Mothers We Could Save

Nicholas D. Kristof
 
Here’s a Mother’s Day thought: There’s a way to save many of the world’s 350,000 women who die in childbirth each year. But it’s very controversial, for it’s called family planning.
Republicans in Congress have gone on the warpath this budget season against family planning programs at home and abroad. To illustrate the stakes, let me share a Mother’s Day story about a pregnant 30-year-old Somali woman named Hinda Hassan.
Ms. Hassan lived in a village near this remote town of Baligubadle in Somaliland (a self-ruling enclave carved from Somalia). She never used family planning, for none is available within several days’ walk. When her eighth child was still an infant, she became pregnant again.
“I was happy when she became pregnant,” said her husband, Muhammad Isse, who tends a herd of 13 camels with his family. “I was very happy, because I had faith in God.”
When Ms. Hassan went into labor, she was looked after by two traditional birth attendants, both of them unschooled, untrained and unequipped. “We try to wash our hands with soap and water,” one of them, Amina Ahmed, told me. “But sometimes we don’t have soap. And if there is no water, we rub our hands in the sand to clean them.”
Ms. Hassan’s labor did not go well. After 11 hours, her husband paid a man with a pickup truck $50 to drive her three hours to the clinic here in Baligubadle. The clinic couldn’t help Ms. Hassan and sent her on another two-and-a-half-hour bone-rattling drive in the back of the pickup to the Somaliland capital of Hargeisa. Shortly after Ms. Hassan arrived at the Edna Adan Maternity Hospital (mentioned in my last column), she died.
Her death was infuriatingly unnecessary — and I felt doubly saddened when I met some of her eight orphans.
There are any number of ways that Ms. Hassan’s life could have been saved. She had an off-the-charts hemoglobin level of just 4, reflecting a stunning level of anemia. A trained midwife could have given her a deworming pill and iron supplements early in the pregnancy, addressing that anemia and strengthening her. Later, Ms. Hassan developed a complication called eclampsia that would have been detected if she had had pre-natal care.
Yet maybe the simplest way to save her life would have been contraception. If Somali women had half as many pregnancies (they now average six births), there would be only half as many maternal deaths. But modern contraception doesn’t exist in this part of Somaliland.
“The only method of family planning we have is breast-feeding,” said Nimo Abdi, the midwife at the clinic here, noting that breast-feeding reduces the likelihood of a new pregnancy. Ms. Abdi thinks that some local people would accept modern contraceptives if they were available.
“If I had injectables and condoms, people would accept them,” she said. “They would want them.”
I wonder if that isn’t a bit optimistic; in a place like this, family planning requires much more than just handing out contraceptives. Ms. Hassan’s husband told me that he had never heard of contraception, and he sounded wary of the idea.
Many people in poor countries want large families, partly to ensure that some will survive despite high death rates. Or a woman may distrust contraceptives or fear her husband’s reaction if she is caught using them.
By United Nations estimates, 215 million women worldwide have an “unmet need” for family planning, meaning they don’t want to become pregnant but are not using effective contraception. The Guttmacher Institute, a widely respected research organization, estimates that if all the unmet need for contraception were met, the result would be 94,000 fewer women dying of pregnancy complications each year, and almost 25 million fewer abortions each year.
Greater access to birth control would also help check the world population, which the United Nations warned a few days ago is rising more quickly than expected. The U.N. now projects the total population in 2100 will be 10.1 billion.
Yet this year, Republicans in Congress have been trying to slash investments in family planning. A budget compromise last month cut international family planning spending by 5 percent, but some Republicans are expected to seek much bigger cuts in future years.
If they succeed, the consequences will be felt in places like this remote Somali town. Women won’t get access to contraceptives, and the parade of unwanted pregnancies, abortions, fistulas, and mothers dying in childbirth will continue.
Ah, but there was one Republican-sponsored initiative for family planning in Congress this year. It provided contraception without conditions — for wild horses in the American West. It passed on a voice vote.
Maybe on Mother’s Day, we could acknowledge that family planning is just as essential for humans as for horses.
 

Too Much Sex? No Such Thing — Why Sex Addiction Is Total B.S.

Raymond J. Lawrence

The idea of sexual pleasure as a harmful addiction parallels the most perverse aspects of Western religious history.
American befuddlement over matters of sex is on the increase, in spite of the fact that one can hardly imagine the subject becoming more befuddling to the people of this country than it already is.

Sex addiction is the latest star in America’s sexual burlesque. Sex addiction has of course been a malaprop from its first usage. Addiction was originally and properly defined as a physiological dependence on a substance to which the body had grown accustomed, such as alcohol, nicotine, heroin and various other drugs. The cure was to end the dependency and abstain from further use of the substance in order to avoid a recurrence of the physiological dependency. These treatments do work and many people have been cured of their addictions and never returned to the addictive substance.

Applying such a metaphor to sexual pleasure creates a misleading and ominous innuendo. Sex is not an addictive substance. It’s a human interaction on which the survival of the species is dependent. It is also possibly the most pleasurable and sought after activity known to humankind, and arguably an experience no one should be deprived of. Most normal people consider more rather than less sexual pleasure to be a major objective in life.

Following the substance abuse mode implies that the only cure for an addiction to sexual pleasure would be a celibate or monastic life, a complete renunciation of the alleged addictive sexual pleasure.

The very idea of sexual pleasure as a harmful addiction plays precisely into the hands of one of the most perverse aspects of Western religious history, namely the teaching that sex is a work of the devil redeemed only by the act of procreation itself. Reliance on the notion of sex addiction in counseling and psychiatric treatment is ominous.

Christianity as a world religion has much to commend it on balance. Nevertheless, its posture toward sexual pleasure has been abysmal. In that respect it should be noted that Christianity, of all the major world religions, is the only one to cast sexual pleasure in such a negative light. Never mind that Christianity’s distaff side – Protestants and others – challenged such negativity toward sexual pleasure. They were eventually and unfortunately drowned out in the debate. It is no coincidence that currently the most Christian of nations, the U.S., is also the most negative toward sexual pleasure. (And at the same time the most confused sexually.) Europe as gone blessedly post-Christian.

We must suspect that the sex addiction proponents unconsciously wish to rebuild something like the medieval Christian social order where virtually every cultured and literate person was bereft of sexual pleasure for life, save for sexual pleasure in the service of procreation

Some psychiatrists are now getting into the fray, offering treatment for sex addiction. However, the Bible of psychiatry, the Diagnostic and Statistical Manual of Mental Disorders (DSM), is currently being prepared for its 5th edition, and is wisely declining to introduce sex addiction to its manual. It does, however, come close by introducing the category of hypersexuality as a mental disorder. This neologism is the editors’ own special, and arguably less troublesome, substitute for sex addiction. But as the saying goes, it walks like the proverbial sex addiction duck.

The pundits are now weighing in on the new DSM 5. Allan Frances in The Los Angeles Times is worried that philanderers and rapists will now be able to claim mental illness as a defense of their anti-social behavior and thereby escape punishment. George Will in The Washington Post astutely raises the problem of medicalizing the assessment of character, which he unaccountably blames on liberals. I thought I was a liberal, but I’m as concerned as Will about defining character or the lack thereof as a burden of psychiatric diagnosticians. And by extension, character as an expected outcome of proper medication.

So now according to the working version of the new DSM-5, psychiatrists will be able to assess whether one is having too much sex, or even whether one simply wants too much sex. Or too little. They will presumably have some kind of measuring rod to determine what is too much or too little.

This new project, of assessing who might be wanting or getting too much sexual pleasure, or too little, should create many more jobs for psychiatrists. We’ve been needing something to improve the job market. Maybe this will do it. Perhaps psychiatry will now join hands with the worst elements of Christianity and recreate the medieval Christian dream, a world where the only sexual pleasure allowable is that accidentally associated with the desire to procreate.

Raymond J. Lawrence is an Episcopal cleric, recently retired Director of Pastoral Care, New York Presbyterian Hospital, and author of numerous opinion pieces in newspapers in the U.S., and author of the recently published, Sexual Liberation: The Scandal of Christendom (Praeger). He can be reached at: raymondlawrence@mac.com
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