All posts by Ayesha Kazmi

‘Iran 9th country with lowest maternity death worldwide’

‘Iran 9th country with lowest maternity death worldwide’

2018-11-12

It’s a big achievement because to end the death during childbirth is a goal that UNFPA has set for the whole world – or, as we say, zero maternal deaths. There are just a handful of countries who have achieved this milestone, Dr. Natalia Kanem said.

“We have to trust women to make choices in planning their families,” a key message from the Executive Director of UNFPA.

“The woman should be the one to decide, and of course it’s natural for the woman to confer. This is the whole point: We have to trust women to make these decisions because the woman is one half of a couple and is the one who bears a child; the woman also understands how many children she already has and she also understands her responsibilities for looking after the next generation,” Dr. Kanem explained.

Dr. Kanem travelled to Iran to attend the HelpAge Asia-Pacific Regional Conference on Population Ageing which was held in Tehran from October 23 to 25, with the main theme of “Family, Community and State in Ageing Societies.”

UNFPA is the United Nations sexual and reproductive health agency. Its mission is to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person’s potential is fulfilled.

Here is the full text of the interview:

1) Based on the latest census figures in 2016, older persons currently constitute almost 9 percent of the total population in Iran and demography experts predict that by 2050 some 20 to 30 percent of the population will be 60 years or older. How can this inevitable demographic transition be addressed with regard to the Sustainable Development Goals?

Everywhere in the world have demographic challenges that are different from each other, of course. UNFPA is quite convinced that the demographic challenges that the world is facing are really closely linked to the issue of choice. The choices that we are making today are going to influence older people as they age, but they are also linked to the cycle of life. So those same choices have to do with how we deal with young people today. Demographic transition typically refers to the phenomenon that we see in populations. In earlier times, a high birth rate was accompanied by a high death rate. Many countries had the high birth rates, women often had 8, 10, even 15 children. Even in Iran, less than 50 years ago, birth and death rates were much higher than today.

People were dying at the age of 50 or 55 and this was considered normal – something we certainly wouldn’t consider normal today. But with development we see that as choices expand typically people would choose to have smaller families so that you can invest more in each child. And as advances in medical care, nutrition and quality of life occur then the death rate also comes down. So this is the demographic transition: you have high birth rate and high death rate and then slowly over time fewer and fewer children, but also people are living much longer. So all of these change the structure of the population.

In less developed countries where UNFPA is working – for example, in parts of Asia and Africa — the “many children paradigm” is still there. The death rate is still relatively high and so the structure of the population in those countries presents a different challenge.

Iran is a very good example of a country where you’ve had these advances in development and medical care. People are now living much longer- on average 20 years longer than a few decades ago- and it’s a big achievement for Iran and for similar countries. And of course [people are having] fewer children but more children are surviving and you are not having a lot of early deaths. Then when you’ve got to the stage where Iran is now and as you look to the year 2050, for the first time you are going to have a high proportion of older people.

At the meeting I attended here we joined other partners, including the government, to develop ideas, regionally, as to how we will address some of these challenges. The Sustainable Development Goals have that word “sustainable.” It means that it should be something that is going to endure over time. Sometimes you can fix things quickly but it’s not going to last. It’s a short-term Band-Aid [solution]. What the Sustainable Development Goals are talking about is prosperity that is going to be long-lasting into the future. So in thinking about the Sustainable Development Goals, there are 17 of them. Of course there are many noble goals of the United Nations embedded in them. Every country wants peace, wants to have productive partnerships, things like health, the end to poverty, the end to hunger, etc. This everyone can agree on. It is not an issue.

But there are some other interesting SDGs which are less known like the SDG 10 which is about an end to inequality; or the SDG 5 which talks about men and women and making sure that the services of the country, of a community and of a family cover both men and women. And as we think about the ideals of climate and the environment there are sustainable goals for water and life in the sea, and there are sustainable goals for agriculture and life on Earth.

For UNFPA the relevance of all of these goals to an ageing population is that you have to strengthen not just the body and mind but the attitude of everybody to understand the cycle of life. If the baby is healthy in the mother’s womb this is a stronger child who is going to be a stronger adult and who is going to avoid some of the health problems when they become 60-70 or 80 years old. But if you have no good nutrition, lots of diseases may occur and if there’s not an understanding about the relationship of men, women, older people and younger people in the family then as you get older you are not going to be well integrated into the society. You will suffer great loneliness which is a problem, which can be even a health problem, and you are also not going to be able to be productive. The big point that we make about the demographic transition is that older people can and should continue to contribute to society.

They contribute to their family, of course, because of love. But they can also contribute to their community economically by their wisdom that they have acquired over so much life experience and also to be able to give guidance to the next generation that’s coming up.

So in a nutshell we also want to stress that these Sustainable Development Goals stand for having a world that is just, and in that just world women are half the population and therefore women are half the solution. The solution to the economic problems, because prosperity comes with more women contributing and more women in the workforce. More women being supported by childcare and other things that are going to allow them to make their contributions all the better. The relationship between healthy old age and providing and planning and protecting women all along a chain makes a difference because women tend to outlive men, so when you look at the population over 60 typically there are more women than men as opposed to half and half. But normally women do not have the chance to have pensions, for example, so poverty among older people tends to have more women represented. These are the type of questions that the Sustainable Development Goals ask us to address and these were some of the things that were discussed in the conference.

2) How does UNFPA evaluate Iran’s effort to address population ageing including increased inclusion of the older persons in the community, making cities more accessible for them, and financial support for health services?

UNFPA has worked very closely with some of the ministries that are in the lead on thinking about the family. We were much honored to have with us the Vice President who has taken leadership on some of the issues on family dialogues that you are having in this country. It’s a very enlightened way of looking at problems that every society has by trying to encourage dialogue among the generations and also to think about family life and family relationships. Iran is doing well when it comes to concentrating on better health for all, including the challenges that you face because of the migrant population and other factors.

UNFPA’s role is to assist governments as we think of what are some of the measures that we can put in place. For example, if something like an earthquake or another type of natural disaster happens, usually women are more affected than men in any country, so UNFPA works with women and girls so that together with government, we can position lifesaving supplies and how we can assure that we are ready to assist the population if, God forbid, something happens in terms of a humanitarian crisis.

We also help government to analyze some of the trends that are happening in the population, not just ageing and but also on the other side of what’s happening with the younger people in the country. Iran has a highly educated population, including women who go to school. This is something that is a model for other countries in the region and UNFPA is helping to share the experience that you have had with other countries in the region. We’ve been very gratified and happy to see that when it comes to women’s health issues Iran takes them very seriously. Your midwifery programs have been very successful, so you have fewer deaths during childbirth than other areas which had started from the same indicators where Iran did.

Iran achieved MDG 5 [United Nations Millennium Development Goals] by being the 9th country with lowest maternity death worldwide. It’s a big achievement because to end the death during childbirth is a goal that UNFPA has set for the whole world – or, as we say, zero maternal deaths. But you are already there. There are just a handful of countries who have achieved this milestone and now we are working feverishly to try to share that example, in particular, the benefits of midwives and safe delivery and antenatal care. All of these are factors that helped Iran to have women survive. No woman should die while giving birth.

Of course there is always more to do and among these is trying to strengthen key policies; we are working with government and together we are encouraging policies that seek to address and end violence against women, for example, and there are other areas that we have been working on very closely with Iran.

3) In the UNFPA State of World Population 2018 report you mention that “choice can change the world”, could you please elaborate on that?

The State of World Population report was published just a few days ago [October 17]. In this report UNFPA analyses choices – including why choices are in short supply everywhere. We looked at every country and we were looking at fertility levels and number of children per woman and we noticed that in the countries that are still very poor and are trying to raise their economic prospects they still have very high fertility. Like I was describing before, women in such countries are having more children that they actually desire. When you have a big family you have big challenges especially in a poor country, so UNFPA is working together with governments to provide contraception and also information. So that women would be aware of the things that they could do safely in order to plan their family.

Now this type of guidance is not ‘one-size-fits-all.’ It has to be done sensitively; you have to work with the culture and religion and social norms of the country and you have to understand what it is that women prefer because it should be their choice. A simple example is if a women wants to use contraception to plan her family size it should not be just one type of contraception. You should have 5 or 6 or 7 modern methods of contraception for family planning, and she will pick the one that works for her and her husband.

Now on the side of countries where fertility is on average two or three children we’ve done an analysis to see choices there and choice is relevant because very often a woman does not have a choice to work; she would like to but there is not enough social support. If there is no grandmother to look after the children, for example, what is she going to do? If there is no consideration for all of the different options, she may have the education and she may have the preparation to achieve her potential, but she may not be able to ultimately participate in the economy of her country. And this is going to make sustainable development much more difficult.

And then we also talk about developed countries where the options of not only future income but things like the policy for maternity and paternity leave are discussed. If you have a job and now you have a child will you lose your job because you now have taken leave while you were pregnant and while the child is young? And we are also very bold about saying that fathers should also have adequate paternity leave, so they can bond with the new baby and be a family together when the baby is very young. This is very helpful for the baby as they are growing to have a few weeks or a month, for example, with their father and not just the mother.

So these are some of the things the report is bringing out. And then lastly in some places – many of them in Asia-Pacific, the average fertility rate is very, very low. In Taiwan, for example, it’s an average of one child per woman – It’s the lowest in the world. In other parts of Asia like Korea and Japan where families are very small, or a country like Finland which also has low fertility, the concern is why women are not choosing to have more children. So we did an analysis to look at choices. Sometimes a woman would like to have two children but she is not able to afford. So this is a type of choice which is limited for her. There are other women whose choices are limited because of, I would say, ignorance about transmitted infections that can lead to problems of reproductive health. This is what UNFPA has to work with not just in Iran but in every country where UNFPA works. We attend to these issues of women’s health.

The current fertility rate in Iran is 2.01. From our perspective what’s normal is what the woman wants, so we don’t have targets labelled good or bad. We look at the spectrum and we provide advice based on what it is that any woman in Iran would want. I would observe that many countries see two as the ideal because you have a stable population. It’s not growing too fast and it’s not shrinking too fast. But again a lot depends on what women themselves want. If a woman wants a bigger family, we should help her to have the support to have the ability to be able to afford more children. If a woman wants a smaller family and that is her choice then we should support that choice. But for Iran your fertility rate of 2 is in balance because that’s considered “replacement rate” of the population.

4) Would you please explain why reproductive health and rights remain in the 2030 Sustainable Development Agenda?

There is no country on earth that can claim that they have made reproductive health and rights a reality for everyone. Even when a country is doing well we see that there are shortfalls, maybe a farmer who is trying to have her farm in a rural area, maybe it’s a migrant or refugee etc. We always know that choices can be limited and the goal of UNFPA is to make sure that these millions and millions of people have more choices, not fewer. This is what I said earlier. It’s not good to try to tell a woman you must have two-and-a-half children

so that the statistics look good. We have to analyze what is happening with your family. Can you afford four or five children if you want that many? Well, this may be a blessing for you. But maybe you cannot afford five children, so maybe you would like contraception because you are afraid everybody will stay in poverty and you won’t be able to invest in each child well, so you should receive the help to exercise your choice accordingly.

Ultimately the point about the Sustainable Development Goals is to make sure that women are able to speak and that women are able to understand what is the future for them and for their daughter or for their son for that matter. Because of course the girl is going to marry the boy and we want to make sure the boy knows about the respect for women, we want to make sure that the boy is in good health, and also in every country we face the challenge of domestic violence and this means that raising awareness among men and boys is very important. They are the ones that are also going to share that understanding.

So as we think about the SDGs and the goal of ending poverty, women have to be an integral part of that equation. As we think about the second SDG to end hunger, for example, you know that many times women are active as farmers, women are the ones who are purchasing the food and cooking the food, so understanding about health and nutrition is good for them personally but it’s also good for the family and it’s good for the community.

And as we go through all of the SDGs, on education for example, I think we want to celebrate examples like Iran where woman have achieved and they can finish their education. This is not true in a lot of the world. In a lot of the world girls are discriminated against, they don’t get to go to school or they finish half way and then they would never go to the university. It’s not just girls that are in school; for many reasons there are girls that are also out of school, and today I saw a wonderful example in Iran of a community center [called Ofogh for adolescents where they can go and to learn to communicate and acquire life skills] where young girls are being taught through workshops and taught through interacting with each other about good health and how to avoid social problems in the future.

And we were accompanied by Dr. [Mohammad Mehdi] Gouya, Director of the Health Ministry’s Communicable Diseases Control Department, who is a brilliant scientist but who is also helping the people in Iran to understand life skills which is so important for their future.

And the last observation I made about Sustainable Development Goals in reproductive health is that it was in Tehran 50 years ago that the first International Conference on Human Rights took place and during this very famous conference that was the first time when the United Nations and all the countries agreed that it is the right of couples to freely and responsibly plan their family. So for UNFPA this was kind of our beginning and we will be 50 years old next year because we were born from this conference so this is why we are very happy to be in Iran and we know it’s a historic location for choice, for women and for couples to be able to plan their families.

5) Why has UNFPA put greater emphasis on women’s role in planning their families regarding the number of children, spacing, etc.?

The woman should be the one to decide and of course it’s natural for the woman to confer. This is the whole point: we have to trust women to make these decisions because the woman is one half of the couple and is the one who bears a child; the woman also understands how many children she already has and she also understands her responsibilities for looking after the next generation, so it’s her body and the right of the woman over her body has been established. So the woman always has the good sense to confer with everyone who is involved. Now when you say the couple it becomes a little ambiguous – you cannot dictate to a woman to either have or not have a child. The world at times had got into troubles by trying to force women against their will either to have a child or not to have a child and this is why we say that reproductive health should be women-centered and when we are talking about fertility the woman that carries the child should be the one to decide.

This is getting very interesting in a time of technology, for example with the new technology we have to be very sure to respect the right of the woman, as you know there are possibilities to either carry the baby or to be a surrogate mother. There are many things that are coming on the horizon where we feel that for the community and for the woman, herself, she should be knowing that’s her choice if she likes to have contraception it should be available; if she would like to have a baby we should support her with all the good care and support and the aftercare in the aftermath as well.

It’s interesting that as we think about the configuration of the family and as we think about the demographic transition- as I have described- the danger when you get into a low fertility environment is that there is a temptation to insist that, “Well, you should have three children – the country needs you.”

Ultimately, if you have a healthy productive ageing population that’s contributing, a smaller population can be better than a bigger one. There are many countries that have a big population but they are very poor – they have too much of a population to be able to care for them, so these are the kinds of issues that UNFPA helps to discuss with governments – and in any case I think governments would want to take good decisions based on what’s good for women in their country.

https://www.tehrantimes.com/news/429414/Iran-9th-country-with-lowest-maternity-death-worldwide

4 Common Sex Addictions To Look Out For

4 Common Sex Addictions To Look Out For

2018-10-25

Did you know that approximately 2.4 million Australians have a sexual addiction? Sexual addiction is one of the most common addictions that both men and women experience.

What is sexual addiction? Well, it’s a condition that occurs when an individual is unable to properly control his/her sexual thoughts and behaviors. More specifically, it occurs when constant sexual thoughts affect one’s ability to develop and maintain healthy relationships, be productive at work, perform daily functions, and/or separate fantasy from reality.

It is also commonly referred to as hypersexuality, sexual dependency, and sexually-compulsive behaviors. In addition, pop culture often refers to sexual addictions as satyriasis (in males) and nymphomania (in females). A person with this type of addiction is obsessed with sex. He or she may also have an extremely high sex drive (libido).

And, although sexual addictions are similar to other addictions (i.e. substance addiction and alcoholism), they differ in one major area – people, who have sex addictions are addicted to the activity, namely sex, rather than a particular substance. So, in this sense, sexual addictions are most similar to a gambling addiction.

If you are unsure if you or your partner has a sexual addiction, you are in luck, because this article will highlight four common sexual addictions that you should look out for.

“Hookups” (Casual Sex Addiction)

One sexual addiction to look out for is a “fascination” or obsession with “hookups”; aka causal sex. The truth is, “hookups” have become extremely popular in recent years. A recent study, published in the Archives of Sexual Behavior, found that causal sex is actually on the rise for white males in the US. Why? Well, mainly because societal views on sex have changed over the decades – with people become more lax when it comes to causal sex.

Plus, for some men, “hookups” offer a variety of benefits, such as “friends with benefits” and opportunities to “test the water” void of any commitments. More specifically, it allows these men to avoid long-term, monogamous relationships with one specific woman. However, when “hookups” or “stranger sex” become an everyday thing or the “ultimate goal,” the risk of a sexual addiction increases.

And, although having sex with a variety of people (without protection) can be detrimental to your physical health, if you are frequently having sex with random people (strangers), it can also negatively affect your emotional/psychological health and well-being. Constantly being in the “hookups” state of mind could also cause you to feel pressured to “perform,” leading to a host of sexual problems like premature ejaculation, erectile dysfunction, and/or performance anxiety.

Porn Addiction

Sometimes watching porn on the internet or television screen can be an exciting way to ignite your libido and heighten your sexual experience. But, for some people, watching porn (on a regular basis) can lead to a full-fledge sexual addiction. In other words, watching one or two porn videos can later lead to watching porn videos or looking at pornographic pictures every day – all day long, if possible.

What happens next? Your world begins to revolve around porn. Then, you start to base your view of a healthy sexual relationship on what you see on the screen, rather than on reality. And, after a while, the only way you can become sexually excited is by watching porn before you have sex. Not only that, but in recent years, there have been a growing number of reports of men, who claim to suffer from porn-induced erectile dysfunction. If you fear you might be suffering from this condition, read the article we published on this topic.

Prostitution Addiction

The truth is some people get a “rise” out of paying for sex or trading things (i.e. drugs, alcohol, cigarettes, jewelry, etc.) for “sexual favors.” These individuals view sex as a commodity – something that can be sold and bought. Some people enjoy being “in control” of the opposite sex, while others believe they are simply paying for a service – just like you pay for any other service – i.e. getting your car washed or hiring someone to remodel your home. However, you may have a sexual addiction, when non-payable sex no longer excites you. More specifically, if the only way you can become aroused is to pay for sex, there is a strong possibility you have an addiction to prostitution.

Masturbation Addiction

Although masturbation, for the most part, is a natural and healthy addition to sexual activity, there is a-such thing as too much of a good thing. The truth is one can become addicted to masturbation – without even realizing it. How? Well, it can occur after you get a boost in feel-good hormones from masturbating (i.e. oxytocin dopamine, serotonin, norepinephrine, and testosterone). This boost feels good – real good, so you keep masturbating to get that feeling again.

And, after a while, you do it so often and become so dependent on the “high” that before you know it… you’re addicted to masturbating. So, even though masturbation is normal, if you do it too much it can produce the same effects as a drug high. It’s important to understand that masturbation should never be used to “escape” or block out reality. A masturbation addiction can hurt your self-esteem/self-confidence, your relationship, career goals, and your sex life.

In Summary…

Nowadays, sex is no longer a forbidden topic. In fact, with the invention of technology, we now have the ability to voice our joys and pains, when it comes to sex – with people all around the world. And, although sex is a fun, exciting, and pleasurable activity that can draw two people together, it also has the ability to cause damage – real damage to one’s sex life, self-esteem/self-confidence, and romantic relationship.

However, by altering your view of sex and avoiding temptations that could lead you towards a sexual addiction, you can acquire a happy, healthy, and satisfying sex life. If you feel that you may have a sexual addiction, it is imperative that you seek help from a qualified sex therapist. With proper treatment, you can go on to have a happy addiction-free sex life.

https://www.menshealth.com.au/4-common-sex-addictions

Antimicrobial resistance to gonorrhoea treatments is rising, says PHE

Antimicrobial resistance to gonorrhoea treatments is rising, says PHE

First-line treatments for gonorrhoea are becoming less effective due to a rise in antimicrobial resistance, according to a report from Public Health England.

The latest figures show that resistance to most first-line treatments for gonorrhoea rose in 2016/17.

As a result, GPs are told to stay alert to any changes to the antimicrobials recommended for first-line use.

The report, published this month, said: ‘The effectiveness of first-line treatment for gonorrhoea continues to be threatened by antimicrobial resistance.’

It reported that resistance to azithromycin (4.7% to 9.2%), ciprofloxacin (33.7% to 36.4%) and cefixime (modal MIC from 0.015 mg/L to 0.03 mg/L) had increased in 2016/17, while resistance to penicillin had declined from 13.9% to 10.8%.

PHE said: ‘Practitioners should ensure that all patients with gonorrhoea are treated and managed according to national guidelines, and should be alert to changes to the antimicrobials recommended for first-line use.’

It also called for ‘regular testing for HIV and STIs’ for men who have sex with men and black ethnic minority women and men, if they are engaging in unprotected sex with new or casual partners.

Anyone under 25 who is sexually active should be screened for chlamydia annually and on change of sexual partner, it added.

Services that provide rapid treatment and partner notification should also be provided to reduce the risk of STI complications and infection spread.

This comes after PHE launched a campaign targeted at people aged between 16 and 24 years old, to raise awareness of STIs.

And a Pulse investigation revealed that nine out of ten councils cut spending on sexual health, alcohol misuse and weight management services, for 2018/19.

http://www.pulsetoday.co.uk/clinical/clinical-specialties/sexual-health/antimicrobial-resistance-to-gonorrhoea-treatments-is-rising-says-phe/20037643.article

To meet gender-related SDG targets, improve the resource allocation

To meet gender-related SDG targets, improve the resource allocation

2018-10-18

The low allocations, huge fluctuations over the years in funds, and the underspending clearly indicate that political interest in efficiently targeting the SDGs is marginal. Political interest is driven either for electoral gains or as firefighting mechanisms

Adequate resource allocation accounts for the continued deficit in health, nutrition and welfare outcomes for women and girls in India.

The trajectory towards realising the SDG targets is not going to be easy with the current level of political commitment to these issues. If this deficit has to be reduced in order to move towards the SDG targets in the stipulated time, budgets for service delivery have to be increased substantially without further delay.

Over the last few years, new programmes and schemes targeted at women and girls have been launched, especially in areas such as health, nutrition, livelihood and protection from abuse. Some progress has been made in law-making on domestic violence, sexual assault, and sex selection.However, inadequate allocation of resources have made implementation of these programmes and schemes ineffective or limited in their reach.

The health, nutrition and welfare deficit in India is still high when compared with countries of similar level of development such as Thailand or Mexico,or even countries which are less economically developed such as Sri Lanka, Bangladesh and Nepal. Within this, there are class, caste and gender inequities, as well as regional inequities. A large part of this deficit is due to inadequate budgetary allocations. Even resources committed in the budget are either underspent or used inefficiently.

The picture we get from the government’s own data sets such as NFHS, SRS and NSSO is that maternal and child mortality remains a major problem in many states in India. Access to basic healthcare services, including maternal, sexual and reproductive health is grossly inadequate. Violence against women and marriage before legal age continue to be high, despite stringent legal provisions and investment in supportive programmes and services.

On the positive side, we see an increased public debate and media attention to gender issues.This periodically leads to increase in budgetary allocations – for instance, when an epidemic strikes, or children die in large numbers due to malnourishment, or rape cases get highlighted in the media.

An assessment of budget allocations and expenditures of some of the key programmes and schemes targeted at reducing gender inequities leads to the conclusion that there is lack of serious intent in achieving the goals. These programmes and schemes are launched with much fanfare but end up being populist proclamations directed towards electoral outcomes or public relations exercises.

Early study results suggest fertility app as effective as modern family planning methods

Early study results suggest fertility app as effective as modern family planning methods

GEORGETOWN UNIVERSITY MEDICAL CENTER

Early results from a first-of-its-kind study suggests that typical use of a family planning app called Dot is as effective as other modern methods for avoiding an unplanned pregnancy.

Researchers from the Institute for Reproductive Health (IRH) at Georgetown University Medical Center are studying women’s use of the app for 13 menstrual cycles, or about one year. The ongoing prospective study design is the first to apply best-practice guidelines for assessing fertility awareness based methods in the testing of an app.

The interim results following Dot’s use for six cycles are published in the journal Contraception (title: Estimating six-cycle efficacy of the Dot app for pregnancy prevention.) Dot is owned by Cycle Technologies, which is solely responsible for the app.

Dot provides a woman with information about her fertility status each day of her menstrual cycle. It uses an algorithm and machine learning to identify the fertile days of her cycle based on her cycle lengths.

After women had been in the study for six cycles, the researchers found that the app had a typical-use failure rate of 3.5 percent, which suggests that Dot’s one-year typical efficacy rate will be comparable to other modern family planning methods such as the pill, injections, and vaginal ring.

“Given the growing interest in fertility apps, it was important to provide these early results,” says Victoria Jennings, PhD, principal investigator of the Dot efficacy study and director of the IRH.

718 participants in the United States enrolled in the study, and 419 participants completed six cycles of use. There were 15 confirmed pregnancies from cycles when participants used the method incorrectly (such as having unprotected sex on days of high fertility). No pregnancies occurred in cycles when participants reported correct use of the app during high risk days for pregnancy.

“Our purpose is to provide guidance to women who want to use Dot as well as to health providers and policy makers who are interested in this emerging method of family planning,” Jennings says. “We hope this paper contributes to the on-going discussion about the effectiveness of fertility apps and how their efficacy should be assessed.”

Final efficacy results are expected in early 2019.

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This study was supported by the United States Agency for International Development grant (OAAOAO13O00083).

In addition to Jennings, study authors include Liya T. Haile, Hanley M. Fultz and Dominick Shattuck of the IRH, and Rebecca G. Simmons of the University of Utah. The authors report having no personal financial interests related to the study. The Dot app is a proprietary technology developed by Cycle Technologies, a company owned by a family member of Jennings’.

About the Institute for Reproductive Health

The Institute for Reproductive Health at Georgetown University Medical Center has more than 30 years of experience in designing and implementing evidence-based programs that address critical needs in sexual and reproductive health. The Institute’s areas of research and program implementation include family planning, adolescents, gender equality, fertility awareness, and mobilizing technology for reproductive health. The Institute is highly respected for its focus on the introduction and scale-up of sustainable approaches to family planning and fertility awareness around the world. For more information, visit http://www.irh.org.

About Georgetown University Medical Center

Georgetown University Medical Center (GUMC) is an internationally recognized academic medical center with a three-part mission of research, teaching and patient care (through MedStar Health). GUMC’s mission is carried out with a strong emphasis on public service and a dedication to the Catholic, Jesuit principle of cura personalis — or “care of the whole person.” The Medical Center includes the School of Medicine and the School of Nursing & Health Studies, both nationally ranked; Georgetown Lombardi Comprehensive Cancer Center, designated as a comprehensive cancer center by the National Cancer Institute; and the Biomedical Graduate Research Organization, which accounts for the majority of externally funded research at GUMC including a Clinical and Translational Science Award from the National Institutes of Health. Connect with GUMC on Facebook (Facebook.com/GUMCUpdate), Twitter (@gumedcenter). Connect with Georgetown University School of Medicine on Facebook (Facebook.com/somgeorgetown), Twitter (@gumedicine) and Instagram (@georgetownmedicine).

Disclaimer: AAAS and EurekAlert! are not responsible for the accuracy of news releases posted to EurekAlert! by contributing institutions or for the use of any information through the EurekAlert system.

https://www.eurekalert.org/pub_releases/2018-10/gumc-esr101518.php

Dear Men of #MeToo: Abuse Is Behaviour, Not a Symptom of Mental Illness

Dear Men of #MeToo: Abuse Is Behaviour, Not a Symptom of Mental Illness

2018-10-12

When abusers bring mental health issues as an excuse to their behaviours it gives birth to a misinformed and ableist narrative.

Trigger warning: Sexual harassment/abuse

The #MeToo movement has helped many women come out with their stories of sexual harassment and abuse at the hands of powerful men. It has also highlighted the problems associated with mental health. Many women have spoken up about the impact of these incidents on survivors and understanding why women take time to come out in the open with their narratives. At the same time, the more catchy mentions of ‘mental health’ have been furthered by the men accused of sexual harassment and assault themselves, through their carefully-worded apologies.

Mayank Jain, a journalist at the Business Standard, comedian Utsav Chakraborty and Abhishek Upadhya, an editor at India TV, attempted to use their mental health issues as a defence after being accused of predatory behaviour by several women. Words like “struggle”, “disease”, “seeking help” and “therapy” were littered on their Twitter timelines. These words say things that these men want us to know – but do they really matter? And why talk about it now?

Putting bad mental health on the table when you’re accused of misconduct is a common gambit. After the poet Mary Karr wrote about how her former partner David Foster Wallace had abused her physically and emotionally, a lot of backlash focused on Wallace’s mental health issues. In a personal essay for the New Yorker, celebrated author Junot Diaz talked about the repression of his childhood abuse and linked it to the accusations of assaulting and harassing multiple women. The courtroom trials of Roman Polanski mentioned his ‘mental illness’ several times, following his arrest for sexually abusing children.

The similarities are clear. All these men, and many others, influenced generations with their work in literature and the media, suffered from mental health issues and abused those who seemed less powerful. However, it would be amiss to connect abuse and mental health.

First off, there are similar patterns of violence perpetrated by people with as well as without  a mental illness. “The intersection of abusers with mental health issues is very thin,” Sadaf Vidha, a Mumbai-based psychologist whose clientele includes survivors of gender-based violence, says. “Think about it while reversing the roles – when women or minorities suffer from mental health issues, do we see them automatically abusing or assaulting other people?”

Research denies a link

The association of mental illness with abusive behaviour isn’t new; the ‘insanity defence’ is probably its most famous byproduct. Researches have been exploring this relationship for decades and have found prevalence of mental illness in convicted sex offenders, but no signs of a clear cause-effect has been found.

1999 study by Jenny Muzos of the Australian Institute Of Criminology dispels the myth that violent behaviour is associated with mental illness. It found that characteristics of crimes such as homicides committed by offenders diagnosed with a mental disorder were no different from those of crimes committed by other offenders.

After a undertaking series of studies, Nancy Erickson, an attorney and consultant on domestic violence and legal issues, concluded that while mental illness may or may not exist in abusers, the abuse they inflict is a behaviour and not a symptom.

meta-analysis of several studies by Andrew Klein, a professor of law at the Indiana University, Bloomington, and funded by the US Department of Justice, for the Battered Women Justice Project states that men who abuse are no more likely to suffer from mental illnesses than the ordinary population. Their paper reads, “Although batterers may suffer from depression or low self-esteem after being arrested or restrained, these conditions have not been found to have caused the abuse.”

Jaydip Sarkar, of the Institute of Mental Health, Singapore, asserted in a 2013 review of the assessments of mental health of sex offenders in India that rape, sexual harassment and other predatory behaviours are not necessarily the result of having a mental health problem.

The issue of perpetrators using stress as a result of work and/or substance abuse as an excuse was discussed in a 1999 review by Sarah Buel, a lawyer and professor at Arizona State University. Buel spent three decades working with survivors of domestic violence and concluded that though violence cannot be caused by stress, stress could exacerbate violence.

When abusers use mental health issues as a shield, it adds to a frightening, misinformed and ableist narrative. “Men directly or indirectly saying that abusive tendencies are due to mental health issues, is just another version of ‘I couldn’t control my desire/anger’,” Vidha added. “This is a very well-known pattern. Abusers will blame health, external environments or the victims, anything that allows them not to take responsibility for their misuse of power.”

The work of Lundy Bancroft

Jain’s tweet about him seeking therapy to “reform himself” was similar to Mark Halperin’s lengthy apology for reportedly assaulting about half a dozen women during his time at ABC News, in the early 2000s. In his statement, Halperin said he sought mental health counselling after he left ABC.

Lundy Bancroft spent years studying and counselling abusive men. In his 2002 book, Why Does He Do That? Inside the Minds of Angry and Controlling Men, Bancroft discusses the myth behind using mental health as a reason to abuse as well as to feed misguided beliefs that perhaps treatment that can ‘fix’ these men.For example, on Diaz’s reference to his childhood abuse, Bancroft writes, “… abusive men may find that accounts of childhood abuse is one of the best ways to pull heartstrings.”

Bancroft states that people have the potential to overcome emotional injuries from childhood and the impact of these injuries need not push the person to inflict same behaviour on others.

When Chakraborty mentioned his mental health, he was attempting to sneak it into his apology and lay the ground for sympathy. Bancroft pointedly dismisses this, writing “… abuse is a problem of values and not of psychology. Mental illness does not cause abusiveness anymore than alcohol does. Perceptions of life circumstances in these men are accurate, their minds work logically and they understand cause-effect.”

The same goes for Jain’s excuse and Upadhya claiming to seek professional help to address “these issues”. Bancroft continues, “I have yet to meet an abuser who has made any meaningful and lasting changes in his behaviour through therapy regardless of how much insight he may have gained.” He also writes that professional help will only help make them “happy, well-adjusted” abusers because interventions like psychotherapy can only address issues they are devised to address, and abusive behaviour isn’t one of them.

It is also important to differentiate between two types of destructive behaviour. One is where severe mental disorders like mania could cause a person to become destructive, as a result of which they may end up hurting the people around them. The other is where the destruction is intentional and isn’t motivated by the illness.

Of course, none of these means that any mental health issues these men may have are invalid or non-existent. They are likely to be as distressing for these men as they are for anyone else. However, the distress does not have anything to do with their inability to understand consent or the agency of the women.

“We are a patriarchal society and allowing mental health issues to become an excuse for abuse or assault will lead to massive misuse of policies and laws like the Mental Health Act,” Vidha said about the consequences of people buying into these connections. “We need to differentiate between what socialisation teaches men that is ‘okay to do’ and what their mental health conditions lead them to do.”

Mental health issues and predatory behaviour can coexist in a single mind but with some distance between each other. There are people who do suffer from a mental illness and are abusive towards women – and there are also people with a mental illness who do not engage in such behaviour. This is where human psychology takes a step back and calls value systems to the stage.

Prateek Sharma is a student pursuing a master’s degree in clinical psychology, a researcher and a mental health activist working to promote inclusive mental health care in India. He tweets @prateekshawarma.

https://thewire.in/health/dear-men-of-metoo-abuse-is-behaviour-not-a-symptom-of-mental-illness

 

Why Won’t Parents Talk About Helping Their Daughters Get Abortions?

Why Won’t Parents Talk About Helping Their Daughters Get Abortions?

“Your daughter’s 14, huh?” asked the guy at the wedding reception. “I guess you’re heading for the Grandma Danger Zone.” I wasn’t offended exactly (it was a party, after all, and most of us were drunk and speaking freely), but I was a bit surprised by the casualness with which a relative stranger commented on my child’s theoretical sexual activity. Trying to move the conversation along, I chuckled politely and replied, “Well, if she did get pregnant now, I would help her get an abortion, so that won’t be an issue.”

There was a long silence as this man and the other people in the conversation looked at me in shock. He’d made a lighthearted comment about my daughter’s potential teen pregnancy, and I’d responded in kind with a lighthearted comment about my daughter’s legal right to exercise her reproductive agency. Why did his comment garner laughs and knowing glances while mine elicited a full-on record scratch? Mercifully, someone changed the subject, and I was left with knowing that I, and not this man, had said something terribly wrong.

ut why? This was Massachusetts. These were liberals who would likely describe themselves as pro-choice. Yet somehow, my taking the concept of abortion from the theoretical to the concrete had shocked their sensibilities. And this wasn’t an isolated incident. I soon realized that being the parent of teenage girls meant many such conversations about the potential for their “bad decisions” ending in an unwanted pregnancy. Friends with girls the same age joked about warning their daughters to “keep their legs together” or not to get “knocked up.” Every time I pointed out that becoming pregnant needn’t result in having a baby, the universal reaction was mouths agape.

Yes, America remains fundamentally conservative on abortion, with Roe v. Wade freshly imperiled by the Kavanaugh Supreme Court. Although, in a recent Gallup poll, support for abortion rights is evenly split—about 48 percent on each side—the number of those who support abortion drops to 29 percent when people are asked if they think it should be legal under any circumstances. Part of this could be due to misinformation about things like fetal development and late-stage abortion, which can override our logical understanding of pregnancy in favor of a more emotional response. But it also has to do with our cultural values around pregnancy and a woman’s responsibility toward it. Often, it takes some other moral issue overcoming one’s fundamental distaste for the act of abortion itself (e.g., rape, incest, or a serious health risk to the mother) for the average American to accept it as a viable option. Our laws and regulations increasingly reflect an assumption that abortion is (only sometimes) a necessary evil, rather than a morally neutral health care option. Even among the progressive, pro-choice left, abortion is often talked about as a last resort—a horrible, traumatic event that must be avoided at all costs. But that’s not how I talk about abortion with my daughters.

Yes, I tell them, there are lots of good reasons to avoid an unwanted pregnancy in the first place: the potential physical dangers of unprotected sex, the potential emotional complications involved. But none of those should affect our ability to support, without judgment, a woman’s right to choose. I remind them that they are lucky to live in a state with access to safe and legal abortions and that should they find themselves in the position to need to avail themselves of those resources, I will give them the support they need.

I wish that other progressive parents were having the same conversations, but based on my experience, I suspect they’re not. And I get it. It’s one thing to believe in a theoretical person’s right to end an unwanted pregnancy; it’s entirely another to consider your own child’s behavior and its consequences. Perhaps parents are worried a child’s unwanted pregnancy might reflect poorly on their own parenting, implying that their daughter has made the kinds of “bad choices” she’d been dutifully taught to avoid. And talking about your daughter getting pregnant feels almost abstract, a cultural trope akin to joking about “getting out the shotgun” to defend her against unsavory gentleman callers. It’s not real; it’s just something parents say to indicate a general anxiety with watching one’s children grow into sexual maturity. Talking about your daughter getting an abortion, on the other hand, isn’t some common cultural shorthand or reference; it’s a specific reference to a specific procedure performed upon your specific daughter. Suddenly these abstract conversations are brought uncomfortably into the realm of the real and the possible. What would you do, the other parents are implicitly asked by my response, if your daughter had a pregnancy that she and you agreed should not be carried to term? What would you actually do? I think it’s time to stop shying away from this very real question, and its very real answer, and align our parenting with our politics.

So long as people still find it acceptable to joke about my daughters getting pregnant, I’ll continue to respond in kind by reiterating my support of their right to choose. I hope more pro-choice parents start to do the same. You’ll likely be met with a similar barrage of awkward silences and shocked looks, but I truly believe that the more comfortable we are talking about abortion without squeamishness or moral judgment, the more normalized it will become, even among those who already claim to support it. And honestly, making people at weddings or a moms’ night out a little uncomfortable is the very least we can do to help challenge cultural assumptions about women’s sexuality and reproductive rights. It’s a small but significant way we can move the needle in the cultural and political conversation around the ethics of abortion—and a huge way we can signal to our own children that we will practice what we preach when it comes to their bodies.