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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