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Dear Girls Inc.

March 3rd, 2011

TO: Girls Incorporated

FROM: Bisi Ibrahim, Class of 2011, Stanford University

DATE:  March 3, 2011

SUBJECT: Initiating Mental Health Programs For Young Women

As evidenced by thorough quantitative and qualitative research, the current state of mental health and healthcare services for young women in the US and internationally has been exposed, revealing a gaping, wanting void. Nevertheless, interventions and initiatives leading to successful outcomes are under-researched and underfunded, while in our societies we continue to adhere staunchly to our belief that it is not a cause for concern.

As a leading, non-profit organization invested in the empowerment of young women, Girls Incorporated has not only created programs for girls’ issues, but also in an extraordinary display of astuteness, Girls Incorporated has established its own Girls’ Bill of Rights. In this document Girls Incorporated has declared and vowed amongst many rights, two very pertinent rights: Girls have the right to be themselves and to resist gender stereotypes; Girls have the right to accept and appreciate their bodies. Both of these rights are directly related to mental health as often gender stereotypes are the root of mental disturbances and they often lead to an inability for girls to accept and appreciate their bodies. Therein Girls Incorporated inherently needs to address, create and maintain newer mental health-focused programs for an oft-stigmatized issue. Girls Incorporated should not continue to foster the silence that shrouds mental health and that endangers the lives of many young women globally, as it goes against Girls Incorporated’s mission.

The Basics

In the US, researchers have noted and repeatedly concluded that young girls, often beginning during puberty, are experiencing internalized mental disorders at a rate alarmingly greater in proportion than their male peers. For Caucasian girls evidence shows that gender stereotypes and societal standards of beauty in concordance with the traumatizing events of puberty are promoting an increase in depression and anxiety disorders in young women. Cross-cultural studies in the US have also revealed mental health discrepancies for minority women (African American, Asian America, & Latinas), as well as for young women emigrating from developing countries (including refugees of war-torn countries who are coping with Post-Traumatic Stress Disorder), but it is unclear whether it relates with the traumatizing effects of puberty.

The latter studies also showed that minority and immigrant women often experience lower incidences of internalized mental disorders, but evidence suggests that the numbers may be unreliable due to the manifestation of these disorders resulting in a different manner than that of Caucasian young women. It has been hypothesized that minority young women are often affected by stereotype threat. For immigrant young women it has been hypothesized that while they are initially afforded economic advantages and general health advantages not conferred by staying in their impoverished, war-torn, or economically unsound country, they arrive in developed countries like the US only to still face barriers in access to mental healthcare—the barrier often being stigmatization and anxiety over the need for assimilation. Therein on top of potential, preexisting mental disorders such as PTSD, they acquire adjustment-related mental health disorders that compound and lead to severe mental health disturbances.

What’s really going on?

With such a wealth of information repeatedly uncovering the same outcomes, one would think that there would be relative success in initiatives and interventions to counteract these findings. This, however, is far from the current state of initiatives and interventions. In fact as a whole, youth mental health is in shambles. The rate at which mental-health care services fail to meet the needs of youth patients is nearly 100%, this figure including developed nations. (Patel, 1303; Hickie, 63) This is a result of many mental healthcare services being adapted from adult mental health models, and assumed that with slight variations would have similar success for young adults and adolescents. Decades later, it is plainly just not working. (Hicke, 63).

For young women, the mental healthcare system fails them twice. Not only are intervention models faulty, but also diagnoses are often occurring decades after the onset of a mental disorder. Young women are not often diagnosed with mental disturbances until they are well into adulthood, and by then their mental disturbances have influenced other health and development discrepancies, including lower educational achievement, substance abuse, violence, and poor reproductive and sexual health. [Note: Girls Incorporated already has programs with many of these aforementioned co-occurrences, so why not deal with the root of the problem?]

What can be done?

Successful interventions are rare but are possible by incorporating several key components. For the few interventions that do exist, many are still being tested and their results are still in infancy; they also often need financial support. Nonetheless, addressing financial allocations and resources should not be the first step in creating successful interventions and initiatives for mental health and wellness for young women.

We must first begin with the minute details such as awareness and education. First, it is important that we begin to see mental health as an issue equal in magnitude to physical health. As a society we cannot continue to put mental health off as something that happens to the “others”—whomever we assume those “others” might be, we often fail to realize are those closest to us. Furthermore, health and wellness as a whole include the body and mind. In fact, it should be noted that mental illnesses are often correlated with the spread of communicable diseases, increased rate of acquiring non-communicable diseases and increased injury.

Secondly, on the cusp of education we must make it very clear that early intervention is key. 75% of adult mental disorders start before age 25, of which 50% have an onset before age 15; either way by adulthood the effects of a mental illness are less reversible and more challenging to care for. (Hickie, 64) One in four young people will experience a mental health disturbance in their lifetime that will significantly influence their adolescence and/or early adult life. However, in spite of this statistic early intervention has been associated with significant improvements in at least the first two years after presentation of a mental disorder. It would be a travesty to not take advantage of an answer sitting right in front of our faces.

Finally, we must work on the development of youth oriented mental health models. Current approaches are ineffectual and we must be open to newer models such as those incorporating the use of online systems, electronics, and computer interactions. We could get bogged down in arguments over whether technology alienates us from each other, but research has repeatedly shown that youth and young adults are less inhibited when interacting with computers and are more willing to share their conflicts and emotions leading to earlier diagnoses. (Coyle, 2007) It still requires that ethical and privacy considerations are hashed out, but it shows significant improvements in comparison to traditional interventions.

By focusing on mental health, Girls Incorporated will come full circle in maintaining its mission to inspire strong, smart and bold girls. If Girls Incorporated were to have a mental health program it could function much like the already existing pregnancy prevention program. The program would be divided along distinction age groups, and in the age groups most affected by mental health disorders (i.e. 12-14, 15-18), there needs to be extra emphasis placed on not just on awareness and education, but the removal of stigmatization in seeking mental health. Further ties should be made with the already existing PEERsuasion Program to make sure that peers do not feel that it is on them to keep mental health issues in secrecy, but instead have peer appropriate interventions (i.e. having peers realize that they are often the first resource for their friends suffering from a mental illness and having them remind their friend that seeking further help is not only an option, but the best option.)

I truly believe Girls Incorporated has the willpower, means and inherent motivation to create such a program that will hopefully become the model for future successful, intervention models for mental health in young women.

Coyle, D., Doherty, G., Matthews, M., Sharry, J. (2007). Computes in talk-based mental health interventions. Interacting with Computers 19, 545-562.

Hickie, I.B. (2011). Youth mental health: we know where we are and we can now say where we need to go next. Early Intervention in Psychiatry 5(1): 63-69.

Patel, V., Flisher, AJ., Hetrick, S., McGorry, P. (2007). Mental health of young people: a global public-health challenge. Lancet 269, 1302-1313.

A Call for Integrating Mental Health into Mainstream Public Health Efforts

March 3rd, 2011

To: World Federation for Mental Health

From: Rita Martinez, Stanford University

Subject: Integrating Mental Health Services within Broader Health Care Systems in Low and Middle-Income Countries

Date: 3/3/11

“Improvement in mental health services doesn’t require sophisticated and expensive technologies. What is required is increasing the capacity of the primary health care system for delivery of an integrated package of care,” says Dr Ala Alwan, Assistant Director-General for Noncommunicable Diseases and Mental Health at WHO

Efforts focusing on how to better incorporate mental health programs into health care systems have been both recent and challenging. The lack of integration has been most strongly felt in developing countries, where access to mental health services are offered in very limited hospital settings, resulting in an increased number of patients suffering from illnesses going untreated. Addressing this important treatment gap will require increased cross sector collaborations are needed and a strong focus on encouraging dialogues that grapple with the stigma associated with mental illness as well as different cultural beliefs.  This movement will have powerful repercussions for greater public health efforts because mental disorders are known to increase the risk of communicable and non-communicable diseases, as well as contribute to incidences of personal injury.

Mental health is an integral part of one’s overall health outcomes, and without a doubt, there can be no health without mental health. About 14% of the global burden of disease has been attributed to neuropsychiatric disorders, mostly due to the chronically disabling nature of depression and other common mental disorders, substance abuse, and psychoses (1). This has drawn attention for the critical importance of mental disorders for public health. However, traditional measures for calculating the burden of disease focus on differentiating the contributions of mental and physical disorders to disability and mortality, thereby leading to the entrenched alienation of mental health from mainstream efforts to improve public health that we observe today (1). Because the reality of their interconnectedness has only recently been promoted, efforts to improve the prevention and treatment of people with mental illness have not been as successful as they could be in addressing the treatment gap.

The Global Burden of Disease report reveals that neuropsychiatric conditions account for up to a quarter of all Disability Adjusted Life Years (DALYs) lost, and up to a third of those attributed to chronic diseases (1). The conditions that contribute the most of DALYs lost are unipolar and bipolar affective disorders, substance- use and alcohol-use disorders, schizophrenia, and dementia. Despite new information, mental health remains a low priority as developing countries tend to focus on controlling infectious disease and maternal/child health, and developed countries focus on non-communicable diseases that cause early death like cardiovascular disease and cancer above those that cause years lived with disability. With that in mind, the aim of any strategy to advance mental health needs to focus on integration since if it continues to be regarded as a distinct health domain with separate budgets, the investment in mental health will be perceived to have an unaffordable opportunity cost (1).

The WHO Mental Health Gap Action Programme (mhGAP) has attempted to address the “treatment gap”- the gap between the number of people with disorders and those receiving treatment, (which is as high as 70-80% in many countries) by developing treatment packages for mental disorders that can be implemented on a large scale in low and middle-income countries. Due to limited financial resources, it becomes incumbent for any program to understand the importance of working with community-based primary care facilities when delivering these packages (2). The argument for integrating mental health services within primary care settings revolves around the reduction of associated stigma within the community and also ensuring that doctors are able to address the increasing prevalence of mental health problems.

This makes good economic sense because mental disorders account for the largest percent of DALYs lost globally. What is more, mental disorders can impact children’s learning and the ability of adults to function in families, at work, and society at large. Addressing this issue would also benefit the poorest people, whom are most likely to be suffering from mental disorders as a result of said poverty and/or the illness itself. Poverty is strongly associated with stressors that interact in complex ways, resulting unemployment, violence, social exclusion, and a sense of loss of control- all of which are closely linked to the onset of mental disorders (3). However, acknowledging that half of all countries only have one psychiatrist per 100,000 people, and a third of all countries have no mental health programs at all further supports the need for alternative approach to mental health (4). A great way to assist developing countries is to support the development of an approach that deals with mental illness in a culturally sensitive way and responds to low resources through training informal health workers. Training health workers and traditional healers to treat patients in poor countries and refer severe cases to a hospital psychiatrist may prove to be a more efficient way to treat more people suffering from mental disorders in low-resource settings.

An effective strategy for addressing mental health must focus on the promotion of well-being, the prevention of mental disorders, and the treatment and rehabilitation of people affected by them (5). However, this strategy cannot be adequately implemented as a stand-alone medical initiative, but must be integrated within the broader health care system or community health center in order to have the greatest impact among those affected. Because mental health is inextricably linked to one’s overall health, (having significant impact on morbidity and DALYs lost) the World Federation for Mental Health must work to facilitate its integration to mainstream public health efforts. This can only be effectively achieved by training primary care doctors in mental health issues and providing counseling services at all levels. Additionally, integration will also facilitate the removal of stigma associated with mental illness and encourage an open conversation on its effects on society at large. To have lasting effects, efforts should dually focus on advancing the status of mental heath and supporting developing countries to design unique innovative programs. With this approach, I believe we will see the greatest impact on those suffering from mental disorders but also promote a more equitable and socially conscious world.

Sincerely,

Rita Martinez

Stanford University, Class of 2012

Sources:

(1) No Health Without Mental Health-http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2807%2961238-0/abstract

(2) WHO Simplifies Treatment of Mental and Neurological Disorders-http://www.who.int/mediacentre/news/releases/2010/mental_health_20101007/en/index.html

(3) UN Enable-http://www.un.org/disabilities/default.asp?id=1545

(4) Mental Illness and the Developing World- http://www.guardian.co.uk/commentisfree/2010/may/10/mental-illness-developing-world

(5) WHO report: http://un.by/en/who/news/world/2004/04-06-04.html

The Anti-Human Trafficking and Juvenile Protection Department in Cambodian National Police under the Ministry of the Interior

March 3rd, 2011

The Anti-Human Trafficking and Juvenile Protection Department in Cambodian National Police under the Ministry of the Interior

To Whom It May Concern:

As a concerned citizen of the world, I would like to bring your attention to the plight of Cambodian girls and women who are forced into the sex trade. As you may be aware, 1 in 40 girls in your country will be sold into the sex trade. I have spent the past nine weeks researching sex trafficking in Cambodia, and hope to share with you my findings, and propose an intervention to rehabilitate the girls and women, so that they may be healthy, productive and contributing members of society. The goal of my research and this policy memo are to address the questions:

1. How can we most effectively rehabilitate these girls and women? How can we empower them to raise strong and healthy children who are the future of Cambodia?

2. How can we prevent the sexual exploitation of future generations of females?

Who We Need to Help:

Sex workers are not just teenage girls – we see women of all ages, and girls as young as infants being exploited by brothel owners and pimps. Paying for sex is a fundamental violation of human rights: the right of a woman to her own body, dignity, and freedom. In addition to violating her at the time of sale and for the duration of time in which she is enslaved, sexual exploitation affects a woman’s entire future. If she contracts a sexually-transmitted-infection or suffers severe physical or psychological injuries during her time in a brothel, she will be unable to raise healthy and productive children, who can contribute to Cambodia’s workforce and future as a nation.

Effective Rehabilitation:

I propose that the Ministry of the Interior model a national program after that of Somaly Mam. Somaly is more than a survivor of sex slavery- she’s a human rights crusader, saving girls from brothels and giving them a new life. Her organization is unique because it employs doctors, social workers, and former victims to teach the girls and women at her centers about AIDS prevention, sexual health, emotional health, women’s rights, and the joys of living freely and independently. “Being a former victim myself, I know exactly what their needs are. What they need most is love and understanding,” she explains. Rehabilitation will be most effective if it combines health professionals with strong female mentors who are survivors of sex trafficking or prostitution themselves. This way, girls are less likely to feel intimidated or judged by the people trying to help them.

  • Goal: Provide girls and women with the skills to reintegrate into society and the courage and self-esteem to reduce their risk of falling back into the sex trade.
  • Approach: “All of our programs share an emphasis on the collective voice of the survivors, who participate in every aspect of our work. Survivors who have gone through our rescue, rehabilitation, and reintegration programs can choose to join our Voices for Change initiative, which offers them the opportunity”  to do outreach and teach classes to other survivors. VFC members visit brothels, distributing condoms and doing HIV/AIDS education. Girls in the program learn how to speak, read, and write English, use computers, and learn trades. They’re also given time for creative expression and reflection.

There are so many psychological consequences of prostitution, torture, rape, and physical violence that absolutely stay with the girls for the rest of their lives. We want to minimize the long-term negative consequences of theses traumatic experiences, so that we will have a healthy and capable workforce, strong families, and a just social system and culture of equality and prosperity. Girls who are living in the Somaly Mam Foundation/AFESIP centers undergo intense post-traumatic stress and grief counseling with social workers and doctors. Rescued children and women cannot just be released back into the world, but need counseling, medical care, education, and support to learn to live independently. This transition to the real world must be done in a safe and nurturing environment, because many escaped sex slaves are paranoid of the world around them, untrusting of all men, and have such low self-confidence that they don’t realize they can make decisions for themselves about their bodies and their lives. In order for a rehabilitation center to be effective, it must be in a safe, protected location. It is important that we allocate enough resources to hire security for the facility, as there have been problems with pimps breaking into centers and stealing their girls back.

Structural Change:

Around the world, sex trafficking and sex slavery are a huge issue. Cambodia is not alone. It’s important to help the survivors, if we want to produce a more productive and sustainable workforce in sectors that do not violate human rights.  The Ministry of Social Affairs, Labor, Vocational Training and Youth Rehabilitation (MOSALVY)’s efforts to eradicate the sex trade are commendable, and I urge you to work towards more of these programs for the benefit of all sectors of society. I was thrilled to learn that the Ministry of Women’s and Veteran’s Affairs and MOSALVY collaborates with UNICEF’s Community-Based Child Protection Network, to teach young community members about the hazards of trafficking, so that individuals are equipped with the tools to recognize potential victims and help them. It is wonderful that MOSLAVY operates two shelters and works to place survivors with NGOs for long-term recovery. I hope that by learning from the Somaly Mam/AFESIP model, the Ministry of the Interior can expand upon its efforts to end sexual exploitation by thoroughly training its staff, expanding its community outreach to both address and prevent these issues, and creating new and improved rehabilitation facilities.  Ideally, we could prevent this before it happens by helping families rise out of extreme poverty without selling their daughters into the sex trade.

Cultural Change:

I believe that Cambodia can benefit from adopting the spirit of Eve Ensler’s V-Day campaign and commitment to ending all forms of violence and silencing of women. Ensler’s “V-girls” global network of activists and advocates is about letting girls embrace their unique energy, compassion, passion, and vibrant joie de vivre to make change. “What changes things is people. People becoming emotional creatures. What’s changing the Congo is people speaking up. if we’re not awake in our emotional creatures, we can’t wake up others,” says Ensler. Cambodia has thousands of girls with strong voices who are being silenced, numbed, buried. If we empower these girls to use their spark to create the change they imagine for this world, we will see a revolution led for the girls of the sex trade, by the girls themselves. What women want and need in a rehabilitation center is a place to heal, a place to be trained to heal others, and a place to gather their strength. We need to use dance, theater, music, art, and writing to harness the energy of girls, and help them rise out of trauma and subjugation. I understand that resources are limited, but may I suggest that we provide every single Cambodian girl who is rescued from a brothel with a copy of Eve Ensler’s “I am an Emotional Creature,” a collection of monologues inspired by girls around the world, about their experiences in and with sex slavery, forced labor, FGM, body image, and the emotional rollercoaster of life. Ensler proves that the written word is tremendously empowering and inspiring of creativity, activism, and lasting grassroots change.

Preventative Measures:

The Human Rights Task Force on Cambodia, an international NGO set up by five Asian and one American human rights organizations, believes that women may be sold into the sex trade by family members, but if they ever escape, they face immense discrimination, isolation, and stigmatization by relatives and friends. We must realize that a woman permanently bears the ‘mark’ of a sex slave, and may be completely abandoned by her former support network. Furthermore, her marriage prospects are significantly diminished, so starting a new life and finding employment and a romantic partner may seem and be impossible. This contributes to the heavy shame that women bear, both during their time in brothels, and once they leave. If we do not do something to eliminate this paralyzing social stigma, we will lose a generation of Cambodians, because their moms will be uneducated, and living in poverty, without the support of their community and government.

In addition to being ostracized, a woman’s physical and psychological health are damaged, sometimes beyond repair. For girls and women who contract HIV/AIDS and other dangerous STIs, as well as those whose psychological distress escalates into severe depression or suicidal thinking, actually leaving the brothel doesn’t have any benefits. Physical “freedom” or distance from the brothel, pimps, and clients doesn’t equal immunity, protection, or an erasure of cumulative damage. If a woman gets pregnant through intercourse with a brothel client, she risks giving birth to an unhealthy baby, or one with HIV. Because of the severity of mother-to-child transmission of this disease, we need to make an effort to make medical services available to these women.

What can the government’s rehabilitation centers do to promote family support of survivors?

  • Offer multi-faceted support (sort of like family therapy) for girls and women who have escaped from the sex trade, or better yet, do it preventatively, in schools and community centers. Teach families that sex slaves are not to blame for the spread of HIV/AIDS, survivors of rape and sexual abuse are not unworthy or impure, having sex with virgins does not cure a man of AIDS, and all women deserve respect, dignity, and the protection of their human rights.
  • Make parents and siblings of survivors a big part of the support network post-rescue. Perhaps holding gatherings to allow parents to voice their concerns, support each other, and learn to accept, respect, and love their daughters, celebrating their strength.

I hope that through collaboration with local and international NGOs, the Ministry of the Interior can expand its efforts to rescue girls and women from the sex trade, and rehabilitate them so that they are empowered, productive members of society. Through dedication to ending the human rights violations of sex trafficking and slavery, we can create a more equal, peaceful, just, and cohesive nation that will thrive economically, socially, and politically.

Thank you for your consideration.

In good health,

Elise Geithner

Stanford University Undergraduate

Sources:

Bureau of East Asian and Pacific Affairs. “Cambodia: Prostitution and Sex Trafficking.” US Department of State. 23 July 2010. Web. 20 Jan. 2011. <http://www.state.gov/r/pa/ei/bgn/2732.htm>.

Ensler, Eve. “I am an Emotional Creature.” Presentation at Castelleja School, Palo Alto, CA. 3 March 2011.

Hansen, Chris. “Children For Sale.” MSNBC. 9 Jan. 2005. Web. 2 Feb. 2011. <http://www.msnbc.msn.com/id/4038249/ns/dateline.nbc

HumanTrafficking.org. “Cambodia.”  http://www.humantrafficking.org/organizations/42

3 March 2011.

Human Rights Task Force on Cambodia. “Cambodia: Prostitution and Sex Trafficking.” Human Rights Solidarity. 13 Aug. 2001. Web. 20 Jan. 2011. <hrsolidarity.net>.

Murray, Anne. “From Outrage to Courage.”

The Road to Traffik. Prod. Norman J. Roy. The Somaly Mam Foundation. Web. 12 Jan. 2011. <www.somaly.org>.

Nair, Sowmia. “Child Sex Tourism.” US Department of Justice. Web. 20 Feb. 2011. <http://www.justice.gov/criminal/ceos/sextour.html>.

“Beauty is Pain”: Beauty Discrimination

February 25th, 2011

For the past several weeks, I have discussed the many ways in which women seek to conform to society’s standard of beauty. I have discussed various cosmetic procedures women have done as well how perceptions of beauty affect women’s mental health and well-being. For this week, I will be shifting gears a bit and focusing on a very real problem that exists in our society – beauty and weight discrimination.

I was first exposed to the idea of beauty discrimination by an article in the “Stanford” magazine that discussed law school professor Deborah Rhode’s new book, Beauty Bias. It was from this article that I got the idea for what would later become my blog topic for this class. A quote that really stuck with me from the article was when Rhode stated that, “We all know that looks matter, but few of us realize how much.” Thus, this blog post will focus on how much looks matter in terms of things like job promotion and perceived intelligence. At the end of this blog post, I hope everyone comes away with a sense of how powerful appearance bias is in our society that unfortunately grants rewards or disadvantages unto people based on their physical looks.

As we are all undoubtedly aware, physical appearance can play a large role in determining whether or not people find you attractive. In a society where appearance matters and physical attractiveness is idealized, it should come to no surprise that this preference for “beautiful” people has been expressed in the workplace. In fact, a reported 12 to 14% of people claim that they have suffered from appearance-based discrimination at their job (Beyerstein). Hiring managers in a wide variety of fields have systematically chosen more “attractive” candidates for positions over those considered unattractive. Researchers found that even in the law profession, graduates of a certain law school who were considered attractive earned more than their less attractive former classmates and also had more opportunities for career advancement (Biddle, Hamermesh).

Thus, for those considered unattractive, research has shown that these people are more likely to be considered less capable, less intelligent, and less trustworthy by society. Furthermore, Rhode found in her research that unattractive people not only get paid less, but that less attractive children get less attention from not only their teachers but also their parents (Platoni, Rhode). This starkly contrasts to the situation of those people considered by society to be attractive. Rhode found that attractive people are not only thought to be more intelligent but that their resumes and essays get more positive responses when hiring managers believe they come from an attractive person.

While women are often held to higher standards of beauty, appearance-based discrimination also affects men. Researchers Jeff Biddle and Daniel Hamermesh found that there is “a significant penalty for bad looks among men.” They found that of the 9 percent of working men that were ranked by interviewers as being either “below average” or “homely” in terms of their physical appearance, that these men also made 9% less in terms of hourly wages. In contrast, the 32% of men that were judged to be “handsome” or “above average” earned 5% more (Lesley).

Thus, biases not only work in favor for those perceived to be pretty, but can work against people who are considered overweight. Known as weight discrimination, this type of discrimination is based on the stereotype that associates overweight people with being unhealthy or lazy (Platoni) and even socially handicapped (Roehling). Indeed, large amounts of research have concluded that there exists a pervasive bias against overweight people in western culture (Roehling). In terms of the workplace, the statistics and studies suggesting that discrimination occurs against overweight people are abundant. In his summary of current research, Roehling found that there is evidence of discrimination against overweight people at every stage of the employment cycle, including hiring, placement, compensation, and promotion.

And indeed, overweight people do believe they are discriminated against. One study found that around 43% of overweight women felt that their employers had discriminated them against. Even more surprising was the differences in pay between overweight people and their thinner coworkers. One study found that obese women earn 12% less than their thinner female coworkers, even if they have comparable qualifications (Breyerstein). In fact, perceptions and stereotypes about overweight people are so ingrained in people’s minds that one study found that even sitting next to an overweight person in a waiting room before an interview could have negative effects on how one is perceived. Researchers found that people who sat next to overweight people were judged as having “inferior professional and interpersonal skills.” (Platoni).

So what to do?
So if beauty and weight discrimination are legitimate problems that might be hampering the ability of a more homely or overweight person from reaching their full potential – especially in the work place – what can be done to prevent this? While undoubtedly our preferences for “beautiful” and “slender” people are subconsciously ingrained in us, Rhode suggests that more states and local districts should adopt ordinances that forbid appearance-based discrimination. Current federal law does not expressly prohibit discrimination based on weight or appearance. While critics argues that such ordinances would lead to an increase in phony litigation, of the localities that do have such laws preventing discrimination based on looks (currently six cities and one state), there have been only a few lawsuits filed (Platoni).

It is easy for many to dismiss the prevalence and relevance of discrimination based on physical appearance. However, as I hope this blog post has showed, discrimination based on physical traits is not only ubiquitous, but it has very real and harmful effects on those people considered unattractive by today’s society.

Sources:
“Fair Enough?” by Kara Platoni. Published in Stanford Magazine. September/October 2010 issue.

“The Influence of Appearance Discrimination on Career Development.” Joseph Lesley.

“The ‘Beauty Bias’ at Work, and What Should Be Done About It.” Lindsay Beyerstein. June 11, 2010. Inthesetimes.com

“Weight-based Discrimination in Employment: Psychological and Legal Aspects.” Mark Roehling. Personnel Psychology, 1999.

Biddle, Jeff. Hamermesh, Daniel. “Beauty, Productivity, and Discrimination: Lawyer’s Looks and Lucre.” National Bureau of Economic Research.

♫ I'm leaving on a jet plane/don't know when I'll be back again ♫

February 25th, 2011

In the interest of full disclosure, for the past few weeks I have been trying to avoid the topic of eating disorders for two main reasons: first, from what I have learned in past classes it is a very Western issue and I am trying to focus on international issues that affect women’s mental health; secondly, it would not be enlightening for me as I have done several research projects on eating disorders and from what I have interpreted, this blog should help us investigate topics that we have not had a chance to delve into. (Disclaimer: This is in no way means that our society, especially media, isn’t significantly influencing the outcomes of eating disorders in young women, nor does this mean that eating disorders are not an important issue in women’s health.) However, I noted that much of the research reveals that in the instances that immigrant women in the US and or women outside of the Western world had eating disorders, it was often correlated with a recent change in their ideology—a change often motivated by an influx of western ideals on beauty. As I mulled this over, I realized that there was still room for another pertinent blog topic. I began to wonder what other issues immigrant women faced with migration into new countries, often having ideology and ethos dissimilar from their own and how that affected their health outcomes.

Immediately, I found research showing that while individuals often “migrate to improve their well-being…migration [tended to be] a stressful process, with potentially negative impacts on mental health.”  (Stillman, 677) In essence, immigrants, often women, from developing nations threatened with war, poverty or disenfranchisement in their own country were fleeing or leaving of their own free will to more developed countries that offered them more freedom and more material wealth, but with a caveat: their mental health. Now sometimes these immigrant women are already facing mental health issues such as schizophrenia, which is often correlated with migration as it is (Stillman, 678), and they are able to find help in the country they migrate to. In fact, Stillman et. al concluded that at the end of the day it was important to put migrant women’s mental health into perspective—it would certainly be worse if they stayed in their home country. (Stillman, 687)

I, however, would like to argue otherwise. Developed nations that immigrant women migrate to may afford them better interventions, but how can this be so when immigrants often are impoverished and the impoverished often face difficulties in access to healthcare. My argument isn’t that they should stay in their home country, but rather maybe we shouldn’t be so quick to think that their mental health is golden by just migrating to a more developed nation.

I decided to test my theory by looking at a few empirical studies. The first by Leu et. al looked at the age in which Asian immigrants migrated and the subsequent outcome  of their social status and on their mental health in adulthood. While SES did play a role in social mobility, SES did not make a difference in mental health for this who immigrated before 25. (1161) If we think about it, often up until 21 humans are still very impressionable as our minds are still being pruned and we are still highly influenced by our peers, so it only makes sense that those that immigrate younger and around this age are not only facing the stress of immigration but also the affects of having to establish a social identity that allows them to fit in—this often leads to anxiety disorders. (Leu, 1161) In this instance, access was not an issue but we can see how immigration does not immediately equate to a well-adjusted individual.

Nadeem et. al. looked at the stigma in African and Caribbean immigrant women in their seeking behaviors for mental healthcare and found that compared to US-born white women, just like US-born black women and Latina women, poor young immigrant women were more likely to report concerns relating to stigmatization and access. (Nadeem, 1547). Williams et. al also reported that Caribbean-born immigrants were more likely to report symptoms of depression and aggression than their US-born counterparts. If migration is supposed to be a successful self-intervention, then why these negative statistical differences?

De Anstiss et. al summarized it very well in my opinion. It is in our best interest to make sure that with material improvements we make sure that we are providing immigrants with the right information for mental healthcare access as well as making sure that younger immigrants are equipped with the proper coping interventions. (De Anstiss, 599)

Works Cited

De Anstiss, H., Ziaian, T., Procter, N., Warland, J., & Baghurst, P. (2009). Help-seeking for mental health problems in young refugees: A review of the literature with implications for policy, practice, and research. Transcultural Psychiatry 46(4): 584-607.

Leu, J., Yen, I.H., Gansky, S.A., Walton, E., Adler, N.E., & Takeuchi. (200The association between subjective social status and mental health among Asian immigrants: Investigating the influence of age at immigration. Social Science & Medicine 66: 1152-1164.

Nadeem, E., Lange, J.M., Edge, D., Fongwa, M., Belin, T., & Miranda, J. (2007). Does stigma keep poor young immigrant and US-born black and latina women from seeking mental health care?. Psychiatric Services 58(12): 1547-1554.

Stillman, S., McKenzie, D., & Gibson, J. (2009). Migration and mental health: Evidence from a natural experiment. Journal of Health Economics 28: 677-687.

Williams, D.R., Haile, R., Gonzalez, H.M., Neighbors, H., Baser, R., & Jackson, J.S. (2007). The mental health of black Caribbean immigrants: Results from the national survey of American life. American Journal of Public Health 97(1): 52-59.

A Sisterhood of Support

February 24th, 2011

After exploring the horrifying causes and consequences of the sex trade in Cambodia, I think it is time to cover a more positive aspect on the issue: the courage of survivors, the importance of support during recovery, and the road to healing. I’ve chosen to explore some successful programs in Cambodia which aim to empower women through various approaches. As Anne highlights in her book, there are many women’s groups who have come together to support each other and advocate for change. I believe that we can learn from these groups’ approaches and experiences how to best support women and girls who have been rescued or have escaped from the sex trade. As emphasized by Betsi Hoody and Devi Leiper of the Global Fund for Women, it’s “rights not rescue” that we must remember to focus on. With issues of human rights violations, I’ve found that is so important to look at both prevention, education, and awareness and ways to rehabilitate the survivors of abuse and help them integrate back into society, in culturally sensitive and healthy ways.

Devi Leiper explained that many women in Cambodia want factory jobs and economic independence. They move to urban centers hoping to find employment that will allow them to provide for their family, gain social status, and feel empowered by her efforts. With the migration of poor women into the cities, we see many getting coerced into trafficking schemes – taken to other parts of Asia for domestic work, and tricked into sex work domestically or abroad. Women are easily trafficked because their labor (not to mention their worth as human beings) is undervalued and often goes undocumented. So what happens when women see their only opportunity for income or economic independence in sex work? In the words of Somaly Mam, many girls and women “have no choice. They have to sell themselves, they have to have sex.” What if they are lured by promises of a good job, but get taken to a brothel and become indebted to the owner?

What about the girls and women to escape the brothels, or are rescued by NGOs or sudden police raids? Where do they live once they are “free?” How do they reintegrate into society, join the workforce, regain the trust and love of their family? How can we help survivors of abuse find support, love, and acceptance in a supportive community of fellow survivors? I believe we can begin to tackle these challenging questions by learning from the missions and actions of these organizations:

1. Kachin Women Association Thailand (KWAT)

  • Fact: Young women are vulnerable to forced sex because of the violent conflicts in Thailand, Burma, Cambodia.
  • Goal: Train young women to become leaders of the women’s rights movement and work to cultivate gender equality in the community.
  • Approach: Promotes women’s rights and tries to restore their status in post-war society through leadership and skills training “to help women become politically aware and economically independent” (Murray 155).

2. Girl Guides Association of Cambodia

  • Fact: Today’s girls are tomorrow’s women. If we empower young females, we can cultivate gender equality and increase understanding of women’s unique health issues.
  • Goal: Educate young girls to become “the agents of change” by teaching them about domestic violence, gender equity, women’s health issues.
  • Approach: Offer non-formal education and encourage participation in community projects and camping trips to help the girls “develop self-esteem, appreciation for leadership, and concrete roles as responsible members of society” (Murray 68).

3. Urban Poor Women Development, Phnom Penh (UPWD)

  • Fact: Poor women in poor urban areas generally have low social status and limited economic opportunities.
  • Goal: Help poor women in urban areas find jobs and develop economic independence and increased social status.
  • Approach: Give funds to women to start small businesses, train women to be leaders in local organizations and NGOs (Murray 5).

4. Strey Khmer in Cambodia

  • Fact: Cambodia’s political system is dominated by men. Women’s voices and rights need to be heard and respected.
  • Goal: Encourage women to get involved in politics, so that at least 30% of government seats will be filled by female leaders in the near future.
  • Approach: Lead workshops in language training and leadership skills, teach classes on gender-based violence and women’s health, include male supporters of women’s rights in the effort (Murray 223).

As I discussed in my first blog post, I am most moved and inspired by the mission and work of the Somaly Mam Foundation. Founded by Somaly Mam, an escaped Cambodian sex slave, the foundation works with AFESIP to fund shelters in Cambodia, Vietnam, Laos, and Thailand that house rescued girls and offer them “the comprehensive services they need to heal, and to create healthy, sustainable futures for themselves.”

Somaly is more than a survivor, she’s a human rights crusader, saving girls from brothels and giving them a new life. “The Road to Traffik” movie explains that “Somaly was once told by a man that if she wanted to survive, she had to keep her silence. But she is no longer keeping silent. She is giving a voice to these girls.” Somaly’s work is a living testament that “raw courage can transcend a world of cruelty.” Her organization is unique because it employs doctors, social workers, and former victims to teach the girls and women at her centers about AIDS prevention, sexual health, emotional health, women’s rights, and the joys of living freely and independently. “Being a former victim myself, I know exactly what their needs are. What they need most is love and understanding,” she explains.

  • Goal: Provide girls and women with the skills to reintegrate into society and the courage and self-esteem to reduce their risk of falling back into the sex trade.
  • Approach: “All of our programs share an emphasis on the collective voice of the survivors, who participate in every aspect of our work. Survivors who have gone through our rescue, rehabilitation, and reintegration programs can choose to join our Voices for Change initiative, which offers them the opportunity”  to do outreach and teach classes to other survivors. VFC members visit brothels, distributing condoms and doing HIV/AIDS education.

The women who have started these organizations are strong, loving, courageous, creative, and determined. The women they serve are survivors, healers, mentors, teachers, mothers, sisters, lovers, and friends. The power of women to envision and actualize change cannot be underestimated. In the words of Maya Angelou, “You can write me down in history with hateful, twisted lies, you can tread me in this very dirt, but still, like dust, I’ll rise.”

Sources:

Murray, Anne. “From Outrage to Courage.”

Roy, Norman Jean. “The Road to Traffik.” <Somalymamfoundation.org>

Women's Mental Health and Aging

February 23rd, 2011

Aging is a universal experience that most people will grapple with during their lifetime. However, I hope to explore how aging (like most aspects of life) becomes gendered and differentially impacts women’s health outcomes. Additionally, in exploring women’s experience with aging, I will primarily focus on mental disorders like Alzheimer’s disease and dementia to understand how these issues impact women’s quality of life.

When looking at mental health issues in aging we notice problems with depression, anxiety, and loss. On the other side of the mental health spectrum, we have women who are also susceptible to Alzheimer’s disease, stroke, and other factors that contribute to dementia. With the passage of time, our brains begin to change in ways that affect how we store memories. In middle age, forgetfulness or mixing up facts can sometimes seem like an early sign of Alzheimer’s, but this is actually quite common. However, knowing when forgetting isn’t a normal part of aging is crucial to receiving a correct diagnosis and treating the problem if it is not dementia (1). Dementia is a group of symptoms caused by (among others) Alzheimer’s disease and stroke. Symptoms include memory loss, confusion, personality changes, and difficulty with normal activities like eating or dressing. Alzheimer’s is a brain disease that cripples the brain’s nerve cells over time and destroys memory and learning. It usually starts in old age and is degenerative, leading to symptoms like loss of memory, problems in thinking, and other changes in normal behavior (1). Serious memory lapses can lead to confused behavior like asking the same question over again, forgetting how to use everyday objects, becoming lost in familiar places, and neglecting personal safety and hygiene.

While one cannot necessarily stop time from taking a toll on the brain and associated cognitive functions, there are several suggestions for activities that can keep your brain stimulated in old age and thereby improve memory and learning. Examples of such activities include: learning to play an instrument, doing crossword puzzles, starting a new hobby, staying informed about current events, and reading (1). Helping women stay active through their middle-aged years and educating them on the ways to keep their minds stimulated would be a great way to both encourage healthy aging and promote the feelings of self-actualization that improve their overall quality of health.

The greater lifetime expectancy for women translates into a greater lifetime risk to various diseases and age-related neurological diseases like stroke and dementia. Researchers from Boston University School of Medicine estimated that 1 in 6 women are at risk for developing Alzheimer’s in their lifetime, while the risk for men in 1 in 10 (2). These neurological diseases can have serious impacts on women’s quality of life, particularly when thinking about access to resources and opportunities. More importantly, pervasive gender inequalities that affect women throughout the lifespan thereby translate into older women living longer, but in persistent poverty and with limited access to health services. Former General Kofi Annan states, “Women comprise the majority of older person in all but a few countries. They are more likely than men to be poor in old age, and more likely to face discrimination,” (3). Consequently, the rights of older women become easy targets for violations on many levels, often rooted in cultural and social biases.

When thinking about the needs of aging women, I would like to focus on three main activities designed to promote the security, health, and dignity of women: promoting income security and poverty reduction in old age, identifying barriers to preventative health care, and finding better ways to provide caregiving for women (4). These are crucial points to consider when exploring women’s mental health as they are poised to impact the progression of mental disorders and overall quality of health in women. Ensuring that women have options and resources available when dealing with mental health problems hinges on their economic security and so governments must work to provide safety nets for financially unstable aging women as well as addressing structural and personal barriers to services in different communities.

Women face significant challenges when aging, still being influenced by the gender relations that structured their entire life cycle. Aging is an important issue for women because while everyone will experience its negative effects, they will indubitably experience it differently. Attempts to improve mental health and aging with dignity for women must center on empowering women through education and policy analysis (ex: monitoring Medicare provisions), while also highlighting the importance of staying engaged in the community and providing caregiving support.  Understanding differential risks for men and women in aging will help inform any strategy aimed at addressing women’s mental health and the design of adequate interventions.

Sources:

(1) Healthy Aging- http://www.womenshealth.gov/aging/mental-health/depression-anxiety.cfm

(2) Lifetime Risk for Alzheimer’s Disease: http://www.sciencedaily.com/releases/2008/03/080318114824.htm

(3) Ageing, Discrimination, and Older Women’s Human Rights: www.globalaging.org/agingwatch/cedaw/cedaw.pdf

(4) Center on Women and Aging: http://iasp.brandeis.edu/womenandaging/mission.html

Sex Deprived? So, Rape Thy Comrad.

February 17th, 2011

“‘Battle buddy bullshit’ said García from the Military Police. ‘I didn’t trust anybody in my company after a few months. I saw so many girls get screwed over, the sexual harassment. I didn’t trust anybody and I still don’t.’” [1]

In my introductory post I promised to look at the many ways war affects women’s physical and mental health and the role the media plays in spreading awareness and empowering women in difficult situations—so far we’ve examined rape as a tool in war, the hidden gender-war on the Mexican border, and the sweeping effects of social and mainstream media—now it’s time to turn to a new lens: women in modern warfare. In the midst if all the ROTC talk on campus, I figured, this would be an interesting exploratory piece for the week. It may appear strides have been made, as women increasingly choose to join military ranks along side men, but the story is much more complex. An excellent piece, written in the midst of Bush’s troop surges in 2007, titled “The Private War of Woman Soldiers” by Helen Benedict explores this exact theme with a unique twist: rape in the military.

After having interviewed over 20 female soldiers in Iraq, Benedict notes, “I can’t help wondering what the women [in the troops] will have to face. And I don’t mean only the hardships of war, the killing of civilians, the bombs and mortars, the heat and sleeplessness and fear. I mean from their own comrades — the men.” [1]
The threat of rape was so bad, women were warned by their officers not to go outside at night nor to enter shower facilities alone without other female companions for security. [1] This suggests several things: first, that the trend of sexual violence is all too real in the US military; second, that the authorities are aware of the regularity of these violations and unwilling to respond; and third, that this sets a dangerous precedent for women entering military service and for the nature of relationships amongst the genders within combat troops. Danger in war should not come from the home base—the last fear that a US soldier should deal with is the threat of his or her own side. Yet, as Spc. Mickiela Montoya, age 21, member of the National Guard in 2005, explains, she took to carrying a knife with her at all times. “The knife wasn’t for the Iraqis,” she told me. “It was for the guys on my own side.” [1]

In a time when going to war is low on the list of priorities for young American generations, there has been a trend to waive violent ad criminal records of enlisted army members—it seems the government is side-stepping laws meant to protect soldiers in an attempt to increase military participation and fight off soldier burnout rates. Consequently, these delinquent soldiers pose an increasing threat to the safety of other army members, particularly women.

Sex and war are a very tricky equation. Soldiers have been known to abuse and misuse foreign females for their own pleasure and carnal desire and (as discussed by several blogs from this course) have fueled the growing sex trades in the countries where they are stationed. As more women than ever before enter the US military service, our nation has to think about how we protect these brave individuals from falling victim to sexual violence in the midst of war.

The rape situation in Iraq became so bad that in 2004 former Defense Secretary Donald H. Rumsfeld ordered a task force to investigate. The statistics remain largely unavailable, but women’s stories are becoming more accessible. Col. Janis Karpinski publicly released that one of the reason several women soldiers died of dehydration was because of fear of traveling to watering centers due to the ever-present threat of rape from their male troop members. [1] In effect, she risked losing her high profile military position because she dared speak out against these offenses. Her superiors threatened her on the charge that she was “bringing attention to the problem” [1]

What astonishes me is that these stories never struck big in the media—it is as if little action was taken to curtail these incidents in order to protect US army’s reputation and to avoid discouraging enlistment. When NPR ran a story on wounded soldiers focusing on women in the Iraq war, they did indeed explore the effects of changing warfare on a growing female military front. It was noted that women fighting in the Middle East make up approximately 15% of troops. [2] While this is still a minority group, it is a larger fraction than has ever before been observed. The article also looked at growing casualties, 1500 US personnel dead by 2005 [2] –and as we all know that number steadily grew.

The NPR piece notes that the nature of modern war is such that all soldiers are always on the front lines, because there are no clear distinctions. Women are in the combat units, despite formal restrictions. As a result women are facing the same wounds and traumas as their male counterparts. [2] There is no gender distinction when it comes to battle.

What this detailed history of women in combat failed to examine, however, is how the changing demographics of the military play out internally. In fact, few pieces covering the war did this. If they had, they would discover a story of perpetual abuse.

Why does the media not care to inquire about these abuses and the stories behind them, so that we can safeguard the lives of women risking themselves for our nation. Even Rumsfeld had taken note of the rising trend, as he ordered the elusive investigation– so how did this slip from the media’s eye?

I was shocked to read Benedict’s piece, and to hear that American soldiers live in fear within their own side’s safe zones as victims of more than just the external enemy, but also the internal “domestic” enemy.

Benedict’s investigation ends on a very somber tone, she concludes, “If this is a result of the way women are treated in the military, where does it leave them when it comes to battle camaraderie? I asked soldier after soldier this, and they all gave me the same answer: Alone.”

We need to start nurturing the physical and mental well being of our soldiers and ensuring that women are provided the necessary protections to serve their nation, not alone, but as part of the US team.

Sources:

[1] Benedict, Helen. “The Private War of Women Soldiers.” Salon. 7 Mar. 2007. Web. http://www.salon.com/news/feature/2007/03/07/women_in_military.
[2] “Wounded in War: The Women Serving in Iraq : NPR.” NPR : National Public Radio : News & Analysis, World, US, Music & Arts : NPR. Web. 18 Feb. 2011. http://www.npr.org/templates/story/story.php?storyId=4534450.

Seeing What’s Right In Front of Your Face—International Perspectives in Women’s Mental Health

February 17th, 2011

For several weeks I have been trying to expand my scope on mental health issues that affect young women into more international perspectives, but have had limited success. I scoured several databases, trying to explore what issues consistently threaten the mental health of young women globally, even just women globally, but it seems that most of the literature is focused in developed nations and often only in the US. I know that mental disorders and illness affects young girls and women all over the world (Afifi, 387), but I could not understand why it was so hard to find research reflecting this fact. Then it dawned on me. Maybe that was just it. Maybe the lack of research being done on mental health in developing nations was a critical issue itself. Maybe the fact that mental illness was taking a backseat to physical illness was another concurrent issue.

When we think of developing countries, let’s be honest many of us automatically think, ‘Let’s resolve communicable diseases such as AIDS…mental illness can wait’. This seems reasonable until we examine and understand the complexity of how mental disorders are seen globally. It has been argued time and time again that the estimated global burden of mental health disorders have been underestimated due to the unintended consequences of separating mental health from mainstream efforts to improve physical health in many developing countries. (Prince, 859) Consequently, there is a general under-appreciation for the interactions of overall wellness and physical health with mental health. For example, a fact often overlooked is that mental illness increases the risk for communicable and non-communicable disease and contributes significantly to many injuries, both intended and unintended. (Prince, 859) Therein, if we are truly trying to fight diseases such as AIDS from all avenues, then we should also understand it from a mental health perspective.

Also, I read Seedat et. al’s article about the gender differences in the WHO’s mental health surveys a few weeks back and remembered that they discussed the fact that there were lower response rates in developing countries. (Seedat, 791) They tried to explain it by saying it might have been due to traditional gender roles, but underreporting occurred across the board in both genders and was overall worse in women. So perhaps we should be placing a global emphasis on mental health and wellness, in general and especially for women. However, even in developed countries we have only recently begun to place an emphasis on understanding and improving mental health and so there isn’t a model to follow. Furthermore, the way the world seems to work is that issues are often advocated first in men, and then applied, often without alteration, in women.

So what can we do? Sitting back and waiting is not an option. Why not encourage women to seek out help and better understand their mental health? Why don’t we try and understand what barriers currently exist that make this difficult to achieve?

In many developing countries, it has been noted that women often complain about a lack of privacy, confidentiality and information about available services. (Afifi, 386) These are all key aspects to successful interventions in mental health and without them men and women alike will face hardship in establishing mental wellness. In particular regions, such as the Middle East issues like domestic violence are not recognized and therein women having mental disorders in relation to domestic violence can never experience a full resolution to their mental health if the cause of their disturbance is not even recognized. (Afifi, 389) In many Asian countries, dominating patriarchal systems consistently affect the value of women and therein less resources are spent on girls. (Patel, 411)

Overall though, it seems that the most critical issue I have learned about young women and mental health internationally is the consistent lack of awareness for mental health globally. This overwhelming complacency for mental health is the biggest barrier to interventions for women’s mental health and until we recognize mental health and its interactions with physical health, we will only be able to scratch the surface of other pressing barriers such as patriarchy, domestic violence, and lacking services.

Work Cited

Afifi, M. (2007). Gender differences in mental health. Singapore Medical Journal 48(5): 385-391.

Patel, V., Kirkwood, B.R., Pednekar, S., Pereira, B., Barros, P., Fernandes, J., …& Mabey, D. (2006). Gender disadvantage and reproductive health risk factors for common mental disorders in women: A community survey in india. Archives of General Psychiatry 63: 404-413.

Prince, M., Patel, V., Saxena, S., Maj, M., Maselko, J., Phillips, M.R., & Rahman, A. (2007). No health without mental health. Lancet 370: 859-877.

Seedat, S., Scott, M., Angermeyer, M.C., Berglund, P., Bromet, E.J., Brugha, T.S., … & Kessler, R.C. (2009). Cross-national associations between gender and mental disorders in the world health organization world mental health surveys. Archives of General Psychiatry 66(7): 785-795.

Saving VAGINAS

February 17th, 2011

Saving Vaginas, Protecting Vaginas, Celebrating Vaginas!

I am still reeling, beaming, and laughing after seeing a phenomenal  performance of “The Vagina Monologues” on campus. It was my first exposure to the production, and I was moved beyond words. It definitely made it particularly special that I am close with the director and several actresses, but it was the spirit of the words and movements that glided across the stage, the engagement of men and women in the audience, and the love and warmth shared by all that really made my week. Watching the monologues got me thinking about our society’s general discomfort with using words such as “orgasm” and “vagina” in conversation, and in public. Or the guilt women often feel when privately reflecting on their pleasurable sexual experiences or fantasies. I consider myself very open, liberal, and extroverted when it comes to discussing sexuality, the female body, and sexual pleasure in general, and yet, it isn’t until recently that I’ve felt comfortable talking about MY vagina, for example. In the medical, education, and philanthropic fields, many of us “get” the importance of prioritizing women’s emotional and physical health, talking about FGM and obstetric fistulae and the injustices of sexual slavery and rape as a weapon of war, domination, and control. Yet, most American schools’ sex education programs are so limited, barely skimming the surface of a topic that is rich with (controversial?) layers of pleasure, mystery, and intimacy. It’s quite common to pick up an article of Cosmopolitan magazine and read “101 Tips to Make Your Guy Go Wild” or “Pampering Your Hoo-Ha,” yet discussing these techniques in a public forum is considered bold.

So, in honor of Eve Ensler and in the spirit of “V-Day” (a global activist movement that supports anti-violence organizations throughout the world, helping them to continue and expand their core work on the ground, while drawing public attention to the larger fight to stop worldwide violence (including rape, battery, incest, female genital mutilation (FGM), sex slavery) against women and girls), I will explore the issues associated with rescuing girls and women from the sex trade in Cambodia, and how to best offer therapeutic support to the girls (and their vaginas) and their families!

Rescuing Girls, Teaching Parents

I’ve really appreciated the comments and feedback I’ve received on my prior blog posts about Cambodian women and girls in the sex trade.

1. Vaughan raised the question, “Are we hurting these girls by raiding their brothels and taking away their livelihoods? Many have no education and came from nothing, many willingly sell their bodies and make much more money in this industry than they could in any other?”

2. Warner suggested, “Families should not have to make a ‘cost-benefit’ analysis of selling their own daughters.”

The Human Rights Task Force on Cambodia, an international NGO set up by five Asian and one American human rights organizations, believes that “the increased punishment for parents and guardians selling children” is ineffective and worrisome. Punishment does not address the root cause of what pushed a parent to sell their child in the first place: desperate poverty. Instead, HRTFC says, “a process of education and awareness-raising of parents” would be a much more positive part of a revised law on kidnapping, trafficking, and exploitation.

What are the problems with family?

  • Women may be sold into the sex trade by family members, but if they ever escape, they face immense discrimination, isolation, and stigmatization by relatives and friends.
  • A woman permanently bears the ‘mark’ of a sex slave, and may be completely abandoned by her former support network. Furthermore, her marriage prospects are significantly diminished, so starting a new life and finding employment and a romantic partner may seem and be impossible. This contributes to the heavy shame that women bear, both during their time in brothels, and once they leave.
  • A woman’s social status, physical, and psychological health are damaged, sometimes beyond repair. For girls and women who contract HIV/AIDS and other dangerous STIs, as well as those whose psychological distress escalates into severe depression or suicidal thinking, actually leaving the brothel doesn’t have any benefits. Physical “freedom” or distance from the brothel, pimps, and clients doesn’t equal immunity, protection, or an erasure of cumulative damage.

What can we do to help?

  • Offer multi-faceted support (sort of like family therapy) for girls and women who have escaped from the sex trade, or better yet, do it preventatively, in schools and community centers. Teach families that sex slaves are not to blame for the spread of HIV/AIDS, survivors of rape and sexual abuse are not unworthy or impure, having sex with virgins does not cure a man of AIDS, and all women deserve respect, dignity, and the protection of their human rights.
  • Make parents and siblings of survivors a big part of the support network post-rescue. Perhaps holding gatherings, much like “Family Members of Alcoholics” support groups, will help parents voice their concerns, support eachother, and learn to accept, respect, and love their daughters, celebrating their strength.
  • Change the way women are portrayed in the media. How can we make it clear that the female body is not an object, to be used, controlled, dominated, and hurt by men?

Unfortunately, many women and men who try to speak out against these unjust views of women and the deplorable condition of brothels, are persecuted and discouraged. As we saw with Somaly Mam and her co-workers, she has been personally threatened by men who are trying to stop her work (her 14-year-old daughter was kidnapped a few years ago, but luckily found in a far away Cambodian village, after having been drugged and gang raped). Mu Sochua is a Cambodian politician and women’s rights activist.

“She founded the first women’s organization in Cambodia, Khemar, and in 1998 became the first woman ever to be elected into Parliament and hold a seat in the Women’s Affairs Ministry. Mu Sochua has worked extensively to end sex slavery, including negotiating an agreement with Thailand allowing Cambodian women trafficked as sex workers to return to their home country instead of being jailed. She was nominated for a Nobel Prize for her work against sex trafficking of women in 2005. In the past year, after witnessing first hand the ongoing injustice against the people of her country, specifically the women, Mu Sochua filed a lawsuit against Hun Sen, the Prime Minister of Cambodia who has ruled the country for over 30 years. As a result she faces persecution and prison.” (VDay.org).

Sochua says, “in many people’s eyes Cambodia is on the road to reconstruction. Unfortunately, this stage of reconstruction has faltered and in many ways Cambodia is fast regressing to soft dictatorship. Thirty years after the Khmer Rouge genocide, at least 1 million Cambodian children go to bed hungry every night while hundreds of thousands of Cambodian girls are ruined in brothels” ( VDay.org).

Sochua has personally experienced the damaging impact of Cambodia’s pervasive attitudes towards women as sexually deviant, if they attempt to use their strength to speak out or break free.  “Despite the fact that I have been assaulted – with clothes torn from my body in the attempt to prevent the improper use of government vehicles for campaigning in Cambodia – by a general nonetheless – I now find myself assaulted yet again – this time by the prime minister himself who recently compared me to a hustler or prostitute, his words of shame blasted through a media that is totally controlled by his own party and family” (VDay.org).