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Abortion: FAQs

ACROSS THE WORLD, ABORTION IS REALLY COMMON.

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.

LEGAL ABORTIONS ARE VERY SAFE.

All types of healthcare and lots of the things we do everyday involve some sort of risk. People have pointed out that having a (legal) abortion is safer than giving birth, running a marathon, having your tonsils out or taking viagra.

PEOPLE OF MANY FAITHS CHOOSE TO HAVE ABORTIONS

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.

Further Information:

  • 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.
  • Centre for Reproductive Rights – (annual report) organisation that uses the law to advance reproductive rights around the world.
  • FSHR-RCOG – abortion factsheet.

Many thanks for support and advice on producing this information from friends and colleagues, including Maria Lewandowska (Researcher in Reproductive and Sexual Health), M and L.

Posted in Uncategorized

With a Side Order of Fat Shaming…

***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.

Tweet from the account ‘@beatED’.

The government itself has stated that this move is intended to ‘improve the nation’s health’, specifically citing the country’s obesity levels.

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!).

MONDAY:

TUESDAY:

WEDNESDAY:

THURSDAY:

FRIDAY:

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.

(All calorie estimates made using product packages or NHS calorie checker)

Posted in sexual health, Uncategorized

Protection

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.

Different shaped condoms. Image credit: Andy Hassall, via Flickr

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.

An internal condom. Image credit: James Mill via Flickr.

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. Image credit: inga via Flickr.

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.

Finger cot. Image credit: Barbara Hastings-Asatourian via Flickr.

We can see that just as sex isn’t limited to PIV sex, protection isn’t just limited to condoms for penises!

Posted in Genitals: A User's Guide, Uncategorized

Seeing Red…

I’d like to take a look at periods!

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!

Resources:

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!

I wrote ‘The Body’ chapter in Sex Ed: An Inclusive Teenage Guide to Sex and Relationships, which is available from Walker Books now! This chapter includes loads of information about periods, and the rest of the book is full of other RSE info for young people!

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!

Follow the Bloody Good Period campaign on social media for period education.

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.

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About Me

Emma Chan works as a Facilitator for The School of Sexuality Education, delivering inclusive and sex-positive sex and relationship workshops, mostly to secondary aged children, across the UK.  Emma is a co-author of School of Sex Ed’s book, ‘Sex Ed: An Inclusive Teenage Guide to Sex and Relationships’

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 is a member of The Candid Collective, regularly helping to run ‘Genital Making Magnets’ workshops.  Emma been interviewed about topics relating to sexual health by The Independent Online, Cosmopolitan Online, Ask Ella, BBC Sound’s Jacob Hawley: On Love and even BBC Radio Devon! They have appeared as a guest speaker at UCL’s Institute of Education, as part of the ‘Gender, Sex and Education’ MSc module.

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…

Posted in contraception, Genitals: A User's Guide, Uncategorized

Put a Ring On (?/In) It!

Last week I was interviewed for Cosmopolitan about ‘femidoms’ or internal condoms. These are one of a handful of contraceptives that often get talked about in sex ed classes, but appear to be less commonly in use.

Another type of contraception that this can be said about is the vaginal ring.

It gets its name from it’s shape – it’s a ‘ring’ made from a soft rubber like materials, about 5 cm across. It is inserted in to the vagina by the user and once inserted sits just below the cervix.

It’s another type of hormonal contraceptive – which means it protects against pregnancy by affecting the womb, ovaries and the fertility cycle.

It contains the same hormones as the combined pill – oestrogen and progesterone. Because of this, it works in a very similar way:

  1. Stops the ovaries from releasing an egg.
  2. Helps make the lining of the womb stay thin, rather than building up (a thick womb lining is needed for a fertilised egg to implant in and grow).
  3. Helps create a thick ‘plug’ of mucus in the cervix – the entrance to the womb. This helps stop sperm from entering the womb from the vagina in the first place and coming in to contact with an egg.

Also like the combined pill, the vaginal ring is used for three weeks and then not for one week – usually with a ‘withdrawal bleed’ in this week off. The main difference is that whilst the pill is delivered to your system by swallowing a pill, the vagina ring releases these hormones in to your system slowly over time.

After the week off, a new one is inserted. This is done by the user – so no need to attend a clinic or other appointment to get it fitted by a health professional, like with other contraceptive methods such as the coil.

From speaking to friends about their personal and professional experiences it seems like the vaginal ring isn’t something that is as easy to get hold of as other forms of contraception, at least in the UK!

Pros and cons

Because it doesn’t form a barrier between the vagina and the penis, it doesn’t protect against STIs. The vaginal ring is a form of contraception (helps reduce the risk of pregnancy) but not protection (doesn’t help reduce the likelihood of passing on infections through sex).

Some people may find it difficult to use – it involves being quite comfortable with your anatomy, slightly more so than a tampon.

On the other hand – it works very well. If used correctly, the vaginal ring is more than 99% effective. For comparison, this is more effective than condoms (98% effective). It only needs removing and replacing every four weeks – unlike the pill, which you need to think about every day.

For further details see:

NHS Contraception advice 

 

Posted in Genitals: A User's Guide, Uncategorized

By Design

Ever heard the term ‘designer vagina’?  This generally refers to a certain type of cosmetic surgery, not to the vagina itself but to the ‘inner lips’ (or labia minora) of the vulva.  Surgery here involves removing tissue from and reshaping the appearance of the labia minora- in other words to ‘trim’ it.   Many people with vulvas have a labia minora that protrudes so that it appears visible – therefore however large this is it is likely to be ‘normal’.  Additionally, in young people biological changes occur during puberty that can change the appearance of the inner labia.  For this reason it is often recommended by the NHS that those under 18 do  not get this type of surgery.  However, there seem to cases of children having labiaplasties.  According to one report over 200 people received labiaplasty procedures funded by the NHS in 2015-2016.  We know that people with visible labia are more likely to think that their genitals look ‘abnormal’ than those without, even though both are equally common (Lykkebo et al, 2017). Some accounts have blamed this on the prevalence of seeing only vulva with neat and invisible labia minora.  Whatever the cause, the desire to have this type of surgery seems increasingly common with a 45% rise seen in labiaplasty numbers worldwide between 2015 and 2016.

 

 

 

Posted in Genitals: A User's Guide, Uncategorized

An Ode to Sanitary Products

Womb carrying folks usually start menstruation (i.e. regular periods) before the age of 16 years*.  I was much older than this when I began to accurately understand what my anatomy ‘down there’ was like.  I think I had a conception of tampons being a cross between a plug and a sponge.  I guess this isn’t completely wrong, but neither is it completely right as the bleeding’s coming from the cervix, with a vagina being a passage way.

I’ve come across a fair few people who have an aversion to using tampons, partly because they are not confident (or downright uncomfortable) with their anatomy and with the idea of placing something in to their vagina.  Even amongst some of my liberated friends, I am considered a bit of a fringe eccentric for using a mooncup – something I’ve done of the last few years.  About the size of an egg cup and made from soft silicone, it sits in the vagina, just below the cervix and catches blood.  It can then be washed, without contributing plastic to the bin or cotton to sewage waste.

n.b. I’ve recently discovered that ‘mooncup’ is just one of many other brands.  This has somewhat blown my mind.

References:

*Lawrence and Impey (2012) Obstetrics and Gynaecology, 4th Ed.