De-Queering the Fetus

recent article by Alice Dreger, Ellen K. Feder, and Anne Tamar-Mattis documents the controversial application of prenatal dexamethasone in pregnant women. The impetus for this pharmacological therapy is to stop virilization in female fetuses that may be affected by a form of congenital adrenal hyperplasia (CAH) called 21-hydroxylase deficiency or 21-OHC CAH.

Don’t allow the medical jargon to turn you away from what’s taking place here: the steroid is administered to pregnant women with the goal of stamping out intersexed bodies while ultimately minimizing the likelihood that a female will grow to be butch, lesbian, bisexual, and/or transgender. Yes, you read that right. This is an ongoing medical project that is motivated by homophobia, transphobia, sexism, and cissexist ideals. Let’s back up a bit and unpack some of the medical jargon that complicates our understanding of systemic hate.

CAH is a disease of the endocrine system (the hormone regulating mainframe of the body). There are variations of CAH and the one of interest here is 21-OHC CAH. 21-OHC CAH leads to an over production of androgens, which could lead to a genetic female fetus “developing along a more masculine pathway neurologically and genitally” (5). The term for this masculinization is virilization, which manifests in many ways but can lead to masculinized female genitalia, of which is a surface motivation (e.g. justification on grant applications) for the use of prenatal dexamethasone. CAH is a serious disease and as such, every U.S. state requires that newborns be screened for it. However, at case here are fetuses that may be affected by CAH, not newborns that are affected by it. The authors expose that 87.5% of those fetuses that are exposed to prenatal dexamethasone stood no chance to benefit from the therapy at all.

Prenatal dexamethasone is a steroid that is theoretically used to stop the effects of 21-OHC CAH. However, the drug is experimental and there is no substantial support for its use. In the U.S. it is categorized as “off-label,” which means that it is not FDA approved. As it stands, there is very little known about the impact of the therapy but it may alter “fetal programming,” which can result in serious metabolic problems that may not be apparent until adulthood. For 30 years, the steroid has been used to combat virilization in female fetuses and yet, little is known of its impact because there are few long-term studies that explore its impact—of those, the populations are not representative and the protocol does not meet national or international scientific standards. In fact, the Endocrine Society set up a task force to look at the effectiveness of the pharmacological therapy. The task force found very little support for the use of the steroid and “could not even say with confidence whether prenatal dexamethasone works to reduce genital virilization” (2).

Nonetheless, it has been administered to pregnant women on false pretenses. The pregnant women were/are not informed that the “off-label” steroid is experimental, that benefits and risks have not been established due to lack of adequate testing and scientific protocol, and that exposed fetuses are studied retrospectively effectively rendering moot any correlation between the drug and the fetus born one way and/or raised another.

The “most prominent promoter” of this therapy is Maria New, a pediatric endocrinologist at Mount Sinai School of Medicine. By 2003, New has “treated” more than 600 pregnant women with dexamethasone in order to prevent virilization in CAH-affected female fetuses. That number is as high as 2,144 fetuses. This is where the story turns sour and scary—or more sour and scarier.

Despite a lack of support for prenatal dexamethasone Maria New insists that it “has been found safe for mother and child” (15-16). The authors of the article do some bold investigative work and turn to New’s grant applications discovering some interesting motivations for the continued use of the steroid.

Those few studies that do exist show that girls affected with 21-OHD CAH exhibit “behavioral masculinization.” These girls are on average “more interested in boy-typical play, hobbies, and subjects that non-affected females, less interested in becoming mothers, and more likely to grow up to be lesbian or bisexual” (6). Some clinicians find that of those females with 21-OHD CAH, 5% may ultimately identify as male. “Behavioral masculinization” is a euphemism for non-traditional gender performance or expression in women, females, and/or girls. It seems that the underlying motivation has less to do with ambiguous genitalia (which is problematic itself) and more to do with minimizing “tomboyism,” non-heterosexuality, and trans* embodiment.

Interestingly, the U.S. National Institutes of Health have funded Maria New’s work in figuring whether or not prenatal dexamethasone works to stop “behavioral masculinization.” Said another way, the U.S. government funds New’s work in stopping queerness and/or trans*ness in those potentially affected with 21-OHD CAH. Please, read that again for the sake of letting it sink in.

One justification for using prenatal dexamethasone is to minimize the chances of having a child that is intersex so that “corrective” surgeries will not be necessary. However, such “corrective” surgeries are elective and yet this reason is used as grounds to administer this potentially dangerous drug.

The unknown effects of prenatal dexamethasone are as potentially damaging and traumatic to intersex bodies as invasive “corrective” surgeries that claim to “fix” a problem when the problem isn’t the fetus at all. The inspiration for this pharmacological therapy is stigma and anxieties surrounding intersexed and/or queer bodies. It is a medical intervention that works to ensure the production of relatively normative bodies no matter the cost to those that are at risk of teetering between cissex and intersex embodiment. The anxiety/fear-inspired application of prenatal dexamethasone points us to the intersection of sex, gender, and sexuality and those systems that work to keep them aligned more nicely.

Speaking to parents of children with CAH, Maria New “showed a picture of a girl with ambiguous genitalia and said: The challenge here is to see what could be done to restore this baby to the normal female appearance which would be compatible with her parents presenting her as a girl, with her eventually becoming somebody’s wife, and having normal sexual development, and becoming a mother. And she has all the machinery for motherhood, and therefore nothing should stop that, if we can repair her surgically and help her psychologically to continue to grow and develop as a girl” (italics mine 6).

For New, the prominent cheerleader in prenatal dexamethasone therapy, girl/female/woman are one and the same and are heterosexual desiring motherhood and marriage. For New, queer variation is inconceivable. For New, prenatal dexamethasone is the ultimate in conversion therapy because it gets at the “problem” before it is a problem. It does so even though the long-term impact is unknown and potentially fatal. New, and her supporters, will do whatever it takes to ensure that queerness is squashed at every chance. For the record, you can contact Maria New at maria.new@mssm.edu.

Remembering Dr. Robert Kinch

Editors’ Note: This is the first post in our series “A Season of Gratitude.” We’re all grateful for the the work of heroes like Dr. Kinch. To read more articles in this series, click here.

The name Dr. Henry Morgentaler is synonymous with pro-choice in Canada, but Dr. Robert Kinch was also instrumental in securing women’s rights as his colleague. Born in Iraq in 1920, Dr. Kinch immigrated to Canada with his family in 1949 after seeing a billboard advertising “Ontario Wants You.”

Dr. Kinch launched his career as an obstetrician and gynecologist in Toronto. In 1968 he moved to Montreal as Professor of Obstetrics and Gynecology at McGill University, eventually becoming chief of Obstetrics and Gynecology at the Royal Victoria and Montreal General hospitals. He was appointed chairman of the Department of Obstetrics of Gynecology at McGill in 1979.

Beloved by his patients, Dr. Kinch delivered thousands of babies while determinedly championing maternal health and the advancement of sexual education.  [Read more...]

Dr. Henry Morgantaler is a Hero of Canada

Today’s post comes to us from Pedgehog, who usually blogs over at Anti-Choice is Anti-Awesome. Pedgehog works at a Morgantaler Clinic in Toronto, Canada.

In 2005, Dr. Henry Morgentaler was given an honorary Doctor of Laws degree from the University of Western Ontario. If you are not Canadian, chances are you don’t know what any or all of that means. Neither did I, at the time.

I remember when it was in the news that Dr. Morgentaler would be receiving the degree, because we were discussing it at the dinner table. A friend of mine was attending UWO (or ‘Western’ as it is more commonly known) at the time and her mother objected to the famous abortion provider being honoured there. All I knew about Dr. Morgentaler was that he had something to do with the legal status of abortion in Canada. I had no interest in the pro-choice movement at that point, having only just begun to discover my feminist self.

My father was firm in his support of the honorary degree, and in an uncharacteristically passionate outburst, he declared: “Henry Morgentaler deserves that degree, and an Order of Canada on top of it! That man has done more than anyone else for women’s rights in this country.” [Read more...]

Dr. Willie Parker Explains Why Abortion is Basic Health Care

Feminist Conversations is a weekly series at Feminists For Choice.  We spotlight activists from across the interwebs to find out what feminism means to them. Willie J. Parker, MD, MPH, MSc, is the Medical Director of Planned Parenthood Metro Washington, and a board member of Physicians for Reproductive Choice and Health (PRCH). We met earlier this year at a reception for Carole Joffe, and he has graciously agreed to be interviewed by me twice: first for my book Generation Roe, and now for Feminists for Choice.

1.  When did you first call yourself a feminist, and what influenced that decision?
That’s an interesting question. Long before I knew what to call myself, I realized that I had a compulsion around working on fundamental issues of fairness across gender lines. As I pursued my consciousness-raising, I came across a simple book by bell hooks called Feminism is for Everybody. In it, she simplifies the fact that feminism is less about biology than it is about how one perceives and operates in the world regarding issues of gender fairness. As I look back, I conclude that while I have been working for gender-neutral equality for a while, I have self-described as a feminist since reading that book about six years ago.

2.  What does feminism mean to you?
Feminism for me is the worldview and effort toward equality based on neutralizing differences in life chances based on gender. I look at feminism as a specific context in which to pursue human rights. I like the definition that I once saw on a bumper sticker: “Feminism is the radical notion that women are human beings.”

3. What led you to become an abortion provider? [Read more...]

Fierce Feminist Takes Campus Activism to New Heights

Feminist Conversations is a weekly column at Feminists For Choice, where we talk to feminists from across the interwebs to find out what feminism means to them. Today we are speaking with Feminists for Choice writer Andrew Jenkins. AJ is a full time student at CSU Long Beach double majoring in Communications and Women’s & Gender Studies. He is vice president of the Speech & Debate team and Director of the first Choice USA chapter at CSU Long Beach. AJ is currently interning in the public affairs department at Planned Parenthood Los Angeles and is also in the middle of a yearlong fellowship with Young People For. AJ is also the Communications Director at Textbooks4change, a student-led fundraising program that enables college students to raise money for progressive causes through textbooks purchases.

1.  When did you first call yourself a feminist, and what influenced that decision?
Although I have always held very strong feminist values at my core, I didn’t really start calling myself a feminist until I was a freshman in college. To be honest, I didn’t even know that feminism existed prior to that. Growing up in such a conservative community removed me from all things progressive, let alone feminist. Despite the values instilled in me from a very early age, I didn’t have a feminist language and worldview quite yet. That changed when I left for college. After years of internalizing my queer sexuality, I finally decided to come out of the closet when I arrived in Long Beach. This experience, both internal and external, is what really brought me to feminism. I began to see connections between my own personal experiences of homophobia and the exploitation that women face on a daily basis. This pushed me to look deeper into what social and political structures shape human relations and it is precisely this journey that brought me to feminism and gender studies.

Once there, I finally had a language to describe a feeling and a sense of self that I had always had.

With that being said, I have to credit my mother for really showing me, through her actions, struggles, and triumphs, what feminism really means. Her balancing of motherhood and professional adventures really showed me what women are capable of. Her successes, despite all of the odds against her (ie: single motherhood, wage discrimination, a history of domestic violence) are what really informed my feminist politics. [Read more...]

Clinic Escort Explains Why Men Must Get Involved in Pro-Choice Movement

Feminist Conversations is a weekly column here at Feminists For Choice. We spotlight activists from around the country to find out what feminism means to them. Today we’re talking to Henry Howard, a long-time anti-war and and reproductive rights activist, originally from New York, who is now a writer in Los Angeles. Henry is a member of World Can’t Wait and the National Organization for Women.

1. When did you first get involved in clinic defense, and what influenced that decision?
I first got involved in clinic defense in November, 1989, when Operation Rescue decided to make Los Angeles its first national battleground. I was active in every major defense from then until 1992, when Operation Rescue folded its tents and finally left L.A. alone. Next they focused on Wichita, KS and Dayton, OH, throwing themselves by the thousands at Dr. Tiller’s clinic, and clinics in Ohio, for weeks at a time. I was not part of those national campaigns, but I went to Wichita in 2000 to defend Dr. Tiller, and last summer to Bellevue, NE to defend Dr. Lee Carhart. I would have to say that Dr. Curtis Boyd will probably be Operation Rescue’s new public-enemy #1, and we will eventually be required to stand in front of his clinic, too.

As for what got me involved in clinic defense: it was really a natural evolution of my activism in the women’s movement, which I date back formally to 1980 and the ERA campaign. I have always been unrelentingly pro-choice; I believe abortion rights are a red line in the sand that must never be crossed again in this country. I have met too many survivors of back-alley abortions, refugees from a time in this country when to be a woman daring to exercise her own biological destiny meant seeking out an underground world that often lead to her death. My own mother had two illegal abortions before I was born—both without anesthesia. [Read more...]

Beyond Ovaries: Is there Room for Men in the Pro-Choice Movement?

The answer is obvious for a gay-prochoice-feminist such as myself. However, it seems like it’s a bit more complicated than that. During last weeks controversial debate in Florida’s house of representatives over a staunch anti-choice ultrasound law, Democratic Representative Janet Long commented to her colleagues to, “Stand down if you don’t have ovaries.” On face, I applaud this comment. I think it’s important to recognize, especially as an arbiter of male-privilege, that women have been marginalized in traditional legal discourse on abortion rights. Not to mention the fact that women are the one’s forced to give birth to an unwanted fetus. However, I find it problematic to assume that men have no responsibility or role in advancing reproductive justice in the United States. Jacob Appel, at The Huffington Post, points to some of the consequences this alienating rhetoric can have for the pro-choice movement.

The underlying premise seems to be that since women are the ones forced to bring unwanted fetuses to term when abortion rights are curtailed, they have a greater stake in the outcome of such debates–and therefore more right to influence policy on the subject. I can sympathize with the frustration that might lead to such an outlook. At the same time, as someone without ovaries who has written and marched for reproductive freedom through my entire professional life, and who has been threatened repeatedly as a result, I fear the ongoing effort to frame the abortion debate primarily in gender terms remains both politically unwise and ethically unsound. Rather than urging men to stand down, abortion-rights advocates should reach out to convince men that they have a deep and equal stake in preserving reproductive choice. [Read more...]

Redefining Masculinity: Are Feminist Men Getting the Job Done?

protesting violence - cartoonThis has been an exciting week when it comes to men, masculinity, and feminism. From so called “men’s rights” groups, to male feminists strategizing about ways in which masculinity can be redefined; the male-feminist hype has definitely surfaced. I’ve always operated from the assumption that men are completely capable of being feminists. Hell…i’m a feminist. With that being said, things tend to get tricky once you move past the basics.

Can feminist men contribute to feminism? If so, to what extent? Do men threaten the feminist agenda? How do the perspectives of queer men differ from heterosexual men, and what does that mean in terms of feminism? Is rejecting hegemonic notions of masculinity enough? The litany of questions could go on for days, and the responses to those questions could last even longer. [Read more...]

The intersection of pro-life and pro-choice

I could certainly see myself identifying as pro-life, but never in the way that the current movement defines itself.  The problem is that life and choice are not at opposing ends of the spectrum, and considering that the debate is about choice, and not about life, I will happily take the moniker of pro-choice.

The weird thing to me is that the “pro-life” movement actually has very little to do with the protection of life, but rather is centered around being invasive and robbing contemporary womyn of their agency, rights and choice.  The way I see it is that this debate has little, if anything, to do with abortion or access to it.  A responsible pro-life advocate would take a harms reduction strategy, because the cold truth is: no matter the legal status of abortion, abortions will happen.  This means that the most responsible strategy would be to make the abortions that will happen safe and affordable, and to create an atmosphere that gives womyn options to decrease the need for abortion.  But that’s not what happens, rather there is a movement that shuns birth control, sex education and open sexual discourse. [Read more...]

Conversing with Myself: Choice, Sexism, and Queers… Oh My!

The following is a cut and paste dialectical discussion about sexism in the LGBT community. The players are me and me, with some borrowed quotations from some fellow dudes for choice. This is part 1. Please, extend the discourse.

Q: In what ways have you seen or experienced sexism in the greater LGBT community?

A: Lots of people mistake me as being a “bear” based solely on my gender performance as masculine. However, I find that my gender is just as ambiguous as the next person. To paraphrase myself in Shira Tarrant’s latest book: Gender, being a performance with performative factors, takes more practice than we like to admit. It is, in fact, the role of a lifetime. Most of the work that goes into performing gender operates at the unconscious level begging the question: how much of gender is a choice. Thus, my bear-ness, is solely based on a viewer’s (read: ignorant gender enablers) limited perception of how one can be gay (or anything else for that matter) within the LGBT community. [Read more...]