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Hmmm. Well, the past couple of posts have been a bit themed, so I… - Sally's Journal
March 25th, 2005
12:53 pm

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Hmmm. Well, the past couple of posts have been a bit themed, so I thought I ought to at least satisfy my readship by telling them my own opinions.

The poll was produced after a conversation on #chiark about the idea of steralising all teenagers (well, the girls) aged 14 with something like implanon, (which is generally as good as hormonal contraception gets, being quite low dose, only needing remembering every three years, and not involving poking the delicate bits). So unlike naaths musings on the last post, followed by her reluctant admittance that we couldn't actually reversably steralise everyone at birth, this is something we have the technology for. It wasn't an idea I liked though... no, that's not true, it was an idea that I thought was quite good on the broad fuzzy scale of "all teenagers" and absolutely hated at an individual level than involved me. I don't mind being on hormonal contraception and taking what risks there may be in an educated way *when there is actually some benifit to me*, but being stuck on fake hormones for three years when I wasn't actually having sex would be really depressing. And having to plead your case to get the thing taken out when you did want children is worrying too.

So the first "point" of yesterdays poll, which I think did show up (small statistical samples, Sally) is that there are quite a lot of people who agree with me that people who are going to be crap parents shouldn't be allowed to have kids. And pretty much noone who would trust the government with the power of deciding who is going to be a crap parent and who isn't. This is a bit of a conundrum. (It brings me back to all those LJ debates the other year about whether "because it's against the law" is a good reason to think something is morally wrong. Where I was happy to say that if I hadn't given the matter any thought, I would trust that the people who made the law had, and so they were more likely to be right than to be wrong, with no other information available. Not many people agreed with me then.) I suppose with our current government (and the media, which is a whole other rant) it's not surprising that the idea of government isn't "people in charge who know better than us who we trust are doing the best thing".

Although it's interesting that "the government" rather emotively causes images of David Blunkett strolling into your living room tearing up your ID card and forcably steralising you, whereas "social services" or "a parenting test" (and social services and the driving test are government run and organised things, arn't they?) seem to be far nicer things to judge whether you can have kids or not.

I'm just confused by it all. The parents right to choose to have children. The whole mess of abortion and the parents right to choose not to have children, even up to the point where they're pregnant. The very interesting point that it's impossible to argue meaningfully whether it would be better not to have been born or not. That even kids from shitty parents can go on and have happy lives, and to say those parents should never have had children is to miss this point completely. The very interesting point that the government already chooses who can have children, by taking kids away from their parents and putting them in foster care.

I suppose my concern is just that I think the current system is completely broken. Kids coming through foster care are hugely more likely to have no qualifications, criminal convictions etc etc Of course, whether you have 5 GCSEs isn't strictly correlated with whether or not you're a nice or a happy person, I know, but in general and on average, by a whole lot of objective and statistical methods, foster kids are messed up. Maybe a lot of this is that it takes so long before the government will take away peoples right to have their children (because this is a very hurtful and difficult thing to do) that they never end up in foster care until so much bad stuff has happened to them that they'll never overcome it. Maybe it's because our foster care system is so horribly broken, with kids being moved round and passed from pillar to post, and...

Also, the whole glib way people wrote about "child abusers" was mildly scary. Is this a media thing? A paedophile in every bush? What do people mean by child abusers? Ok, there's the sex thing. People who are going to rape, or similar, their children shouldn't be allowed to do this. But there's a far cry between occasionally fantasising about something in the abstract, and actually wanting to do it with real people for real, and an even further cry to actually doing it. If the government could test if you were turned on by pictures of semi naked 13 year olds, this shouldn't be enough to stop you looking after your children. On the other hand, sex aside, "child abusers" could be read as people who are cruel to their children. Except on one level, the job of a good parent is to be cruel to their children. OK, only when said children are bad. But a lot of the most badly behaved children in society are the ones where the boundaries weren't laid down, where they have no idea of right and wrong. Ignoring your children and not caring what they do or if they like you is a far worse form of child abuse than smacking them when they're bad. Maybe. Although you shouldn't beat them senseless obviously. Not sure what the point of this paragraph was. Just that I didn't like the way that people talked about "child abusers" as though, given all the information about what someone did with their children, you could point at them and say "child abuser" or "not child abuser" when it's really just a fuzzy scale - and ok, some people are so far gone that it's obvious they're evil, and some people must be so perfect that it's clear they never do any harm, but it's just a big struggle to do the best you can.

Hmm. Enough wibbling. My plan for fixing the world, tm, is therefor that first, the accidents must be stopped. So lots of education about contraception. Stop promoting the pill, FFS, because it's hard enough to remember it if you're an obessive mathmo type, and start promoting decent long term contraception, like implanon or the depo. Yes, it's more expensive in the short term, who cares? Stop making it a struggle so that only very intelligent focussed women with too much time on their hands can get the contraception they want... Can we make getting contraception easier? Lots of places do lunchtime family planning clinics. This is a good idea. Bring it into schools? Such a fine line between promoting sex and promoting contraception to tread. But if everyone had an individual appointment with a family planning nurse at their school as part of their sex ed once every three months? a year?, so there was no stigma in going because everyone had to go, and you could talk one to one, and if you wanted contraception it could be prescribed there and then, and noone would know... Not sure how you carry this idea on into the real world once people have left school. Now there's implanon and stuff you might be able to do it by giving every woman a once a year compulsory appointment with their gp (and you could do cervical smears and stuff then too) But it would be expensive in doctors time, and how do you make people turn up, even to compulsory appointments?

So you try and fix the accidents. Then you only have the people who want children, but arn't fit to have them to worry about. I quite liked the idea of a test that everyone passes, but that you have to sit, that educates people and just flags up the people who might need more help and support. And then give them more help and support. A social worker? but one whose role was almost "godparent"ish, to keep an eye on, and build up a relationship with the child? But you'd need so many social workers. And you'd need good social workers as well. Sigh.

Maybe we do live in the best possible world :-(



Where am I in my life? Lots of stress. Seem to have been suffering from wild moodswings, from deepest gasping despair to overwhelming happy exuberance. Lots of work, the happy whistling sound of deadlines flying by. The meeting of doom got moved, so now it's further way, but inconveniently in the middle of a week I'd had pencilled in my brain as "holiday". Ah well, holidays are for wimps in the whittle lab.

Today I'm going to take things easy, get things tidied up at work, and maybe make a little progress, but no stress. It's strangely freeing.

(23 comments | Leave a comment)

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From:bopeepsheep
Date:March 25th, 2005 02:16 pm (UTC)
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Long term hormonal contraception - particularly Depo Provera - has newly-discovered nasty effects on bones. Early osteoporosis and a high tendency to fractures, specifically. The new recommendations are that no one spends more than two or three years on it - I hear this after spending the majority of ten years on it. :/ I won't be going back to it again, particularly since I was a very low consumer of dairy products and other calcium-bearing things in my teens.
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From:flats
Date:March 25th, 2005 02:27 pm (UTC)
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Apparently Depo's actually been banned in Australia.

I think the pill's enough - if someone who's sexually active is on that, then uses condoms for new/casual partners for the sake of STD prevention, both together will be pretty damn reliable.
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From:naath
Date:March 25th, 2005 03:49 pm (UTC)
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No. Because you have to *remember to take it*. And it's *the same hormone anyway*. I don't care. I'd rather get osteoperosis than pregnant...
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From:bopeepsheep
Date:March 25th, 2005 04:58 pm (UTC)
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It might be the same hormone but the side-effects and the way it actually works on your body are radically different. Pill users don't commonly report weeks and weeks of bleeding as a side-effect, and you can clear the Pill from your body at will, pretty much. The method failure of Depo is actually lower than sterilization, the user failure of the Pill is insanely high (particularly when people can choose to misuse it quite easily) and the method failure is also high because of antibiotic interaction (and others, but that's the most common medication-caused disruption). I am not convinced that either is better than the other, having had both.

Early osteoporosis could cripple you before the age of 40. If you're that sure that you don't want to be pregnant, get sterilized. It's really a much better option, for people who know they don't want children at all, than long term hormones.
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From:naath
Date:March 25th, 2005 05:11 pm (UTC)
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But I don't have weeks of bleeding (on implanon, which currently has a failure rate less than sterilisation but not much data) *and* on the pill I got bleeding every 4 weeks (aparently this is *good* for you. In some way).

On the other hand *the NHS is full of morons*. ie - they won't sterilise me. On the other other hand I quite like having no periods.
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From:bopeepsheep
Date:March 25th, 2005 05:20 pm (UTC)
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Oh, I was period free for ages on Depo. But others aren't so lucky and until you (generic) try one you don't know which you are. And of course then you have up to a year (with Depo, at least) of trying to get the hormones back out of your system if you're unlucky. It can be a nightmare.

I think the situation with the NHS improves the more you ask
(pester factor) and the older you get. Sooner or later someone will listen and honestly, if I decided I definitely didn't want another child I'd be pestering them myself (of course I'd probably have more luck, being older and 'having completed my family'). The consequences of LTHC just sound more horrible the more I read about them. It's something we really haven't had enough time to research, in the scheme of things, since some of the first generation of Pill users are still in their late fifties and early sixties. :(
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From:flats
Date:March 25th, 2005 05:18 pm (UTC)
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From what research I've done [ie internet discussion forums, rather than talking to medics], it's very hard for a woman to get sterilised unless she's over 35 and has already had 'a reasonable number' (i.e. two) children. Doctors (a) assume they know best, and even if a woman says she doesn't want children, they think she'll actually change her mind and (b) don't want to be sued for providing 'inappropriate' sterilisations if someone does indeed change their minds.

Other options would be the nuva ring or various sorts of interuterine coils such as mirena. The coils are I think regarded as unsuitable for women who haven't had kids [viz. the joy of getting them through a cervix that hasn't seen a child come the other way] but they are very reliable and, whilst containing hormones, need a very small dose because they're so localised.
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From:atreic
Date:March 25th, 2005 05:47 pm (UTC)
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I know several women (well, two) who have had mirenas in, despite not having had children. One loves hers, and the other didn't get on with it. But it is available on the NHS, it's just that, like implanon, its one of those things you have to be really well informed and pushy to get.
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From:wildeabandon
Date:March 25th, 2005 11:19 pm (UTC)
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Am I one of those women? Because if not, chalk me up as another who loves it, and hasn't had kids.
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From:vyvyan
Date:March 25th, 2005 05:31 pm (UTC)
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If you're that sure that you don't want to be pregnant, get sterilized. It's really a much better option, for people who know they don't want children at all, than long term hormones.

If only it were straightforward to get oneself sterilized! I waited until I was over 25, in the mistaken belief (caused by an NHS leaflet on contraceptive methods) that the NHS would agree to sterilize me then. I spoke to a nice woman at the local Family Planning clinic, who had previously dealt with all my contraceptive needs (free condoms, morning after pills for the half-dozen times the condoms failed...), and she said that almost certainly no NHS doctor would agree to sterilize me since I did not have any children already, and they would assume I would change my mind later. After I explained to her at great length how determined I was, how my feelings had never wavered since earliest childhood, how I disliked children and how the very idea of pregnancy gave me nightmares, she said that even if I could convince a doctor to agree to sterilize me, the waiting list would be several years long, and I would probably be over 30 by the time it got done. She suggested I went private (but that was out of the question given the cost and the fact I was living on a PhD grant at the time). Finally, she referred me to the Marie Stopes charity, who perform sterilizations on demand, at basic cost (about L600 at the time, which I could just about afford out of savings).

I went through with this, although it was a ghastly and medically very dubious experience, for which I had to travel down to central London to a very run-down clinic. Amongst the problems: They muddled up the papers and I almost ended up signing an agreement to have an abortion. Their previous instructions had indicated the operation would be under local anaesthetic, but it turned out on the day to be under general anaesthetic (the first I had ever had) which I had not prepared for by abstaining from food for 24 hours beforehand, resulting in serious nausea when I woke up. They refused to give me sufficient pain relief following the operation. They basically evicted me from bed a couple of hours after I woke up, since they wanted to go home themselves, and dispatched me from the clinic still very queasy and in a lot of pain (I threw up on the pavement outside the clinic) to travel back to Cambridge on the tube and train (there were no seats, and no one gave up their seat to me although I was doubled over in pain). They gave me conflicting and largely incorrect advice about when it would be safe to have unprotected sex after the operation. They gave me no advice on how to look after the operation site or whether my stitches would need to be taken out (I had to make an appointment with my own doctor in Cambridge to find this out).

I feel sure my sterilization would have been much safer and less ghastly if I could have had it done at Addenbrookes, on the NHS. However, I was not given that option. All this said, I am very glad that the Marie Stopes Trust exist and do perform sterilizations on demand, since it means I am now free from the fear of pregnancy!

Sorry to rant a bit, but I had to point out that getting sterilized (as a childless young woman, in the UK) is not at all easy.
[User Picture]
From:bopeepsheep
Date:March 25th, 2005 05:40 pm (UTC)
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I know. And I'm sorry it was quite that horrible for you. :(

I think the more people push for 'early' sterilization the better though - the long term health benefits must push some financial buttons somewhere in the NHS, no? Lobbying and pestering and so on could start getting through to the people who count. Sterilization now costs 700/705 at Marie Stopes (I just looked), and I'm sure some GPs would be sympathetic to referral (judging by friends' stories) given that this is the same cost as around 6 years of prescribing the Pill. I'm pretty sure it's possible for them to do this (it's now possible to get WeightWatchers on prescription, FFS!) and the more people ask the more it might get through that the NHS should be doing it.
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From:vyvyan
Date:March 25th, 2005 06:02 pm (UTC)
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I don't know about the legal status of this, but I would have been happy to sign any number of forms giving up all rights to sue an NHS doctor over my sterilization if I ever changed my mind. (In fact, IIRC, this is pretty much what I did do at the Marie Stopes clinic - I'm sure they don't want to be sued either! Checking that I really wanted to do it was one thing they did very well, incidentally - I was interviewed by one doctor for almost an hour before the operation, to confirm my wishes, and asked if I understood the irreversability of the procedure by about 6 different people, as well as signing numerous consent forms.) Maybe if the NHS could implement such a thing, to safeguard themselves against legal action, they might be more willing to perform sterilizations on young childless women.
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From:naath
Date:March 31st, 2005 10:18 pm (UTC)
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Ewwwww. I thought that Marie Stopes might be a viable method of getting it done... because the NHS suck. It's not too much to save up for. But yuck!

I am thinking of suing the NHS for ageism though.
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From:rmc28
Date:March 25th, 2005 06:17 pm (UTC)
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Depo was banned for many years after it was first developed. I can find no indication that it has recently been banned as a result of this research.
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From:rmc28
Date:March 25th, 2005 06:10 pm (UTC)
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When I read up on this a few weeks ago it's not as bad as that. The current advice is simply that Depo shouldn't be given to women under 19, and that women on it for more than 2 years should consider what risk factors they have for osteoporosis and whether Depo is the best contraceptive choice for them.

Even the Family Planning Association says that current research into Depo-Provera "is conflicting" on the subject of osteoporosis. Osteoporosis is not mentioned in the disadvantages of Mirena, nor those of Implanon

Implanon and Mirena release rather lower doses into the body than Depo, and are both more reliable and more instantly removed if it becomes necessary. An unquantified risk of osteoporosis has to be compared against a quantified and very real risk of pregancy, and also the known risks of e.g. stroke for many women (including me) from taking combined oestrogen and progestogen.
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From:naath
Date:March 25th, 2005 03:48 pm (UTC)
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I wouldn't want to put everyone on hormonal contraception because it is potentially *bad for you*. Which is why I think that some form of reversible *physical* sterilisation would be better. The fact thet we suck at it doesn't mean that we couldn't figure out how. They even have non-surgical methods (esure) for physical sterilasation - lowering the risks considerably. No-one got osteoperosis from having a tubal.

I think that more workably we need to take children away from parents for a larger % of the time they spend growing up. Put the children in a variety of environments so that at least if one sucks there is a good chance that one of the others won't. Parents have a *huge* capacity to metaly and physically abuse their children and they don't allways know that they are doing it (the parents who raise their gay son to believe that gayness is Teh Evil for instance do huge amounts of harm). It takes a village to raise a child and the reason is that in that 'village' you expose the child to different ideas and opinions so they can form reasoned opinions for themselves. We need to do away with the memetic inheritance that makes children of poor parents poor and children of racists racist - we could stop the bad memes by killing people or sterilising them but it is clearly far more humane to stop them by educating the young to be different.

You wouldn't need to actually take the children away permanently unless the parents were being really abusive but you could do more with debating issues in schools and giving children a usefull rather than academic education (allmost noone uses their academic education). Youth clubs and sports teams and orchestras and all sorts of things that expose children to 'not home' with various levels of structure.

To make this have the desired effect it must be forbidden to only interact with 'people like me' 100% of the time (of the two ways that that reads I mean must spend time with other people). Stop children from attending only the faith school and the church youth group for instance (I have huge problems with entirely faith based upbringings in any faith so that's why I used that example). When the 'other' becomes familiar it will stop being scary.
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From:bopeepsheep
Date:March 25th, 2005 05:09 pm (UTC)
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Right up until your faith-based point (which I agree with) I thought you were advocating kibbutzes. ;-) That's how they work to some extent - small children live with their parents but older children live communally (but don't lose touch with their parents either). It seems to be a good concept, but how practical it is in this country I don't know!

The trouble with the 'it takes a village' concept is that so few people who aren't parents actually want to do it. :( Too much 'not my kid not my problem' attitude. Too many of the people who express that opinion are also very quick to shout about yobs and so on, but they don't want to be at all involved in raising a generation so that they don't grow up to be yobs. To a smaller degree, I get some flak for staying at home and raising my son, like I'm 'betraying feminism' to do so. Isn't my work in (hopefully) raising him right, and with luck influencing his friends positively too (as part of 'the village'), valuable? Can't I raise a feminist-friendly boy? Argh, the conflicting ideologies! ;-)
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From:naath
Date:March 25th, 2005 05:18 pm (UTC)
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I think that I most emphatically do not want to deal with screaming babies but I can deal with teaching older children. Also many parents hate it if another person tells their child off for doing something (clearly) bad.

I don't have anything against people who stay home to raise their children but I *do* worry that some people who homeschool keep their child from seeing any pov that isn't theirs - thus exagerating memetic inheritance. You can probably raise a good child (for any value of good you choose) if you work at it but that doesn't mean that I like your thoughts on 'good' or that you are going to work at it (not you you, some general you).

One thing I really hate is that as a non-parent parents tend to think that I can't possibly know anything about child rearing. There are lots of things that I don't know, true, but I *do* know what pisses me off (crying babies in fancy restraunts) and I *do* know what parts of my raising were annoying at the time but good in the end and what parts have left me screwed up...
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From:aldabra
Date:March 27th, 2005 09:33 pm (UTC)
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The trouble with "it takes a village" is that by the time everyone has moved three or four times to go to University and have a Career you're no longer rooted in the community that would help. People don't invest in the neighbours' kids because they're probably never going to see them again once they grow up. This job mobility bind is seriously over-rated, unless all you're expecting to have is a job.
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From:teleute
Date:March 25th, 2005 04:24 pm (UTC)
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Remember to ask M about the effects of the hormones in the pill (and most other hormonal contraceptives) had on me. I could never be in favour of enforced taking of something which runs the risk of making you suicidal.

But then I disagree with the whole scope of this debate: some people who start out being fabulous parents end up as shitty ones after job losses, divorces and the general stress of 21st century life (Elena and Kurt at college would have seemed to be going to make great parents: all four of their children have been on antidepressants, only one made it through college despite all of them having 180+ IQs and one is still living at home because he is too socially maladjusted to move out), and some people you imagine would suck at parenting end up doing a great job (Elena's youngest, who got pregnant by her 37yo boyfriend at 18 is now a very proud mother of an 8mo, and doing a remarkable job, despite coming across as an absent-minded ditzy bimbo before this). You can't look at people at one age and specify how they will act under circumstances that are completely life-changing. So as far as I can tell, the discussion is moot.

However, I do like your ideas about encouraging people to use long-term hormonal contraception over the pill (because I always worried about forgetting it too), and I think that private meetings with someone qualified to prescribe it at school would be an excellent idea. But you'd probably never get the religious right to agree with it.
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From:lacuna
Date:March 25th, 2005 08:47 pm (UTC)
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Elena and Kurt at college would have seemed to be going to make great parents: all four of their children have been on antidepressants, only one made it through college despite all of them having 180+ IQs and one is still living at home because he is too socially maladjusted to move out.

What's to say that means they're 'shitty' parents? What's your measure of good parenting? That a child attains certain credentials? That he or she is always happy?

Both my brother and I have been on anti-depressants, and so's my half-brother (three of my dad's four children. I don't know about my half-sister). I left my first university after a year because I was too depressed to carry on. Far from it being the fault of my parents, they were pretty much the only thing which helped me through (and enabled me to get to the point that I'm shortly to sit finals at another university). Depression runs on the dad's side of my family (whether due to genetic or the environmental factors associated with being raised by a parent with a tendency to depression, I don't know); I don't think my dad should be blamed if that's the reason for it affecting me, and I don't think my mum should be blamed if her own lack of confidence was somehow translated to me. Depression can be caused by other experiences, which have little to do with one's family and upbringing. I don't think it's fair to beat people over the head with the most minor of 'shortcomings' that may result from how they've been raised themselves.

I think the proof of your point - or at least the way you've expressed it - is quite seriously blinkered.
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From:teleute
Date:March 25th, 2005 11:01 pm (UTC)
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I am prepared to accept that I expressed the above sentiments badly, however, I didn't want to go into too much detail of the situation for the sake of the family. I probably shouldn't have said anything at all. However, of the four children, two have not achieved anything like their full potential, and one of those is so messed up that he thinks its normal and fine to be 23 and still living at home, without a degree, without a job and doing nothing but playing WOW and D&D. The only one who seems to be managing to have a normal life is the one who got pregnant at 19 and married the 37 year old father, which while it is working out fine, is not what the majority of society would want for an intelligent high-schooler. Knowing the parents well, I know that quite a lot of the problems of the children have been caused by the parents (mostly the father).
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From:rmc28
Date:March 25th, 2005 06:27 pm (UTC)
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By the way, I really do like your idea of regular enforced medical checkups for teenage girls. It could be about genito-urinary health in general, not just SEX. For example, I was seeing my doctor repeatedly while a teenager, trying to find a way of managing my period pain so that I could actually cope with it. I ended up on the pill after about 2 years of this game, but ugh. Cystitis is another "simple tips for a happy life" condition that could be discussed in this kind of setting.

Annual checks are probably all that's affordable, but if you've seen a nurse to discuss GU health once or twice by the time it's an issue, you're probably armed with education.

Mind you, preventative medicine is the new big thing. Don't we have annual health checks for all children anyway? Just add genito-urinary health to them explicitly from the age of 13 for both sexes - I'm sure there's equivalents to cystitis and periods that boys should be talked through - and make contraceptive knowledge a unisex thing as a side-effect.
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