Female sexual dysfunction or not knowing how to ask what feels good?

Female sexual dysfunction or not knowing how to ask for what feels good?

By Sally Hunter, University of New England

The recently published Italian study suggesting women can only have clitoral, rather than vaginal, orgasms raises important questions about the medicalisation of female sexuality and sexual dysfunction.

Many women would be happy to have an orgasm any old way, as University of Western Sydney researcher Jane Ussher points out, especially those who experience sexual difficulties.

It’s difficult to write about the topic of female sexuality without using negative language such as “female sexual dysfunction” or “failure” to orgasm.

Much of what has been written about the female orgasm is based on phallocentric assumptions, such as that women “should” have orgasms through penetrative sexual intercourse with men. And if they don’t achieve orgasm, there is something wrong with them.

Many women have absorbed these culturally acceptable views and the ongoing medicalisation of female sexuality continually reinforces them.

Defining ‘female sexual dysfunction’

According to the latest psychiatrists’ Diagnostic and Statistical Manual, the DSM-V, a woman suffers from “female orgasmic disorder” if she experiences a “marked delay in, marked infrequency of, or absence of orgasm or reduced intensity of orgasmic sensations” in 75-100% of situations of sexual intercourse. This must occur for at least six months and be accompanied by clinically significant distress.

Many women of my mother’s generation experienced such an absence of orgasms but without experiencing clinically significant distress because they had no real expectation of receiving sexual satisfaction from their partners. Their main concern was not to “fall” pregnant.

Past generations had different sexual priorities.
Iriana Shiyan/Shutterstock

The other most common female “dysfunction” is “female sexual interest/arousal dysfunction disorder”. Unlike “female orgasmic disorder”, this does at least have a male equivalent: “male hypo-active sexual desire disorder”.

Arousal difficulties are surprisingly common. A large-scale UK study found that 54% of women (compared with 35% of men) reported some form of sexual problem lasting for more than a month. The main problems these women experienced were a lack of interest in sex, an inability to orgasm, painful intercourse or trouble lubricating.

We know that sexual difficulties have a negative impact on women’s quality of life, their overall well-being and relationship satisfaction.

We also know that only one in three US women who report a distressing sexual problem have ever spoken to their doctors about their difficulties. This is mainly because of their embarrassment about discussing sexual topics with a physician. As a result, many clinicians lack experience in the diagnosis and treatment of female sexual difficulties.

The complexity of female sexuality

There is a myth propagated in the media of sexual spontaneity: satisfying sex happens spontaneously without the need for communication or negotiation and is mutually satisfying for both partners.

The reality is, of course, much more complicated. University of Pennsylvania researcher Maureen McHugh describes what women really want as:

better, more affectionate relationships, fulfilling consensual sexual relations, more time and energy for the expression of sexual desire, acceptance and acknowledgement of female sexual desire, and more sex education.

It is disconcerting to consider that more than one in five women have experienced sexual coercion at some point in their lives. Hardly surprisingly, then, that some of these women experience some form of “sexual dysfunction” or difficulty later in life.

Sexual problems often have relational, cultural and power dimensions.
Spencer Davis/Flickr, CC BY

The medical model tends to pathologise the complex sexual difficulties women experience, which often have relational, cultural and power dimensions. According to the DSM-V:

women differ in how important orgasm is to their sexual satisfaction. There may be marked sociocultural and generational differences in women’s “orgasmic ability”. (my emphasis)

This leads to the question: does women’s ability to orgasm vary greatly, or does women’s ability to ask for their sexual needs to be satisfied vary from culture to culture and from generation to generation?

Empowerment of women

A multinational study demonstrated that the reported prevalence of sexual problems does vary by region. For women, a lack of interest in sex and inability to reach orgasm were the most common sexual problems across the world regions, ranging from 26% to 43% and 18% to 41%, respectively.

Participants described issues such as age, physical health, mental health and relationship satisfaction as influencing sexual functioning, as well as cultural differences.

We like to think women are empowered in Australia and yet we are under-represented in boardrooms and in parliament. Women in positions of power still suffer from sexism and misogyny, as then prime minister Julia Gillard so powerfully described in her misogyny speech. This resonated with women around the globe who, unfortunately, could relate to her experiences.

Is it any wonder, then, that women find it hard to negotiate their own sexual satisfaction?

Stanford University clinician and researcher Leah Millheiser has done much to promote female sexual health, particularly for women with cancer. Her Youtube video, What our mothers never taught us: changes in female sexual function throughout the lifespan, outlines a wide range of treatments available to women to improve their sexual functioning.

These treatments vary from drug therapy to sex therapy, with a great range in between including the use of vibrators, vaginal lubrication, pelvic floor exercises and so on. Despite using medical language, it is empowering for women to have easy access to the knowledge that they are not alone in experiencing sexual difficulties and that treatments are available.

The future is brighter

It’s still easy to gain the impression from popular culture that women should prioritise the sexual satisfaction of their male partner, over and above their own. I sincerely hope this generation of young women know more about how their bodies work and are willing to prioritise their own desire for sexual satisfaction along with their partner’s desires.

Sally Hunter is affiliated with the Psychotherapy and Counselling Federation of Australia.

This article was originally published on The Conversation.
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World Aids day: How effective is PMTCT?

By Donah MBABAZI. Photo: Breastfeeding is very important for the first 18 months. (Internet photo)

A research article published last year titled “Prevention of mother-to-child (PMTCT) transmission of HIV: cost-effectiveness of antiretroviral regimens and feeding options in Rwanda” summarizes the progress the country has made in that direction. According to the research, Rwanda’s national PMTCT programme aims to achieve elimination of new HIV infections in children by 2015.

What the experts say

Dr Alphonse Butoyi, an obstetrician at Hopital de lo Croix, says a pregnant mother can transmit the virus to the baby at any stage but the risk is higher during delivery. He says when the membrane gets ruptured; there are secretions in the vagina or blood which the baby may come into contact with hence infection.

“While delivering an HIV-positive mother, we put a barrier between the secretions and the baby to minimize contact and the process must really be done fast,” Dr Butoyi says.

“As soon as the child is born, both the mother and child are given antiretroviral drugs. The baby is also bathed in an antiseptic solution.”

He says in such circumstances, mothers are advised to either breastfeed the children exclusively or give the child artificial milk only.

“You cannot mix the two options. It is either only breast milk or artificial milk not both,” Butoyi warns.

Butoyi further says HIV-positive women should continue taking ARVs even when they conceive but advises them to consult the doctor for advice since some drugs are not good for pregnant women.

“The mother should start treatment early to minimize the chances of infecting the baby,” Butoyi says.

Dr Laurent Munyankindi, the head of gynaecology and obstetrics at Kacyiru Police Hospital, says a child has between 5% and 10% chance of getting HIV while in the womb, and 5% to 20% chance of getting infected during breastfeeding. However, the figures have not stopped doctors from encouraging the practice.

“Initially HIV-positive mothers were advised against breastfeeding for fear of infecting the baby. It was, however, discovered that it was leading to malnutrition among the children and that counsel was dropped. Instead, doctors decided that besides breastfeeding, a baby should be given ARVs right from the time of birth until they clock 18 months of age as a prevention measure,” Dr. Munyankindi says.

“As a way of prevention, the mother is given ARVs from 14 weeks of pregnancy and thereafter. A CRP test is done on the baby after birth to confirm it’s not positive. Another test is done at 6, 9 and 14 months as a follow up,” he adds.

Nathan Mugume, the head of division Rwanda Health Communication Centre, says most babies are born HIV-negative because of the countrywide sensitization campaigns about PMTCT.

World AIDS day

World Aids Day is on December 1 with the theme being “Focus, Partner, Achieve: An AIDS-free Generation.” According to sources, the World Health Organization (WHO) will issue new recommendations to help countries close important gaps in HIV prevention and treatment services.

The guidelines will include advice on providing antiretroviral drugs for people who have been exposed to HIV such as health workers, sex workers and survivors of rape. They also include recommendations on preventing and managing common opportunistic infections and diseases such as severe bacterial and malaria infections and the many oral and skin infections that can affect people living with HIV.

HIV counsellor Chamaine Allen fills out paperwork. Pregnant women should consult doctors and counsellors for advice. (Internet photo)

In 2013, WHO published consolidated guidelines on the use of anti-retrovirals that promote earlier, simple and less toxic interventions to keep people healthier for longer and help prevent HIV transmission. A growing number of countries with a high burden of HIV adopted these guidelines that same year (2013) and 13 million people were able to access life-saving ARVs. However, many people still lack access to comprehensive HIV treatment and prevention services.

The big picture

According to UNICEF, in 2009, 33.3 million people around the world had the human immunedeficiency virus (HIV) that causes AIDS, and 22.5 million of them were living in Sub-Saharan Africa.

In 2009, more than 2.5 million children under the age of 15 were living with HIV, 90% of these cases were due to mother-to-child transmission of HIV during pregnancy, delivery and breastfeeding (UNAIDS 2009).

Each day, 1,500 children worldwide contract HIV, the vast majority of them newborns (UNAIDS 2009)

In Rwanda

Rwanda’s HIV prevalence rate is at 3% (UNAIDS 2008). Over half of all infants born to HIV-positive women received anti-retrovirals in 2008 (UNAIDS 2008).

According to the Ministry of Health, the HIV-free survival rate amongst children aged 9 to24 months born to HIV-positive mothers is 93% if these mothers are accessing treatment and care through the national PMTCT programme.

Key message

According to UNAIDS, halting and reversing the spread of Aids is not only a goal in itself, it is a prerequisite for reaching almost all other millennium development goals. It will impact all efforts to cut poverty and improve nutrition, reduce child mortality and improve maternal health, curb the spread of malaria and TB.

The risk of HIV transmission to infants may be reduced to less than 2% if HIV positive pregnant women receive comprehensive counseling, health care and antiretroviral treatment during pregnancy and through the first six months after child birth, according to statistics.

UNICEF believes that the elimination of mother-to-child transmission of HIV is possible by 2015, this means reducing the MTCT rate to below 5% and the number of children contracting HIV from their mothers by 90%

An HIV-positive mother should be provided with information and skills to select the best feeding option for her baby. She should also receive nutrition or both and her new born and be supported in having her child tested for exposure to HIV.

HIV-positive women and men should be encouraged to have their partners and other children tested and counselled.

This article was originally published on The New Times Rwanda.

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Lips are most exposed erogenous zone

Lips are the most exposed erogenous zone, which makes kissing feel very good

By Sheril Kirshenbaum, University of Texas at Austin

Scientists in the Netherlands have reported that we share about 80m bacteria during a passionate ten-second kiss; a finding that makes puckering up seem cringe-worthy – and downright unsanitary at the start of cold and flu season.

But take heart: we’re more likely to get sick by shaking hands throughout the day than through kissing. And the science behind this behaviour reveals that along with all of those germs, we share plenty of benefits with a partner as well.

Early beginnings.
Sami Taipale, CC BY-NC-SA

Kissing is not all about bacterial exchange or romance. Our first experiences with love and security usually involve lip pressure and stimulation through behaviours that mimic kissing, like nursing or bottle feeding. These early events lay down important neural pathways in a baby’s brain that associate kissing with positive emotions that continue to be important in throughout his life.

Our lips are the body’s most exposed erogenous zone. Unlike in other animals, human lips are uniquely everted, meaning they purse outwardly. They are packed with sensitive nerve endings so even the slightest brush sends a cascade of information to our brains, which can feel very good.

Kissing activates a very large part of the brain associated with sensory information because we’re at work making sense of the experience in order to decide what to do next. Kisses work their magic by setting off a whirlwind of neurotransmitters and hormones through our bodies that influence how we think and feel.

Kissing codes

If there’s real “chemistry” between two people, a kiss can set the stage for a new romance. A passionate kiss puts two people in very close proximity – nose to nose. We learn about each other by engaging our sense of smell, our taste buds and sense of touch. And through that information all sorts of signals are being sent to our brain informing us about the other person. In fact, the scent of man can provide subconscious clues about his DNA to his partner.

Evolutionary psychologists at the State University of New York at Albany found that 59% of men and 66% of women say they have ended a budding relationship because a kiss didn’t go well. It’s nature’s ultimate litmus test, nudging us to be most attracted to the people that may be the best genetic partners.

Research by Swiss biologist Claus Wedekind found that women are most attracted to the scents of men who carry a different genetic code for their immune system in a region of DNA known as the major histocompatibility complex or MHC.

Scientists suspect that when a couple who carry distinctly different genetics for fighting disease, their children are likely to benefit by having a strong immune system. We may not exactly be thinking about parenthood when we connect with someone at the lips, but kissing provides clues to help us decide whether to take a relationship further. (However, it’s important to add that women who take the birth control pill show the opposite preference toward men with MHC genetics most like their own. This suggests that when we are on contraceptives, we may be fooling our bodies in more ways than we realise.)

Getting hot under the collar

Aside from helping us find a great match, kissing has other perks as well. It sets off a cascade of neural impulses that bounce between the brain and the tongue, lips, facial muscles, and skin. Billions of little nerve connections distribute information around the body, producing chemical signals that change the way we feel.

Fostering ‘love’ sensations.
Lst1984, CC BY-NC

A passionate kiss can spike the neurotransmitter dopamine, which is linked to feelings of craving and desire. Oxytocin, known as the “love hormone,” fosters a sense of closeness and attachment. Adrenaline boosts our heart rate and can make us start sweating as our bodies begin to anticipate what might occur later. Cortisol, known as the stress hormone, also dips to reduce uneasiness. Blood vessels dilate, breathing can deepen, cheeks flush and our pulse quickens.

Kissing fosters the sensations we often describe when we are falling in love. In this way, a kiss can herald in a new romantic relationship. It can also solidify the strong bonds we share with family members and friends. Kisses come in many varieties and are inherently tied to the most meaningful and significant moments of our lives by providing a means to communicate beyond what words can convey.

Science has barely begun to study kissing, despite its obvious evolutionary and personal significance, but what we already know demonstrates that there’s a lot more to going on than meets the eyes – and lips.

Sheril Kirshenbaum is the author of The Science of Kissing

This article was originally published on The Conversation.
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Doctor Being treated for Ebola died

This time, the challenge of Ebola was much steeper for the doctors and nurses at Nebraska Medical Center, one of a handful of hospitals specially designated to handle cases of the deadly virus in the United States.

Unlike the two Ebola patients they had successfully treated earlier this year at the hospital’s biocontainment unit in Omaha, the man who arrived from Sierra Leone on Saturday, Dr. Martin Salia, was in extremely critical condition. Dr. Salia, a legal permanent resident of the United States who had been working as a surgeon in Sierra Leone, died early Monday morning, barely into his second day of treatment, but almost two weeks into his illness.

“Even the most modern techniques that we have at our disposal are not enough to help these patients once they reach a critical threshold,” said Dr. Jeffrey P. Gold, chancellor of the University of the Nebraska Medical Center, the hospital’s academic partner.

Dr. Philip Smith, the medical director of the biocontainment unit, said that Dr. Salia, 44, had initially been tested for Ebola in Freetown, the capital of Sierra Leone, on Nov. 7, but that the test came back negative. He was retested there on Nov. 10, at which point the results were positive. Dr. Smith said such false negatives were not uncommon early in the illness.

Dr. Daniel W. Johnson, the director of critical care at the University of Nebraska Medical Center, discussed how Dr. Martin Salia died after being brought to the hospital with advanced Ebola symptoms.

Dr. Daniel W. Johnson, a critical care specialist at Nebraska Medical Center, said that Dr. Salia’s kidneys had stopped functioning and that he was laboring to breathe when he arrived at the hospital late Saturday afternoon after a 15-hour flight. Doctors quickly tried two treatments they had used on their other Ebola patients: an experimental antiviral drug and a plasma transfusion from the blood of an Ebola survivor, which researchers believe may provide antibodies against the virus.

But Dr. Salia was already so ill that within hours of his arrival at the hospital, he needed continuous dialysis to replace his kidney function. By the pre-dawn hours of Sunday, he was in respiratory failure and needed a ventilator, Dr. Johnson said on Monday. Around the same time, he added, Dr. Salia’s blood pressure plummeted.

“He progressed to the point of cardiac arrest, and we weren’t able to get him through this,” Dr. Johnson said at a news conference in Omaha. “We really, really gave it everything we could.”

Dr. Smith said he did not know how Dr. Salia had contracted the virus. “He worked in an area where there was a lot of Ebola disease, much of it probably unrecognized,” Dr. Smith said, “and there were many opportunities for him to have contracted it.”

In the frenetic neighborhood of Kissy, on the eastern end of Freetown, an eerie quiet hung over the United Methodist Hospital on Monday as news spread that Dr. Salia had died. He was the chief medical officer and the only surgeon at United Methodist Kissy Hospital, according to United Methodist News Service.

Leonard Gbloh, the administrator of the hospital, said he did not think Dr. Salia could have contracted Ebola there.

“We have not been taking Ebola patients here” he said. “And we had stringent control measures in place to prevent it entering.”

The hospital even stopped all surgical work several months ago as a precaution, Mr. Gbloh said. Now, the hospital is being decontaminated and several staff members who came into contact with Dr. Salia after he fell ill are in quarantine there.

But Mr. Gbloh said that Dr. Salia — whose wife and two children live in New Carrollton, Md. — had also been working at other hospitals and clinics in the area.

How Many Ebola Cases Are Outside of West Africa?

At least 20 cases have been treated outside of West Africa.

He said that Dr. Salia would be remembered as kind and dedicated, adding, “He was a great professional, always willing to work overtime.”

Yahya Tunis, a spokesman at the Sierra Leone Ministry of Health and Sanitation, said he had known Dr. Salia well. He recalled how, during a doctors’ strike earlier in the Ebola outbreak, Dr. Salia had turned up at Connaught Hospital in Freetown and persuaded his colleagues to return to work.

“He had left the comforts of America to come and work here in his home country,” Mr. Tunis said. “We are very saddened by his passing.”

Despite signs that Ebola is in decline in eastern parts of Sierra Leone, as well as in neighboring Liberia, the virus is still rampant in Freetown and its environs. According the government’s count, the country saw more than 500 new cases last week, with the highest number in Freetown.

Five other doctors in Sierra Leone have contracted Ebola; all have died. Although the State Department arranged for Dr. Salia’s travel to Omaha from Sierra Leone on a specially equipped plane, patients or their sponsoring organizations are typically responsible for the costs of such evacuations.

Dr. Salia is the second patient to die of Ebola in the United States. The first, Thomas Eric Duncan, died in early October at a Dallas hospital after traveling there from Liberia. Two nurses who cared for Mr. Duncan, Nina Pham and Amber Joy Vinson, also contracted the virus but recovered.

Two other Americans who contracted Ebola in West Africa, Dr. Rick Sacra, a missionary doctor, and Ashoka Mukpo, a freelance cameraman, recovered after being treated at the Nebraska unit in September and October. But both arrived there earlier in their illness and did not need dialysis or a ventilator. Each patient at the Nebraska unit has received a different experimental drug, and doctors say it is hard to know whether they helped Dr. Sacra and Mr. Mukpo.

Dr. Salia’s body will be cremated, Dr. Smith said, adding that he and his staff are still waiting for the results of Dr. Salia’s blood tests, which will show how much virus he had in his body.

Dr. Smith said the nurses, doctors and respiratory therapists who had cared for Dr. Salia would monitor their temperatures and be on alert for any symptoms of the virus in the coming weeks, logging the results into an electronic database that will be checked daily. But they will continue to work, he said.

“The staff gave it everything and then some,” said Rosanna Morris, the hospital’s chief nursing officer. “Now they need a little time to grieve and really find peace within themselves, awaiting our next patient.”

@The New York Times

Know your disease education is key to living well with diabetes

Know your disease: education is key to living well with diabetes

By Timothy Charles Skinner, Charles Darwin University and Isabelle Skinner, Charles Darwin University

Type 2 diabetes is often referred to as the ticking time bomb because of its insidious onset and vague symptoms. But if it’s managed well, people with diabetes can avoid the complications that usually stem from the disease.

Diabetes is caused by an interaction of genetic susceptibility and lifestyle choices (central weight gain, for instance, and lack of exercise), so it’s not surprising that its incidence and prevalence is on the increase.

In Australia, 0.7% of adults reportedly develop diabetes every year. And, between 1989–90 and 2011–12, the prevalence of diabetes in this country more than doubled – from 1.5% to 4.2%.

Diabetes’ symptoms are subtle and can include tiredness, minor wounds that won’t heal, and thirst that often occurs for a long time before diagnosis. When someone finally goes to their doctor with these symptoms, they can be shocked to find they have the illness.

Still, if the disease is well controlled, by keeping blood pressure, cholesterol, and blood glucose levels low, people with diabetes can live relatively free of its complications (heart disease, stroke, eye disease, kidney disease, circulatory problems, and nerve damage, among others). But controlling it is a demanding, all-day-every-day kind of task.

Education at diagnosis

Once diagnosed with diabetes, people are supposed to be educated about the illness so they can manage it. This is not only a fundamental part of care, it also forms part of the national, and international guidelines for diabetes management.

But this is rarely done well, and many people don’t get access to any structured quality education early on. Indeed, a recent national survey indicates 49% of people with diabetes have never been offered structured education about the illness.

People have diabetes for life, so perhaps doctors believe there will be plenty of time for education. But, with short consultations and infrequent appointments, time is never made for comprehensive diabetes education.

Apart from the initial testing regimen, people diagnosed with diabetes need to change their lifestyle to incorporate monitoring and treatment, and manage any complications. Diets need to be changed and more exercise introduced to keep blood pressure, cholesterol levels and blood glucose levels down.

Small changes in diet and activity, and taking prescribed medication together make a substantial difference. to quality of life.
Jeff Fillmore/Flickr, CC BY-NC-SA

Good, structured self-management education at diagnosis helps people understand all this, and fosters better long-term outcomes. When blood pressure, cholesterol and blood sugars are not kept within the optimal range, people with type 2 diabetes are at risk of developing debilitating complications, such as deteriorating vision due to retinopathy, and the loss of sensation in their extremities, which can lead to foot ulcers and amputation.

Avoiding distress

Recent research shows that if you don’t educate people about diabetes well at diagnosis, they continue to hold a range of misconceptions about the illness for some time.

Probably the most important issue is that people believe diabetes will have a large impact on their day-to-day life. And that following treatment advice will result in a reduction in the quality of their life. But this doesn’t have to be the case. Small changes in diet and activity, and taking prescribed medication together make a substantial difference.

There’s strong evidence showing beliefs that form around the time of diagnosis are good predictors of diabetes distress three years later. Notably, it’s not the perceived seriousness, or the duration of diabetes that predicts such distress; it’s the illness’ perceived impact on life.

Severe diabetes distress is experienced by approximately one in five Australian adults with type 2 diabetes, and it’s associated with poor self-management of the illness.

Structured education for those newly diagnosed with diabetes has been shown to benefit people for up to three years after diagnosis. It helps learn skills and gain confidence in being able to manage the illness over their lifetime. But what happens in the first three months after diagnosis sets the course of the disease.

More and more Australians are expected to develop type 2 diabetes in coming years. Of course, prevention is the best answer but, for people who do develop the illness, high-quality education at the point of diabetes diagnosis is vital.

Timothy Charles Skinner receives funding from Diabetes UK for the clinical trials of the DESMOND diabetes education program. He also supports Diabetes WA’s roll out of the DESMOND program in Australia, but receives no financial re-imbursement for this work. Timothy Charles Skinner is also chair of the board of Decision Support Analytics, that is providing data analysis support for Diabetes WA evaluation of the DESMOND program.

Isabelle Skinner is a Director of Decision Support Analytics Pty. Ltd.

This article was originally published on The Conversation.
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Not just potheads: a look at who supports legal marijuana

By Joseph Palamar, New York University Langone Medical Center

The United States is experiencing a drastic change in attitudes towards marijuana and marijuana policy.

Four states and the District of Columbia have legalized recreational marijuana use and more than a dozen states have decriminalized it.

Pew Research Center’s latest national poll suggests 52% of adults in the US now favor legalization. In addition, 42% of high school seniors surveyed in 2013 favored legalization and another 25% favor decriminalization, according to Monitoring the Future.

But there is some misunderstanding about legalization and many people simply don’t know what it really means. For example, many people don’t realize that with legalization comes strict regulation. However, aside from misunderstanding its real meaning, there is a prevalent misconception that only “potheads” support legalization.

As a public health and drug policy researcher who discusses marijuana policy on a regular basis, I hear all too often people equating legalization with approval — or even promotion — of use. Supporting legalization does not necessarily condone use. In fact, many supporters are very much against use.

The Pew Research Center’s 2013 poll on marijuana attitudes found that a third (35%) of adults who have never tried marijuana support legalization, an increase from 25% in 2010. My new findings published last week from Monitoring the Future national high school senior data suggest that 17% of non-users support legalization with another 27% supporting decriminalization instead. So clearly not all support for legalization is coming from users.

An individual can be strongly against any potentially unhealthy behavior, but this doesn’t mean that he or she feels it needs to be illegal. One can be strongly against fast food, alcohol, or tanning salons. One can also be strongly against pornography, curse words, or even baggy pants. But that doesn’t mean people feel that these things need to be illegal in order to discourage or control use.

Yes, marijuana users are in fact more likely to support legalization. Results from my new study suggest those who are heavier users or who have used more recently are much more likely to support legalization than other users and non-users. This finding was not unexpected.

Support from both users and non-users can be based on many different viewpoints and beliefs. Support for legalization can be based on support for liberty, eliminating arrests, raising tax revenues, reducing black markets and associated corruption and harm. It can also be supported as an attempt to reduce access to young people.

Oregon is one of four states to legalize recreational marijuana.
Steve Dipaola/Reuters

Of course, many users and potential users do in fact support legalization to eliminate the threat of their own arrest — or to eliminate the threat of arrests of friends or family members who use.

However, there are plenty of people who have used (or still use) marijuana and are against legalization. For example, Pew Research Center results suggest that about a third of adults who have used marijuana are against legalization. My new study found that 7% of high school senior lifetime users feel use should remain a crime.

At face value, this might seem a bit hypocritical, but I, personally, prefer to give these individuals the benefit of the doubt and think they at least have good intentions.

For example, many cigarette smokers regret smoking and now hope to prevent others from using. But society needs to remain cognizant about what the word “illegal” really means. It means engaging in a legally-forbidden behavior that can lead to arrest and possible incarceration.

However, I’ve noticed that many people contradict themselves, as while they support the illegality of marijuana, they don’t seem to support the arrest of users.

“I don’t want my kid using marijuana so it needs to stay illegal.” If these are your intentions then you’re probably a great parent. However, you need to consider what happens if your teen rejects abstinence and uses marijuana. Do you feel your child should be arrested for using it? Probably not. Do you think you should have been arrested for trying marijuana? Again, probably not.

I’ve found that a lot of supporters of illegality would expect application of the law to be unfavorable if they or their children get caught.

However, in some respects it’s sad that many people who hold these views are more able to circumvent laws when they break them. It is often their black and Hispanic counterparts who are less able to circumvent such laws even though racial minorities actually tend to use at lower rates than whites. In fact, results of my new study suggest that black and Hispanic teens are actually more likely to support legalization than whites, possibly for this reason.

If supporters of marijuana remaining illegal had the same likelihood of getting caught as non-supporters there would likely be big changes, and fast.

Some national studies have found that about two-thirds of the young adult population have used an illicit drug in their lifetime. You’re allowed to disagree that this huge portion of the population shouldn’t be arrested for trying a drug. After all, wouldn’t our most recent presidents have been arrested if they got caught using? Supporting legalization does not mean you promote or even condone use. It simply means you don’t agree that a user should be arrested.

This article in no way promotes or condones marijuana use. In fact, it doesn’t even promote legalization. However, times are changing quickly and the concept of legalization clearly needs to be demystified for the general public.

Support for legalization does not mean than one promotes or condones use.

Joseph Palamar does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.
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From decisions to disorders: how neuroscience is changing what we know about ourselves

By Barbara Sahakian, University of Cambridge; Abdul Mohammed, Linnaeus University; Alejandro Anton Fernandez, Spanish National Research Council; Andrea Santuy, Cajal Institute; Diana Furcila, Cajal Institute; Francesco Cavarretta, The University of Milan, and Léon Homeyer, University of Stuttgart

People have wanted to understand our motivations, thoughts and behaviours since the ancient Greeks inscribed “know thyself” on the Temple of Apollo at Delphi. And understanding the brain’s place in health and disease is one of this century’s greatest challenges – take Alzheimer’s, dementia and depression for example.

There are many exciting contributions from neuroscience that have given insight into our thoughts and actions. Three neuroscientists have just been awarded the 2014 Nobel Prize for their discoveries of cells that act as a positioning system in the brain – in other words, the mechanism that allows us to navigate spaces using spatial information and memory at a cellular level.

There are many exciting contributions from neuroscience that have given insight into our thoughts and actions. For example, the neural basis of how we make fast and slow decisions and decision-making under conditions of uncertainty. There is also an understanding how the brain is affected by stress and how these stresses might switch our brains into habit mode, for example operating on “automatic pilot” and forgetting to carry out planned tasks, or the opposite goal-directed system, which would see you going out of your usual routine, for example, popping into a different supermarket to get special ingredients for a recipe.

Disruption in the balance between the two is evident in neuro-psychiatric disorders, such as obsessive compulsive disorder, and recent evidence suggests that lower grey matter volumes in the brain can bias towards habit formation. Neuroscience is also demonstrating commonalities in disorders of compulsivity, methamphetamine abuse and obese subjects with eating disorders.

Neuroscience can challenge previously accepted views. For example, major abnormalities in dopamine function were thought the main cause of adult attention deficit hyperactivity disorder (ADHD). However, recent work suggests that the main cause of the disorder may instead be associated with structural differences in grey matter in the brain.

What neuroscience has made evidently clear is that changes in the brain cause changes in your thinking and actions, but the relationship is two-way. Environmental stressors, including psychological and substance abuse, can also change the brain. We also now know our brains continue developing into late adolescence or early young adulthood, it is not surprising that these environmental influences are particularly potent in a number of disorders during childhood and adolescence including autism.

Environmental matters
SMI Eye Tracking, CC BY

Though critical, there is much interest in understanding resilience and mental well-being, for example people who develop post-traumatic stress disorders. Furthermore, knowing the action of drug treatments and psychological therapies and other treatments, such as mindfulness, will allow us to develop novel and more effective treatments for those who do not respond to the currently available ones. Understanding how environment can enrich the brain is also vital.

There really is an explosion of neuroscientific techniques that will help us with these and other important challenges in understanding our brains and what makes us who we are. At the forefront will be the new researchers coming up the ranks. Here are just five who were involved in the Human Brain Project school and what they think will have the biggest impact in the field:

Andrea Santuy

The detail with which the brain will be described will allow us to identify the causes of some of the most disabling brain diseases and therefore treatments to improve the quality of life of patients, along with millions in savings for the state. Knowledge of the brain’s neural connectivity will also be a huge advance for computational science as it will foster the development of hardware and software that emulates the brain; highly integrated and energy efficient. So neuroscience will not just improve our health but also generate new, faster and more efficient technologies.

Francesco Cavarretta

The brain is life. All sensory signals, such as vision, hearing, taste and smell, pass through the brain and through nerves, where each one becomes an action. Although this may appear really mysterious, this is the only way to make any sense and reason and this will be at the forefront of study. For example, CA1, which is part of the hippocampus, identifies all the input and output signals in order to recognise any type of information; the substantia nigra is linked with pleasure sensations; and the amygdala with our emotions.

Diana Furcila

Neuroscience in the future will join together findings about how the human brain works at all its levels and of human behaviour. We should expect – and believe – that we can get proper treatment for all psycho-pathological and biological problems, such as neuro-degenerative diseases like Alzheimer’s for every single individual brain according to someone’s personal history. There is a time for everything and this is the moment for neuroscience – it can help us to exceed what we currently consider the limits of knowledge.

Léon Homeyer

Grounding mental phenomena in the activity patterns of our neural network will give us with a deeper understanding of human cognition and psychology. There have already been studies to predict criminality, for example which criminals might re-offend. But as with other ethical implications of future neuroscience, we can’t be naive about neuro-determinism. Severe physical impairments may deprive people from acting responsibly, but as our insights into the causal workings of the brain become more fine-grained, we might be able to explain more about what determines a person’s actions and question current notions about responsibility. Future neuroscience will contribute to a holistic understanding of human beings.

Alejandro Anton

Neuroscience will bring us a complete knowledge about the brain: how many types of nerve cells there are, in what proportion, how these different cells are regulated by their molecular machinery, as well as about their functioning in small circuits and their overall interaction in the brain as a whole. As is the case throughout the history of medicine with other physiological systems, knowledge about the brain will facilitate therapies against brain diseases.

An extensive knowledge of the human brain will also help us to answer the classic question: “who are we?” and what distinguishes us from primates. Answering the Greek challenge to “know thyself”, will be a turning point in the development of our civilization – for the first time we will achieve complete self-awareness.

Barbara Sahakian consults for Cambridge Cognition, Servier and Lundbeck. She holds a grant from Janssen/J&J. She holds shares in CeNeS and share options in Cambridge Cognition. She is also associated with the Human Brain Project.

Abdul Mohammed’s research is currently supported by the Family Kamprad Foundation. He is associated with the Human Brain Project.

Alejandro Anton Fernandez, Andrea Santuy, Diana Furcila, Francesco Cavarretta, and Léon Homeyer do not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article. They also have no relevant affiliations.

This article was originally published on The Conversation.
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How taking drugs while pregnant harms unborn babies

By Mairead Black, University of Aberdeen

Women smoking while pregnant has been an uncomfortable reality for decades. Whatever the reason – whether a lack of concern about the risk, belief it’s too hard to quit or even reports that a resultant smaller baby will make for an “easier” birth – the reality is that a small baby that was meant to be bigger is at risk of stillbirth, cot death, future heart disease and shortened life span.

Substance misuse has affected all strata of society for millennia. And for several decades, researchers have been studying the effects of recreational drug use in pregnancy. An annual survey of more than 65,000 women in the US found that one in 20 pregnant women said they had used illegal substances, while one in 10 of the general population did so. These relatively stable rates appear lower than those identified in smaller UK studies, but what is clear is that rates are highest among pregnant teenagers and lowest in the highest maternal age groups.

Cigarette smoking was the first to receive attention, and this was followed by alcohol in the 1980s and subsequently given to other drugs such as marijuana, opiates, cocaine and methamphetamine. But although we have a wealth of knowledge about the risks, illegal drugs – unlike cigarettes or alcohol – don’t come with a warning label that says “using this substance while pregnant may harm your baby.”

One recent study from University College London suggested that using recreational drugs while pregnant put babies at risk of brain abnormalities. The study found that babies born with brain defects were twice as likely to have a mother who used illegal drugs in pregnancy than babies with normal brains. Of the 517 women studies, one in six had used recreational drugs – predominantly cannabis and cocaine – around conception or during pregnancy, which was confirmed by testing hair samples.

Crossing the placenta

Crossing through the barrier.
Sean Dreilinger, CC BY-NC-SA

Different substances might do different things and carry varied risks, but virtually all commonly used recreational drugs cross the placenta, where they are exposed to a developing foetus. Studies assessing these risks have been limited by both willingness of women to agree to testing (for example through urine or hair samples) or reliability of self-reporting. However, both animal and human studies strongly suggest that recreational drug use in pregnancy leads to problems from those that are visibly apparent at birth, such as cleft lips, to those manifesting in behavioural problems which may have consequences throughout adulthood.

Drugs may harm a developing foetus via multiple mechanisms and can vary depending on the stage of pregnancy. Direct effects on organ development are possible with drug use in very early stages of pregnancy, but evidence of this link beyond cigarette smoking is very limited, making the recent study from UCL a particularly welcome contribution. In later stages of pregnancy, more subtle effects include impaired delivery of nutrients that affects foetal growth and altered signalling within its brain.

Nicotine in cigarette smoke has been linked to development of cleft lip and palate, while heavy alcohol puts the baby at risk of foetal alcohol syndrome which disrupts development, with early signs including drowsy newborns and later problems including attention deficit and disrupted schooling.

Many pregnancy problems attributed to recreational drug use are common to multiple drugs, with the obvious example being poor foetal growth. This occurs commonly with cigarette smoking, heavy alcohol use and cocaine use, which has also been linked to smaller head size at birth. The effects are particularly prominent with alcohol as the effects are seen throughout childhood. These effects are likely to arise from restricted blood flow from the placenta. This also puts an unborn baby at risk of placental separation, which often results in vaginal bleeding, preterm birth and/or stillbirth.

Babies born to opiate-dependent mothers often suffer the effects of withdrawal syndrome following birth. This may include an unsettled baby with feeding problems, diarrhoea and seizures. The seriousness can be such that many such babies require an infusion of opiates to stabilise them before gradually reducing the dose until weaned entirely, which may take several weeks.

A mothers’ illegal drug use may also indirectly expose unborn foetuses to additional dangers – poor nutrition, for example, or exposure to violent situations, avoidance of healthcare and an increased likelihood of mental health problems.

Behavioural problems

Behavioural consequences of maternal substance abuse – the best known result from foetal alcohol syndrome – arguably gives rise to the greatest social burden, but tend to receive less public attention.

The behavioural effects of cigarette smoking and opiates such as cocaine appear to extend into childhood, with impulsive behaviour and attention problems particularly problematic (one study on cocaine suggested environmental factors also play a key role). Tobacco and alcohol have also been linked to delinquent and criminal behaviour, in addition to substance misuse in later life. Maternal use of cannabis appears to cause attention problems and impulsive behaviour about the age of ten, while metamphetamine also leads to drowsy or stressed babies.

In parallel with behavioural problems are those affecting thought processes, with recreational drug use in pregnancy resulting in impaired ability to memorise, analyse and problem solve, with or without a lower level of intelligence as measured by IQ. These problems are particularly apparent with heavy alcohol use, while cannabis appears to cause difficulty with problem-solving skills that require sustained attention. Cigarette smoking may impair language development resulting in poor language and reading abilities in children aged nine to 12.

Happens to normal people

Drug use casts a wide net.
Prensa420, CC BY-NC

Many of the risks described above can be mitigated by reducing or stopping drug-use in pregnancy. However, identifying who needs help isn’t straightforward because it is often a hidden activity. These women are not always in the heroine addicted, petty crime-associated circles of popular imagination, but may be part of outwardly thriving families, where boredom, loneliness or domestic abuse may lead to hidden substance abuse.

There has been a consistent fall in the number of pregnant women who class themselves as smokers in the UK (in England, the number of women who smoked in the 12 months before or during their pregnancy fell from around 15% in 2006-7 to 13% in 2011-12) and in the US.

% of maternities smoking at time of delivery in England.
Guardian/HSCIC

This still leaves a significant number still but gives reason for optimism. But any possibility of this occurring in illegal drug use seems unlikely – these drugs aren’t used as publicly and so aren’t exposed to the same level of everyday scrutiny. These behaviours are also not subject to large-scale public health campaigns.

The mainstay of current treatment of recreational drug use in pregnancy is advice, support and detox, or replacement therapy. Alcohol detoxification is offered to those heavily dependent on alcohol, where risk of foetal alcohol syndrome is high. Opiate-replacement programmes, traditionally involving methadone, have enabled women to adopt more stable lifestyles and to regularly access healthcare.

This somewhat supportive and tolerant approach in the UK is in stark contrast to elements of policy in the US (though a recent UK test case of a mother accused of attempted manslaughter after heavily drinking while pregnant is currently in the courts). A rise in popularity of “crack” cocaine in the 1980s prompted some US states to legislate the reporting of any women known to use drugs in pregnancy for alleged child abuse or possible homicide.

The risk of this approach clearly include fewer women who are likely to come clean with their healthcare providers. Legislation was recently extended that obliges physicians to report all cases of newborn babies who show signs of drug addiction. But the impact of such legislature on actual drug-use in pregnancy or adverse consequences of the practice has yet to be seen.

The effects of using recreational drugs in pregnancy are wide-ranging. While many women who have used recreational drugs in pregnancy go on to deliver apparently healthy infants, severe problems may manifest in later years, whether encountering difficulties with education or displaying behavioural problems. Yet the enormity of the social burden on family dealing with such consequences may never be attributed to what happened during pregnancy.

Mairead Black does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.
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Clash of orgasm, Clitoris vs Vaginal…

Health Check: clash of the orgasms, clitoral vs vaginal

By Jane Ussher, University of Western Sydney

Controversy over vaginal versus clitoral orgasm is nothing new; it’s a debate that has consumed sexologists and psychoanalysts for the last 100 years. Now, new research has added fresh fuel to the controversy.

Completed by a team of Italian sexologists and published in the journal Clinical Anatomy, the review concludes vaginal orgasms don’t exist. Female orgasm is only possible if the clitoris is stimulated during masturbation, cunnilingus, partner masturbation or with a finger during intercourse, the researchers say. Penetration alone is not enough.

This latest swing of the pendulum – from the view that vaginal orgasm is the ideal that women should aspire to and anything else is second rate – is unlikely to actually affect women. Indeed, one of the more interesting threads in this whole debate is the predominance of men’s voices. Perhaps what we should be talking about is why male experts dictate the parameters of women’s pleasure.

Frigidity and failure

Sigmund Freud was one of the first to investigate the “dark continent” of female sexuality. He declared the clitoral orgasm “infantile and immature”. A woman could claim sexual maturity only when she experienced a vaginal orgasm, he said, ignoring her “amputated penis”, the clitoris.

Inability to achieve vaginal orgasm meant a woman was “frigid” or “not a real woman”, claimed Freud and many of his followers. This failure was attributed to deep-rooted neurotic problems.

Sigmund Freud declared the clitoral orgasm ‘infantile and immature’.
Max Halberstadt/Wikimedia Commons

The pressure was on. To be “normal” and “mature”, women had to orgasm during sexual intercourse. And successive generations were diagnosed with sexual dysfunction when they failed to achieve this holy grail of sexual response. Many felt like failures; their bodies had let them down.

Unsurprisingly, faking orgasms during intercourse became the norm. No one wants her partner to think she is failing to be a “real woman”.

Celebrating the clitoral orgasm

Then US sexologists William Masters and Virginia Johnson came along. Observing couples having sex in the laboratory in the 1960s, they concluded women’s orgasms started in the clitoris and then extended to the vagina.

Any pleasure women experienced through penetration was due to the connection between clitoris and vagina. They reported “frigidity” as resulting from poor sexual technique, not women’s ambivalence about their social role. And that women were capable of multiple orgasm, while men were not.

Feminists in the 1960s took up this research with glee, declaring the clitoral orgasm the mark of a liberated woman. Some went further, arguing women should eschew penile penetration altogether. Now a symbol of women’s oppression, it was unnecessary for sexual pleasure.

The feminist argument went mainstream when Shere Hite appeared on the cover of Time magazine in 1987. She had interviewed 1,844 American women and declared the “true” female orgasm was clitoral. The female sexual revolution seemed to have been won with women speaking for their own sexual pleasure.

Phallocentric backlash

Then came the inevitable backlash. In recent years, there has been a proliferation of sex research attempting to establish the superiority of the vaginal orgasm, and the role of the penis in producing it.

In echoes of Freud, we are told the vaginal orgasm is the only way for women to achieve sexual, life and relationship satisfaction, as well as good psychological health.

Women enjoy all kinds of sex – and some prefer to have a cup of tea.
danor shtruzman/Flickr, CC BY

Women who don’t have vaginal orgasms are described as emotionally unstable, with immature defence mechanisms and low emotional intelligence. Apparently, you can even identify a woman who has a history of vaginal orgasm by her walk – it is that central to her very being.

So what causes a vaginal orgasm, according to these researchers? Not stimulation of the clitoris during intercourse. Rather, a long penis, which allegedly gives an evolutionary advantage to well-endowed men. Or long-lasting intercourse, which we are told is much better than “foreplay”, with simultaneous orgasm during intercourse being the best of all.

Would it surprise you if I told you this phallocentric research is all conducted by men? Would their interest in the vaginal orgasm possibly have something to do with maintaining the primacy of the penis?

After all, the implications of the clitoral orgasm are grave for heterosexual men. Women can pleasure themselves (or be pleasured by each other) as effectively as they can be pleasured by a man if the penis is superfluous to their ability to orgasm. A man’s fingers become more important, or his smell, which some heterosexual women rate more highly than penis size.

A woman’s perspective

From a woman’s perspective, this whole debate is a little irrelevant.

Some women enjoy vaginal penetration – with penis or fingers – and gain considerable sexual pleasure as a result. Other women prefer to be touched, use a vibrator, or receive oral sex. A lucky few have orgasms in in their sleep, in the absence of any physical stimulation. And some prefer to have a cup of tea.

To imply that all women are the same, that we should have any sort of orgasm and are dysfunctional if we don’t, is the most damaging part of this controversy.

Regardless of how orgasm is achieved, it is, by definition, an extremely pleasurable experience. And no woman I know would rate one form of orgasm as more “mature” than another. Most would just be happy to have one, any old way.

Jane Ussher receives funding from the Australian Research Council, Cancer Council NSW, Family Planning NSW, Prostate Cancer Foundation of Australia, and the Community Migrant Resource Centre, for research on sexuality.

This article was originally published on The Conversation.
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Giving a foetus personhood will have serious consequences for women

Giving a foetus ‘personhood’ will have serious consequences for women

By Nicky Priaulx, Cardiff University

A story of a woman who drank a half-bottle of vodka and eight cans of strong lager daily during pregnancy and gave birth to a disabled child that ended up in foster care, was certain to stir up emotion and interest. Many will feel that “something must be done” to address behaviour that sounds unnatural, selfish and morally wrong. Based on what we know, heavy consumption of alcohol is clearly not giving the foetus the best chance. Nevertheless, how we respond to such a situation is critical.

The case which has just been heard by the Court of Appeal brings the question of how we should respond keenly into view. Judges are considering their decision after a day-long hearing on a case brought by a local council seeking criminal injuries compensation on behalf of a six-year old child, “CP”, now in foster care.

CP was diagnosed at birth with Foetal Alcohol Spectrum Disorder (FASD) allegedly caused by her mother as a result of consuming excessive quantities of alcohol during pregnancy. The council claims, as was accepted by an initial tribunal, that this consumption of alcohol meant that the child had been a “victim of violence” by virtue of the mother having maliciously administered poison so as to endanger life or inflict grievous bodily harm as defined under Section 23 of the Offences Against the Person Act 1861. The upper tribunal, however, found that the child did not constitute a victim of violence because at the relevant time, the child was “not a person” in legal terms, but a foetus. As such, no crime had actually been committed to underpin a compensation claim. It is this decision that the Council appealed.

All about compensation?

At face value, the council’s objective looks pragmatic. The aim is not to encourage the prosecution or conviction of CP’s mother. It seeks an indemnity for costs incurred in providing for disabled children in its care. If successful, the “personal injury” it is claimed CP has suffered, of FASD (as opposed to Foetal Alcohol Syndrome) could lead to many compensation claims, given that a significant proportion of children may have been removed from environments where parental neglect or abuse emerges as a result of substance abuse.

But to tap into the Criminal Injuries Compensation Scheme in the absence of an actual conviction, it needs to be determined whether a relevant crime has actually been committed. And this is why the case raises far broader issues than the health of the council’s finances. Though only involving a theoretical assessment that a crime has been committed, the ramifications for women will be very real, potentially inviting a whole host of legal measures with foetal protection at their heart.

Such fears are justified. In the United States, many states now prosecute women for committing criminal offences against their foetuses. Substance abuse by pregnant women has been a popular target with some States going to extraordinary lengths to protect foetal life. Some have passed legislation declaring the foetus to be a legal person, affording it a right to life from the moment of fertilisation. This makes applicable a wide range of offences, including that of child abuse or homicide that wouldn’t otherwise apply to the foetus. Short of recognising foetal personhood, some courts have stretched child abuse laws to include the foetus; in one case, a court prosecuted a woman under drug trafficking laws for passing drugs to her “child” during the 60-second gap between birth and cutting the umbilical cord.

UK position

Such approaches stand in stark contrast to English law where the foetus lacks legal personhood until born and holding a separate existence from its mother. The broad position is that a woman’s autonomy and right to bodily integrity trumps any interests a foetus might be said to possess. A pregnant woman can refuse medical treatment even when this may result in the death of a viable foetus. The priority afforded to women’s interests is also reflected by the Abortion Act 1967 which applies to England, Wales and Scotland; providing an abortion is performed in accordance with the 1967 Act, there is no offence.

It seems unlikely that the judiciary would risk unsettling a position so firmly embedded within English law, by suggesting that a woman could even theoretically have commissioned an act of violence against her foetus. Much is risked by so doing. Those most opposed to abortion and keen to limit women’s access to it, however, will see a successful appeal as a critical step in encouraging a legal regime which offers ever stronger foetal protection.

Nevertheless, the urge to extend the criminal law may emerge for completely different reason – those who see this as a truly exceptional and hard case demanding an exceptional response.

Criminal law and extreme cases

Hard cases, typically involving extreme situations, can generate powerful debate around our moral responsibility to prevent harm-causing behaviour – “something must be done!” The danger is that if not tempered by a full evaluation of broader concerns and a critical look at the criminal law as a vehicle for behavioural change, we can end up believing that criminalising conduct is justified.

The criminal law is a very blunt instrument. Even if we could be certain that the law would only be directed at those exceptional cases involving pregnant women engaging in heavy substance abuse (rather other kinds of risky activities), it’s unclear what benefits this could deliver, or for whom. The idea that criminal measures may be powerful in deterring women from engaging in such behaviour would seem to be founded upon some fallacy of choice and rational risk-benefit: that pregnant women who engage in such risky practices will weigh the risk of imprisonment and change their behaviour as a result.

More likely is that the threat of criminalisation will push those women who are most in need away from any help on offer for fear of criminalisation. As Emma Cave suggests: “pregnant addicts would shun health care to avoid detection. It would constitute a step backwards’.

Game of consequences

A recognition of stronger foetal interests would have far-reaching consequences for women’s rights and bodily integrity and risk constructing all women as potential threats to foetal life.

So too would this sit at odds with abortion policy given the incoherence of criminalising women who it is alleged have caused serious or even lethal harm to their foetuses through alleged substance abuse or other “risky” practices, yet accepting as lawful the intentional demise of foetal life through abortion. When sat side-by-side it would create a perverse incentive for those engaged in risky behaviour to terminate.

Critically however, as US scholars have notedlink text, women are being punished in these cases for “risky” behaviour that would not, absent of pregnancy be subject to criminal punishment. As such, what makes substance abuse, alcohol consumption, even sex or attempted suicide the subject of the criminal law is not the behaviour itself, but the fact of pregnancy. Pregnant women – and indeed women – are being unfairly targeted.

Nicky Priaulx does not work for, consult to, own shares in or receive funding from any company or organisation that would benefit from this article, and has no relevant affiliations.

This article was originally published on The Conversation.
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