TV & Radio
The New York Times
January 6, 2006
Abortion Rights in Latin America
For proof that criminalizing abortion doesn't reduce abortion rates and only endangers the lives of women, consider Latin America. In most of the region, abortions are a crime, but the abortion rate is far higher than in Western Europe or the United States. Colombia - where abortion is illegal even if a woman's life is in danger - averages more than one abortion per woman over all of her fertile years. In Peru, the average is nearly two abortions per woman over the course of her reproductive years.
In a region where there is little sex education and social taboos keep unmarried women from seeking contraception, criminalizing abortion has not made it rare, only dangerous. Rich women can go to private doctors. The rest rely on quacks or amateurs or do it themselves. Up to 5,000 women die each year from abortions in Latin America, and hundreds of thousands more are hospitalized.
Abortion is legal on demand in the region only in Cuba, and a few other countries permit it for extreme circumstances, mostly when the mother's life is at risk, the fetus will not live or the pregnancy is the result of rape. Even when pregnancies do qualify for legal abortions, women are often denied them because anti-abortion local medical officials and priests intervene, the requirements are unnecessarily stringent, or women do not want to incur the public shame of reporting rape.
But Latin Americans are beginning to look at abortion as an issue of maternal mortality, not just maternal morality. Where they have been conducted, polls show that Latin Americans support the right to abortion under some circumstances. Decriminalization, at least in part, is being seriously discussed in Colombia, Brazil, Venezuela, Uruguay and Argentina, and perhaps will be on the agenda after the presidential election in July in Mexico.
International pressure is helping. In November, the United Nations Human Rights Committee decided that Peru had violated a woman's rights when a hospital denied an abortion to a 17-year-old carrying a severely malformed fetus, who died shortly after birth. United Nations conferences on women also have forced governments to track and publish their progress on expanding women's rights. This has emboldened women's groups and led to the creation of government offices on women's issues, which have helped the push for abortion rights.
Latin American women, who are increasing their participation in the work force and in politics, have also become more vocal. Their voice would be much louder were it not for the Bush administration's global gag rule, which bans any family planning group that gets American money from speaking about abortions, or even criticizing unsafe illegal abortions. This has silenced such respected and influential groups as Profamilia in Colombia. Anti-abortion lawmakers in Washington can look at Latin America as a place where the global gag rule has worked exactly as they had hoped. All Americans can look at Latin America to see unnecessary deaths and injuries from unsafe abortions.
Cover Story/ Royal allure:Japanese love brand-name products, and nothing has a greater cachet than the imperial family.
By TARO KARASAKI, Staff Writer
This is the fifth part of a series on issues and topics facing the imperial family.
Part 1: Imperial Family/ Uncharted terrain:Those who do not want females or their descendants to become emperor feel stymied.
Mao Komuro was searching an Internet bookshop looking for some bedtime reading for her 18-month-old daughter when a blurb stopped her in her tracks. "Crown Princess Masako's favorite," trumpeted the entry for "Goodnight Moon," by U.S. children's writer Margaret Wise Brown.
Although Komuro was unfamiliar with the title, the Masako connection was almost spellbinding--she had to have the book.
Komuro, a 33-year-old Tokyo homemaker, said: "I was under the impression that since our daughter enjoyed Aiko's favorites, she would enjoy Masako's favorite, too."
She said that over the past year she's developed an appreciation for products favored by Masako's daughter, Princess Aiko. Before that, she had no particular feelings for the imperial family one way or another, she said.
When she saw Brown's book, she thought of how much her baby enjoyed the same picture book that TV news-variety shows said Crown Princess Masako had read many times to Aiko.
Then, there were the cute animal slippers Komuro picked up in a children's clothing shop, whose tag bragged "Aiko's favorite."
Komuro next signed her little girl up for a calisthenics class. These classes became de rigueur for many moms after the toddler princess was seen dancing in video footage aired by news-variety shows.
Brown's book turned out to be a disappointment when it arrived. Calling the purchase "a bad choice," Komuro said the illustrations were "somewhat drab" and the story was too difficult for a toddler.
No more official certification
For merchants, having their wares selected for use by the imperial family has been both an honor and sales tool dating back as far as medieval times. And though a system to officially certify such products was discontinued more than half a century ago, the allure of goods favored by royalty still remains strong, thanks in great part to publicity generated by the media, imperial watchers say.
Purveyors to the imperial family, often referred to as goyotashi, who supply goods ranging from soy sauce and exotic fruit to kimono and umbrellas, enjoy a huge following in this brand-conscious country.
Critics see the phenomenon as a textbook example of the blind faith Japanese place in brand-name products.
For German stuffed toy manufacturer Steiff, recognition by members of the imperial family helped it win a crucial foothold in this country.
According to officials at Takara Co., the toy maker's marketing agent in Japan since 1988, Steiff's high-priced products had underperformed for years.
All that changed in 1994 when TV viewers glimpsed Steiff's trademark yellow tag on a teddy bear owned by Princess Mako, the eldest daughter of Prince Fumihito, younger brother of Crown Prince Naruhito.
TV broadcasters were inundated with calls from parents and grandparents about the unfamiliar toy. In the twinkling of an eye, shoppers descended on Steiff's flagship store in Tokyo's Ginza district, snatching up the bear, known as Molly. Now named "Princess Molly" and selling for 8,925 yen, it remains a favorite, with some 1,000 bears sold each year.
Another Steiff toy, a small stuffed elephant, shot from obscurity to stardom after magazines listed the doll as one of Princess Aiko's favorite toys. Today, Steiff sells 30 to 40 of the elephants a month.
"Recognition by the imperial family helped people understand the history behind Steiff products, and the work that goes into each doll, in a way that previous marketing methods could not achieve," said Yoshiko Shimoda, an official in charge of Steiff's Japan operations.
While having your product chosen by a member of the imperial family can certainly help, it is no guarantee of success, particularly when the economy isn't exactly purring along.
In July 2005, a tofu supplier to the Imperial Household Agency filed for bankruptcy. The manufacturer, based in Mitsukaido, Ibaraki Prefecture, was struggling with a debt of almost 5 billion yen when it could no longer keep its head above water.
"It came as a shock, because most of the employees didn't think such a thing could happen to a goyotashi business," said a spokesman for the company. The brand name, now held by another food manufacturer, continues to survive, but production volume has been slashed.
Hard-won imperial recognition can actually backfire, if unscrupulous businesses emulate styles, methods or even steal whole designs.
The Nishijin Textile Industrial Association has decreed that member weavers should "refrain from using the phrase goyotashi in advertisements." This policy was adopted at the end of a kimono makers meeting held in autumn 2004 to counter fakes.
Toshimitsu Ikariyama, a senior association official, said his organization still receives five to 10 inquiries a month from wholesalers concerned about claims from manufacturers who purport to have supplied kimono to the imperial family. He said he personally knew of five companies untruthfully asserting a royal connection.
While kimono makers in the Nishijin district of Kyoto do in fact supply clothing to the imperial household, "never will you hear a real merchant say so" Ikariyama said.
The hype over the imperial family's favorite products is simply an extension of Japan's brand consciousness, says Mei Sasaki, a journalist and former guest professor at Tama Art University who specializes in intellectual property issues.
"It reflects a desire to acquire status through the possession of brands. At the same time, it shows a lack of confidence (in one's judgment)," Sasaki said.
While brand consciousness exists in many Western countries too, those who favor brands are also careful in choosing products and are aware of the history and quality behind a product, he says.
The royal brand
Calling the imperial family itself a brand, Sasaki said that several years ago on a study trip to South Korea, he witnessed knockoff businesses avidly following news footage of Masako. Their interest was more than casual--they watched what she wore, what products she was interested in so they could "steal designs and make copycat products for the Japanese market."
Still, the allure seems to be contagious.
In mid-November, news programs covering the marriage of Princess Sayako to commoner Yoshiki Kuroda discussed traditional imperial household wedding gifts that would be handed out to guests. Hearing that konpeito--a kind of rock candy whose distinctive studded form is likened by some to a meteorite--was on the list, hundreds of people flocked to the 150-year-old confectionary shop Ryokujuan Shimizu in Kyoto.
As long lines formed in front of the old-fashioned shop, Kyoto taxis added the candy store to their tours of the ancient capital.
Overwhelmed, the operators of Ryokujuan said they couldn't possibly meet the unexpected demand while sticking to a recipe that required boiling sugar in giant kettles over a period of two weeks to 20 days.
"I can't recall when I last had konpeito. But when I saw it, I thought right away, that's what I want," said Miki Uchiyama, a 25-year-old company employee from Tsu, Mie Prefecture. She added that she was quite moved by a story she heard about why konpeito was chosen for the wedding: Just as hard work and perseverance are the secret to a happy marriage, the effort required to create konpeito is much the same.
Alas, the imperial family does not have the same hold on everyone. Her boyfriend, not willing to wait another half hour for the candy, however romantic, took a hike--to find a convenience store to kill some time.(IHT/Asahi: January 6,2006)
Issue: Vol. 36 / No. 1 / 5 January 2006Serving the gay, lesbian, bisexual, and transgender communities since 1971
NEWS by Zak Szymanski
New law seeks to level insurance for TGs - Bay Area Reporter
Assemblyman Paul Koretz. Photo: Rick Gerharter
Healthcare access has long been a concern for transgender people, many of whom either can't disclose their status in order to secure the treatment they need, or avoid going to the doctor altogether. Some trans people have anatomy traditionally associated with the opposite sex, making coverage for certain procedures – a woman's prostate exam, for instance – difficult to obtain. Others who do not have insurance may fear that their previously diagnosed gender identity disorder will show up in their records and keep them from securing future insurance policies.
So it was good news when AB1586 passed the California legislature and was signed by Governor Arnold Schwarzenegger in 2005; the law, by Assemblyman Paul Koretz (D-West Hollywood), went into effect January 1 and prohibits insurance companies – including health insurance companies – from discriminating against people on the basis of their transgender status. But in an industry centered around discriminatory criteria for who and what is covered, what exactly does this new law mean?
It's complicated. Though rumors circulated about the law's effect, the reality is that AB1586 does not require health insurance companies to cover sex change procedures, nor was it ever intended to do so. It doesn't even require that transgenders be given policies if there is actuary data to show that they are in a higher risk category for certain diseases or cost more than the average patient to insure, as that is the same criteria for anyone seeking insurance.
"The nature of nondiscrimination law is that there is uncertainty about its scope. With AB1586 we could not enumerate the thousands of ways discrimination may occur and then expressly prohibit them one by one," said Koretz in a statement to the Bay Area Reporter . "Instead, we have said that transgender people should be treated no better or worse than others. This is basic principle that my colleagues in the Legislature supported. The unfortunate reality is that current insurance law permits unfairness for everyone, and AB1586 didn't change that."
But what AB1586 does state is that without actuary data and evidence proving otherwise, there is no reason to deny coverage or certain procedures for people based upon their transgender status alone.
"We have added gender identity and gender related appearance to the nondiscrimination provisions of California's insurance laws," said Koretz. "It is an incremental step and does not mandate coverage for specific benefits, but it will provide protection from blatant discrimination based solely on prejudice."
There are two general areas in which transgenders tend to experience health insurance discrimination: one is through trying to access care through their policies. The other is in trying to get an insurance policy in the first place, a scenario encountered mostly in the individual – rather than group or employer – insurance market.
People are denied individual policies when their particular histories or backgrounds are perceived as costlier to insure than the average individual. Under "pre-existing condition" exclusions, it is common for individuals to be denied coverage based upon previous health conditions that a new insurer deems too costly to treat, from heart disease to depression to cancer, even if such conditions have since been brought under control.
Transgenders make the equation a bit trickier. Gender dysphoria is considered a medical diagnosis, while the more controversial gender identity disorder is the psychological counterpart and is often a necessary label for transgenders to pursue their gender transitions.
But there is no actuary data, and thus no legal reason, said advocates, for trans people in particular to be considered more of a risk to insure. Sexual reassignment procedures are already specifically excluded from most insurance policies, and the general rule is that a policy must cover the treatment of a condition in order for that condition to be a reason for policy denial.
Still, there are certain trans-related procedures that may fall into a general pool of what is considered higher risk to insure. Some companies may claim that the health costs are higher for all people who have undergone certain surgeries, for instance, while others may believe that a gender identity disorder diagnosis is accompanied by higher than average psychological bills.
"What we're saying is you can have that concern, but it has to be backed up by actuary data. You can't assume that just because a person is transgender that they are more costly to insure," said Chris Daley, director of San Francisco's Transgender Law Center, in reference to AB1586.
Koretz's law was necessary, he said, because of how assumptions, rather than evidence, were dictating insurance companies' decisions about transgenders.
"Our belief is a lot of these coverage denials have been based on stereotypes," he said, adding that insurance companies now "have to find sound actuary data that people with GID cost more to insure on average if they are going to exclude them based solely upon their transgender status."
Considering that most people have some kind of condition in need of monitoring, it is believed that data will not be able to show that transgender people as a whole have more health costs than other populations.
Meanwhile, biases that affect transgender people who already have insurance usually reveal themselves in the form of policies denying specific medical procedures. Sometimes this denial is because policies often assume an anatomy based upon someone's gender, other times the policy claims that the conditions in need of treatment were caused by a person's transgender status and therefore not covered.
The fact that trans people are routinely denied necessary medical procedures based upon insurance company bias has been known throughout the community for decades; there are stories upon stories of such incidents: FTMs with pelvic pain, for instance, being denied hysterectomies because their policy did not cover transgender surgeries and there otherwise was "no such thing" as a man with a uterus and ovaries.
Such discrimination was the impetus for San Francisco's landmark decision to cover sex change procedures for city employees; by removing that exclusion, companies could no longer deny basic healthcare to people by claiming that such care violated their policies. The city law went a step further to declare that transgender specific procedures were medically necessary as dictated by the gender dysphoria diagnosis.
Unlike San Francisco's law, AB1586 did not require companies to drop their exclusions or cover transgender specific procedures, and in many areas the new state law will remain uncertain until specific situations arise. But like San Francisco's law, state law now says that there will be no more denial of procedures to people based solely upon their transgender status or perceived gender incongruence.
"Health insurance is an incredibly complicated field. It's impossible to say exactly what the parameters of this law are going to be," said Bart Broome, former legislative aide to Koretz. "But what is clear is that there can now be an end to some very real situations that transgender people have encountered. There can no longer be denials of prostate care for someone just because she is legally a woman, or denial of gynecological care just because he is a transgender man."
The law also "gives a little bit more security to transgender people so they feel more comfortable being themselves with their providers," said Broome. Such a comfort is necessary not only for health maintenance and check-ups, but for providers to be able to communicate with insurance companies why certain procedures are necessary.
The law itself is a major victory and provides a foundation upon which other steps can be built, said advocates, who also cautioned that transgender patients and insurance seekers act cautiously when pursuing complaints and challenges, so that judges unfamiliar with transgenders don't wind up narrowly interpreting the law and limiting access for the majority of transgenders in need of basic care. Now would not be the time, for instance, to pursue a court ruling to get sexual reassignment surgeries covered and jeopardize the future and potential of the law, advocates said.
"Our hope is that people will be patient so that we can be strategic in getting the courts to interpret this law," said Daley, advising people with complaints or potential challenges to approach community organizations such as TLC before any legal action is taken "to make sure we're not making bad case law through the courts."
Broome said transgender people who believe their insurance companies discriminated against them should seek remedy through the state agencies set up to handle complaints; the state Department of Insurance can be called at (1-800-927-4357) while the Department of Managed Care is at 1-888-HMO-2219. The agencies report already having handled cases – transgender and non-transgender alike – that could be applied to this new law, and in the past have ordered insurance companies to cover remedies for medical complications due to faulty genital surgeries and ruptured breast implants.
"For the first time, a state has said explicitly that transgender people cannot be discriminated against in health insurance, which we know is major issue in the community. But this is a cutting edge issue and as situations come up we'll figure out how the law will be applied," said Broome, who added that the each of the many possible procedures and scenarios faced by transgenders has yet to be tested under this law. "The victory may be in each of those smaller procedures that we win along the way."