Be it a matter of stem cell research or the morning-after pill, the United States seems to be leading the charge right back to the Dark Ages. Our public policy debates are increasingly characterized by a fear of medical science and technology that is downright retrograde and superstitious.
Last week, in Bangkok, American AIDS ambassador Randall Tobias enhanced this reputation by trying to promote abstinence at the International AIDS Conference. The main thrust of the Bush administration's AIDS strategy has been to persuade young women around the world to "Just say no" to sex rather than offering condoms (along with lube to make sure they actually work) and better sex education.
The U.S. insistence on prioritizing sexual morality over human suffering – to the point of preventing our own scientists from attending the conference – left us isolated. Even Britain made a point of publicly distancing itself from our policies, as if American phobias about the body are themselves a communicable disease which any self-respecting modern country – even a loyal military ally – should protect itself from.
But this tendency to demonize medical technology – i.e., the use of medicine to protect the body from the consequences of human behavior – is hardly a preserve of Bible-thumping conservatives. Authoritarian attitudes about the body – especially the female body– can also stem from ardent, well-meaning worship of Nature.
Take, for example, the contentious issue of elective Caesarian-sections. As a recent article in Salon.com reveals, Americans are deeply conflicted over elective C-sections, which inevitably spark a heated debate between those who view it as a feminist choice and others who abhor them as an affront to nature or a nasty symptom of over-medicalization.
"Cut and Run" author Dana Hudepohl left me wondering whether Americans are more superstitious about childbirth than other cultures, including Brazil and Denmark.
In Brazil, the overall caesarean delivery rate is 50 to 60 percent. It climbs to 90 percent among the wealthy, which suggests that women who can afford to choose a medical alternative tend to do so overwhelmingly.
But are elective C-sections the exclusive preserve of those who are just "too posh to push"?
Not quite. In Denmark, a country with less dramatic extremes of wealth than Brazil, 40 percent of the doctors support a woman's right to request a Caesarian delivery. Charlotte Wilken-Jensen, chairman of the Danish Association of Obstetrics and Gynecology, and an attending physician at Roskilde County Hospital, simply shrugged off the increasing number of elective C-sections, saying, "Women's threshold for all things painful and uncontrollable is lower. It's become more unusual for Danish women to just let things run their course."
In stark contrast, elective C-sections in the U.S., which accounted for 2.2 percent of deliveries in 2002, a 25 percent increase in three years, are far more controversial. Many American doctors see Caesarian deliveries as a problem, period, elective or not. Dr. Theodore M. Peck, the author of "Empowered Pregnancy" told Salon, "The outrageous Cesarean rate we now have in this country is a national medical disgrace."
So a healthy woman today who requests a C-section for her own reasons may encounter fierce resistance – often from her own doctor. The current movement against medical intervention is the polar opposite of 1950s technomania, when breast-feeding and natural birth were unfashionable, and your doctor thought he was God.
But some things – like the pressure to conform – haven't changed at all. Today, we must bow to Nature's edicts instead of those of an obstetrician. An equally dangerous logic is at work in the dogmatic insistence on vaginal delivery. The logic of nature-worship tells us that a woman is not virtuous unless she tries to have the baby the way God intended.
Amazingly, these values are often promoted by Americans who regard themselves as secular, feminist or forward-thinking consumers of technology. Recently, a friend who opted for surgery to improve his vision (because he finds eyeglasses cumbersome) spoke of an "alarming increase in unnecessary C-sections." This kind of doublethink is hardly unusual.
Women who have "unnecessary" C-sections are often stereotyped as victims of medical bureaucracy. Or else, they are selfish monsters who don't love their babies enough, shopping for an easier birth. You're either to be pitied as a prisoner of medicalization or spanked for wanting to be serviced at this primal, awe-inspiring moment. As one Salon reader put it, "Child rearing is not for the selfish or the faint of heart. If you can't even deal with the delivery, then God help you with the rest!"
Oddly, according to the natural-is-best logic, it is more "acceptable" to have a Caesarian because of last-minute complications than a planned one. Yet, medical studies show that while having a C-section during a difficult birth is common, it is also riskier than consciously planning for one.
But it is not as reprehensible and shallow, according to the vaginal birth advocates, because Nature has been given her due.
It's not unlike girls – taught to feel guilty about their sexual desires – who felt more virtuous if they didn't carry birth control. Sure, sex was more spontaneous and "natural" – but it was far more likely to result in pregnancy or disease. Both maternal and erotic love are thought to spring magically from Nature. In reality, they benefit a great deal from Nurture.
Many nature-worshippers tend to forget that medical intervention has made it possible for us to experience sexual intimacy without the attendant dangers by offering us STD protection and birth control. Had our sex lives never been "medicalized," we would not have gained the freedom to express our sexual desires.
We view conception itself as an elective – not a supernatural occurrence or a religious obligation but, ideally, a choice. Why not extend some of this secular reasoning to the actual process of birth? Is there something deep within the American soul that views childbirth as Woman's unchanging contract with a God-like version of nature?
Up North, summer comes and goes but it looks like Brazilian waxing is here to stay -- as a permanent resident, not a visitor.
This begs the question: Is pubic hair the new garter belt?
In the 1960s, an entire generation of men -- holdovers from the Fifties -- mourned the disappearance of the garter belt and swore they would "kill the man who invented pantyhose." Today's analogous protestors are vehemently opposed to the current passion for extreme bikini waxing. These thwarted voyeurs, yearning for a glimpse of lush nature, are the 21st century cousins of those who once bemoaned the demise of garter belt and stockings.
My friend Sally had a romantic run-in with one such man after their second bedroom encounter. "Tim is hinting that I should grow it back!" she told me. Men like Tim think there is something inherently noble and glorious about pubic hair growing wild on a woman's body. They see themselves as part of a wilderness preservation movement, and they want to prevent profiteering beauticians from destroying this natural resource. If you buy into their Rousseauist assumptions, they are valiant eco-defenders, protesting the defoliation of the female rainforest. And if you don't? Maybe they're trying to impose old-fashioned ideas about womanhood on a culture that is outgrowing its Northern chauvinism, embracing the styles and sounds and sexual attitudes of the Southern Hemisphere.
The Brazilianization of the North's hidden regions is now a fact of urban life. Globalization is not always about U.S. values imposed on other cultures. It can work both ways: Our most personal body parts are being "colonized" by beauticians from below the equator. As one with roots in both regions -- North and South -- I find this new trend encouraging.
There are fashions in pubic hair -- for those who doubt me, a quick perusal of porn through the decades will confirm this. But you don't have to be a porn consumer to know what's up down there. At one time, waxing was ladylike. Adventurous women kept their nether locks untrimmed as a gesture of womanly defiance against all that was prim and proper. In those days, emphasis was placed on how the waxee would look in her bathing suit and many salons provided a proxy bikini (made of paper) to wear during the session.
All this has changed. Waxing is no longer for prudes and the paper panties are pointless if you want the full treatment. Extreme pubic waxing is now associated with exotic dancers, porn stars and hookers. It has little to do with swim wear and more to do with how you look in the buff, perhaps during certain sex acts. My friends in the sex industry are all self-appointed experts on the lay-out and design of the female pubic region. To opt for a light bikini waxing (removal of a few stray hairs) -- in lieu of a Brazilian job (removing all but a few stray hairs) -- is to be "natural" and therefore conservative.
Lisa is a Brazilian waxing partisan, a New York call girl who began by grooming her lower lips, leaving "a small growth on the mound" because, she explains, "removing hair from the lips is less painful -- my nerve endings are more sensitive up top." She had been waxing for seven years, removing more each time, until she "went for it" and requested a "total Brazilian." Lisa takes ibuprofen before each waxing to reduce redness and swelling. Others take naproxen, the generic form of Aleve. Curiously, the hair on her head is long and wavy, creating a memorable contrast when she undresses. To be completely natural below the waist "is a sure sign that you're monogamous or celibate," says Lisa. To her, there isn't much difference.
Sally, who is still sparring with Tim over the length of her pubic hair, didn't start waxing until she was 24. Now in her thirties, she says, "It bothers me when I hear about 15-year-old girls removing all their pubic hair." What ever happened to that moment in a young girl's life when she takes pride in her budding womanhood? Is it disappearing as we speak -- like the rainforest?
"These girls are . . ." Sally gropes for the right words. "They're growing up too fast! I'm old enough to take my pubic hair for granted," she explains. "They're not!" But thirty-something notions about innocence and experience are often meaningless to people in their teens. A Toronto friend reports that her 17-year-old niece "is dating boys her own age who remove their own body hair. Her new boyfriend is a cyclist who says excess hair will just slow him down. For her, extreme bikini waxing isn't extreme, it's normal."
If mass body-waxing is about the normalization of the exotic, surely it is just a matter of time before pubic hair -- once taken for granted -- becomes a hot new fashion statement. Can pubic hair be "repackaged"? Can it be redefined as a deliberate architectural style choice -- rather than a gift of nature? By next June, we may have some answers.
Tracy Quan is the author of "Diary of a Manhattan Call Girl." Her next reading will be on Tuesday, June 17 6:30 pm at Barnes&Noble (212-807-0099) at 18th Street, 105 Fifth Avenue, New York, NY 10003. Her website is www.tracyquan.net.
May is Asian American History month. As a writer with a Chinese surname and Asian ancestors (from both India and China), I have mixed feelings about what we're supposed to be celebrating.
Having any word before the "American" in your description is a mixed blessing. On one hand, you are encouraged to feel that you are interesting because you did not grow up eating Wonder Bread. On the other hand, you are always being asked, "Where are you from?" and when you answer, being asked, "But where are you really from?"
It's a recurring motif for Asian-Americans: If you say you're from Philadelphia or Boston, some people think you're ducking the question. This makes some Asian-Americans angry.
My response has been to ask other Americans, "Where are you from?" in return. Sometimes, the puzzled reply is: "What do you mean? I'm from here."
Use that as a conversation starter, and you may broaden somebody's understanding of what it means to be American -- although I'll be the first to admit it's exhausting to go through life treating each social encounter as a diversity training session.
You may also discover that many people do not know very much about where they're "really" from. Yes, you might envy such people because they seem to fit in, but if they are unclear about how they got to that point of fitting in, is that a good thing? I don't think so.
For that reason, I have never wanted -- entirely -- to fit in. While it may be annoying at times to be asked where you're "really" from, perhaps it is healthy to keep thinking about what that question means.
The normalization of European immigration to the United States has deprived many so-called white Americans of a strong sense of their own history. Many Americans of European background feel so thoroughly American that they don't search very hard for that history.
It's different if you're "exotic" -- a term used for Asians quite a bit. If you're exotic, whether you're hated or welcomed, you cling to your history for as long as you feel foreign or "hyphenated."
A number of my American friends of European heritage are quite blank about how their ancestors lived when they got to the New World -- but I have been plied from an early age with stories about my forebears. My parents and other relatives have been weaving this narrative for me ever since I was in kindergarten. As I grew older, I was given more detail, some of it R-rated: a male ancestor (Chinese) who had syphilis; a female ancestor (Indian) whose widowed father put her in an orphanage so he could work in the cane fields to pay off his indenture. These stories are the spoils of hyphenization.
When I have tried to make common cause with my fellow Asian Americans, I have discovered what we don't have in common. My parents didn't come here from Asia but from another part of the Americas, the British Caribbean, where our ancestors had arrived in the 1800s.
As a child, I sometimes grew weary of telling my friends that my parents were from Trinidad -- a country so small nobody knew where it was. It was much easier to say I was Chinese. China is a vast country, everybody has heard of it, and I have a Chinese name. I found myself "passing" for Chinese, a habit I outgrew when I decided it was cowardly to align myself with the bigger nation -- after all, my origins really lay in a small, multiethnic and relatively powerless democracy not far from Venezuela.
And this is why I have mixed feelings about Asian American History month. Despite its name, it is presented as a celebration of the voyage from Asia to the United States, without recognizing other stops along the way, without emphasizing the larger region of the Americas.
Its boosters appear to be wearing blinders about the history of Asian migration -- blinders that sport a "Made in the USA" label. During the last two centuries, people from Asia have settled in other parts of the Americas -- in Latin America and the Caribbean, for example -- and many of their descendants have come North. Perhaps Asian American History month could be renamed, to prevent Asian Americans from losing touch with their global roots -- whether as Americans or as Asians.
Changing the name of the month would be a good place to start. How about "Asian Diaspora Month"?
Tracy Quan is the author of the novel "Diary of a Manhattan Call Girl" (Three Rivers.) Her next reading will be on Wed., May 28, 7 p.m.: Barnes & Noble, 1805 Walnut Street., Philadelphia. On June 17, she will be reading in New York. Her web site is Tracyquan.net.
Former call girl Heidi Fleiss recently announced that a Hollywood movie about her life is in the works. "Pandering," her new book about her misadventures as a Hollywood madam, has been getting airplay on the talk shows. But the Hollywood spin shouldn't allow us to overlook Heidi's travails; she spent almost two years in federal prison. When she was arrested in 1995, there were rumors about celebrity sex, wild partying, inflated dollar amounts. This is the American way of seeing prostitution: as a fantasy gone bad. We're hooked on the glitter and the punishment.
America's prostitution fantasies are also reflected in our laws, which are among the strictest in the world. Outside of Nevada, the buying and selling of consensual adult sex is always illegal. (Even in Nevada, prostitution laws are more complex and forbidding than most people realize.)
We are out of step with our closest neighbors, Mexico and Canada, where prostitution laws are similar to those of Europe or Britain. In Canada, federal solicitation laws will soon be reviewed by the Standing Committee on Justice and Human Rights, to assess their impact on the safety and health of prostitutes. Although prostitutes in every country face discrimination, the actual exchange of money for sex is not a crime in most democracies.
We are also out of step with the United Nations, where prostitutes have worked hard to have their human rights taken seriously for the last 15 years. In January, at a two-day UNAIDS conference in Geneva, prostitutes from Europe, Asia and other regions met with representatives of the International Labor Organization, UNICEF, the World Health Organization and UNESCO. The Network of Sex Work Projects (NSWP), a global coalition of sex workers and their advocates, played a crucial role in designing the agenda by forcing onto the table a number of issues that had been overlooked.
"We insisted that the conference talk about ethics in research and health care," says Paulo Longo, a former prostitute, practicing psychologist and co-founder of NSWP.
Prostitutes are often subjects of HIV studies but too much of this research has been astonishingly careless and inhumane. That's why Longo, who lives in Rio de Janeiro, got involved with prostitutes' rights.
"In 1988," he recalls, "I was training at a public hospital and I was asked by a local NGO to help a researcher do a study of rent boys in Rio."
A year later, when Longo saw the so-called results in a British medical journal, he reacted with horror: "They were saying that 43 percent of Brazilian male sex workers were infected with HIV -- but I knew that this study only tested 33 people, eight of whom were seropositive."
The boys, whether infected or not, were never told about their results. Longo was discovering a pattern of unethical research: "Getting the blood of boys and women on the streets, everywhere in the world. Never giving them the results. That's when I started to get more politically involved."
At the Geneva meeting, Thailand -- a country famous for its sex industry -- was well represented. A bar girl from one of Bangkok's busiest red light districts criticized her government's health policies, bluntly addressing the coordinator of Thailand's national AIDS program. This outspoken sex trade worker might sound, to American ears, like a fantastic anomaly. Yet, she represents a global trend. As one sex worker explained, "Empowerment is not only about getting free airfare to a UN meeting. It's also about having the courage to say what you think to a government official."
On the last day of the conference, the NSWP proposed (and got) a moment of silence for 10 South African sex workers who had recently been victims in a Cape Town shooting. "It was important for all those U.N. officials to observe that moment of silence," one participant told me.
It's equally important to note that, in these circles, the shooting or death of a sex worker is not used to justify anti-prostitution laws. Instead, the moment of silence was a demonstration of support for a prostitute's right to work safely. Aurorita Mendoza of UNAIDS described sex workers as "one of the biggest mobilizers in the AIDS response," going on to deplore "laws which criminalize them and prevent them from receiving needed information and services."
Twenty-five years ago, the pioneers of the prostitutes' rights movement could not have envisioned the Geneva event. A marginal movement has come of age, spawning a whole generation of human rights bureaucrats who are turning sex workers into a mainstream cause. Prostitution is losing some of its edginess.
Acknowledging that prostitutes have basic rights -- that we are an important part of every society -- is no longer radical. Those who refuse to do so, those who continue to defend the persecution and arrest of sex workers, are increasingly seen as extremists. America's prostitution policies are so backward in comparison to those of most advanced countries -- and a number of developing ones, too -- that we provoke sarcastic comparisons with Islamic theocracies. Given our self-image as a secular democracy, this is more than embarrassing; it's bizarre.
Tracy Quan firstname.lastname@example.org is the author of the novel, "Diary of a Manhattan Call Girl" (Three Rivers Press) and a contributor to "NYC Sex: How New York City Transformed Sex in America" (Scala.) To visit her website, go to www.tracyquan.net.
A version of this article originally appeared in The Philadelphia Inquirer.