“Lies, Damned Lies, and Statistics”

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abortion, birth control, contraception, Cuba, Gender Inequality Index, maternal mortality, reproductive health, South Korea, statistics, teen pregnancy, UNDP, UNIFEM

These famous words, which Mark Twain attributed (probably erroneously) to British Prime Minister Benjamin Disraeli, have served as a warning that statistics, if used carelessly, can be as misleading as outright lies.

In the mid-1990s I was asked by the United Nations organization UNIFEM to examine cross-cultural statistics on women’s participation in science, technology and medicine (STM). The goal was the compilation of tables for the UN fact book The World’s Women: 1995 .

This being well before the days of easy internet data searches, UNIFEM sent me cartons and cartons of policy papers, data sheets, and women’s organization pamphlets. I poured over the materials for months, trying to contrive tables that would fairly put the status of women in STM in each country in comparative perspective.

I was forced to conclude that the task was impossible. Some data sets only included the percentage of women in STM in tertiary institutions, while others only included women in government research institutes; some collections lumped together women of different ranks or in different scientific specialties, while others meticulously differentiated ranks and subfields; some included even the social sciences and humanities in their definitions of “science,” while others included the physical sciences but not mathematics or engineering. Ultimately, I wrote a piece (the only signed one in the volume) explaining the absurdity of trying to derive meaningful comparisons from such sources.

We find a different sort of methodological morass if we examine the UN’s comparative Gender Inequality Index (GII) (Human Development Report,
United Nations Development Program, 2016). The GII is calculated from three components, one of which is purportedly a measure of reproductive health; it is that component that I’ll discuss here.

The reproductive health component of the GII is computed by combining two indicators: maternal mortality per 10,000 live births and teen pregnancy rates per 1000 women. Once could ask: What about other indicators that in some countries are much more significant than maternal mortality and teen pregnancy rates in assessing the situation? At the very least, the data should include availability of contraception and legality/accessibility of abortion. In the United States one should also track the number of abortion doctors harassed or murdered, the number of clinics and schools intimidated out of offering birth control and abortion information, the number of states with outrageously restrictive TRAP laws, the number of raucous demonstrations at abortion clinics, the number of “Crisis Pregnancy Centers” staffed by anti-abortion zealots masquerading as neutral reproductive health advisers, the decreasing availability of abortion and certain forms of contraception, and so on.

The likely explanation for the UNDP’s use of maternal mortality and teen pregnancy and nothing else is that those are the data that are readily available from most countries of the world with some degree of accuracy (although the ratio of reported teen pregnancy to actual teen pregnancy undoubtedly varies widely from country to country). This is the typical reason why “proxy data” are used: you use the data that’s easiest to get, not the data that would really be most revealing, and you hope that the proxy data at least correlate with what you’re trying to measure.

In the case of the UNDP’s proxy data for reproductive health, what they do correlate with is the overall wealth and level of development of a country. More than anything else, low maternal mortality means a relatively affluent population and a highly developed health care system.

Similarly, the use of teen pregnancy rates skews the results in favor of the wealthier countries, where in fact it’s reasonable to expect that a low teen pregnancy rate signifies widespread availability of birth control as well as adequate sex education in the schools. But note that `teen’ is defined to include 18- and 19-year-olds. In many low-income countries where most men and women do not go to college and a high proportion of the population is rural, early marriage and child-bearing are culturally accepted and not correlated with failure in life. (This was the case in the U.S. until well into the 20th century.) Why then should the GII penalize low-income countries for a high teen pregnancy rate?

Because of what is counted, and equally importantly, what is not counted, there are some curious oddities in the GII rankings. Take South Korea, for example, which ranks tenth in the world in the GII. Because South Korea has a reported teen pregnancy rate of 1.6/1000 (the lowest in the world) and a maternal mortality rate of 1.1/10,000, the reproductive health component of its GII appears close to ideal, and that leads to its high GII ranking. But abortion is almost completely banned in South Korea. Doctors have been prosecuted for performing the procedure, the illegal abortion industry is booming, and there is a large black market in abortion pills obtained illegally over the internet. Women activists have been trying to get the draconian abortion laws revised for years, and have only recently succeeded in convincing the legislature to revisit the issue.

To cite another example, Cuba has a GII ranking of 62 out of 159 countries, while the U.S. ranking is 43. Why does Cuba come out poorly compared to the U.S.? By far the main reason, ironically, is Cuba’s reproductive health component, which is greatly affected by its relatively high teen pregnancy rate of 45.6 per 1000 vs. 22.6 for the U.S. Meanwhile, Cuba has a health care system that is a model for developing countries, and it is the only country of Latin America that has had unconditional reproductive freedom for women for over half a century. (In addition, women constitute 48.9% of the Cuban legislature and 27% of the Cuban Academy of Sciences; the latter figure is the highest percentage in the world.)

My point is not to castigate the UNDP for using statistical methodology that favors the wealthy countries and underrates low-income countries such as Cuba that have progressive traditions in women’s health and women’s rights. Rather, the lesson here is that issues of reproductive health and gender equity are far too complicated to be captured by a single number, especially one that’s computed from proxy data.

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An Airport Meeting with the Legendary Carol Downer

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abortion, birth control, Carol Downer, Hyde Amendment, menstrual extraction, reproductive health, second-wave feminism, self-examination, women's medical self-help movement

 

On October 2 I had the pleasure of meeting for several hours with the famous second-wave feminist Carol Downer. For those who don’t know, Downer (born in 1933) was one of the founders of the women’s medical self-help movement. She and her fellow activists taught women all over the world to do their own cervical and breast examinations, and popularized a simple method of menstrual extraction by means of a two-tubed cannula. This technique, normally performed on the first day a woman’s period was due, ensured a state of non-pregnancy. In the early 1970s Downer and her associates created women-led clinics in southern California, many of which exist to this day. In 1972, Downer was arrested and charged with practicing medicine without a license for recommending yogurt as a treatment for yeast infections — in the feminist and progressive press the charge against Downer was derisively called “the Great Yogurt Conspiracy”. She was acquitted. Her vindication in the legal system contrasts sharply with the fate in 2014 of Jennifer Ann Whalen, now in prison in Pennsylvania for practicing medicine without a license after she ordered abortion pills for her daughter on the internet. Downer subsequently obtained a law degree, and for over forty years has been an outspoken advocate of women’s health and abortion rights.

Carol Downer contacted me after reading Sex and Herbs and Birth Control and arranged to route herself through Phoenix to meet with me on her way to a talk she was giving to African American midwives and doulas in New York. Our discussions were wide-ranging and frank. Among the topics touched upon were the ups and downs of her federation of women’s clinics, her international experiences promoting cervical self-examination, her disgust with the cavalier attitudes of many medical professionals and state legislators toward reproductive health issues, and the difficulties of attempting to interest American youth in progressive activism of any sort. Downer expressed deep reservations (which I share) about using the consumerist rhetoric of “choice” to refer to the right to access to a safe abortion. She also said that the women’s movement should have protested far more vigorously against the 1976 Hyde Amendment prohibiting federal funds from being used for abortion; activists at the time thought that it would have minimal impact and failed to see that it was merely the opening salvo in a steadily increasing barrage of attacks on women’s reproductive rights and health.

Downer was intrigued by the description in my book of abortifacients such as slippery elm sticks, which were inserted into the uterus by the midwives of several indigenous cultures to induce abortion. She commented that the midwives must have had extensive knowledge of the womb in order to place the sticks properly, and she speculated that they might have done self-examination of the cervix as part of their midwifery training.

My conversation with Carol Downer was stimulating and inspiring, but it was also poignant. In the third chapter of Sex and Herbs and Birth Control I discuss what John Riddle calls the “broken chain of knowledge” that occurs when the younger generations of women — either through urbanization or “modernization” or perhaps complacency about the progress that women have made — lose interest in the knowledge and traditions of their foremothers. Something similar seems to have happened in recent years. At least in the U.S. most young women know little if anything of the techniques and struggles of the pioneering second-wave feminists who fought for women’s reproductive health in the 1960s and 1970s. All too frequently one encounters the smug attitude that those were the “bad old days”, and things are so much better now. Yet as recent events in Texas, Pennsylvania, South Dakota and elsewhere attest, women’s reproductive rights are under siege. Without a revival of the activist and medical self-help movements that were started by Carol Downer and her associates almost a half-century ago, access to safe, affordable abortion and contraception is likely to become difficult if not impossible for more and more women.

St. Bridget and Abortion

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abortion, birth control, Catholic Church, St. Bridget

This semester, students in my Women as Healers class at Arizona State University are reading Sex and Herbs and Birth Control. One young man, Brian Anderson, was so intrigued by the story behind the title of chapter 3, “Praying to St. Bridget,” that he decided to do further research on the saint for his first essay. (The chapter title comes from the St. Bridget amulet that some Irish women wear to protect themselves from pregnancy — see the post “Loss of Indigenous Knowledge in Veracruz, Mexico”.) Brian discovered a fascinating 2002 article by Judith Maas in the Irish Times. Titled “St. Bridget would vote No if faced with this referendum,” the article expressed opposition to a proposed amendment to Ireland’s anti-abortion law that would increase the punishment for anyone obtaining an abortion to twelve years’ imprisonment. The author pointed out that St. Bridget, though an abbess of the Catholic Church and a patron saint of fertility, was willing to help women in desperate circumstances:

“A symbol of motherhood, Bridget is also known as Muire na nGael — Mary of the Gael. However, if necessary, she did not hesitate to interfere with nature. In the first Life of Saint Bridget, written by Cogitatus around AD 650, a woman in crisis pregnancy came to her for help. ‘A certain woman who had taken the vow of chastity fell, through youthful desire and pleasure, and her womb swelled with child. Bridget, exercising with the most strength of her ineffable faith, blessed her, caused the foetus to disappear, without coming to birth, and without pain. She faithfully returned the woman to health and to penance.’ This account of an abortion cannot be found in current translations of the book. In the 19th century it vanished from the official version of St. Bridget’s life….

“In the early Middle Ages, abortion wasn’t considered a serious crime. The Penitential of St. Finnian states that ‘if a woman by her magic destroys the child she has conceived, she shall do penance for half a year.’ This is mild compared to other penalties and compared to the proposed 12 years’ jail in the current proposal for the abortion referendum.” (Irish Times, 5 March 2002)

It is not surprising that when the Church’s stance on abortion changed in the 19th century (see the post “Questions to Ask Your Priest”), the Church also changed the official biography of St. Bridget. Church authorities have consistently attempted to conceal the fact that earlier Catholic notables such as St. Bridget, Hildegarde of Bingen, Tomas Sanchez, and others had more flexible attitudes toward abortion.