Our Daughter's Bedrooms

Yes, as anticipated, graduate school is kicking my butt. I don't know how often I'll be able to post. But when I can, I will draw your attention to stuff I think is worthwhile. Like this new book by Joyce McFadden. It's called Our Daughter's Bedrooms. The book emerged from McFadden's mental health care practice. Following up on trends she was seeing among her patients, she launched the Women's Realities Study, in which she interviewed hundreds of women from 18 to 105. Three major themes (which will not surprise you) emerged from this study: masturbation, menstruation, and relationships with mothers. McFadden found that women's relationships with their mothers profoundly influenced the development of their sexuality: their self-confidence, their feelings about their bodies, and how they deal with challenges around sexuality and fertility throughout their lives. Her book discusses the development of sexuality within the context of the mother/daughter relationship and sets out a model for how we can nurture girls and raise healthy, confident women who are comfortable with themselves as sexual beings.

You can watch a video of McFadden discussing the book on her website (link above). And, if you're in NYC, you can catch her doing periodic speaking engagements. She'll be at Bluestockings on Tuesday, September 13th, at 7PM. Bluestockings is at 172 Allen Street at Stanton (on the Lower East Side). 

Ilene is on Hiatus!!!

As some of you know, I will be starting a full-time, two year master's degree program in September, in social work. And, just to make things more exciting, I'm also moving (both home and office, because I work at home). Therefore I am going on hiatus. Actually I am already on hiatus, at least as far as teaching is concerned. I have already begun to refer new clients to other teachers. I'm not sure how long the hiatus will last. I'm going to see how things unfold. 


I will continue to be involved in Fertility Awareness, but mostly in ways that won't be obvious to the general public. In addition to teaching, I do a lot of behind the scenes stuff having to do with Fertility Awareness as a profession. Although there are a few paths to professional certification, there are no national or international standards in place regarding qualifications to teach. Anyone can call herself a teacher (or sell fertility-management software). And of course practitioners in the field find little or no support from the medical community, and are often isolated in their own communities because qualified, secular (non-religious) instructors are so few and far between. Thus it can be difficult for them to find peer support and to grow as professionals.


I have been involved in the issue of professionalism in this field since I began teaching 10 years ago. I will be focusing on this work in the coming year, by expanding and strengthening our professional network, and by creating what I hope will be a widely recognized set of standards. I will also continue to coordinate professional forums through which people involved in the field communicate with and learn from each other. So, in the coming months I will be primarily involved in those activities. I will leave the teaching, at least temporarily, to others. 


One of the things I've been focusing my energies on this past year, as I prepared to make this transition, has been the training of new teachers. I've had the privilege of working with several young women who are well on their way to becoming qualified instructors, with a wide range of interests and areas of concentration. They will continue their training with Oregon instructor Sarah Bly, and I look forward to introducing you to them in the future as they embark on their teaching careers.


I have also been working with Sarah on another project which I think at this point is still a secret :) I will tell you all about it once it's ready to go public.


And actually I've been working on another project having to do with Fertility Awareness that is also not quite ready for launch; that's something else I hope to share with you in the near future. 


Ok, so maybe "hiatus" isn't the right word. I guess it's more like "scaling back." 


So, if you are reading this, and you are in need of instruction, what should you do? Here are my suggestions:


--If you want to obtain instruction in a secular context, the Justisse website lists many qualified FA teachers, including graduates and current students of their own teacher training program. Make sure to pay attention to the various designations. I would suggest sticking to FAE's and full (graduated) HRHP's. A lot of teachers can work by phone or by Skype these days, so don't worry if there is no teacher in your area (and there probably isn't).
Justisse directory of instructors


--Not on the list, but worth considering, are:


Katie Singer (author of Garden of Fertility)
New Mexico
(505)820-0773
You will need to have read one of her books if you want to make an appointment with her.

Sarah Bly
Oregon
www.graceofthemoon.com

--Please mention my name if you contact any of these instructors so they know where the referral came from.

--Of course if you're open to studying Natural Family Planning (NFP), as opposed to FAM, you'll have many more instructors available to you, including some from whom you might be able to learn in person (as opposed to long distance). NFP is in many ways the same as FAM, but is taught in a religious/moral context. Sexual activity outside of marriage (and certainly same sex activity) is considered unacceptable, as are all forms of "artificial" contraception and abortion. The main NFP organizations in the US are the Couple to Couple League and the Billings Ovulation Method Association. Their websites can direct you to local teachers. Be aware that NFP teachers often have fairly rudimentary training and may not be able to advise you with respect to complex or health-related issues.

I will miss teaching like crazy, but I am also very excited about all the new developments in my life. I plan to keep updating the blog and the Facebook page, though probably not as often as I do now. As always, I invite you to keep in touch with me. Having a baby? I would love to hear about it! Moving? Send me your new coordinates! My coordinates, by the way, will probably remain the same. The email address will definitely stay the same, and I think the phone number will, too. If not, I'll let you know. 


Enjoy the rest of the summer. 

Two Good New Books About Your Down There

You've heard this before: there are so few realistic images of women's bodies, and so many images of airbrushed, surgically-altered women, that most women have no idea what normal is, and often think that they are abnormal, unattractive, etc. Although the problem is pervasive when it comes to women's overall appearance, it's even more acute when we consider women's vulvas. Aside from images in pornography, many women have never seen another woman's external genitalia. And just as our breasts don't look like porn star breasts, our genitals don't look like porn star genitals.

A few women (and men) have taken matters into their own hands. I've written many times about Alexandra Jacoby's vulva portraitraiture project. Now there is a new book, out of Canada, which essentially tackles the same idea. By showing each other what we look like, we can come to understand that variety is normal, and beautiful. I'll Show You Mine consists of 120 portraits of 60 women, all in exactly the same 2 poses (frontal and with legs spread), along with text written by the women about their relationships with their vulvas. The women are fairly diverse, ranging in age from 19 to 60, with varied backgrounds and lifestyles. They comprise a range of ethnicities and sizes; there is even a trans woman. The book is beautifully produced, in an environmentally sound manner, and 10% of proceeds go to women's charities. And as with so many media products these days, there is a highly interactive website to accompany it. The book is mainly available in Canada. If you're in the US or elsewhere, you'll probably need to order it by mail from their website. 


I've also been very impressed by a new book that deals in a straightforward, cogent way with a problem that many women have, but few women talk about. The book is called When Sex Hurts: A Woman's Guide to Banishing Sexual Pain. Although there are many causes of genital pain in women, we generally divide them into two broad categories. Vulvodynia means "pain in the vulva" and is considered a chronic pain condition, though the pain may be constant, intermittent, or primarily provoked by touch. Dyspareunia ("dis-pah-roo-nee-ah") refers to painful intercourse. Just as women tend not to discuss their feelings of shame or inadequacy around the appearance of their genitals, they rarely talk about their vulvar pain, even with their doctors, who can be dismissive and/or ignorant. The authors estimate that up to 40% of women with these pain conditions don't seek medical care, and those that do will often end up seeing many different practitioners before obtaining a diagnosis, if they receive one at all. The book is written by 2 doctors and a psychologist, and I found their approach to be smart, frank, understanding, and hopeful. Women with these pain conditions can become very depressed and disempowered. While this book will never hit the best-seller list, I hope that many women who need it will find it.  

India's Girls Are Being Decimated

Most people who use the word "decimate" do not understand its true meaning or origin. They use it to mean a wiping out, a massive defeat, or a natural disaster. The tornado decimated Joplin, Missouri. In reality, it means the slaughter of 1/10 of a population. Decimation was used as a form of military punishment for cowardice in Roman times, and occasionally thereafter. So there aren't too many instances in which one can correctly use this word. But the appalling truth is that it can accurately be applied to many parts of India, where one in ten female fetuses is now being selectively aborted.

You may be familiar with this phenomenon from China, where the one-child policy, along with a preference for males, has been a major contributing factor to a skewed birth ratio. In a normal human population, slightly more boys are born than girls, with ratios ranging from around 103 to 109 males born for every 100 females. This naturally leads to a roughly 1:1 ratio of adults. But in countries such as China and India, where sex-selective abortion and infanticide occur, this ratio can become extremely skewed. In 2005, the ratio in China was at 119 to 100, and in some parts it had reached the astonishing imbalance of 130 males to 100 females. It is estimated that some 24 million Chinese men will be unable to marry when they reach adulthood around 2020, because their potential brides were selectively aborted.

India has apparently learned nothing from China's example, and although education and income levels have been rising in India, so too has the problem of selective abortion. In fact, according to a new study, it appears that the phenomenon is actually directly linked to affluence and education: educated, well-off women are far more likely to obtain an ultrasound and abort a female fetus. Thus, the latest Indian census found a ratio of 914 girls for every 1000 boys, which is the most imbalanced since India gained independence in 1947. Girls in India are literally being decimated.

The total numbers are staggering: in the last 30 years, it is estimated that between 4 and 12 million Indian females have been selectively aborted. Of course, the practice of using ultrasound to determine the sex of a fetus in order to selectively abort is illegal in India, but until deeply held cultural beliefs are changed, the laws are essentially meaningless. So-called "honor killings" are also illegal in India, yet a 2010 study found that 1000 people per year were being murdered by their family members for bringing "disgrace" to their family.

Here are a couple of recent articles which discuss the phenomenon of sex-selective abortion in India, as well as a link to the original study from which these articles were drawn:
-As Wealth and Literacy Rise in India, Report Says, So Do Sex-Selective Abortions  
-Earlier article on same topic, also from NY Times, with more social context
-Original study published in The Lancet 

Note: An earlier version of this post contained a typo regarding the Indian birth statistic. 

The Happenings, the Non-Happenings, and the Future of Fertility Awareness

This post is late! Here's what's been happening, with backstory:

I am currently working with some wonderful, talented women who are on the path to becoming teachers of Fertility Awareness. I think an important part of the teacher-training process is being connected to, and learning from, other Fertility Awareness educators. So when my Israeli colleague Michal Schonbrun told me that she would be coming to NY for a couple of days in May, I asked her if she'd be willing to spend a few hours working with my students. She readily agreed, and somehow that idea grew into a two day event. One day was for teacher training, just for my students: Michal in the morning, and me in the afternoon. We also decided to create a public event. That event was to have centered around an introduction to Fertility Awareness (my presentation), and also was to have included presentations by two artists who do incredible work related to fertility and sexuality. The artists are Alexandra Jacoby, whose work I've mentioned & written about before, and Rebecca Morton (whose website is nearly complete, I'm happy to say).

So we poured a lot of time and energy into creating both these events, and my last blog post was to have been in late April, promoting the public one. But about a week beforehand, we decided to cancel the public event, due to poor ticket sales. We were all very disappointed, of course, but there came a point where we had to make a tough decision, and that's the one we made. I see again and again how people who know about Fertility Awareness tend to be quite passionate about it, but people who don't know about it tend to be indifferent. FA is a hard concept to get your mind around, since we're not used to thinking about fertility management, or body literacy. We think about birth control, until and unless we're ready to get pregnant. Then we think about pregnancy achievement. And we hardly ever think about empowerment around our sexuality or reproductive health care, unless something goes wrong. In short,  we don't have a holistic approach to our bodies in general, and much less so when it comes to our fertility and sexuality. So, Fertility Awareness, which offers a comprehensive approach to fertility, sexuality, and reproductive health care, is off the radar for most of us. It just doesn't fit neatly into the boxes we're used to ticking off.

So we cancelled the public program, but proceeded with the teacher training day. And that was a big success! I look forward to introducing you to each of these women as they get closer to actually teaching. There are so few qualified, secular teachers of Fertility Awareness in the US. My colleagues and I are actively working to make sure that there are new, younger teachers to carry on this work in the future. It may never be "popular," but it's life-changing stuff, and we want to ensure that personalized, non-religious instruction will always be available to those who need it. Charting on your iPhone is convenient, of course, and I think keeping track of your data electronically is a great idea, especially as our devices become more entwined with our lives. But electronic charting will never eliminate the need for personal instruction. When your smartphone can discuss with you the relative benefits of progesterone supplementation vs. Traditional Chinese Medicine for luteal phase defect, or how to assess if you can have unprotected intercourse up to day 3, day 5, or using the formula S-21, or helps you negotiate when to start trying for pregnancy when your partner is on the fence, or does any of the myriad other things that only a human teacher can do for you, you let me know, and I will take a nice long holiday.

By the way, in anticipation of the public event, I finally got the Facebook page for the Fertility Awareness Center up and running. It's been pretty active thus far. In fact, I think eventually it might supercede this blog. So if you're on Facebook, please "like" us. You'll be rewarded with more frequent postings, news of events, links to like-minded orgs, and photos. And of course you'll be part of a community of other FA devotees.

Orgasm, Inc. Also Heads Up re Upcoming Event.

Have you seen Orgasm Inc. yet? It's still playing around the US and Canada, and of course it's available on Netflix. This funny, insightful documentary is about the medicalization of female sexuality, and the enormous profits to be made at the expense of women's health. Filmmaker Liz Canner centers her film on the race to develop and market a drug to treat something which is essentially a made-up disease, "Female Sexual Dysfunction,"  and explores the range of what one reviewer called "the commodification of women's pleasure centers," including the relatively new and extremely lucrative field of vaginoplasty. (Grrrr...) You can read more about the film and find a list of "playdates" here.



Unrelated but important heads up!
The Fertility Awareness Center will be having a public event on Sunday, 5/1, in the afternoon, in Brooklyn. There will be an intro to Fertility Awareness (for those who are interested in, but not yet practicing FA), and presentations by two artists whose work is sure to provoke conversation. More information coming soon. Tell your friends! Save the date!

Two Drug Warnings for Pregnant or TTC Women

Wanted to let you know about a couple of drugs which pose significant risks to women and their fetuses.

Terbutaline is an asthma drug, available in oral and injectable form. For many years, it has been used "off-label" to prevent or delay pre-term labor, a use for which it was never approved. Despite evidence that the injectable drug doesn't have any benefit after being given for 3 days, and that the oral form of the drug doesn't work at all for this use, some women are still being given the drug in ways which simply don't work, and suffering cardiovascular events as a result. At least 16 pregnant women are thought to have died from the unapproved use of Terbutaline. The FDA has finally stepped up to the plate and now requires Terbutaline to carry a "black box warning" in order to prevent further deaths and injuries.

Here are the new guidelines and warnings re Terbutaline.

Topiramate (brand name Topamax) is a drug used for treatment of epilepsy and prevention of migraines. It is also used off-label for treatment of bipolar disorder. The FDA recently reclassified it as a Pregnancy Category D drug, meaning that it has been demonstrated to pose a risk to fetuses, but that in some cases the benefits to the pregnant woman may outweigh the risks to her child. The FDA took this action after evidence that Topiramate significantly increased the risk of a child being born with an oral cleft (cleft lip or cleft palate).

Here is some info from the FDA re the new risk assessment of Topiramate in pregnancy.

Ina May Gaskin teaching & discussing new book, Birth Matters, in US & Canada. Free event in Brooklyn!

Ina May Gaskin has a new book out and will be making some appearances, and teaching, in NY and elsewhere in the next few months. Ina will be discussing and signing copies of her new book, Birth Matters. She will also be giving a couple of workshops. Some of the events, including the one in Brooklyn, are free. This is an amazing opportunity to hear from one of the pioneers in midwifery live and in person. You can find a list of her upcoming events on the Seven Stories Press website. Here is info about the event in Brooklyn:


Sunday, March 6, 5PM
WORD presents Ina May Gaskin 

Warsaw, at the Polish National Home

261 Driggs Ave, Greenpoint/Williamsburg Brooklyn
L train to Bedford Ave; G to Nassau Ave


And here is some info from the publisher about Ina's new book:  "Birth Matters: A Midwife's Manifesta  (Seven Stories Press; April 2011) explains why birth is an issue that concerns us ALL. With one in three babies born via cesarean, the US ranks behind thirty other nations in neonatal mortality rates, and forty other nations in maternal mortality rates.  Amnesty International recently released a damning report titled “Deadly Delivery: The Maternal Health Care Crisis in the USA,” which outlined various failures in the way the US health care system treats pregnancy and birth. Confidence in women’s bodies and women’s choices has been lost. Birth Matters is a spirited manifesta showing us how to trust women, value birth, nurture families, and reconcile modern life with a process as old as our species."

Men: When Trying to Conceive, Don't Ride Bike to Supermarket to Buy Canned Food

Couple of recent studies re things that are bad for male fertility. One, easy to avoid. One, not so much.

In the "You actually got money for this research?" department, we have a study which showed that men who bicycle for at least 5 hours a week have lower sperm counts and poorer sperm motility than men who don't. Here's the original study abstract, for those who like to see the numbers.

And in the more insidious news department, we have yet another study showing that BPA, which the FDA refuses to ban, causes endocrine disruption. This study, the third of three examining the effect of BPA on male sexual function and fertility, showed a reduction in semen quality in men with higher levels of BPA in their urine. BPA is found everywhere, from food packaging to sales receipts to dental sealants. And, increasingly, in our bodies.

Sperm scene from "Everything You Always Wanted to Know About Sex." 

Are We Confused Yet?

If you're confused about how to take care of yourself (and your children), I don't blame you. The public health community seems to change their opinion every 5 minutes, about everything from mammograms to optimal vitamin D levels. And now, they can't seem to agree about how long mothers should exclusively breastfeed. Mind you, no one is talking about whether or not "breast is best." That hasn't changed. What is up for debate, however, is when solid foods should be introduced.

In 2001, the World Health Organization (WHO) established a guideline, advocating 6 months of exclusive breastfeeding in both industrialized as well as developing nations. This guideline continues to be borne out by research. For example, in early 2010, a study was published in the journal Pediatrics which showed that exclusive breastfeeding to 6 months was healthier than to 4 months, in terms of reducing infectious diseases. But now a group of scientists, publishing in the British Medical Journal, are saying that health issues that were not taken into account at the time of the WHO's guidelines need to be considered, and that in fact exclusive breastfeeding past the age of 4 months is more detrimental than beneficial. Harmful effects include an increased risk of celiac disease, as well as iron deficiency.

I'm guessing that this is going to stir up some controversy.