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Sunday, April 13, 2014

Why can't a man be more like a woman?

Why Can’t a Man Be More Like a Woman?

Sex, Power, and PoliticsMalcolm Potts, MB, BChir, PhD, FRCOG
American College of Obstetriciansand Gynecologists, Professor
Vivian Dickerson set out a Women’sHealth Bill of Rights (box).
Human behavior is a rich, complex,ever-changing interaction between
our inherited predispositionsand the influence of our culture,
and this commentary uses the lensof biologic evolutionary psychology
to ask why women’s rightsremain so controversial. Evolution
is not about what is fair, moral, orjust, but about what works. What
Charles Darwin called the ‘‘war ofnature’’ exists not only between
species but between the  sexes of  the same species. Evolutionary
psychology posits that certain behaviorshave evolved to be universal
because they helped our ancestors’genes to survive and that
human behavior is a complex, ever-changing interaction between
our inherited predispositions and the culture I suggest that sexual
competition not only extends togenomic imprinting6 but also that it
can be found in church pulpits andcourts of law. In My Fair Lady,in
accepting the presidency of Conflicts between male and female
 reproductive agendas continue to play out in contemporary issues of
 sex, power, and politics. Viewing genderthrough the lens of biologic
 evolutionary psychology reveals persistent controversies
surrounding women’s rights.The history of oral contraceptives compared
with that of erectile dysfunctiondrugs is just one example of the disparity
between female and male reproducti choices. Contraceptives, maternal
 mortality,abortion, and domestic violence are issues directly influenced by
 politics,religion, and gender biases. Ultimately, everything that can we can
 do to give women control over their bodies and their fertility is not only just
 and humane, but it also changes the world for thebetter. The United States
must restore its leadership in international family planning—ensuring
reproductive freedoms could be the genesis of other freedoms.
Henry Higgins laments, ‘‘Why Can a Woman Be More Like a Man?’’
but it might be better if men weremore like women.


SEXUAL CONFLICT

Primatologist Sarah Hdry has written that ‘‘The demands of reproduction
have led to the evolution of two quite different creatures, two
sexes caught in the bounds of irreconcilable conflicts. In only a few
cases will the self interest of consort overlap.’ Behavioral and anatomic
competition between the sexes is found in all species. In the
praying mantis the female often supplements her food supply by
eating the head of the male during copulation. In the tiny marsupial
mouse, Anticinus stuartii, males maturein the year of their birth and
engage in an orgy of sex, manifest signs of stress, and die. The females
live to the second year, when they deliver equal numbers of male and
female pups and the cycle repeats. It is interesting that in our species
women live longer than men. Castrated male Anticinus stuartii, like
females, live to the second year and remarkably, castrated men live a
remarkable 12 years longer than men with intact testes It might be
said that not only does life seem longer for a eunuch—it is longer!
Evolution predicts that the sex that makes the most biologic investment
in the next generation will tend to be cautious in mating
choices, while the one that makes the least investment will be more
competitive, less discriminating, and more risk taking. Men are
more competitive and risk taking than women (eg, young men fracture
their long bones more often than young women). Interestingly,
Jane Goodall found that among chimpanzees—with whom we share
98.4% of our genes—males fall out of trees more often than females.
From an evolutionary perspective, it is in the interest of women to
choose their partners from as wide a variety of males as possible and to
have the ability to decide when to have children. Conversely, it is in
the male’s interest to secure the greatest possible freedom in his
own mating while making sure any female he impregnates is faithful to
him and unable to exercise choice over the timing or number of her
pregnancies. Conflicts between male and female reproductive
agendas continue to play out in contemporary issues of sex, power,
and politics.

THE PILL AND VIAGRA

In the 1950s, Margaret Sanger cajoled a private research laboratory in
Boston into developing the Pill. At the time, contraception was illegal in
Massachusetts and the National Institutes of Health was forbidden to
support research in contraception. No large company wanted to develop
an oral contraceptive. Flash forward to the 1990s and the accidental
discovery that sildenafil overcame some cases of erectile dysfunction.
With no laws prohibiting the study of male erections, there was
immediate investment and eventually a blockbuster drug.
In the late 1960s deaths from the original high dose Pills hit the
headlines and a 1970 Congressional hearing came close to having
the Pill withdrawn from the market. By the end of 2001 over 500
deaths have occurred in sildenafil users. As with the Pill, the link
between use and death is not always causal, but unlike the Pill
there have been few headlines and no Congressional hearings. Senator
Robert Dole endorses Viagra (Pfizer Inc., New York NY) but no
woman with name recognition advertises she is using the Pill. Medical
insurance companies have been quicker to pay for erectile dysfunction
drugs than contraceptives. The Harvard obstetrician John
Rock, who led the clinical work on the first oral contraceptives, was a
Roman Catholic who attended Mass every morning. In The Time
Has Come  (1963), he argued that the Pill was morally appropriate
because it merely extended the natural suppression of ovulation during
lactation. The Vatican established a Commission to study
contraception. The majority agreed that the Pill was theologically acceptable,
but in the encyclical Humanae vitae (1968) Pope Paul IV
condemned all actions ‘‘specifically intended to prevent procreation—
whether as an end or a means.’’ He was reaffirming a tradition going
back to Saint Augustine, 354–430, who held that Original Sin had
been transmitted in the semen since Adam, like some latter day
virus. Augustine not only condemned birth control but he interpreted
spontaneous erections as proof positive of Original Sin, arguing
that ‘‘. . .these members are rightly called pudenda (parts of
shame) because they excite themselves just as they like, in opposition
to the mind which is their master. . ..’’ Revealingly, no theologian
condemned Viagra, Levitra (Bayer Corp., West Haven, CT), or
Cialis (Eli Lilly, Indianapolis, IN) for encouraging the ‘‘parts of
shame to excite themselves.’’ Such biases cut across cultures.
In 1967, the Japanese Ministry of Health and Welfare rejected oral
contraceptives on the grounds that Japanese women were physiologically
unique; in 1990, it was sug-gested  availability would accelerate
the spread of human immunodeficiency virus; and in 1998—with an
obscurantism worthy of a medieval theologian—marketing was refused
because artificial hormones in the sewage might feminize fish! When
sildenafil was introduced into Japan, it received marketing approval
in 6 months. The asymmetry between the 2 drugs had
become so grotesque that the Pill was finally approved on sildenafil’s
coattails—35 years after the initial application. The male desire to enhance
their erections while restricting access to the Pill can be interpreted in
terms of evolutionary psychology.Safe, effective contraception for
women is indeed a formidable challenge to the deeply ingrained
male reproductive agenda. Superficially, it might seem that with the
passage of time, the biases against fertility regulation would soften;
however, when the acid of male hostility is contained on  subject, it
tends to leak out and corrode women’s options in another. This is happening
with emergency contraception. The expert advice of an FDA
advisory committee to make emergency contraception available
without a prescription was disregarded in the face of political pressure.
From the Stone Age to the present administration, the male
predisposition to dominate the lives of women has often held
sway; ultimately, controversies over contraception may be less about
 morals and more about patriarchy.


Women’s Health Bill of Rights

1. Safety and accountability in health care.
2. Freedom from domestic and sociopolitical violence both here and throughout
 the world.
3. Appropriate and effective insurance coverage.
4. Equity in gender-specific research.
5. Freedom from discrimination based on gender, gender identity, sexual
 orientation, age, race, or ethnicity.
6. Socioeconomic and political equality.
7. Accessible, affordable, and safe forms of contraception including
 postcoital contraceptives.
8. Freedom of reproductive choice.
9. Culturally sensitive education and information.
10. Access to healing environments and integrative approaches
 to health and health care.


MATERNAL MORTALITY

The lifetime risk of death from childbearing (the total fertility rate _
 Maternal mortality ratio) varies from as low as 1 in 5,000 in the West to an
appalling 1 in 24 in Africa. Two to 3 times as many women will die
from pregnancy, delivery, and abortion this year as the men, women,
and children who were killed in the terrible December 26, 2005, tsunami.
The international community responded generously to the tsunami,
but America is turning its back on the needs of Third World
women. Fortunately, promising developments are occurring in the
treatment of postpartum hemorrhage—the single most common cause of
death in childbirth. Prata and Mbaruku, working in Tanzania, have
found a way traditional birth attendants can diagnose postpartum
hemorrhage accurately, and they have gone on to demonstrate that
even women who cannot read can stop hemorrhage safely and effectively
with generic misoprostol. Most postpartum hemorrhage deaths occur
during home deliveries without a trained birth attendant. The challenge
will be for decision-makers to endorse a policy where misoprostol
is made available to traditional birth attendants without prescription.
Fortunately, the Ugandan and Kenyan governments held policy meetings
last year to introduce the use of the drug.

REPRODUCTIVE CHOICE

The mortality associated with unsafe abortion in Africa (6 to 700
deaths per 100,000 abortions) is up to 1,000 times higher than safe
abortion in the West (0.2–1.2 deaths per 100,000),15 yet abortion
remains illegal in much of the world and abortion on request is
under attack in America. Obviously, abortion presents deeply ethical
choices, but extreme manifestations of the male desire to control
women have clouded the possibility for thoughtful debate. Men—and
it has always been men—have now murdered 7 abortion providers and
clinic staff. We need to strip away the passions and see the core issues.
The abortion debate is not deciding whether abortion is right or wrong,
but accommodating in a respectful way to a variety of deeply held
opinions on a complex topic. When the Supreme Court justices
wrote Roe v. Wade in 1973 they reaffirmed the tradition of religious
tolerance on which this country is  founded, writing, ‘‘. . .we need not
resolve the difficult question when life begins. When those trained in
the respective disciplines of medicine, philosophy and theology are
unable to arrive at a consensus, the judiciary, at this point in the
development of man’s knowledge, is not in a position to speculate as to
the answer.’’ Religious assertions about when life begins are philosophically
parallel to beliefs about life after death,and both are beyond the realm of
science or theology to prove or disprove. It follows that in a society
that separates church and state, it should be no more surprising to find
an abortion clinic in a city where many people oppose terminating a
pregnancy, than it is to have churches, synagogues, mosques, and
Hindu and Buddhist temples in the same city.

DOMESTIC VIOLENCE

In every country, men make up the majority of convicted criminals.
Male nastiness evolved precisely because of sexual competition,
where aggression shaped the path to reproductive success. Testosterone
is the primary hormone modulating male sexual activity, and it is
also a hormone that can stimulate his temper and aggression. Darwin
wrote, ‘‘. . .the male. . .seems to owe his greater size to his ancestors having
fought with other males during many generations.’’ In genuinely
monogamous mammals or birds, such as beavers or penguins, the 2
sexes are the same size, or the male is smaller. Although sexual dimorphism
is not as marked in Homo sapiens as in some other primates, it betrays our
descent from a promiscuous or polygamous species where males
fought for access to females. The male predisposition to control
women is so strong that sometimes women end up adopting the
male agenda, as in wearing a burka, foot binding, or female genital mutilation.
Violence against women is often nearer the surface than we
care to think. One third of young American men asked to imagine
what they would do if they could rape a woman and be certain they
would never be found out said they might rape. A pregnant woman
in America is more likely to be murdered, nearly always by a sexual
partner, than to die of any single disease during pregnancy,
such as heart or kidney failure. Even religion can express gender
biases. Saint Augustine explicitly praised his own mother, Monica, for
never complaining about his father’s infidelities. He argued that the way
to escape domestic violence was for a wife not to criticize her husband,
however badly he treated her. ‘‘Many women, although they had
gentler husbands, bore the marks of blows on their disfigured faces and
blame their husbands in conversation with their women friends.
Monica laid the blame at their door for neglecting to keep silent.’’

POPULATION AND PEACE

Forty years ago, obstetricians such as Alan Guttmacher were effective
 Advocates for international family planning. Although less discussed,
Rapid population growth remains significant.The world adds 1 million
More births than deaths every 110 hours; India every 3 weeks. The
Trajectory of future growth will be highly influenced by whether women
are given access to family planning. In the 1960s East and West Pakistan
both had a total fertility rate of 7. Each was desperately poor
and highly conservative, but after the 1972 War of Liberation when
former East Pakistan became Bangladesh, contraception backed up
by manual vacuum aspiration became widely available and family
size fell 50%, whereas in Pakistan, with less access to fertility regulation,
the total fertility rate remains high. In Thailand, which has excellent
family planning, the average family size is now below 2, whereas
in the Philippines, where the church is actively obstructing family
planning, it is well over 3. The difference may not look large, but
in 1950 the 2 countries had exactly the same population, whereas in
2050 the Philippines will be twice as large. As the huge numbers of
unsafe abortions in the Philippines demonstrate, it is not that Filipinos
want more children; it is that a patriarchal interpretation of religion
and male power prevent poor women from getting the contraceptives
they want. Rapid population growth both distorts the population
structure, increasing the proportion of younger to older men, and
exacerbates problems of unemployment. As stated in The 9/11
Commission Report, ‘‘By the 1990s, high birth rates and
declining rates of infant mortality had produced a common
problem throughout the Muslim world: a large, steadily increasing
population of young men without any reasonable expectation of suitable
or steady employment—a sure prescription for social turbulence.’’
This generalization has academic confirmation from regression analyses
run by Mesquite and Weiner, who found approximately
one third of the variance in the probability of violence in the
contemporary world could be explained by the population structure.
In the past decade, with the exception of Bosnia, every U.S.
military operation of the past decade has been in 1 of these high
fertility countries with a total fertility rate of 4 or more.
The male reproductive agenda is spelled out in the life of Osama
Bin Laden, who was the 17th child of a father who had 11 wives. The
female agenda is encapsulated in the 120 million women in the
developing world surveys show do not want another pregnancy but
are unable to obtain the contraception or the correct information
about it that they need. By 2050, global population will explode by
between 1.1 and 3.7 billion—a difference greater than the world
population in 1950. The real difference between these high and low
demographic trajectories is the difference between a world of loved,
wanted children in an increasingly democratic, economically
prosperous society and a divided world where 1 part is increasingly
poor, increasingly violent, and where many births remain unwanted.
Evidence of the power of offering women realistic choices over
childbearing comes from an unexpected source. In 1987, economists
in the Islamic Republic of Iran saw that the country’s population
growth was steeper than its economic growth. The Holy Koran
endorses family planning. With the permission of religious leaders, the
government set up Pill and condom factories, male as well as female
sterilization was made available, and all couples must attend
family planning instruction before marriage. There are still many
conservative aspects of Iranian life. For example, a woman cannot
undergo a surgical operation without the written consent of a male
relative. Remarkably, however, family size has fallen more rapidly
than it did in China. As family planning became more available, the
 percentage of couples rose to the U.S. level and the gap in total fertility
rate between rural and urban areas closed (Fig. 1). Family planning save
lives (up to one third of the decline in maternal mortality in the West during



           



the twentieth century was due to family planning). Smaller families
improved educational options. Today, there are now more women
than men in Iranian universities. It may be a long time before all
traces of a patriarchal culture completely disappear in Iran, but a country
with educated women able to decide to have small families is likely
to be profoundly different from its neighbors, such as Afghanistan, Iraq,
or Pakistan. In the specific case of Pakistan, if the United States continues
to withhold support of the United Nations Population Fund
and if the unmet need for family planning in that country is not met
then, by 2050 Pakistan could have many more people than currently
live in the United States—and Pakistan is just slightly larger than Texas.
Everything that can we can do to give women control over their bodies
and their fertility enhances reproductive health; it is not only just and
humane, but it also changes the world for the better. Without more
attention to women’s opportunities and health, especially in the Middle
East and sub-Saharan Africa, we can be sure that the frustrations of
Increasing numbers of unemployed young men will continue to spill
Over in acts of terrorism. The biggest problem in rolling back male
control of women—of making a man more like a woman— is not the
different perspectives of Republicans and Democrats or of conservatives
 and liberals—those are merely healthy divisions in any pluralistic society.
The damaging fissure in contemporary America is between science and
 antiscience, between fundamentalism and toleration. In the contemporary
 United States, when it comes to women’s reproductive health, ideology is
trumping science. In a recent CBS poll, only 13% of those questioned
thought human beings evolved without divine intervention. While the
rest of us try to understand the problems confronting us in a complex,
interdependent, twenty-first century society, fundamentalists respond
intuitively and unthinkingly to their predispositions left over from the
Stone Age and incorporate them into their mythologies.   In his second
Inaugural address in January this year, President Bush called for ‘‘freedom
in all the world,’’ and he spoke specifically of the ‘‘humiliation
and servitude’’ that women still suffer in many countries. If we
are to help lift women out of ‘‘humiliation and servitude’’ then we must
restore U.S. leadership in international family planning. Not only is
freedom from the tyranny of unwanted pregnancy a basic freedom,
it is often the genesis of other freedoms as is happening in Iran. In the
long run, injectable contraceptives and intrauterine devices may prove
more powerful weapons against conflict and terrorism than Abrams
tanks or F-16 war planes—the Pill, I suggest, is mightier than the sword.



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