HIV Discrimination?

Here's another one of those stories that seems sort of reasonable at first:

A federal judge this week dismissed an HIV discrimination lawsuit brought last year by an AIDS activist against the former owner of a Schofield restaurant.

District Judge Barbara Crabb concluded that Korrin Krause Stewart failed to show that her HIV-positive status substantially limited a major life activity, a requirement to succeed in a disability suit.

Stewart, 21, was born with the disease. She sued Lee's Log Cabin Inc. after she failed to get an interview for a waitress job for which she had applied in March 2004. A few days after applying, Stewart returned to the restaurant to add dishwasher experience to her job application. She then noticed that Curtis Zastrow, a manager trainee, had written "HIV+" across the top of the application.

Crabb, however, ruled that Stewart's HIV status didn't meet the definition of disability because she didn't show any impairment due to her HIV status. Being impaired doesn't mean disabled under Americans With Disabilities Act case law, unless the plaintiff can show it limits her ability to eat, breathe, reproduce or other major life activity.

"In the present case, however, plaintiff has adduced no evidence regarding the impact of HIV on any of Stewart's major life activities. ... No reasonable jury could conclude from the evidence plaintiff has adduced that having HIV rendered Stewart disabled," Crabb wrote in the 10-page opinion.

Obviously, refusing to hire someone because they have HIV is a shitty thing to do regardless of whether or not their condition is disabling. Let's make that perfectly clear first. But given that a great many people with HIV are in perfect physical condition, it does make sense that HIV infection is not considered to be a priori evidence of disability, and therefore it makes a certain amount of sense to say that this woman's complaint didn't fall under ADA enforcement. Or, it seems to, anyway.

But guess again:

The EEOC filed suit, claiming unlawful refusal to hire on account of HIV status. In responding to the defendant’s motion to dismiss, EEOC provided information about how Stewart as a person with AIDS was physically limited in her major life activities, in order to establish her identity as an "individual with a disability" under the ADA.

Judge Crabb, asserting that there is a big difference between being HIV+ and having AIDS, found that the complaint only asserted discrimination based on HIV+ status, not AIDS, and therefore the evidence about how AIDS limits Stewart’s major life activities was not relevant to the question whether she had a disability under the ADA. [...] Crabbe would not credit any of the EEOC’s evidence about the impact of AIDS on Stewart’s abilities, because of the purported distinction Crabbe found between HIV and AIDS.

Abruptly, the story veers from "makes a certain amount of sense" to "batshit crazy." HIV is the virus that causes AIDS. A person infected with HIV becomes "AIDS-defined" when they develop one of the disease's characteristic opportunistic infections, or when their CD4+ (T-cell) count drops low enough to make them extremely vulnerable to such infections. In other words, by saying that Stewart had AIDS, the EEOC was simply saying "She's HIV-positive and it has made her sick" - the very thing the documentation was supposed to prove. Judge Crabb's "gotcha" claim that the EEOC shifted arguments midstream by bringing AIDS into it doesn't make the slightest bit of sense.

What on earth is going on? I don't think Crabb's been swayed by the claims of AIDS denialists. Is she just prejudiced, and looking for any justification, however specious, to ensure that someone with HIV won't be pouring her coffee? It's a possibility. But I also wonder about this:

Dean Lee, the restaurant's owner at the time, had said that Stewart wasn't hired because she put a 10-pound lifting restriction on her application. Since 1980, the job has required that waitresses be able to lift 20 to 25 pounds about 20 times per shift, he said.

Law professor Art Leonard comments, "after reading Crabb’s summary of the EEOC’s evidence of Stewart’s AIDS-related symptoms, one wonders how anybody so afflicted could possibly provide effective service as a waitress." I wonder that too, and I imagine that Crabb wondered it as well. It seems possible that Judge Crabb developed the conviction that Stewart didn't apply for the job in good faith, and then looked for reasons to reject the complaint. It's hard to imagine how a person might legitimately think that they could work a waitressing job without ever having to lift more than ten pounds. Was Stewart trying to provoke a confrontation?

Stewart had already won one employment discrimination case locally - that's how the restaurant manager knew that she had HIV. The earlier case seems as clear an open-and-shut example of HIV discrimination as you'll ever see - she lost her job as a supermarket bagger because the management was afraid she'd infect customers or other employees. (They didn't specify how.) Now, I don't have a very hard time believing that Schofield, Wisconsin is particularly ignorant about HIV, or that a young HIV-positive woman living there might be discriminated against twice in three years. But I keep coming back to the fact that, on her job application for a waitressing position, she said that she couldn't lift more than ten pounds. That's when I stop being able to buy her as the innocent victim of discrimination. She might've been trying to be a provocateur, to raise awareness of HIV discrimination. She might've been out for settlement money. I haven't the slightest idea. But, no matter how much I strain to give her the benefit of the doubt, I just can't think that she was out to work as a waitress.

(Via The Gimp Parade.)

Trauma is "Easy?"

This post is a collaboration between Respectful of Otters and Idealistic Pragmatist.

Think of the most terrified you've ever been. Heart pounding, mouth dry, sweat beading on your forehead, muscles locked rigid, violent or frightening images flooding your mind, screaming so loudly on the inside that you're barely aware of your surroundings. Now imagine being dropped randomly into that state a few times a day, every day, triggered by some innocuous thing or nothing at all.

This is Post-Traumatic Stress Disorder (PTSD), an anxiety disorder in which a person who has experienced or come into close contact with serious trauma later experiences crippling levels of anxiety, combined with vivid re-experiencing of the traumatic event and an intense desire to avoid anything that might bring the trauma to mind or trigger anxiety symptoms. PTSD is known to have a strong biological component; severe stress causes lasting alterations in brain neurochemistry. Trauma appears to damage specific receptors responsible for regulating catecholamines, which are hormones essential to the stress response. In people with PTSD, these stress hormones are elevated, leaving them constantly on the verge of a neurochemically-induced panic. "It's not fashionable," according to Canadian conservative columnist Margaret Wente, to be derisive of people going through that experience. But she courageously does her best all the same.

Wente's got a column up in The Globe and Mail, a Canadian national newspaper, that's been attracting favorable commentary even from bloggers who are ordinarily thoughtful and intelligent. (The column is behind a subscribers-only link, but you can currently access it through Google here). In the column, she suggests that PTSD in soldiers and veterans (and especially in the Canadian forces) is exaggerated and overdiagnosed, and insinuates that servicemembers diagnosed with PTSD are either whiners ("War is hell. But life can be pretty rough, too. You don't need battle trauma to cope badly with it.") or goldbrickers out for an easy life on disability benefits ("some people will abuse the system if it is financially attractive"). Her claims demonstrate little acquaintance with the scientific literature on PTSD; instead, they are heavily based on arguments by an American psychiatrist named Sally Satel, who is affiliated with and funded by the ultra-conservative American Enterprise Institute. Satel's - and, by extension, Wente's - claims about PTSD are baseless. Let's look at them one at a time.

Claim 1: PTSD rates among recent servicemembers are too high.

It's hard to know exactly what Wente means by this. We doubt she means that it's a terrible thing that so many servicemembers are suffering, although if she did, we would certainly agree. At times, she seems to mean that soldiers didn't used to suffer from PTSD, back in the high-moral-fibre days of World War II. She treats an elevation in rates over time as prima facie evidence that current diagnoses are overinflated. In fact, although PTSD has always been with us - previously it was called battle fatigue or shellshock - military strategists argue that aspects of the military and social context of modern wars increase the likelihood of PTSD. The increase in PTSD diagnoses is also due to changes in diagnostic criteria. Prior to the Vietnam era, psychiatric diagnosis was vague and tended to be based on Freudian theories rather than observable symptoms. Modern diagnostic systems, based in empirical research, have led to wider agreement about who has specific psychiatric illnesses, including PTSD.

Claim 1a: Therapists encourage veterans to blame everything that goes wrong in their lives on combat stress.

Wente implies that veterans who have moral or behavioral problems, such as a violent temper or an inability to hold a job, are encouraged by therapists to attribute their problems to PTSD rather than trying to fix them - thus, also, inflating PTSD diagnosis rates. But PTSD simply cannot be diagnosed without the presence of the three core symptoms listed in the second paragraph: intense anxiety, vivid and intrusive memories of trauma, and avoidance symptoms. You don't get to just go to a doctor and say "My life problems are caused by PTSD, now fork over a check."

Claim 1b: Servicemembers and veterans are just faking PTSD to get disability benefits.

Wente cites no evidence for this, which is probably because there is none. The Dart Center for Journalism & Trauma demolishes this claim completely:

Matthew J. Friedman, M.D., is the executive director of the National Center for PTSD, a division of the Department of Veteran's Affairs. In an e-mail to the Dart Center, Friedman said that Satel's argument was based on a "misreading or inability to appreciate the meticulous process by which personal reports of combat exposure were verified by military records" in the 1990 National Vietnam Veterans Readjustment Study. Friedman noted that the vast majority of veterans surveyed had not applied for medical disability because of their PTSD.

The notion of veterans falsely claiming to have PTSD is also contradicted by statistics published by the U.S. Department of Veteran's Affairs. In 2002, 65,154 Vietnam veterans claimed 100 percent disability for "Psychiatric and Neurological Diseases" (about 2.1 percent of the 3.14 million soldiers who served in Vietnam). A total of 202,183 Vietnam veterans claimed a partial level mental-health disability (about 6.4 percent of all Vietnam veterans).

The National Vietnam Veterans Readjustment Study found that 31% of Vietnam vets met full diagnostic criteria for PTSD. Given the low percentages of vets actually receiving benefits for psychiatric disability, there can hardly be an epidemic of false claims. And if And if Wente is going to claim that things are different in Canada, it is incumbent on her to provide proof. She hasn't. She can't.

Claim 2: Therapists are brainwashing PTSD patients into believing that they'll be disabled for life.

The vast majority of cases of PTSD either resolve on their own or are responsive to treatment. According to the Diagnostic and Statistical Manual of Mental Disorders - the very manual used by the mental health establishment that Wente denigrates - half of all cases of PTSD resolve within a few months. Another 20% of cases resolve within the first year after the trauma. Even among chronic cases that last for years or decades, treatment is often effective in reducing the severity of symptoms and allowing people to return to normal social functioning even if symptoms of anxiety continue. (A good overview of treatment options can be found here.)

But early identification and intervention are critical. According to the Veterans Administration:

Extensive research indicates that early distress and symptoms of PTSD are not very good predictors of a long-term prognosis. Thus, while Hoge et al. (2004) reported that 18% of soldiers newly redeployed from Iraq have PTSD - a rate that is alarmingly high, it is likely that this rate will decrease over time. Studies suggest that in the face of severe military service demands, including combat, most men and women do remarkably well across the lifespan. [...]

For those soldiers who don't recover, the most troubling aspect of military-related PTSD is its chronic course. There is evidence that once veterans develop military-related PTSD their symptoms remain chronic across the lifespan and are resistant to treatments that have been shown to work with other forms of chronic PTSD. Thus, it is vitally important to provide early intervention to reduce the risk of chronic impairment in veterans.

Unfortunately, the prejudice and derisive attitudes of Wente and her American counterparts stand in the way of these servicemembers getting the early intervention they need.

Claim 3: PTSD is just like normal worries and stresses, an sufficiently "resilient" people get over their worries and stresses without help.

Conservatives never seem to get tired of belittling severe traumas by pointing out their superficial similarities to minor traumas. (Remember the "fraternity hazing" analogies about Abu Ghraib?) There is no excuse for this kind of unconscionable dishonesty. It's as if Wente were to dismiss and minimize the consequences of blindness based on the argument that sometimes everyone has to strain their eyes to see in dim light. Even if you're heartless enough to doubt the testimony of people with PTSD, the altered neurochemistry is undeniable.

None of this information is hard to find, even without the resources of one of Canada's largest newspapers. The entire first page of Google hits for "Satel PTSD" are either articles by Satel (Wente's only "scientific" source), or articles debunking her claims about overinflated PTSD diagnoses. Wente really had to work hard to avoid evidence that Satel is not credible. Either she's so incompetent that she can't manage a Google search, or she has a serious agenda. We vote for the latter.

Interestingly, this column isn't the first time Wente has written about PTSD in the Canadian military. Back in May of 2005, the Globe and Mail published a different column of hers that could have been the current column's more inflammatory cousin. The arguments were identical, although the tone was even more openly derisive: there are so many cases of PTSD these days that they must all be faking it, many of those cases sound absurd on paper (especially when the paper is the Globe and Mail and the columnist describing the cases is Margaret Wente), isn't it obvious that they're all just in it for the cold hard cash. Her closing line was even "But resilence is out of fashion. Besides, it won't get you a cheque." One underresearched, ideology-laden column might be a passing fancy, but two certainly smacks of an agenda, or even an obsession. We can't help but wonder what might drive Wente to write what amounts to the same column twice--could it be that she didn't manage to convince anyone a year ago, so she decided to tone down the rhetoric and recycle her original words once the casualties in Afghanistan had started mounting and the polls had started indicating a dip in support for the mission?

Although Wente is quick to declare that doubting the validity of PTSD is "unfashionable," in fact, with her commentary, she joins a whole framework of American conservatives with close ties to the Bush Administration, who are currently engaged in an effort to discredit the entire concept of PTSD - particularly the notions that it is common and frequently disabling.

Why do so many conservatives in both countries want to deny the reality of PTSD? On the American side, many are motivated by a reflexive disapproval of federal spending, and a corresponding desire to decrease spending on psychiatric treatment and disability benefits for servicemembers and veterans. Others fear that honesty about the prevalence of PTSD will hurt the war effort:

Dr. Susan Mather, a former top VA official who retired in January as its chief public health officer [says that] "They already have a recruitment problem...the parents of these youth, if they think their children will come back from the military experience changed forever - which they undoubtedly will be; not only changed but disabled by the experience, mentally as well as physically - they are going to be a lot less anxious to have these kids join up. And there’s a feeling that if this gets too much publicity and appears to be too widespread, it will hurt recruitment."

But neither of those pragmatic reasons explains the fervor of their attacks on PTSD-disabled vets, or the contempt that drips from Wente's words as she writes about young soldiers in trouble. It seems that there are deeper ideological factors at work. Generally speaking, any argument that individuals may be helpless to escape their life circumstances is threatening to the conservative ideology of personal responsibility. Social psychology research demonstrates that conservatives are more likely to hold the implicit worldview that bad things don't happen to good people, or, conversely, that the troubles people suffer are generally deserved. Finally, conservative discomfort with PTSD is also motivated by the perceived need for aggressive support of the war effort. It's as if they believe that negative effects of war must never be acknowledged, or the case for military action will collapse. In Canada, this is currently being expressed as denial that Canadians are even engaged in war in Afghanistan - the preferred conservative terminology is "peacemaking." (Hello, Orwell!) Clearly, that case collapses if large numbers of Canadian troops engaged in such a mild, inoffensive activity are found to be suffering from major psychiatric trauma as a result.

But the hysterical denial of war's negative effects is most common among conservatives who are far removed from the actual work of combat. Lieutenant Colonel Dave Grossman, a retired Army Ranger and a professor at West Point, paints a very different picture:

It is essential to acknowledge that good ends have been and will continue to be accomplished through combat. Many democracies owe their very existence to successful combat. Few individuals will deny the need for combat against Nazi Germany and Imperial Japan in World War II. And around the world the price of civilization is paid every day by military units on peacekeeping operations and domestic police forces who are forced to engage in close combat. There have been and will continue to be times and places where combat is unavoidable, but when a society requires its police and armed forces to participate in combat it is essential to fully comprehend the magnitude of the inevitable psychological toll.

Exactly so. If you believe that war is sometimes necessary, then it is your special obligation to be aware of the human cost of what you are asking your soldiers to do, and to mitigate the damage - with early treatment, when possible, and a supportive safety net for those who don't respond to treatment - to the greatest possible extent. More and more, the military recognizes that. Why don't the conservative hawks?

Friday Baby Blogging

I like this picture because it conveys a rare hint of her inner life. Mostly, at 15 months, everything is right there on the surface.

She's had a rough week with her Papa away. I thought she might cry for him or search for him a lot, given that before he left she was in a very papacentric mood. She'll talk about him when we look at his picture, but she doesn't bring him up. Instead, the stress of his absence is manifesting as extreme clinginess to me. I had to leave work early today because she spent the entire morning crying for me. It's as if she has figured out that if he could leave, I could leave - and then she'd be alone.

(Fortunately, the Significant Otter returns tomorrow.)

Putting The Pieces Together

Steven Green, the former U.S. soldier arrested yesterday for the rape of a young Iraqi woman and the murder of her entire family, received a medical discharge from the service based on a diagnosis of Antisocial Personality Disorder.

ASPD is defined as "a pervasive pattern of disregard for and violation of the rights of others," including failure to obey rules or laws, excessive temper or aggression, poor planning, impulsive behavior, an inability to meet basic social demands, and - probably most importantly - a lack of remorse. The diagnosis subsumes, but is not synonymous with, the much more serious diagnosis of psychopathy - true consciencelessness, the inability to empathize with others, and a consistent, remorseless tendency to manipulate, use, and hurt other people to meet one's desired ends.

All cracks about the inability to distinguish ASPD from proper soldierly behavior aside (and please keep them aside, because I don't want to hear them), soldiers with ASPD or psychopathy are a disaster for any military organization. To meet criteria for the diagnosis, these characteristics have to be general, inflexible, and persistent across contexts and situations. In other words, it's not possible to aim the person's psychopathy at the enemy and yet be able to trust them at home. They don't adhere to discipline or obey military regulations. They exploit and fight with their comrades as well as the enemy. No officer or NCO wants to be responsible for them. Many police forces screen candidates for psychopathy; they make terrible cops for many of the same reasons that they make terrible soldiers.

So, on the one hand, this analyst's comment is totally plausible:

Loren Thompson, a military analyst at the Washington-based Lexington Institute, said it is standard practice to discharge soldiers whose profiles suggest they are incapable of maintaining military discipline.

"Despite all the stories about the military having trouble recruiting, it is considered anathema to retain somebody like that," said Thompson.

And yet. Something about this story just doesn't pass the smell test for me.

ASPD is not something one suddenly develops at Green's age. To qualify for the diagnosis, significant symptoms have to have been present prior to age 15, and the person has to have a substantial track record of failure to meet basic social standards in a variety of settings. It's true that the Army has historically been a common destination for young men like that - families, and judges, have often reasoned that a heavy dose of military discipline will straighten them out. Green's family seems to have thought so as well. But the pattern of behavior that constitutes ASPD, or psychopathy, has to have been in place at the time that he entered into military service, by diagnostic definition. If he was constitutionally incapable of conforming to military discipline, that should have been evident to his commanders by the end of boot camp, at the latest.

Plenty of guys with ASPD-like symptoms enlist. Some of them are kicked out early for "failure to adjust to military service." Some of them are "administratively separated" for problems like drug use, or receive bad conduct discharges. Not many of them get a medical discharge for being antisocial. This table demonstrates that even for servicemembers who have personality disorders bad enough to require hospitalization, only 40% wind up being discharged for that disorder. (That's all personality disorders considered together - not just ASPD. And some of the other disorders, like Borderline PD, which often involves suicide attempts, seem likely to account for more of the medical, as opposed to punitive, discharges.) And that was in 1998, well before the current desperate drive to hold onto soldiers.

I asked the Respectful of Otters Military Advisory Board, who seemed to have a pretty clear mental picture of what kind of soldier Green would have been. "Why a medical discharge, and not some kind of bad conduct discharge?" "Probably because they wanted to get him out of there as fast as possible, and a medical discharge was the quickest option."

So here we have a guy who, by diagnostic definition, had a pattern of disregarding the rights of others and failing to conform to authority or social expectations for years. And nonetheless he was retained in military service for a year. In March, in the company of other soldiers, he raped and murdered a young woman and killed her entire family. In April, he was pulled out of Iraq, and in May - apparently without any kind of court martial charges or major disciplinary action - he was officially declared to be so antisocial that he was no longer suitable for service. And yet, supposedly, the military didn't learn of the rape and murder until last month.

If no one was aware of his crimes, what happened to precipitate his discharge, by the quickest and quietest means possible? Something doesn't add up.

Edited to add: Just to clarify, I think there are three possibilities.

1. The Army just got tired of his general disregard for rules and discipline and sent him for a psych eval, thus landing him the ASPD diagnosis. By sheer coincidence, this happened just after he had committed a horrific war crime, unbeknownst to them.

2. On some level, his superiors were aware that he had committed a horrific war crime. That was the precipitating factor for the ASPD diagnosis. He was medically discharged rather than investigated and prosecuted.

3. His superiors didn't know about his horrific war crime. However, he did something else that was awful - not necessarily another war crime, but some notable breach of discipline or crime against a fellow soldier - and that was the precipitating factor for the ASPD diagnosis.

State Of The Otter

I realize that my posting volume has dropped again, and I'm sure it's making some of you twitchy - wondering if I'll claim to be running out for a pack of otter pops and then disappear for another nine months. That doesn't seem likely to me; even though I haven't had time to post, I've still had post ideas crowding my head, and they're not likely to leave me alone until they're written. But first there were some health issues, and now my Significant Otter's long annual business trip has combined with our nanny's illness to make me, temporarily, a stay-at-home single mother. So I've been busy.

Given that I am back, though, I badly need to update my blogroll. Some blogs have died, and some have moved; that much I can fix on my own. What I don't know is who I ought to be reading these days. The blogosphere changes a lot in nine months. Okay, obviously Firedoglake and Glenn Greenwald - but who else? Suggestions, please.

Dying From Red Tape

Millions of poor Americans may lose their health benefits:

A Medicaid rule takes effect tomorrow that will require more than 50 million poor Americans to prove their citizenship or lose their medical benefits or long-term care.

Under the rule, intended to curb fraud by illegal immigrants, such proof as a passport or a birth certificate must be offered at the time a person applies for Medicaid benefits or during annual reenrollment in the state-federal program for the poor and disabled.

Critics fear that the provision will have the unintended consequence of harming several million U.S. citizens who, for a variety of reasons, will not be able to produce the necessary paperwork.

Unlike many Republican policies towards the poor, which read as though they were written by someone who was cackling and twirling his mustache, this one seems reasonable on the face of it. Citizenship (or, in some cases, permanent residency) has always been required for enrollment into Medicaid, and this new rule simply establishes a documentation requirement. Probably most of the people reading this post could produce the necessary documents without much effort - a phone call to Mom to ask for the birth certificate, perhaps, or, at worst, a letter and a check sent to the registrar of the county where they were born. A reasonable amount of effort to ask people to put forth, if the payoff is reducing fraud and saving health care dollars.

But it only seems reasonable if you haven't had much contact with people living on the margins of American society. This rule affects homeless people who have only a garbage bag full of posessions to their names, and no idea where any of their relatives might be. People institutionalized because of mental illness or mental retardation. Elderly people born before all births were recorded - particularly elderly black Southerners, who were likely to be born at home due to Jim Crow hospital policies, and the rural elderly poor. People who are no longer able to communicate clearly due to disability. They don't have passports. They may not know where they were born, or be able to communicate it to their caregivers.

Look at some of the plaintiffs in lawsuits challenging the new rule:

Ruby Bell, 95, born in an Arkansas county that did not issue birth certificates until 1914, and George Crawford, 80, who is so incapacitated from strokes that he cannot speak. According to attorneys, the church members who care for Crawford in Illinois don't even know where to start looking for documents that would pass muster. [...]

Alphonso DeShields, who was born in his parents' home in Spartanburg, S.C., a few months after World War I began. For five years, he has lived in a nursing home in Northwest Washington. He has a severe heart condition, cancer and other ailments.

Do these sound like they must be just a few odd, isolated cases? I've worked in health care for the desperately poor for six years now, and I can tell you that they sound pretty typical to me.

Even if most of these people are eventually able to document their citizenship, they are likely to experience gaps in medical treatment. Probably the ones dependent on institutional care won't be kicked out, but others will go without their insulin or HIV drugs or blood pressure pills. They'll wind up in the ER as indigents, suffering from preventable complications of chronic illness. And beyond the human cost, the financial cost of all of this documentation will be appalling. Social service agencies, nursing homes, and institutions will spend money that could be spent on direct services, tracking down their clients' birth certificates in cases where citizenship is not in the slightest doubt.

We all know that the Bush Administration and their allies in Congress have never signed on to the maxim, "better that ten guilty men go free than one innocent man be punished" - their Guantanamo policies make it clear that they believe the reverse, many times over. On the domestic side, it's clear that they also believe that it's better for ten deserving people to go unhelped than for one "undeserving" person to receive benefits to which they are not entitled. And yet they, the majority of them, call themselves Christians.

Pro-Choice Motherhood

On my last post about abortion, a commenter named Christina asked, "don't you notice any irony between your own love of your born child and your vehement declarations that other children are disposable?"

Now, I can't tell if that was supposed to be a genuine question or an unanswerable drive-by zinger, but I think that a lot of pro-lifers believe, like Christina, that pro-choice parents must be compartmentalizing their parental feelings away from their opinions about abortion. (I am being charitable here, and not dwelling on the ones who claim to believe that pro-choice parents are ready to kill their children at the first sign of inconvenience.) Regardless of whether Christina was really looking for an answer from me or not, I think it's worth addressing the question of how maternal love and pro-choice beliefs interact.

As longtime readers of Respectful of Otters know, my strong support for abortion rights is tempered by personal ambivalence about abortion. I find it hard to imagine a situation in which I would have one myself, and in fact, when I was pregnant, my Significant Otter and I declined prenatal testing for birth defects and genetic abnormalities. But my ambivalence arises from a complex and deeply personal calculus of circumstances, experiences, feelings, and religious beliefs. I don't expect, or want, or have any interest in legislating, that other women come to the same decision.

I didn't ever imagine that pregnancy and motherhood would reverse my opinion on abortion law, but I did wonder if the experience of being pregnant with a child I wanted very much would make abortion seem more awful to me, or make me feel more personally uncomfortable with women who choose abortion. Instead, I found that the opposite was true: my personal experience with pregnancy, childbirth, and motherhood has strengthened and deepened my conviction that abortion is a valid choice that must remain safe, legal, and available.

I had an easy, healthy pregnancy (even morning sickness was just a mild annoyance, rather than a real problem); a loving husband I trusted to take care of me; a supportive family; excellent prenatal care from knowledgable, supportive, and empowering midwives; an uncomplicated and relatively quick delivery; an uncomplicated physical recovery from the birth; and no postpartum depression. I had, in short, about as easy a time of it as you can have. And yet I was acutely aware of how much of my energy was drained away by the developing fetus, how incapacitated I became as my pregnancy advanced, how vulnerable and dependent on my husband I felt, how crushing the sense of responsibility was. Even the least complicated of pregnancies is a profound burden and a profound vulnerability - physically and emotionally. I never fully understood that until it happened to me.

At the same time, during the first trimester (when 88.5% of abortions occur), I didn't feel much of a connection to my developing fetus. It felt... theoretical, to be honest. Like a great idea that I hoped would come to fruition. The crushing responsibility felt very real, but not the sense that there really was a new life developing inside me. (That didn't come until later, when I first heard the heartbeat at 13 weeks.) Because I wanted a child so much, I spent most of that disconnected time fearing that I would miscarry or somehow turn out never to have been pregnant at all - but it was easy for me to imagine that someone else, desperately wanting not to be pregnant, would find that the same "theoretical" feeling allowed her to have an abortion without guilt.

I took on the burdens of pregnancy joyfully, and I accepted the vulnerabilities trustingly - because I. Chose. Them. But even under the brainwashing power of maternal hormones I felt a deep conviction that a woman who does not choose to be pregnant should never be forced to bear those burdens, and risk that vulnerability. That the pressures and risks and pain and resource drain of nine months of pregnancy and (conservatively speaking) a month of postpartum recovery should never be waved away with the claim that "she can just give the baby up for adoption."

Because adoption exists as an option I am focusing on pregnancy and birth here, and not on the experience of raising a child. But I will say this: as hard as it is to carry and deliver a baby, motherhood is much much harder. Again, my circumstances have been excellent: financial comfort, flexible job, supportive and involved husband, loving family and friends, plenty of childrearing knowledge, et cetera. But still there came a moment, in my daughter's third week of life, that I broke down in hysterical sobs and asked her why she hated me so much. I'm telling you, motherhood is HARD. You have to really, really want it. If you don't, I'm not sure how you get through - but I don't think it's good for either you or the child.

So no, Christina, I don't "notice any irony between the love of [my] born child" and my support for abortion rights. My experience of carrying her, bearing her, and raising her has been a powerful experience of love, and it has only affirmed my belief that it would be an utter perversion to demand that other women go through that experience when love and desire are absent.

Friday Baby Blogging

Or, more accurately, Friday toddler blogging. Look at her! She's fourteen months old - practically a grown-up. She walks, she climbs, she never stops talking.

Back from my shameful nine-month absence from blogging, I notice that little has changed from my pre- to post-hiatus political posts: the Bush Administration is still hell-bent on arrogating all power to the executive, abortion rights are still threatened, horrible accounts of torture are still surfacing, ideologues are still restricting women's access to health care. I could probably just recycle my old posts, and it would be a while before anyone noticed. But baby blogging! The last time I baby-blogged here, Alex had just begun sitting up without support, and was trying her first taste of solid food. Now she's climbing up on the couch to steal the TV remote, obsessively identifying body parts, and giving her stuffed doggy a ride in her dump truck.

At least there's progress somewhere, huh?

The Only Good Abortion

The June 26th New Yorker has an interesting piece by Cynthia Gorney (regrettably not included in the online edition), about the referendum drive to overturn South Dakota's abortion ban. Apparently, quite a few South Dakotans who consider themselves to be pro-life are balking at the absolute nature of the new law, which bans abortions even in cases of rape, incest, or danger to the health of the woman. (Although there is the sodomized virgin exception which made South Dakota Senator Bill Napoli so justly famous.)

It turns out, according to Gorney, that the national anti-abortion movement is not as happy about the South Dakota law as one might have expected from the outside.

"In our hearts, we're going, Yeah, come on, you guys can do it, but in our heads we're going, This is not good," one longterm Midwestern right-to-life lobbyist told me. "Wrong bill. Wrong language. Wrong time. I used to envision the day we ban abortion in our state - people carrying on and crying with happiness and 'Oh my gosh, the world has erupted,' and here we were just, like, Ugh. I remember some of the questions: 'Do you think we're going to get press calls about it?' 'Do we have to respond, or can we just blow them off?' I can't even think of the talking points we'll use. We won't talk about it."

In fact, both the National Right to Life Committee and Americans United for Life opposed the South Dakota law; they anticipated what seems to be happening now. Many South Dakota conservatives, who would be perfectly happy to ban what they think of as "abortion for convenience," are finding themselves troubled by the idea of a rape victim forced to carry her rapist's baby to term. The absolute nature of the ban is awakening a sense of nuance in people who previously, in a world in which Roe v. Wade was firmly entrenched, were very comfortable calling themselves "pro-life" and meaning that they opposed most abortions, frivolous abortions, bad abortions. People who never had to confront the question of what the world would be like if it were completely without legal abortion... until the South Dakota state legislature passed its law.

As Gorney explains, the absolute ban holds no conflict for hard-core pro-lifers, to whom an abortion ban with exceptions for rape, incest, or health "is the equivalent of one that makes slavery legal only for those who really need slaves."

A person who professes to be pro-life but insists on a rape-and-incest exception (which covers most pro-life politicians in this country, including President Bush) is saying one of two things: either it is justifiable to kill children in some circumstances, or what grows in a woman's uterus is a child if the woman had sex voluntarily but not if she was forced into it. [...]

Here's the dilemma: how prudent is it to push people who might otherwise be your allies - who might be at least partially helpful to your cause - to examine the inconsistency of their own position? You might win them over to the true-believer ranks: it's a child, so the law can't permit killing it unless that's the unfortunate consequence of trying to save the mother's life. Or you might alienate them so thoroughly that they end up in the enemy camp: abortion has to be legal at least for rape and incest, which means that it isn't a child, which means that [...] abortion is not child-killing after all but, rather, a morally complex act that requires society to weigh one thing against another - the severity of the pregnant woman's distress, for example, versus developing human life.

The national right-to-life movement isn't confident that South Dakota voters (or the Supreme Court, even with Alito), faced with that dilemma, will choose the true-believer side. The success of the referendum drive, in which nearly five percent of South Dakota's population signed petitions to get the measure on the ballot, suggests that they are right to worry.

Now it's up to the pro-choice movement. How can we frame the debate in South Dakota in order to evoke this dilemma? How do we call forth the moderate pro-lifers' sense of ambiguity? If the women of South Dakota are to retain even the fragile vestiges of abortion rights they have now (there's only one abortion clinic in the entire state, with doctors flown in from Minnesota because no local providers can be found), it will be because moderate pro-life believers vote to overturn the abortion ban. South Dakota simply doesn't have enough self-identified pro-choice voters to carry the measure, even if every last one is mobilized. It's going to throw strong pro-choicers (like me) into our own uncomfortable dilemma, as we try to make common cause across a deep moral, philosophical, and often cultural divide.

A thoughtful reading of Gorney's article is a good place to start. Buy the dead tree edition.

Throwing Mothers To The Wolves

Henry Farrell asks why the Mommy Wars (stay-at-home vs. working mothers) hurt so much - "why this is such a loaded and painful subject matter in the first place, for women who have made either choice."

So far, unfortunately, most of the answers he's getting are either located in the indvidual psyches of the mothers involved - insecurity, et cetera - or they blame outside agitators for injecting guilt and judgment into a situation where all choices are equally beneficial. I think both of those types of answers have a partial truth to them, but they leave out important systemic factors.

With few exceptions, the design and organization of the American workplace are still predicated on the assumption that each employed person has a back-up person who handles all the responsibilities of home and family. Similarly, the design and organization of the major American professions (medicine, law, academia) are still predicated on the assumption that one's twenties, and probably one's early thirties, will be spent working as many hours as possible. Prevailing theories of good parenting are far more time- and labor-intensive than the practices of our mothers. And meanwhile, unprecedented levels of economic instability, the shrinking social safety net, the higher incidence of divorce combined with the end of alimony, the spiraling costs of housing and higher education, and the stagnation of low-to-midrange wages mean that, for most Americans, the two-income household looks a lot more like a necessity than a lifestyle option.

These factors combine to place enormous pressure on families with young children. And mothers are told by our society, magnanimously, that feminism has bestowed upon us the "choice" to kludge together whatever solution to the problem we can manage on our own. And the stakes are enormous: the well-being of our children is entirely our responsibility, and every last detail of maternal behavior is presumed to have profound implications for our children's future and the future of society.

I've quoted before from Susan Douglas and Meredith Michaels' book The Mommy Myth , which focuses on the ways in which children's developmental outcomes are seen as being entirely caused by individual parenting choices made by their mothers, for good or ill.

"First, the media warned mothers about the external threats to their kids from abductors and the like. Then the “family values” crowd made it clear that supporting the family was not part of the government’s responsibility. By the late 1980s, stories about welfare and crack mothers emphasized the internal threats to children from mothers themselves. And finally, the media brouhaha over the “Mommy Track” reaffirmed that businesses could not or would not budge much to accommodate the care of children. Together, and over time, these frameworks produced a prevailing common sense that only you, the individual mother, are responsible for your child’s welfare: The buck stops with you, period, and you’d better be a superstar."

Is it any wonder that women sometimes become defensive under these pressures? Is it any wonder that we sometimes cling rigidly to our chosen solutions, and strenuously avoid any suggestion that alternative paths have different advantages? Is it any wonder that it hurts to be told that we've made the wrong choice, especially by people who seem blind to the tradeoffs and compromises inherent in all the options?

Before I throw this open for general discussion, I want to be absolutely clear about one thing: I will not tolerate Mommy Warring in my comments section, and I will disemvowel attacks as necessary. In particular, I pre-emptively forbid the use of the following phrases, or variations thereof: "I didn't want someone else raising my kids," "I didn't want to waste my brain/education," any application of the term "warehouse" to daycare or "lazy/deadbeat/parasite" to mothers without paid employment, "why even have kids if...?", and, from the childfree, "why should the rest of us have to support your hobby?" If you simply must use one of those phrases to express yourself, please get your own blog. Thank you.

A Nation Of Torturers

Spencer Ackerman proposes an experiment:

Take all the shelving out of a typical filing cabinet. (My own office cabinet happens to be slightly smaller than the cell described here.) Now lock yourself in it for two days. You may notice you can neither stand up straight nor lie down, and crouching gets really uncomfortable extremely fast.

He's referencing a report from what the New York Times rather optimistically identifies as the "last" inquiry into the abuse of prisoners by American troops.

General Formica found that in the third case at a Special Operations outpost, near Tikrit, in April and May 2004, three detainees were held in cells 4 feet high, 4 feet long and 20 inches wide, except to use the bathroom, to be washed or to be interrogated. He concluded that two days in such confinement "would be reasonable; five to seven days would not." Two of the detainees were held for seven days; one for two days, General Formica concluded.

You might have missed the article. There have been so many outrages that they begin to blur together after a while: beatings, "waterboarding," sodomy with objects, broken kneecaps, relatives as hostages, dog attacks, extended sleep deprivation, food deprivation, extended restraint, electric shocks, outright murder. None of the recent revelations have sparked the kind of outcry that Abu Ghraib did. Americans seem to have settled - numb with horror or belligerently defensive, depending on our individual moral compasses - into the knowledge that we are a nation that tortures defenseless prisoners.

Conducting Spencer Ackerman's experiment would probably do us all a great deal of good.

As I prepared to write this post, I looked back through my archives to find the posts I'd written about Abu Ghraib, in April and May of 2004. From the first, I was pretty sure that the abuse that was coming to light would not turn out to be the work of a few sociopathic "bad apples," entirely divorced from military policies and directives from the Administration. But I don't think I could have imagined, then, that two years later the Administration would defy Congress in claiming that the President has the unrestricted right to authorize torture, and that the Army field manual would be rewritten to omit Geneva Convention provisions forbidding Abu Ghraib-style abuses.

I'm not sure anyone outside the Pentagon could have imagined it, actually. The notoriously rabid conservatives at the Wall Street Journal's Op-Ed page apparently didn't, even as they sneered at and belittled the victims of Abu Ghraib. Here's a quote from a May 2004 WSJ editorial:

Enemy propaganda notwithstanding, this underscores the fundamental difference between America and totalitarian regimes like Saddam Hussein's Iraq. Evil is part of human nature, and Americans are as susceptible to it as anyone else. But in a civilized country like ours, the state uses its power to prevent and punish brutality.

In 2004, what made us civilized was that our soldiers only abused prisoners behind the government's back, and were then lectured sternly for it. What "underscores the fundamental difference between America and totalitarian regimes" in 2006, now that we know that we literally took over Saddam Hussein's torture chamber and made it our own? I'm afraid we'll be waiting quite a while for our answer.

Fun With Referrer Logs

Someone just found this blog by searching for "adhd link to gay sex."

I want to know why Google considers me to be the seventh most authoritative source on the topic.

I want to know why one of the other top sites for this search segues from group sex to group health insurance in its page title.

But most of all, I want to know what the heck that person was looking for. What, are women supposed to require more concentration?

The Jobs Americans Won't Do

According to the Washington Post, the Bush administration's concern about employers who hire illegal immigrants is apparently very, very new.

Between 1999 and 2003, work-site enforcement operations were scaled back 95 percent by the Immigration and Naturalization Service, which subsequently was merged into the Homeland Security Department. The number of employers prosecuted for unlawfully employing immigrants dropped from 182 in 1999 to four in 2003, and fines collected declined from $3.6 million to $212,000, according to federal statistics.

In 1999, the United States initiated fines against 417 companies. In 2004, it issued fine notices to three.

These numbers are especially interesting given that total immigration prosecutions rose 82% from 2003 to 2004, and that "immigration matters now represent the single largest group of all federal prosecutions, about one third (32%) of the total." Isn't that understandable, though, in the wake of 9/11? Not really. "Only seven out of the 37,765 prosecutions filed arising out of [DHS] immigration enforcement were classified as involving international terrorism during FY 2004, and only one out of 20,771 prosecutions involved international terrorism during FY 2003."

(These data are all from a nonpartisan clearinghouse at Syracuse University that does nothing but track federal staffing, spending, and enforcement, and man does that seem like a website a blogger could get lost in all day.)

The Post article doesn't present the statistics about prosecutions of individual immigrants; that would detract from its breathless lovefest between immigrant activists, employers, and politicians about the economic benefits of an endless influx of cheap and easily exploited laborers. The showcase story in the article is 1999's Operation Vanguard, in which (we are given to understand) INS investigators misguidedly went after the 19% of midwestern meatpackers with dubious citizenship papers, until industry lobbyists and their favorite Congressmen encouraged the INS to embrace the new multicultural heartland.

Congress "came to recognize that these people [...] had become a very important part of their community, churches, schools, sports, barbecues, families -- and most importantly the economy."

The meatpacking industry is presented to us as a prime case for the necessity of illegal immigrants - so let's take a closer look. Why are illegals so necessary in this industry? "White Americans are not going to apply for [meatpacking] jobs," an immigration activist tells the Post reporter, begging the question. Really? They really won't? Not at any salary? Not in any working conditions? Are we to believe that, without illegal immigrants, American cows would stand unslaughtered in the fields, and Americans would be reduced to subsisting on fair-trade tofu?

Of course not.

Thirty years ago, meatpacking was one of the highest-paid industrial jobs in the United States, with one of the lowest turnover rates. In the decades that followed the 1906 publication of The Jungle, labor unions had slowly gained power in the industry, winning their members good benefits, decent working conditions, and a voice in the workplace. Meatpacking jobs were dangerous and unpleasant, but provided enough income for a solid, middle-class life. There were sometimes waiting lists for these jobs. And then, starting in the early 1960s, a company called Iowa Beef Packers (IBP) began to revolutionize the industry, opening plants in rural areas far from union strongholds, recruiting immigrant workers from Mexico, introducing a new division of labor that eliminated the need for skilled butchers, and ruthlessly battling unions. By the late 1970s, meatpacking companies that wanted to compete with IBP had to adopt its business methods—or go out of business. Wages in the meatpacking industry soon fell by as much as 50 percent. Today meatpacking is one of the nation's lowest-paid industrial jobs, with one of the highest turnover rates. The typical plant now hires an entirely new workforce every year or so.

Maybe it's true that "white Americans," for which you should probably substitute "Americans of any color who have even a shred of employment choice, and even a whisper of a voice to speak up for themselves," aren't willing to work in today's meatpacking industry. But the argument that "immigrants take jobs that Americans don't want" is really the argument that "immigrants protect employers from having to offer acceptable wages and working conditions." The preferential prosecution of individual immigrants over the companies that hire them is ample evidence that the employers' interests are the first and only priority.

But again, nothing of this perspective was presented in the Post article. No, illegal immigrants and the companies that exploit them are all part of one big happy family, sharing their "community, churches, schools, sports, barbecues, familes," and their acceptance of workers suffering injury and disability for $9.50 an hour. Let's hear it for brotherhood.

All Fall Short Of The Glory Of God

Those of us who favor social justice interpretations of the Bible have long suspected it, but now it's official: Jesus Christ himself has been declared unsuitable for leadership in the Southern Baptist Convention.

Wednesday, the SBC unofficially barred members who drink alcohol from serving as trustees or members of any SBC entity.

The ban, part of a larger anti-alcohol resolution that was easily approved by delegates, was proposed by Jim Richards, executive director of the Southern Baptists of Texas Convention. While stopping short of officially preventing drinkers from serving, it "urges" that no one be elected or appointed to SBC offices if that person is "a user of alcohol."

"Use of alcohol as a beverage can and does impede the message of Jesus Christ" that Southern Baptists are trying to spread, Richards said.

Also impeding the message of Jesus Christ, John the Evangelist:

On the third day there was a wedding at Cana in Galilee, and the mother of Jesus was there. Jesus also was invited to the wedding with his disciples. When the wine ran out, the mother of Jesus said to him, "They have no wine." And Jesus said to her, "Woman, what does this have to do with me? My hour has not yet come." His mother said to the servants, "Do whatever he tells you."

Now there were six stone water jars there for the Jewish rites of purification, each holding twenty or thirty gallons. Jesus said to the servants, "Fill the jars with water." And they filled them up to the brim. And he said to them, "Now draw some out and take it to the master of the feast." So they took it. When the master of the feast tasted the water now become wine, and did not know where it came from (though the servants who had drawn the water knew), the master of the feast called the bridegroom and said to him, "Everyone serves the good wine first, and when people have drunk freely, then the poor wine. But you have kept the good wine until now." This, the first of his signs, Jesus did at Cana in Galilee, and manifested his glory.

My Significant Otter, who has suffered through a great deal more contact with Southern Baptists than I have, made me aware of tortured chains of reasoning which attempt to demonstrate that the "wine" referred to in the Bible was so weak that it was essentially just grape juice. And I guess I can see that reading of the Cana story. You know how it is, at weddings. They serve the good nonalcoholic grape juice first, and then when people have drunk gallons of the good stuff they bring out the weak grape juice, because, um, their palates have been so dulled by the hearty grape flavor that they don't notice the difference.

Lactation Or Bust

Faced with a mountain of evidence demonstrating the significant health benefits of breastfeeding, a consortium of health experts and U.S. government officials is making an aggressive push for paid maternity leaves; longer maternity leaves comparable to the recommended length of exclusive breastfeeding; exemptions from welfare-to-work programs and welfare time limits for nursing mothers; insurance and/or public funding for lactation clinics, breast pumps, and milk-bank milk; greater support for nursing mothers doing salaried work, including protected opportunities to pump milk at work, increased flex-time employment options, and greater availability of part-time daycare slots; discouragement of routine obstetric and neonatal care practices which hinder breastfeeding; and, of course, stricter controls on environmental contaminants, such as mercury, known to taint breastmilk.

Hahahahahahahaha! No.

They're pushing an extensive PR campaign to make formula-feeding mothers feel guilty. Because who needs all that other stuff, when we could focus on personal responsibility?

The President As Monarch

This is not a post about a breaking story. If you expect only cutting-edge news from your blogs, blame Teresa Nielsen Hayden for not adding this story to her Particles section until yesterday. If my other regular reads posted about the issue, it slipped past me...

...Which is odd, all by itself. Or maybe it just seems odd to the quaint, naive part of me which imagines that, if the President of the United States were to openly and repeatedly state that he was not bound by laws, people would be so appalled that the story would be front-page news until the man was stopped.

Glenn Greenwald has a good sense of the gravity of the issue:

It is not hyperbole to say that these actions and theories are as antithetical to democracy as can be. [...] It is not uncommon for a President to refrain from executing a law which he believes, and states, is unconstitutional. Other Presidents have invoked that doctrine, although Bush has done so far more aggressively and frequently. But what is uncommon - what is entirely unprecedented - is that the administration's theories of its own power arrogate unto itself not just the right to refrain from enforcing such laws, but to act in violation of those laws, to engage in the very conduct which those laws criminalize, and they do so secretly and deceitfully, after signing the law and pretending that they are engaged in the democratic process.

What I find most dispiriting is the paltry defense the Administration's supporters presented to the Globe reporter, Charlie Savage. There was no effort to outline a constitutional argument for Bush's behavior, or to engage, even glancingly, with the concept of checks and balances. Instead, the administration response to Savage reeks of smug contempt for the very idea of accountability.

Jack Goldsmith, a Harvard Law School professor who until last year oversaw the Justice Department's Office of Legal Counsel for the administration, said the statements do not change the law; they just let people know how the president is interpreting it.

''Nobody reads them," said Goldsmith. ''They have no significance. Nothing in the world changes by the publication of a signing statement. The statements merely serve as public notice about how the administration is interpreting the law. Criticism of this practice is surprising, since the usual complaint is that the administration is too secretive in its legal interpretations."

Sheesh, this liberal media. They complain when the Administration violates the law secretly, and they complain when the administration announces its plans to violate the law. What on earth would satisfy them?

As far as I can tell, by "nothing in the world changes by the publication of a signing statment," Goldsmith must mean that the President is prepared to set aside laws with or without advance notice to the American people. And the only solace we are offered, as citizens who are ourselves bound by the rule of law, and who believe ourselves to be living in a democratic republic?

Defenders say the fact that Bush is reserving the right to disobey the laws does not necessarily mean he has gone on to disobey them.

The king has absolute power. How grateful his subjects should be, that he sometimes refrains from exercising it!

Or, you know, not.

What's incredible here - okay, wait; one of the many incredible aspects here - is that the laws he is setting aside were entirely crafted by his own people. The Republicans have a stranglehold on Congress:

Republican leadership has sidelined legislation unwanted by the Bush administration, even when a majority of the House seemed ready to approve it, according to lawmakers, lobbyists, and an analysis of House activities. With one party controlling the White House and both chambers of Congress, and having little fear of retaliation by the opposing party, the House leadership is changing the way laws are made in America, favoring secrecy and speed over open debate and negotiation. Longstanding rules and practices are ignored. Committees more often meet in secret. Members are less able to make changes to legislation on the House floor. Bills come up for votes so quickly that elected officials frequently don't know what's in them. And there is less time to discuss proposed laws before they come up for a vote. [...]

Longtime Congress-watchers say they have never seen the legislative process so closed to input from minority-party members, the public, and lobbyists whose agenda is unsympathetic to GOP leadership goals.

And still Bush has felt it necessary to set himself above ten percent of the laws passed during his presidency. Clearly, it isn't even about content: it's the naked exercise of power, and nothing more.

Rejecting Vaccine "Choice"

By now, pretty much every blog reader in the Western world knows two things about human papillomavirus (HPV), the virus which causes cervical cancer: the FDA has approved an effective vaccine, and the Religious Right doesn't want children to be vaccinated.

"I've talked to some who have said, 'This is going to sabotage our abstinence message,' " said Gene Rudd, associate executive director of the Christian Medical and Dental Associations. But Rudd said most people change their minds once they learn more, adding that he would probably want his children immunized. Rudd, however, draws the line at making the vaccine mandatory.

"Parents should have the choice. There are those who would say, 'We can provide a better, healthier alternative than the vaccine, and that is to teach abstinence,' " Rudd said.

Enough has already been said about the outrageous awfulness of preferring the risk of cervical cancer to the risk of sexual activity - my personal favorite comment comes fromKatha Pollitt: "Faced with a choice between sex and death, they choose death every time."

My major concern is that they not be permitted to get away with co-opting the language of choice for pernicious purposes. The idea of vaccine choice sounds reasonable on its face; Americans tend to believe that parents should be given wide latitude to make health decisions for their children, and some parents from both sides of the political spectrum choose to refuse all vaccinations for their kids. So Focus on the Family's position statement [PDF] - "Focus on the Family supports widespread (universal) availability of HPV vaccines but opposes mandatory HPV vaccinations for entry to public school." - looks, at first glance, like a reasonable compromise.

But "choice" is a red herring. Focus on the Family has religious objections to the HPV vaccine? Religious exemptions to mandatory vaccines are already available in every state but West Virginia and Mississippi. (Anyone think that Focus on the Family would have trouble convincing the Mississippi or West Virginia state legislature to add in a religious exemption for the HPV vaccine? Me neither.) They will have the right to opt their daughters out of this health-, fertility-, and potentially life-saving vaccine, mandatory or not. What they're really angling for is a way to deny it to other people's daughters.

If it's easy to opt out, why the battle over mandatory? Because mandatory = affordable. States cannot make a vaccine mandatory for school entry unless they are willing to provide it to those who cannot pay. And thus, through the CDC's Vaccines For Children program, every state supplies children with required vaccines free of cost. But optional vaccines are a different story. For example, check out this price list for various optional vaccines at the Shelby County (Tennessee) Health Department; the price per shot is as high as $96. Required vaccines at the same clinic cost $8. And that's at a health department, which is pretty much the cheapest place to get vaccinated anywhere. Put simply, if the HPV vaccine is not made mandatory, it probably won't reach the low-income women and girls who need it most. Of course, that means that the Religious Right's tax dollars won't go towards providing women with an immunological license for promiscuity... and don't think that they aren't thinking of it that way.

It's important not to underestimate the threat that the HPV vaccine poses to the Religious Right. For years, they have used HPV as the centerpiece of their anti-condom, anti-sex-education campaign. "The HPV Epidemic: Condoms Don't Work", proclaims a widely-reprinted statement from the Family Research Council. The National Physicians' Center for Family Resources has a pro-abstinence, anti-condom broadsheet that focuses exclusively on HPV. When Tom Coburn tried to get cigarette-style warning labels placed on every condom, HPV was his justification. It's true that condoms don't provide full protection against either HPV or herpes, because viral shedding can occur from areas not covered by a condom. But condoms do reduce transmission risk, and of course they provide excellent protection against other STDs. But the anti-sex Right has misused HPV to tell teenagers that condoms are completely useless. (Is it any surprise that teens in abstinence programs are less likely to use condoms when they do have sex?)

The development of a safe and effective vaccine for HPV means that the abstinence movement just lost its poster virus. They're going to fight this one, and fight it hard.

So what can you do?

1. Contact the members of the CDC's Advisory Commitee on Immunization Practices and tell them that you want the HPV vaccine to be added to the mandatory schedule. You might want to specify that you believe that state religious exemptions provide adequate protection to parents with religious objections.

2. Contact your state's Vaccines For Children coordinator. Let them know that you want the HPV vaccine to be included in your state's free vaccine program.

3. Find out whether your state allows adolescents to be vaccinated without their parents' consent. If not, lobby for the right of girls to receive the HPV vaccine regardless of their parents' consent, just as they are currently able to receive STD treatment without parental consent.

4. Spread the word: the CDC funds free or low-cost breast and cervical cancer screenings in every U.S. state and territory. If you've been avoiding a Pap smear because you don't think you can afford it, give them a call at 1-800-CDC-INFO.

5. Write a check to Planned Parenthood. They're going to need the money.