What is Reproductive Coercion?

Reproductive Coercion is getting some surprise attention this week after actors Nikki Reed and Ian Somerhalder went on Dr Berlin’s Informed Pregnancy Podcast and related their pregnancy story with a few red flags. (Note: Dr. Berlin is a prenatal chiropractor, chiropractors are not medical doctors.)

I’ve linked the podcast so you can listen for yourself (the section in question is within the first 8 minutes) as well as a Jezebel article that includes a partial transcript, but basically, Reed says Somerhalder knew way before she did that he definitely wanted children, after they were married Somerhalder wanted to have children around the same time his best friends’ did, and then one night on vacation with aforementioned best friends, he popped Reeds’ birth control pills out one by one into the toilet while their friends filmed it and Reed was “freaking out.” Somerhalder ends the story by admitting really he was the one who decided to get pregnant, rather than his earlier use of “we.”

Is this reproductive coercion? And what is reproductive coercion anyway?

Reproductive Coercion (RC) is a type of intimate partner violence where one partner seeks to limit or control the other partner’s ability to make choices about their reproductive health. RC is a spectrum of behaviors, which can range from pregnancy promoting behaviors like tampering with birth control, sexual assault, and preventing someone from seeking an abortion if they want one, to behaviors that attempt to pressure, control, or harm a pregnant person with the aim of ending the pregnancy against their will.

When you listen to the actual audio, it seems as if they’re trying to make this into a cute, jokey story, but I can’t shake the red-flag-feeling. Reed’s response on twitter, shortly after media outlets started picking up on the story on Friday, characterizes the controversy as something the media has blown out of proportion, while most fan replies to her tweets are encouraging and insist that they knew it was lighthearted.

Screen Shot 2017-09-23 at 5.42.03 PM

Here’s the thing – the narrative was their own. There are many times that a controversy over how something was reported in a profile of a celebrity – which come from much longer interviews that are condensed for publication and may only feature select quotes, but this came from a podcast where Reed and Somerhalder were speaking openly and unedited. The multiple journalists and outlets that picked up on the podcast (a podcast which I imagine rarely makes national headlines) raised the red flag over Somerhalder’s description of tossing her birth control in the toilet while Reed was upset, and that Reed asks about the video that was taken and wonders if she was too drunk to remember. These elements are alarming facts, and I when I listened to the actual audio the way they were told didn’t make me feel any better. Maybe they didn’t tell the story in an artful way, but these are tactics that are part of the spectrum of behaviors known as RC.

Reed and Somerhalder later put out a joint statement addressing the allegations of reproductive coercion:

Screen Shot 2017-09-25 at 7.53.19 AM

Celebrities are very often not experts on the topics they become associated with. This is true. However, it is a rare moment in pop culture that a relatively little-known public health problem is gaining some attention, which is ultimately a good place to start a conversation.

Links Roundup: The Wellness Industry

Maybe I’m the target demo, but wellness seems pretty inescapable right now.

In the context of the “wellness industry” that is primarily marketed toward women, wellness is not just personal health but also a kind of moral superiority. The idea of wellness that is sold by Goop, fitness influencers and celebrity chefs on Instagram is a hard nut to crack because truly, people are ill, our modern diets and lifestyles make feeling healthy and maintaining good health difficult, and striving to attain better health is something that all people should be interested in, but it’s also very aesthetically rigid, expensive, and scientifically ambiguous.

Health trends change over time (running used to be weird!), and the wellness industry that promotes everything from “clean eating,” jade vagina eggs, crystals, natural deodorant, exercise regimens, supplements, fasting, and juices (and more!) is diverse and also runs a spectrum of helpfulness.

However, like all trends, I think we should be critical of what we’re consuming (literally and figuratively) and take a step back to examine what exactly we’re being sold. I do partake in some of these kind of crunchy, wellness related fads and enjoy them (chlorophyl water is pretty refreshing, although I don’t think it had any particular impact on my wellbeing), but I try to take everything with a grain of salt. It’s hard to be a woman in the world and not know someone with some kind of disordered eating, and I admit that when I see food bloggers using words like glow, warming, and nourishing about recipes I feel kind of the same way some people do when they hear the word moist. There’s is nothing inherently wrong with it, it just feels like something’s not quite right.

I think the part of these trendy, wellnessy-marketed things that troubles me the most is the idea (sometimes overt, sometimes implied) that attaining whatever your chosen leader’s form of wellness is something that can put you on a path to self-actualization or moral superiority. I think many people can feel empowered by feeling more in control of their health and lives, but kind of how many people who aim to lose a lot of weight and do but don’t become the happy carefree people they assumed they would be when they finally reached their goal weight, there are no magic fixes to what ails you and believing there are is a slippery slope to disappointment.

Anyway, I have a lot of ambivalent feelings about wellness, but I think these articles are all really helpful for understanding the salience of this industry and what we as consumers should consider:

Why we fell for clean eating (8.11.17 via the Guardian) Really comprehensive history of the evolution of “clean eating” and the wellness industry.

You can’t found a new faith system with the words “I am publishing a very good vegetarian cookbook”. For this, you need something stronger. You need the assurance of make-believe, whispered sweetly. Grind this cauliflower into tiny pieces and you can make a special kind of no-carb rice! Avoid all sugar and your skin will shimmer! Among other things, clean eating confirms how vulnerable and lost millions of us feel about diet – which really means how lost we feel about our own bodies. We are so unmoored that we will put our faith in any master who promises us that we, too, can become pure and good.

We exercised with Nina Dobrev and the experience nearly killed us (7.20.17 via Jezebel) For a lighter take on the hegemonic aesthetics of wellness, I really enjoyed this.

Women are flocking to wellness because modern medicine still doesn’t take them seriously (6.15.17 via Quartz) I liked this article because it is more validating of seeking “wellness” than most articles (there are legitimate reasons people, especially women, look for alternatives!) but also drops some important points like this:

But it’s important to remember that the dollars we drop on salt lampsand Moon Dust aren’t the same thing as agitating for change—and that retreating into wellness is only an option for the privileged set. Medical outcomes in the US are largely predicted by race and socioeconomic status, and it is minorities and poor people who face the worst consequences when toxins get dumped and regulatory systems break down.

Dear Gwyneth Paltrow, we’re not f**king with you, we’re correcting you. XOXO, science (5.22.17 via Dr. Jen Gunter) Dr. Gunter is a damn delight, and taking on the snake  oil salesman ways of Goop is a frequent topic on her blog. This is one of several take downs Dr. Gunter has done, all of which are informative, science and fact-based, and often hilarious as she deconstructs Goop’s latest fad with incredulity.

Wellness, womanhood, and the west, how Goop profits from endless illness (4.28.17 via Jezebel)  Stassa Edwards is really fantastic and you should read this whole thing.

Learning to chew, swallow, and shit at Viva Mayr, an Austrian Detox spa for the ultra wealthy (3.15.17 via Jezebel) I read this with an open, non-judgemental mind, just because I think it was really interesting to hear about how Detox spas like this work. It reminded me of an older article from the Cut on a celebrity weight loss “wellness” retreat, and I think both articles provide some important observations on the pros and cons of these spas/camps/retreats that you really cannot make without some first hand experience.

Healthy Outdoor Spaces & Environmental Pollution

20170819_124137
A plastic bottle floats in the Darby Creek.

The first time my partner and I used our inflatable tandem kayak (yes, I know that’s very dorky but we’re renters and don’t have space for a real kayak) we took it to the John Heinz National Wildlife Refuge at Tinicum to go out in Darby Creek. We had been to the Heinz before, but on foot. The Heinz is the nation’s first “urban refuge,” established in 1972 to preserve the marshland and the ecosystem that relies on it.

Last year while I was taking a class on environmental public health for my MPH degree, we had Josh Barber, the EPA Remedial Project Manager at the Clearview Landfill come speak to us about Superfund sites. The Clearview Landfill is located above the Heinz, while the Folcroft Landfill is located downstream, partially in the Heinz. Both landfills are Superfund designated sites, which are highly polluted areas identified by the government for remedial action in the interest of environmental and human health.

1-1_General_LocationREVzoom
That big body of water is the Heinz refuge. Image from: https://response.epa.gov/site/site_profile.aspx?site_id=5864

So this was in the back of my mind, but I didn’t think much of it until we we lugging our equipment out and passed a paddle boarder who was leaving the Creek. He asked if we were headed down to the boat launch.

“It’s gross,” he said. He explained he’d been in bodies of water all around Philadelphia, but Darby Creek seemed to be the most litter-filled and brown. He said he was glad he was an experienced paddle boarder and didn’t fall in. My partner and I got our kayak out and went out anyway, but on the water, it was hard to not think about litter since every few feet or so, we passed more plastic bottles, condoms, soda cans, and unidentifiable plastic pieces.

The US Fish and Wildlife Service page for the Heinz even lists out 10 points of interest for those going out in canoes and kayaks to look for, which includes the Folcroft Landfill, a Sun Oil tank, and a sewage treatment plant. Scenic!

20170819_123955
It’s hard to escape visual reminders of the pollution that impacts Darby Creek
20170819_125841
Trash collects in little islands along with fallen branches in Darby Creek

For people living in large, urban areas like Greater Philadelphia, access to nice outdoor spaces is really important for human health. I grew up in Maine, and access to nature was definitely something I took for granted because it just… wasn’t something I had to think about. It was everywhere. Since I’ve lived in Philadelphia for almost 10 years, getting out into green spaces is something I have to be more intentional about.

In my public health classes we frequently discuss interventions that are aimed at improving population access to outdoor spaces and increasing the amount of time people spend outdoors being physically active. In Philadelphia, pediatric doctors are now even prescribing children with time out in nature as part of the NaturePHL partnership to increase physical activity.  Even small modifications to urban environments, like cleaning and greening vacant lots, can have an impact of residents’ health and stress levels.

So… what happens when those outdoor spaces are polluted? 

Environmental pollution has very real impacts on human health. For the Eastwick community that surrounds the Heinz and the Folcroft and Clearview Landfills, they have long reported elevated rates of asthma and cancer, believed to have come from their polluted environment besieged by frequent floods. Dr. Marilyn Howarth (who taught the class I took when I originally learned about the Heinz as a Superfund site) recently did an interview with the Philadelphia Inquirer where she spotlighted the issues in Eastwick:

If your only exposure is to a particular chemical in the soil that might be left over from a hazardous waste site, in and of itself, it might not pose a very big risk to you for cancer or some other health effect. But say you are being exposed at the same time to air pollution from a nearby highway, and you’re also close to refineries that have emissions, even if those emissions are lower than allowed by their permit. Adding all these together, the opportunity for these exposures to cause you harm increases.  The varied exposures  might be working on the same body parts and the same mechanisms of causing disease. That cumulative exposure might mean you’re more likely to get the disease than if you’re exposed to any one toxic chemical singly.

This concept of cumulative exposure is pretty important, because interacting with one’s accessible outdoor environment is generally thought to be healthy, however, many people are not so lucky if the actual environment is itself unhealthy! Studies have found that poor, minority-majority neighborhoods are more likely to be exposed to higher levels of air pollution, and that minorities and low-income individuals are more likely to live near a toxic waste site.  In old cities like Philadelphia, lead-contaminated soil is a concern for developers, gardeners and children playing outside.

The amount of trash in a space is often a factor in whether you decide to hang out there or not. Trash is unfortunately pretty much ever-present in Philadelphia (we’re trying to be better!), and on top of the more-unseen environmental pollutants like air quality and lead in soil, I know for me personally, I’d much rather hang out in a park that appears clean than one filled with a bunch of gross litter. Clean outdoor spaces influence people to spend more time outside where they are more likely to be physically active and outdoor spaces in poor condition influence people to stay inside, where people are more likely to be sedentary.

That said, individual bottles and pieces of plastic in the creek aren’t probably a huge threat to my personal health, but I am definitely not going out of my way to touch the water. There are still tons of turtles, fish, and birds in the Heinz but their health is most likely negatively impacted by the amount of trash in their living space! People who have lots of easy, close access to pristine outdoor spaces are very privileged, but should also feel pressure to help maintain the cleanliness of those spaces. Trash is something that all humans produce, but where where that trash ends up is often where people already have less access to outdoor spaces and fewer social and economic resources to enjoy outdoor spaces.

So if you’re feeling kind of Not-In-My-Backyard about trash- remember the earth is everyone’s backyard! Clean spaces and less trash are better for everyone.

Racism is a Public Health Issue

“Racism is a system of structuring opportunity and assigning value based on the social interpretation of how one looks (which is what we call “race”, that unfairly disadvantages some individuals and communities, unfairly advantages other individuals and communities, and saps the strength of the whole society through the waste of human resources.” —APHA Past President Camara Jones, MD, PhD, MPH

The news out of Charlottesville this weekend is sickening. Unsurprisingly, lately I’ve been thinking a lot about how racism impacts individual and societal health. Experiencing racism is stressful, and stress impacts health. In a 2013 article in the Atlantic, the impact of racial discrimination on health is described thusly:

Discrimination has been shown to increase the risk of stress, depression, the common cold, hypertensioncardiovascular diseasebreast cancer, and mortality. Recently, two journals — The American Journal of Public Health and The Du Bois Review: Social Science Research on Race — dedicated entire issues to the subject. These collections push us to consider how discrimination becomes what social epidemiologist Nancy Krieger, one of the field’s leaders, terms “embodied inequality.”

Embodied inequality. When you examine health outcomes by race, it is really striking how far-reaching the divide goes, from infant mortality rates, to life expectancy, and disease rates. Then there are the psychological impacts of dealing with racism. Trauma has devastating impacts on physiological health. On top of that, medical professionals have exploited racial minorities for centuries, from slavery to eugenics to medical experiments to discrimination in medical practices. These gross racist, exploitative practices have happened and continue to happen, and I recommend that anyone who is interested in the history of racial discrimination in healthcare read Medical Apartheid by Harriet A. Washington.

I’ve linked a bunch of articles in this post, and it’s all good reading, but I’d urge anyone who is interested in public health to consider anti-racist work as an integral part of improving society-level health outcomes. It is not and should not be the responsibility of Black people, or Latinx or any other racial and ethnic minorities to “fix the racial divide.” Racism is perpetuated by systems and the white people who benefit from them, even when they do not individually work to maintain them. It is all our responsibility to dismantle racism and the toxic effects it has on society.

How can we support anti-racism? There are many organizations that are in need of donations, like the Charlottesville Solidarity Legal Fund, which fights white supremacy in Charlottesville, VA.  We can also have conversations with our friends and family to challenge racist assumptions, attend protests and physically show up for anti-racist events. I think particularly for white people, it is important to listen and educate ourselves as much as possible. Read and watch media created by people of color. When you feel like your own beliefs are being challenged, listen and wait. Really listen. It’s uncomfortable and hard to think about our own biases, but it’s not more uncomfortable or hard than receiving racist treatment and dealing with racist systems every day. Our society is better when everyone has access to the things they need to live healthy and stress-free lives, and it’s essential that we treat racism like the public health issue it is.