they feel more ‘secure’ which I’m moving about in my sleep.
Another thing that doesn’t get talked about very much is problem periods. There’s sometimes a feeling that periods are meant to be unpleasant – for example, painful. Whilst some discomfort is common, there is such a thing as as a problem period. A period might be a problem might be one that:
Is too painful (e.g. effects your ability to do the things you would usually do), including pain just before your period.
Is very heavy (e.g. you have to change pads or tampons very frequently or no period products seem to deal with period blood at all), including last for a very long time (i.e. longer than 8 days).
Causes you lots of emotional distress, including just before your period.
Is very irregular (e.g. your cycle varies by more than several days between each period).
If this or something else is bothering you about your period, it’s probably worth talking to a healthcare professional – like your GP – about it!
I cannot recommend the book Red Moon Gang by Tara Costello enough, for anyone who has periods (or who doesn’t, and wants to know more). Informed by Costello’s extensive research, as well as interviews with what seems to be a huge range of people who have periods (including people of different genders). There is also a blog and information site of the same name, which includes a really nice and short article on what a period is!
This video from Amaze.org is a nice summary of the basic of a period (although briefly gets a bit reproductive focused).
Episode 23 of the Guilty Feminist is all about Periods! Nice, normalising discussion of periods. The guest on this episode is Evelyn Mok, who talks about being diagnosed with PCOS (i.e. problem periods).
This short film about getting a period for the first time might be a nice conversation starter!
I am the Co-Founder of PeriodPal – an online app for tracking periods that aims to be inclusive and ethical. This is funded by donations, with no subscription fees. To sign-up for a free account to track periods and your health, go to periodpal.eu.
****Content Warning: In the audio you’ll find general discussions of sexual assault and false rape allegations, and misogyny*****
Where, exactly, do we get our sex education from?
Most people would say that they learnt something at school. But when we think about formal sex ed lessons, we are often talking about the biological aspects of reproductive sex – e.g. how people get pregnant, or how to avoid pregnancy.
The messages about sex that we pay attention to – what it is, what makes ‘good’ sex and what a sexual relationship is meant to look like – come from all sorts of places other than the classroom. From rumours and ‘dirty’ jokes that circulate on the playground, to the bizarrely genital-less sex scenes from PG rated films.
In this week’s Conversation Starters, I think about where our sex ed can and does come from, looking at things like:
How do we learn what sex actually is?
What are these messages – what does ‘good’ sex look like?
Are some types of sex or relationships seen as more valid than others?
Where can we look to for reliable information if we have questions about sexual health?
Listen to this episode of Conversation Starters to find out more…
Phallocentric: focusing on a phallus (i.e. penis), especially as a symbol of importance and dominance.
Heteronormative: a view or assumption that heterosexuality is the ‘normal’ or only important sexual orientation.
PIV sex: a specific type of sex act, (penetrative) penis-in-vagina sex!
Sexwise from the FPA contains loads of resources (generally aimed at young people) on topics like contraception, STIs and unplanned pregnancy.
The School of Sexuality Education has a website, which features blogs, information and also links to the Teachable Moments project, where you can find worksheets to accompany programmes such as Netflix’s Sex Education, the BBC’s Noughts and Crosses, and Disney’s Hercules.
The Amaze.org website has a whole host of videos, each one about a different sex ed topic. Examples include ‘Porn: Fact or Fiction’ and ‘HIV and health disparities’. These are aimed mostly at pre-teens. They are English language and made in the US, so some of the references (e.g. to the healthcare system) might need a bit of contextualising and explanation.
Everyone’s Invited is a web-based project that encourages young people to talk about their own experiences of sexual harassment and violence in schools and universities.
A first look, it may seem phrased as a reasonable request. It asks members of the public to submit their opinions on ‘toilet provision for men and women’, citing disability access and the wellbeing of women as reasons for the request.
So what’s the problem? Well, in context the statement which accompanies the call is a clear dog whistle for transphobia and gender stereotyping. It invokes a whole set of ideals and values aimed at policing peoples’ bodies and gender presentation.
The statements made are not neutral. There is a clear support for public toilets that are gender-segregated, with many arguments being listed in favour of this stance. One part reads,
‘Women are also likely to feel less comfortable using mixed sex facilities, and require more space.’
As someone who has been assigned female at birth and is generally ‘read’ easily as female, this does not fit in with my own experiences. In recent years I have encountered a growing number of gender-neutral bathrooms in schools, universities and entertainment venues. Personally I have found these to be welcoming, inclusive and safe spaces, which are convenient to use. The narrative that gender-neutral spaces are inhospitable jars so much with my personal experiences.
It also ignores the actual opposite effect which I seem to be increasingly hearing of. Friends who do not look stereotypically feminine or masculine in some way (regardless of their actual gender or what genitals they have) have reported being challenged on using gender-segregated bathrooms more and more in recent times. This seems an increasingly common experience amongst those who are either butch looking lesbians or trans women. This is misogyny, clear and simple – with women who do not conform to certain ideals of femininity being harassed and made to feel unsafe.
Encouraging people to police each other’s gender performances in public spaces is damaging to many of us. I once heard the artist Travis Alabanza describe this practice, as it relates to gender and bathrooms, as “women doing the work of the patriarchy”. Their excellent live-streamed theatre piece, Overflow, explored exactly some of these issues in relation to trans women navigating the use of public toilets.
Gender-based violence is said to have increased during lockdown in the UK – largely in relation to domestic violence. Calling for more separate public toilets for men and women does nothing to address what has been described as a ‘hidden epidemic’ in the private sphere. What it can do, however, is to make an already marginalised group of women (i.e. trans women) feel even more surveilled, challenged and ultimately unsafe. A Stonewall survey reported that 2 in 5 trans people had experienced a hate crime or incident because of their gender identity, in the 12 months prior to being interviewed.
Other covers used in the call for evidence to attack gender-neutral public toilets are the needs of disabled people and menstrual health needs. Disability access and period health needs are bizarrely used as arguments against gender-neutral toilets. This is disingenuous. It is not an ‘either/or’ situation. It is possible to make gender-neutral toilets accessible to all, including those with physical disabilities. This makes them truly accessible – including to those with disabilities who don’t consider themselves to be either men or women and would be uncomfortable using facilities exclusively for either.
Similarly, it is perfectly possible to provide period hygiene facilities (such as access to pads, tampons and dedicated disposal bins) in gender-neutral toilets. This makes them easier to use for those who have periods but who would not be able to use women’s toilets (such as some trans men).
I also strongly believe that this situation would be beneficial in reducing the stigma that so often surrounds periods. Periods are often assumed to be ‘dirty’ and embarrassing – particularly by those that don’t have them – because of the secrecy surrounding them. It is beneficial in tackling these ideas that people of all genders might use toilets where things like tampon dispensers or sanitary bins are common place. The need for menstrual hygiene should be normalised – both for those that have periods and those that don’t. They should not be presented as something that is so taboo, it should be enshrined in building law that all evidence that they happen must be kept away from people that don’t have them!
The call for evidence is open until 26th February 2021. If you believe that banning gender-neutral toilets is unwelcome, you can let the government know what you think by emailing: firstname.lastname@example.org . A good template to base your response on is available here. The original call for evidence is available here.
As a new President has been elected in the US, you might hear campaigners in sexual health talk about ‘The Global Gag Rule’. But what is it and why does it matter to people working in sex and relationship education?
The Global Gag Rule is US policy which forbids NGOs (Non Governmental Organisations – for example, health charities) from taking part in certain activities if they receive US funding.
These activities include providing abortion care directly. But it also includes referring pregnant people to abortion services, simply providing them with information about abortion, or campaigning around legal reform in this area.
So NGOs (Non-Governmental Organisations) that want to receive US funding are effectively ‘gagged’ from working in abortion care – hence the name.
This policy was originally called The Mexico City Policy and was first introduced by the then President Reagan in 1984. Under the Mexico City Policy, the ‘gag’ applies to all of the work that an NGO does. For example, an organisation cannot use funds from another source to fund work in abortion care.
How big a deal is this? Well the US provides a huge amount funding to overseas NGOs. The US can be a major source of funding for NGOs. The Global Gag forces them to balance the importance of abortion care with the need for financial stability.
In addition to this, US culture and political ideology is hugely influential around the world. This is true, even if you are living in a high income country which doesn’t rely on overseas funding from foreign powers, like the UK.
The US position on abortion care is really important right now, at a time when some countries are rolling back on abortion laws – for example in Poland.
So why are we talking about the Global Gag Rule at this particular time? Well, since it was first introduced this policy has been removed and reintroduced several times. There has been a pattern of Presidents from the Democratic Party to overturn the Global Gag Rule, and for it to be reinstated the next time a Republican President gets in to power.
The outgoing US (Republican) President – Donald Trump – is noted to have reinstated the Global Gag Rule. In fact, some people say that his version of the Mexico City Policy made it even more restrictive – for example by making it apply to all of the global health assistance funding, not just that set aside for family planning.
Many people hope that new US President will, as the pattern has been, remove the Global Gag Rule and allow NGOs to be supported in providing essential health care. At the time of writing this, there is an international petition to call on him to do just this.
A really common idea is that men and women are just fundamentally ‘biologically different’. Perhaps so common that it can lead us as a society to mentally overwrite objectively known facts.
The idea that gender itself is not necessarily related to biological traits is easy enough to recognise and call out. In most countries in the world, genital presentation at birth is how people are assigned a sex of either ‘male’ or ‘female’ – i.e. a penis for a boy, a vulva for a girl. But many of us seem comfortable enough with the idea that gender identity can be separate from the sex someone was assigned at birth. There even appears to be growing recognition that gender identities exist beyond the Western-centric binary standards of ‘man’ and ‘women’ only. In other words, that non-binary people exist.
Even where the above is generally accepted though, the idea persists that there are only two biological sexes and they are enduring different from each other. There is an assumption that everyone can be divided in to one of two groups: people with a penis and people with a vulva. Furthermore, we are taught that these two groups are mutual exclusive – someone can’t fit in to both categories.
Why is this a problem? Well, for a start it isn’t true.
There are a whole range of ways in which some people are born with physical, biological traits that don’t fit neatly in to a binary ‘male’ or ‘female’ presentation. This includes being born with genitals which are not typically or just either a vulva or a penis.
Sometimes when someone is born this way, the term intersexis used – although it might be considered problematic to define people in relation to what they are not. Other phrases like variations in sex characteristics might be more accurate and less emotionally loaded.
The existence of people whose natural biology defies the way in which we commonly define biological sex – as a society, but also in law. Very few countries in the world recognise any sex designation other than male or female in official spaces, like birth certificates or passports. This means that when someone is born with biology that doesn’t conform to our notion of the binary of male/female, we usually simply ignore it. This surely has huge implications for how valid or accepted people feel in bodies not conforming to this binary.
It’s hard to say how common it is for people to naturally not fit in a binary sex category – precisely because most societies pretend that it doesn’t happen. The United Nations say that it may be as much as 1.7% of all people born – which they also note is a similar figure for the percentage of people around the world born with red hair. So while it may not be common, it certainly seems a significant amount!
Other challenges to the binary notion of sex characteristics are very common. Many of these relate specifically to something called secondary sexual characteristics. These are the changes that generally occur during puberty.
A biology textbook-type explanation of these would be something like:
Secondary sexual characteristics are some of the changes that occur during puberty because of hormones.
People with testicles produce the hormone testosterone, which causes changes in puberty like facial hair to grow, the voice getting suddenly much deeper (‘breaking’) and the body to get muscular.
People with ovaries produce the hormone oestrogen, which causes changes like breasts to develop and hips to get wider.
I said this was a ‘biology textbook-type’ explanation. In fact, this is identical in terms of factual content to the BBC Bitesize GCSE biology revision page. Except that I used the phrase ‘people with testicles’ instead of the word ‘boys’ and ‘people with ovaries’ instead of ‘girls’, because I understand the difference between anatomy and gender!
Like a lot of school science, this is a simplified version of what is actually known about biology. And in some ways, this makes sense in the context. However, I would argue that it’s an oversimplification… and a socially damaging one at that.
This explanation gives the impression of a firm dichotomy of biological sex. Biological males make testosterone, which is produced in the testicles and this produces masculine physical characteristics. On the other hand, biological females produce oestrogen because they have ovaries and this leads to well recognised feminine characteristics. This is a neat, comprehensible explanation of biological sexual characteristic traits.
It’s also wrong. For a start, it ignores the fact that oestrogen and androgen hormones (testosterone is a type of androgen) are both made by people with ovaries and by people with testicles – just usually in different amounts. It’s therefore possible for someone with one set of anatomy to show the physical traits that we overwhelmingly associate with the other.
A very common example of this is someone with testicles producing enough oestrogen to develop breast tissue. The medical word for this is gynaecomastia (pronounced guy-nah-coh-mast-ee-ah). It’s reported to be experienced by up to 70% of people with testicles undergoing puberty, exactly because this is a time of hormonal changes within the body.
Despite this meaning that gynaecomastia is very normal and frequently experienced by people with a penis in puberty, it is often described as a medical condition (for which, read: problem) or a hormonal imbalance (for which, read: your body isn’t working properly).
So fixed are our notions of binary sexual male and female characteristics, that it leads us to recognise a common bodily change as a medical condition – to label the majority of peoples’ experiences as abnormal.
Another reasonably common example of this phenomenon is hirsutism. This is when a person with a womb and ovaries has facial hair. The most common reason for this is for someone to have Polycystic ovary syndrome (PCOS). PCOS in itself is not at all rare, with one in ten people who has a womb and menstruates having it. But according to our oversimplified biology textbook definition, beards and moustaches are solidly masculine traits.
Can you imagine learning biology in a way that invalidates your physical experiences and makes your healthy, biologically non-binary body feel like it’s actually a freak of nature? Well, it turns out a lot of us don’t have to imagine, as this is what school curriculums are already teaching many of us!
Cordelia Fine’s book Delusions of Gender: How Our Minds, Society and Neurosexism Create Difference (2010) is a hefty but excellent book on how science research is influenced by our social constructions of sex.
Here’s a piece in the Independent online where me and some other excellent peeps in the field talk about some of the biggest taboos in Sexual Health – in other words, what we should be talking about more in sex ed!