4 February 2010
Dear RHM board members, editors and authors,
We have a controversy brewing in the RHM office, which I am seeking your views on. Attached the cover I have chosen for the May 2010 journal on “cosmetic surgery, body image and sexuality”. It is a segment of a photograph of a larger plastercast sculpture, which is also shown here. This sculpture and how it was made with plastercasts from the vulvas of 40 women aged 18 to 76, including transgenders, was shown on British television two years ago.
Two people in the RHM office think it will be seen as shocking and offensive by some of our readership and indeed potentially risky for some of them, and that it could be included in the journal but not on the cover. Do you agree? Or do you think that it's fantastic and provocative in a really good way, as I do, and very exciting as a visual, artistic and educational image to illustrate the theme of the journal…
Marge Berer
Here are the responses I received over the following two months:Footnote*
I think the image could be relevant to body image, but not to cosmetic surgery. On those grounds, I'd say do use it inside the journal in a relevant section, but pick a cover that speaks more to the main journal topic.
Susanna Rance, UK
I think it is shocking and fantastic in one way and were this the cover of a magazine or journal that did not have a political goal and very important outreach in parts of the world where such images are considered completely unacceptable from a moral perspective, I would say go for it. But I think I would have to sacrifice something I really love for the importance of not interfering with my core messages being heard. Again, while I like it in certain ways, given the pain vaginal appearance creates for some women, I don't think I would provoke or contribute to that in the cover of a journal that is about sensitivity to women.
Frances Kissling, USA
I think Frances is right although that was not my first reaction. My first reaction was that the message sent is that the vulva represent the woman's body, something I do not believe you intend. In other words, although it is fantastic, I do not receive the appropriate message for the content of the May RHM.
Aníbal Faúndes, Brazil
Totally love it and think that kind of pushing the boundaries is what RHM should be doing.
Barbara Klugman, South Africa
I do not mind the “provocative” aspect, but feel that it is not exactly “gender sensitive”. Of course, people will interpret it differently and some could relate the journal theme directly to the image of the cover. I vote against using it for the cover, but can be included in the journal.
Iqbal Shah, Pakistan
I agree with Aníbal, I feel uncomfortable with the disembodied images focused entirely on vulvas for an issue that addresses ‘bodily image and sexuality’ along with ‘cosmetic surgery’.
Asha George, India
You have not got any supportive messages yet!!
Iqbal Shah, Pakistan
I join the consensus that this should not be on the cover but strongly support the image being contained within the issue – precisely for the sort of conversation it is generating amongst us.
Sofia Gruskin, USA
I agree, I mean, it doesn't offend me, but it may offend others. Why don't you do it creatively: Present a lady with underwear on the outside – all covered private parts – and – then the models inside.
Johanne Sundby, Norway
I'm afraid I endorse the consensus that such a cover may shock the sensitivities of a proportion of the RHM readership and might damage the reputation of RHM. It would be OK to have it somewhere inside with an appropriate explanation as to the origin of this piece and, even more importantly, what it tries to convey.
Paul Van Look, Belgium
Although it is an very nice piece of art and I find it completely relevant to the theme, I don't like it because I find it ugly (I don't think the same of real pictures…) and it makes me think of dead bodies, of death, genocides. Women represent life and beauty and I would rather have that image shown in RHM.
Thérèse Delvaux, Belgium
I don't find the proposed cover offensive, or provocative; it's almost antiseptically medical. But I do worry that this issue could be banned from entering some countries, the Philippines included.
Michael Lim Tan, Philippines
I appreciate the bold stance and desire to be challenging. Having said that, I'm inclined to agree with putting it on the inside (with a note that it had been considered and debated for the cover), but not on the cover itself. I just tried to imagine people having it lying around on a table in the office or sharing it with colleagues – and felt folks might feel they had to hide it away discreetly (representative of the shame and ambivalence about women's bodies/sexuality that this issue is trying to highlight). Not so much about the reputation of the journal (will undoubtedly please some, offend others), but about distribution (being the pragmatist here).
Julia Kim, USA
I have read this entire correspondence with fascination – obviously this is a conversation that needs to happen, more extensively, more deeply, both within RHM's pages and beyond. I can't remember a more instantaneous, impassioned response to an editorial query to the advisory board; quite amazing. That said, I tend to agree with Mike Tan on two counts: (many others on this point as well) that we need to think about impact in different regions and countries and where the image might be difficult or dangerous for some of our readers (though, I'd love to know what colleagues in the Middle East, North or West Africa might have to say); and that personally the image does remind me of all those medical journals my dad used to have lying around. I'm for keeping it inside the journal with a brief commentary summarizing all the comments and soliciting more. I also think the field of cosmetic surgery is much broader, though this is one aspect, and the theme might be better captured in a different image.
Rosalind P Petchesky, USA
For reasons already well expressed by several colleagues, the old man goes with the view not to have it on the cover. However, it can be included inside, in relation to a relevant article. Congratulations on the courage to put it forward, and on the wisdom to seek collective opinion.
Mahmoud F Fatalla, Egypt
I would have suggested going with it too, but will go along with majority opinion on not having it on the cover but definitely having it inside.
Gita Sahgal, UK
Judging from what we know about certain cultures and settings, I think your two staff people are right. This may affect just a small minority of our readership, but I think we don't want to add to their existing problems given that the provocative cover is NOT essential to our mission here. Including the images and the important written content inside the covers is essential, of course. Given that freedom of speech just does not exist in so many parts of the world, I think it makes sense to be careful to protect our colleagues working in a more difficult milieu than we might ever imagine.
Judy Norsigian, USA
This a very interesting discussion. I think that if we want to have everybody talking about RHM, this should be the cover. Nonetheless, there are two risks: one has been pointed out by the other colleagues (reactions in many different regions and people) and the other is that some people can reject this because these are not images after any surgery, am I right? After this I have to say that maybe we can include this inside with the explanation BUT also to promote the journal in other frameworks. It is really a challenge between conservative settings and the need to provoke.
Ana Cristina González Vélez, Colombia
It is good to be brave, but there is a fine line between being provocative and causing offence or distress. My feeling is that the image provides a disembodied and rather cadaverous (due to the grey tones used) image of women.
Toni Belfield, UK
I am pretty certain that it would be a problem distributing this here in Malaysia and it is certainly not something my colleagues would pick up (in public anyway) to browse through, which would be a shame. Even if it's been on TV, that is a different medium and anyone who feels confronted can change channels or switch off – we don't want that reaction from readers and potential readers. We don't want the risk of cancelled subscriptions and I can just see that happening with my senior management (at the least) even if customs let it through. I would go for the majority suggestion of keeping it inside – and I think the summary/comment of this discussion would be very important.
Pascale A Allotey, Ghana
I think that it's great to push boundaries, but worry that it will offend some people, and cause problems for others.
Charlotte Watts, UK
Maybe you should do some statistics on the average age of your editorial group!!
Paul Van Look, Belgium
My concern is that it may be difficult to find a good cover picture… but the thing is that the appearance of genitals is a very private thing, not readily visible to other people… except in porn – and today's fashion both hides and displays genitals (string panties, etc) in a more sexualised than practical way… in the West. I have a lot of experience as a clinical ob/gyn, on how unsure women are about what “normal” external genitals look like… (I have seen many, they haven't). So, metaphorically this “hide and display” theme is difficult to illustrate.
Johanne Sundby, Norway
Yes, Marge, the censors – post office, schools, wherever – would see red on the cover even if it's antiseptic grey!
Michael Lim Tan, Philippines
I absolutely agree that it is “fantastic and provocative in a really good way, and very exciting as a visual and artistic (and educational) image to illustrate the theme of the journal”. And my general feeling about this – as you know from discussions years ago, I think – is that if you ask too many people, you will always get some who think almost anything is offensive (or unfunny or whatever). An editor has to go with their judgment.
But in this case the picture will clearly violate pornography provisions in some places. Remember US movies now do not show nipples so as not to be banned in many Asian countries (though I think one snuck in very briefly towards the end of Avatar! OK to kill people, of course). Perhaps the versions you see in the UK do, but not the ones we see here with a huge Asian (=east and southeast Asian) audience. The atmosphere here at the moment re images of children is punitive and oral-panicky in the extreme. A local man is in court at the moment for possessing child pornography because he took photos at [a local] beach and a father complained that he was taking pictures of his five-year-old son who was naked (how the kid was allowed to be naked in the current climate is puzzling in itself).
Indeed, if any of the models were under 18 I have breached the university's IT code and probably broken the law myself. In this case, the law is an ass and I would fight it happily, but I tell you this just to indicate how incendiary this can be in a certain climate.
If you use the image for the cover, you – or the recipients of the issue, who don't get to make the choice – cannot use the “necessary for medical education” defence if they are accused of having or displaying pornographic images. So I'm afraid I agree with the more prudent position. Hate to be on that side! But there it is. It's pretty challenging even for inside, but don't let them talk you out of that!
Juliet Richters, Australia
This [table of contents for the journal issue] is indeed useful. What I find interesting to contemplate is that such a high proportion of the submissions/possible final papers are about vaginal and labial surgery, when there is such a wide range of body-changing cosmetic surgeries, involving a variety of male/female body parts, that go on all over the place. Hmmm.
Rosalind P Petchesky, USA
I would also worry that it would shock many readers and may hurt RHM's reputation. Its fine for the insider, especially if there is some caption explaining its relevance, but not for the cover.
Shireen Jejeebhoy, India
I don't like them cause they're all white. I know you explained they were plaster casts from all kinds of people, and since plaster is white – yet that was my first impression. (An interesting aside – groin area/armpit whitening is a bane in Asia, because some of ours are really black. And its true, there are some dark women walking around with pretty pale vaginas, ok.) Second, the message I got from the picture was that different (and white, I can't let it go) is good and beautiful. And so there's no need to change anything to fit the norm.
But you remember our discussion in Oslo. I still feel young people with “bat-like” labias have the right to change them to “mouse-like” ones, if it's going to provide short term benefits. I don't see it different from a nose operation. In the long term, the target should not be the service providers and whether they should or should not carry out these operations, but rather social values and gender norms, which need to change. I can see Johanne already preparing for a return salvo…
Yes, the image said all that to me, because of our discussion on it. However, I agree that if the image is causing this much debate, it may be interesting to run it anyway. Perhaps play around with colours a bit and make some of them darker, maybe?? Photoshop some hair?? Ha, just kidding. But serious about the colours. Not about the hair.
Saira Shameem, Malaysia
Interesting discussion and very useful indeed. I agree that this cover is not appropriate as the cover. This is because it would probably negatively affect local sensibilities here in the Occupied Palestinian Territory, as probably elsewhere. But the discussion prompts me to ask a few questions regarding breaking boundaries, which is a vital concept for public health if we are to move forward. However:
| • | When do we want to break boundaries? | ||||
| • | For what purpose? | ||||
| • | How? | ||||
| • | When is the right time? | ||||
Rita Giacaman, West Bank, Occupied Palestinian Territory
Personally, I would love it as it is. It appears that sometimes our soft landing makes people not take us seriously. However, having read other opinions, I reluctantly support putting it inside so that we get many readers to pick up the publication and read the excellent contents rather than ignoring it due to being offended just by the cover. This is my very reluctant opinion.
Bene Madunagu, Nigeria
30 responses and counting – you certainly do know how to throw a party. May not be the outcome you would prefer but great process.
Pascale A Allotey, Ghana
My point of departure is probably not that of individual neoliberalism (“anything goes, whatever you want you can buy it”) but a more Darwinistic approach: we are like we are for a purpose… hair or lips or whatever… I think one of the driving forces to genital surgery is actually fed by ideas of pornography and maybe even paedophilic dreams, of the “forever virgin” state of the private parts… a very long and winding road back from an old lady's hairy de-oestrogenised, urine-leaking, used vulva… alas. And I guess in solidarity with those who are not sexy, not pretty and cannot afford plastic surgery I like tight boundaries and use of medical skills for real medical reasons… Thus, I don't even like silicone breasts!
Johanne Sundby, Norway
Personally, I find this image amazing and a beautiful illustration of human diversity. I think it will not work nearly as well inside the journal as on the cover. It is very graphic and powerful as a front cover and illustrates perfectly the themes at issue. In her work on Picasso, Gertrude Stein wrote: “A picture may seem extraordinarily strange to you and after some time not only does it not seem strange but it is impossible to find what there was in it that was strange” (quoted from Lynn Morgan). Images like this accomplishment movement (as this discussion clearly shows). Even though I agree with the point raised earlier about the importance of being clear on what kind of movement we try to accomplish and why and when, I believe there is much reason to try to push boundaries in this realm. That said, I can certainly follow all the points raised earlier, although I am not sure about the degree to which this front cover would really put (some) people off. Sometimes people's reactions differ from what could have been imagined.
Tine Gammeltoft, Denmark
I would like to be in a world that could accept and love this cover, but I agree with most of the comments I've read until now. The picture is provocative and interesting but first it is not really in relation with plastic surgery, lightning creams or anything like this; second, it does not represent women. Third and last, I think we will have some problems for diffusion of this issue with that cover in many countries and it could be counter-productive for the topic of this issue. I propose as several others to keep it inside but not as a cover.
Philippe Msellati, France
Wow, you hit something Marge (maybe a clit?) Amazing response for sure. At the risk of going against the grain, I would support the picture on the cover. Yes, you'll be smashed for being “culturally insensitive” or “insensitively pornographic”. Yes, it will piss off some, antagonise some, shame some, disgust some, yes, it might be banned in some places. And it will (also) please others – count me in. Agree with Sham, though, that some colour would be good. And I'd dare add a cut & paste of all these responses as an additional contribution to the journal.
Anissa Helie, Algeria
This very fascinating discussion definitely spiced up a very grey, cold, rainy day in Switzerland for me. I find the discussion incredibly stimulating and exciting.
My first reaction when I looked at the cover was: why only vaginas? Why only women? But I looked at it again and again and my feelings became more complex, various thoughts started to rush through my mind, and when I read the various comments, I felt how unfortunate it would be to lose such an artistic, indeed provocative piece from this RH Matters! (I don't find it ugly, or disgusting, this is what vaginas look like… so from that perspective, it is indeed appropriate.) It made me also very curious what the content is, that probably would be the case with many readers. My thoughts became associated with the Vagina Monologues, how shocking the plays were/are all over the world but they became one of the most celebrated, considered to be educational pieces all over the world, kind of a “must see”.
I also have to admit that there is a huge difference between the cover and the title page [with the whole plaster cast]. Honestly, I like the title page more than the cover. It reflects so much more clearly the artistic nature of the piece. It indeed looks like a painting or picture. Your first reaction is not a shock, but what is it? How was it made? Can they really look so different? – and not an immediate shock as with the cover. Is it possible to use the title page as the cover, but with a more dominant frame around it and give a matching colour for the rest of the cover? do you think it would make a difference? I thought in that way it may be less offensive and shocking, those who find it immoral may find it more acceptable since it is clear that it is a borrowed piece of art and part of freedom of expression (for both the original piece and RHM).
Personally, I can't wait to distribute it, whether you keep it as a cover or not but I totally agree with the colleagues to be very careful not to jeopardise the accessibility and use of the issue, since it is a very important one and a topic that needs a lot of discussion. So I do agree that we need to listen to those colleagues, who may be in trouble to distribute the issue because of the cover. That would be very unfortunate and not worth it.
Eszter Kismodi, Hungary
I love love love Sham's response and it does truly reinforce the point that people read these things from so many different head-spaces. I think Eszter's point about putting it in a frame is an option. But frankly, given you chose to consult and got this response, I wouldn't put it on the cover, and I might suggest that you put it inside and offer an opposite page commentary on the pic pulling out some of these responses… without naming the people; talk about a myriad of paradigms at work.
Barbara Klugman, South Africa
I like the cover very much; however, after reading some of the concerns, I would support Sham's idea to try to make it less direct, more symbolic – with colours or other artistic means to strengthen its artistic side versus purely biological.
Wanda Nowicka, Poland
I took a second look… and my dear, my dear…, these vulvas are hairless… a modern trend… or a trend in some cultures. What if we had a similar comparative display of noses?
Johanne Sundby, Norway
I must say, I wasn't expecting these negative responses. I was thinking with my “fine art” hat on. In the heady days of 1960s art school, plaster casts of bits of bodies were routine, and shocking people was a positive advantage. I thought of this image as a 21st century version. My response was also that this is a thought-provoking image in relation to women, presumably mainly in rich countries, getting cosmetic surgery to achieve an awful “normality”. Looking at all the different shapes and sizes ought to convince people that there is no such thing. However, we live in a hypocritical world, unfortunately. Juliet Richters is making sane points, even if this is disappointing for you. You can't redress the visual impact of the cover with explanations and caveats, so it might well offend. Whereas putting the image with the article is a different story. It's a difficult decision to make, but Juliet may be right.
Carol Brickley, RHM's design and production manager, UK
For the reasons already well canvassed, I side with those that advise against having these images on the front cover. One legal point is that in addition to the publisher being liable to prosecution for pornographic images, the distributors of RHM would be similarly liable for display and distribution of such images. You will have to think through whether you want to subject your distributors to the risk of criminal prosecution and subsequent costs of defence. As has been explained, there is a medical defence that could be used if prosecuted. However, I wonder how well this defence would stand up in court if medical images are used on a front cover, and not with respect to a particular article discussing that part of the body, as they are in medical journals. I hate to reduce this fascinating debate to the risks of criminal prosecution for the publication and distribution of pornographic images, especially as I understand this is not your intent. I am afraid and am sorry that it is a point you cannot ignore.
Rebecca Cook, USA
Thank you for inviting me to share the email debate. I'm glad we started it. I can't structure this response without losing the charge which makes me want to write it [I have already] (it would also take too long), so I'll let it be a stream of consciousness. Which starts with the Rijksmuseum diary on my desk. The cover shows almost the entire ‘Winter landscape with ice skaters’ by Hendrick Avercamp, which is reproduced inside. The whole picture shows a community, at work and having fun, a community embedded in a landscape which is in turn embedded in the soft light of a winter sky. An entire three months of images (14 in all) pick up tiny details from this landscape and bring the individual out of the collective. This is when we see the man who has fallen over, the woman holding her nose, the shivering man, the scratching dog… All the vulvas in Jamie McCartney's piece belong to individuals and all put together they retain or increase their individuality but they are also anonymous and disembodied. So while the wall of vaginas is full of variety, it also says:
“So what?” It is very neutral, very anatomical. Like a poster of different kinds of fish – or fossils. The colour is very dead. (We associate Gothic cathedrals with stone, usually grey, and soaring architecture – but when they were places of passionate worship, they were full of paintings and colour.) It is hard – the antithesis of a real vagina. It is indifferent to what it depicts. I would like other opinions, but it appears to me completely unerotic.
So although I think it is a good piece of art, and it is certainly an educational one, I don't know that I like looking at it. It takes me back to “The Dinner Party”. Which I could also reduce to the image below (insert “vulva” on each plate).
But here there is no “so what?” – because each vulva, each dinner plate is different – fantastic variety and creativity and wit – and all the plates are in praise of famous women. Each plate is made of soft materials and constructed with love as part of a huge collective creative enterprise. Perhaps it is sentimental. So am I.
Now I want to discard the word ‘vagina’. Because we are not seeing a wall of vaginas. If they were plaster casts of vaginas, we would have a wall full of holes and it would be a piece which we would have to touch. Or not touch – like an Antony Gormley piece – we would just know that that was what they were.
I realise I don't know the derivation of “vulva”. Apparently it is the Latin word for womb and is a variant of volvere, to roll. This is a distraction so I'll shelve it after some quick associations – revolver – revolved – involved – convolvulus – convoluted – convolution – revolution…
Girls/women first (if ever) see their vulva when they look in a mirror. At that moment, they are wondering what they look like and their vulva becomes the object of their gaze. We can never see our own vulva (or vagina). It is genuinely a ‘private part’. In many or most cultures, we acquire inhibitions, modesty or shame about it being on display. We wore short skirts but climbed ladders, escalators or stairs with care. Having our feet in stirrups to give birth or be subjected to a vaginal examination felt like a humiliation. Mobile phones have been banned in some schools because the boys use them to take surreptitious photos under girls' skirts.
But the girls are wearing short skirts because they are required to put themselves on display, a display which seems to be all the time more explicit. In adolescence, teetering between vanity and self-doubt, I went through all the usual anxieties about bits which were too big or too small or the wrong shape. Naturally that extended to the invisible (unless mirrored) vulva. I remember examining my labia minora and not liking the look or the texture or the way they dangled. But those anxieties went away once I started having sex because I enjoyed it, my partners enjoyed it, and no one ever said there was anything wrong with these private parts. I suppose in my and their usually limited experience, vulva variety was taken for granted as in any other body part. I might have wished for different labia as I might have wished for different breasts or a different nose or a different head of hair, but I wouldn't have thought I needed to do anything about it. I felt “within normal limits” and I pass no judgment on those who really feel they aren't. I pass judgment on those who create the prison of what are normal limits.
In due course, I came across the story of Saartjie Bosmans, the Khoi-san woman who was brought to Europe from South Africa in the early 19th century by a ship's surgeon, who persuaded her she could make money out of exhibiting herself, particularly her large buttocks and long labia (as the Hottentot Venus). She can't have imagined – and nor can we – how she would feel about the way she was required to put herself on display. She was told to sit or squat so that her labia would be fully revealed to the stooping, peering audience, male and female. She was considered less fully human (or evolved, but no Darwin yet) than they themselves, covered from neck to toe so that there was no shame in their curiosity. Having been handed on to an animal trainer, she ended her life in prostitution and poverty.
I can feel vicarious shame for the lack of compassion or respect in the way Saartjie Bosmans was treated, but should I feel shame for her exposed genitals? What is shame? Is it the same as modesty? Can either emotion be healthy? Perhaps modesty can also be a shield against a curious, judgmental or hostile gaze, which gives women, especially young women, a space to feel at ease with themselves.
At this point, I get lost in thought and I need to get back to more practical (reproductive health) matters. So to return to the matter and cover in hand, will this image make readers feel more comfortable about their own bodies? Is it empowering? Is it reassuring? Does it confront men and women with their own insecurities in a positive way? What does it tell them about what's inside the journal?
It certainly provokes debate and thought – for us. Not all our readers are used to or possibly want to enter into that debate. I imagine myself at a conference with 500 of these journals to hand out. It won't be fun to meet people's eyes as it was with DKT's smiley-penis sex education quiz. Will I have to debate it over and over? Is it the main issue in the issue? I do think there will be readers who will be shocked and offended by it although shock and offence is not in itself a concern… It's too literal.
Pathika Martin, UK
I agree with Susanna's position. Also thought Juliet's arguments were very pertinent. It depends what you/we want to achieve, and I have a feeling that getting the journal to people is probably more important than getting it banned at this point. Can't wait to know what you finally decide.
Jane Cottingham, UK
I agree with Mahmoud, Ros, Julia (though not the old man part) and Judy, among others.
Adrienne Germain, USA
Marvelous. I wish all my editor queries were so delightful. Artistically, I prefer the combo picture of vaginas, penises, and breasts! RHM should win an award for best medical journal cover design. On principle, censoring art is unacceptable; however, I suppose there are reasons to be somewhat cautious. I will ask [Elsevier's] Legal [Department] if there are any potential problems. My only doubts stem from the fact that the journal goes to many Third World and Islamic countries that may not be amused. I will let you know Legal's advice ASAP.
Greyling Peoples, Publishing Editor, Elsevier
Well… you will upset some people. The New View Campaign had the image on its website in 2008. (Maybe that's where you got it?) and we used it with journalists, etc. I think it is very appropriate and a great example of pro-women art. But, there are some radical feminists who feel that by showing just the vulva you are reproducing patriarchal oppression. So you should expect some upset – we got two angry emails.
Leonore Tiefer, USA
Thanks for Pathika's thoughtful remarks… all this discussion has been useful for other purposes as well. Bill Parker, a gynaecologist in Los Angeles best known for his studies on all the unnecessary oophorectomies in the US, is on the war path now about all the labiaplasties and other vaginal reconstruction that he sees all the time. He wants us to create a website with photos demonstrating the huge variety of what is normal (and should be seen as perfectly fine if not beautiful), and we MAY do this next year, if time and resources permit. Meanwhile, I have put him in touch with Nancy Redd, whom I adore (I am sure you are familiar with her book Body Drama) and who also lives in LA. She had quite a fight to keep the pictures of real young women's labias in her book (she found these women through [website], and they did a photo shoot together….).
Judy Norsigian, USA
Okay, I am so moved and inspired by Pathika's “stream of consciousness” that it definitely persuades me this dialogue needs to be reproduced in the journal, with the image, maybe with variations (colours, photo-shopped, hair, whatever). The only thing missing from Pathika's commentary is some reflection on the politics of the speculum and those days back then when feminists were all looking up their own vaginas, visibilising the invisible, insisting this was empowering. Could someone add a reminiscence about that? This has truly been an adventure – maybe we should do a whole issue on reproductions of reproduction and sexuality.
Rosalind P Petchesky, USA
Why colour, but no hair? Or is hair part of the texture that you can't make out in these plaster casts? I remember reading somewhere that one reason why Gustav Klimt's paintings were radical is that they departed from artistic norms of the times and dared to depict pubic hair… Years ago in the art museum or parks of Mexico City, I came across these two huge murals of black and white photos… one whole wall of male genitals and another whole wall of female genitals… again it pushed across the idea of diversity… but this time they had hair too and seemed more casual and not so much on display as the plaster casts. Not sure if any of you came across this exhibit… may have been 1995?
Asha George, India
See FAQ about having a plastercast made of your genitals, on the artist's website: “Do I have to be shaved?” “No not necessarily. Hair produces less good results so a close trim is better than the full bush! Shaving does produce the best results but it really is up to you.”
Anissa Helie, Algeria
Thank you for such a fabulous discussion, and I go for writing something on this discussion, maybe in the editorial. I agree with the majority, these are real worries, and so I go for having the photo inside, and that in itself would be real pushing of the boundaries in some contexts. In some places producing RHM in local languages is in itself pushing the boundaries. Having said that I do agree that sometimes we work, unintentionally, as gatekeepers. I showed the photo to some of my colleagues (veiled young women) they said it would be shocking on the cover, but they all agreed, contrary to my expectations, to have it inside the issue. I am not sure about the colour; however, having the photo in black and white gives it the “neutrality” and also “coldness” of science, which help in pushing the boundaries. Interestingly, there is no infibulated vagina!! though it is promoted sometimes as a kind of cosmetic genital surgery.
Amal Abd El Hadi, Egypt
The cover: I loved it, and also the title [of the plastercast] Great Wall of Vaginas. It reminded me of those feminist books of the 70s like A New View of a Woman's Body, when they took pictures of hundreds of vulvas to show a complete variety instead of the shy and modest vulva of medical books that made us all look like abnormals. Adding colour would be great, check if it is acceptable to intervene with the artwork, copyright, etc. For me it would win an award as a cover, as the Elsevier guy said. But to be on the safe side we need to consider sensibilities, legal problems, etc.
Different cultural contexts and responses: In the meeting of the editors of the translated editions of RHM, I remember (let's check) that we decided that it would be good to follow the cover picture of the English edition, but that it would not always be possible, given that some have just one edition per year or an issue with mixed papers, or the cover had no cultural appeal, so some flexibility was needed. I tend to think that this cover would be acceptable in Brazil, I will check with my colleagues. I understand Amal's concerns and I am happy that they think the picture is acceptable on the inside.
Vulva, self-exam, feminist nostalgia, thanks Pathika and Ros: we still do routine self-exam in the Coletivo Sexualidade Saude, and we have a site called Fique Amiga dela (Get friendly with her) with booklets, instructions and links to sites on vulvart, including photography, graphic art, poetry etc. It gets >1,000 hits/day. We were never accused of pornography, but we are frequently hacked. Believe me, young women love it, there is an incredible audience waiting to be reached. It is a real pity that it disappeared from feminist meetings, as they were the place for it to be disseminated.
Classification of pornography: I read somewhere (maybe on sexylabia.com, adults only) that the classification of pornography and nude art for magazines depends on showing inner vaginal lips, so many models have them excised for this “legal reason”.
A feminist nostagia note: I understand that we tend to call the whole genitals (sexual/reproductive) as a set of pelvic organs as “vagina” (sheath or scabbard, for the sword, a very phallocentric perspective), but what the picture is showing is the vulva, as many feminists have insisted. There is a political issue on the appearance and disappearance of the vulva (not an organ but an anatomical area, like “face”) and its structures in anatomical texts, as part of the denial of the vulval-clitoral structures, as discussed in debates by feminist anatomists of the 70s. In the last few years, a new generation of anatomists have done incredible work on vulval anatomy, with magnetic resonance imaging (such as Helen O'Connell's Anatomy of the Clitoris).
Simone Diniz, Brazil
Medical terms, slang terms: the correct terminology for the outer semi-visible female genitals is “vulva” from a medical point of view (it consists of small and big lips, clitoris, and perineum). Vagina is the “inside” part. Inside the vagina there is the vaginal wall and the portio (tip of the uterus, or mouth of the uterus). Introitus is the “entry” to the vagina, sometimes covered by the hymen (virgin fold). Labia majora and labia minora are the genital lips (in some languages unfortunately called the “lips of shame”). Perineum is the area between the vaginal opening and the rectum. Other languages have other slang words too: in Norwegian the vulva may be called “mouse” (mus) and if the inner labia are a bit long: flaggermus which means bat (or flapping mouse). Language is important.
Johanne Sundby, Norway
It's a very powerful image. I don't think it's in the slightest bit pornographic because of the way it's presented. However, it may cause offence in some places the journal is held, for instance in a library? Not sure what to suggest really, I can see that an image like this will make people think. I am not sure about whether the image could be changed in any way to make it clear on the inside cover and less on the outside?
Mags Beksinska, South Africa
Maybe the option Simone refers to (i.e. different covers in different contexts, as discussed by the editors of RHM translated editions) could be an answer here? Especially because I feel that some of the strategic dimension is getting lost in our various warnings about cultural soft spots within specific contexts. We are all aware of the risks involved in challenging the status quo – anywhere – but the question is political and about strategies. It is too risky? Will it be used to undermine years of efforts (yes? likely?) versus: it is definitely risky but. (Amal and I had a similar discussion ten years ago about chapters to include/leave out in an Arabic translation of a Center for Women's Global Leadership manual.) So wouldn't it be fair and safe to let the editors of the translated RHM editions decide on the basis on what they know of their own context and, importantly, on the basis of what backlash they are willing to face? Also, Marge, am curious if you'll address/connect with surgery performed on intersex infants?
Anissa Helie, Algeria
I think Simone has provided an important strategic solution that balances our needs, both our ambition to push the boundaries and to take into consideration our very diverse contexts with their diverse cultural and legal aspects. We definitely need RHM in our context for pushing the boundaries, for example, on abortion, which up to this moment is criminalised except for saving the mother's life (the National Council for Women defended this position two weeks ago before the CEDAW committee!!). Still, this should not prevent those who can push for higher levels for the whole movement.
Amal Abd El Hadi, Egypt
I was a little shocked to see the image, perhaps because I come from an Asian culture! Furthermore, RHM discusses not only physical health but also mental health, while this cover focuses mainly on the physical aspect. I expect to see something less direct but give the idea of both physical and mental health.
Phan Bich Thuy, Viet Nam
I would agree with Mags – the image is not pornographic but I do see problems arising with some libraries… if nothing else, copies of this issue may end up being nicked by fascinated students! Could the art people perhaps try to add some effects to make the images less stark? Or would that compromise the whole idea? Not sure.
Fiona Scorgie, South Africa
I agree that this image provides a strong statement and I think it is better not to shy away from that. I have used photos of this sculpture in presentations and I always warn people that some of the images I plan to show are explicit. Despite this I have always chosen to include the image because of its educational value, so I think bringing this piece of art to a wider audience is a positive step and adds to the discussion that is the topic of the issue.
Tracey Plowman, UK
As for the question of the cover I had different reactions: The first was to be “shocked” – after all the taboos work with me as well. And I felt uncomfortable to display women's vulvas like that (even though I work on these topics)! In this context I also thought about how offensive it must be to readers with even stronger taboos on sexuality. In which countries is RHM available? I am sure that it will be impossible to have this magazines on the table in some contexts! I just think about the University in Burkina Faso and remember my experience there and how awkward it would be to have a cover like this… Is there an excised vulva among the displayed? What would that mean? The second reaction was to clearly see the positive in showing the diversity of female genitalia! Especially in order to break the taboos and point out the false images woman have about their vulva (in an Euro-American context?). Which leads us to the genital cosmetic surgery as technique of equalisation to a mystic ideal genital. I think that is what you want to achieve? But there is yet another point – I am sure you are familiar with cases like the Hottentot Venus, where an African woman, Saartjie Baartman, was brought to England and France in the early 1800s and was exhibited there naked as a curiosity. Europeans were fascinated by her naked body, which was also caricatured a couple of times. And played a huge role in generating the stereotypical images of African female bodies and associated sexual promiscuity. After her death her body was dissected and her skeleton, brain, and genitals (!!) were preserved and displayed at the Musée de l'Homme in Paris until 1974 (!!). Her remains were at last interred in South Africa in 2002. This somehow reminds me of the display of these body-less vulvas in the picture of the piece of art you would like to use for the cover. In my opinion if these pictures are used there, or even only in the volume, there needs to be a thorough explanation who these woman were, what is suggested with the piece, etc.
Elena Jirovsky, Austria
Having this illustration on the cover is likely to provoke a lot of energy among some in a country like India, to challenge it as being pornographic and hence being worthy of being banned. Whether they might seek a ban on the issue or the journal, I wouldn't know. If the illustration does not directly correlate with the focus of the issue, as some respondents have stated, I would feel that the likely cost of this on the cover outweighs its benefit. Hence I would personally advise against this on the cover. Including it inside the journal would get the message across.
Sharad Iyengar, India
I agree with Mags' and Fiona's comments. It is a very beautiful image, rather like an intricate sculpture of an ancient building. It is however certainly controversial as you have already found. It will be provocative, and while this may be in a good way in some instances, I think it will also be regarded in a negative light by some (maybe many). Although not pornographic, some will also probably find it offensive and too explicit. To reach a decision, the readership of RHM should be considered broadly, taking into account the religious and cultural sensitivities and sanctions that may result. Just a thought: I first looked at the image on a small laptop screen, and then later on a large PC screen. The bigger the image, the more stark the image, so one way to handle this may be to reduce the size considerably so that it becomes much more subtle? You could perhaps make a block or a strip of a number of smaller photographs.
Jenni Smit, South Africa
The cover is very original, but after a discussion with our team we concluded that it is not acceptable for our country and for regions where we are disseminating the Russian version of RHM.
Irina Savelieva, Russia
To be honest, I really like it and I would put it on the cover. But, as you have said, it is provocative and maybe shocking for some people and surely it will cause controversies, but I think that's good!
The image shows the whole range of diversity of the female genitals – still a taboo – and this should be shown, because (almost) nobody shows it. And in a journal for reproductive health it is absolutely o.k. to show it, that's my personal opinion. Again, for me it is fantastic and provocative but in a good and artistic way!!
Daniela Dorneles de Andrade, Austria
Having been away for some days, I come back to a waterfall in my inbox of strong opinions on the proposed cover. I loved reading it, and of all the reactions, Pathika's and Simone's were the ones that gave me a lot of surprise, knowledge and thought provocation. On the pictures themselves, I found them just too strange. But I am a physician, and have been a clinician for so many years that the fact that there are differences in the appearance of the vulva is completely self-evident. So I did not get that a-ha experience. Taken out of context (which it would be if they were on the cover) they can easily be taken as promotion of removal of hair. In Norway, as I presume in many other countries, shaving the vulva is a big thing, often linked to Lolita-discussion (women should be girl-like and “innocent”). That combined with the greyish colour also gave me the notion of corpses. So I definitely would support those who say that it should not be on the cover, but inside with a text with explanations.
Berit Austveg, Norway
I think the cover is beautiful, and when Birgitta and I have presentations together, we often use this picture to show that true variety when it comes to female genitalia. I have thought a lot about whether it would be too offensive on the cover of a journal. Personally, I do not think so, but perhaps some readers of the journal would. Maybe it would be better to have the picture included inside the issue instead of on the cover. However, I'm ambivalent, since I'm very fond of the picture.
Sara Johnsdotter, Sweden
I do agree with Sara. Although we are living in the 21 century, over the years I have learnt that both pictures and text are sometimes ‘bombs’ and thus will steal the focus of the important issue/aims with what you intend to present. Anyway you know your readers better then I do!
Birgitta Essén, Sweden
Wow, it's amazing how much an image gets us all to respond. It's interesting because many times the debates around films or images are more interesting than the film or image themselves. Anyway I think the images are beautiful and educational and can fulfill their purpose on the cover or inside the journal alongside the relevant article/s. The images did not offend me.
I showed it to two friends – one who liked it and it did not offend her. She thought vulvas/vaginas are a good proxy for sexuality. Another friend talked more about the art and thought as a work of art it was too direct and did not like it. So as you can see from this and all our emails we will get as many diverse reactions and opinions as the number of people that see the images. All images are essentially ambivalent texts and we will never have a universal reading of them. They will always be open to different types of meanings and reactions. Look what Sham said about the whiteness!!! (Since the image was black and white I did not think about that). And we all know that looking at or reading an image can be classed and gendered, etc.
I would put it on the cover and deal with all the risks – the risk of censorship, being called sensationalist, insensitive, etc etc. I would also put it on the cover because it isn't often that these kinds of spaces are created (thank you, Marge, because for a change it's a journal and not a museum, art show or a sexuality journal that is willing to include a representation such as this one). Spaces for these kinds of images are few and far between and it's great that audiences not used to seeing these forms of representation get to see them and debate issues that have something to do with the subject at hand – body image, sexuality and cosmetic surgery. What's wonderful about putting this on the cover will be how open-ended you are leaving the viewer of the image to think about so many things in relation to these topics… In my view that is a good thing. I also think not putting the image if I was the editor and had chosen this already would be a form of self-censorship which is the final goal of many censorship proponents – not to offend public morality, making safer choices that appeal to the majority, and focusing on the view that the image causes harm (or that the image itself is the harm). All fights about censorship are fights over meaning. Maybe in these ways we need to fight in terms freedom of speech and expression around sexuality.
But that is my choice in respect to this specific image on the cover of RHM based in the UK and because Marge is willing to put it out there. In my country it would not be possible to make this choice so easily based on my own arguments because we might be attacked by the right-wing, get our NGO shut down, be criminalised by laws that exist around offending public morality etc. I would respect whatever choice anyone else makes. I would also agree that whatever other people have raised as concerns will be true. I would not argue with any of the issues raised against putting it on the cover. I think there is a risk of some readers getting shocked and offended that they would not read what's inside, there is a risk of being banned etc etc. But it won't be everybody and it won't get banned everywhere. The thing I would think carefully about is the legal aspect of being sued and other issues that have to do with the sustainability of the journal and other risks that we may not have thought of. So what I am trying to say is that the strategic decision of putting it on the cover or not needs to lie with Marge (which I guess is the case but want to reiterate this point). We are all only opinion givers.
And to end I want to share an image that I recently saw that I associated with cosmetic surgery and it made me laugh so here you are… It's a cartoon from a New Yorker calendar on moms – it has a girl telling her friend: “Actually I do look like my mom, it's just that I have her first nose…”
Geetanjali Misra, India
This is the best of all – hurray Geeta – and sums up all the ambiguities, plus rightly throwing the ball back to Marge. I vote that Geeta's statement be deemed a fitting culmination of a very rich, fascinating debate (which certainly needs to be documented, in the journal or elsewhere). Well done all! RHM rocks!
Rosalind P Petchesky, USA
Legal views
Quite unfortunately, but understandably, the [Elsevier] Legal Department is recommending that you do not proceed with the proposed cover. Please find below a synopsis of the comments made by our legal counsel in London, New York, and Amsterdam: “In the UK, the test of obscenity is whether the material would have the tendency to deprave or corrupt a significant proportion of the likely audience, and there is also a defence that applies to magazines and books where publication is in the interests of science or learning. If the image is inside the journal and it is relevant to the content of that issue of the journal, then I think we could have a possible defence here. However there are also restrictions on “indecent” material, which is material that is offensive to public sensibilities, rather than harmful. The courts have said that this is something that “offends against the modesty of the average man, offending against recognised standards or propriety at the lower end of the scale”. It is a specific offence to send indecent material through the post. If the image were used on the cover, it would require an overcover guaranteeing it could not be seen by anyone other than the subscriber. I would imagine that other jurisdictions have more stringent laws than this so, I think we would be courting trouble here. I can imagine this proposed cover art generating not only controversy but confiscations in many countries, which seizures would defeat the purpose of publishing the issue.” Greyling Peoples, Elsevier Publishing Editor
I sympathise with the dilemma you're facing. First, I love the cover. Second, it is neither obscene nor pornographic. In legal terms, it would not qualify as obscene. And while any picture of the body could presumably potentially be pornographic, the context here of your magazine and its focus removes any possible pornographic connotation. So it really does boil down to a question of taste and offence.
The definition of obscenity is: material that ‘depraves and corrupts’ (this goes back to the 19th century). There is a ‘public good’ defence (since 1959) as follows: a person is not liable ‘if it is proved that publication of the article in question is justified as being for the public good on the ground that it is in the interests of science, literature, art or learning, or of other objects of general concern’.
So that would cover you if you wanted to publish photographs at any time that could be interpreted as obscene. However – the photographs that you want to publish are NOT obscene. The kind of material that may be prosecuted as obscene today includes: bestiality, necrophilia, rape and torture, and depictions of sexual gratification through lavatorial functions.
I'm not sure how a journal on reproductive health could in any way fall foul of obscenity laws for publishing photographs of a reproductive organ. Or, for that matter, be considered pornographic.
Pornography of course is harder to define. I've no idea what the laws are in the Philippines, so I would have thought the only concern should be how to insure that copies don't get seized. And they can be mailed, I imagine, in an opaque cover? Much of discussion around this subject depends on context so I think it's very important to emphasise that the context in which the images are being published is eminently respectable, which renders them a medical rather than pornographic or sexual illustration.
Jo Glanville, Editor, Index on Censorship
I spoke with a colleague here, a law professor in Ireland and the UK, and she immediately said legally this cover is neither pornography, nor obscene/indecent, although it is shocking. She stated that in Europe the publication could not be seized, nor could the publisher be prosecuted. In Canada, under Butler and Little Sisters, the Bureau of Customs was impounding material as obscene, but the Supreme Court in 2005 issued a different standard; that focuses entire on harm (R. v Labaye) – whether “the conduct (here the circulation of the journal) causes or presents a significant risk of harm to individuals or society – that undermines or threatens a value in the Constitution or fundamental rights AND this risk is incompatible with the proper functioning of society.”
This is such a high bar that there is little concern that the publication would be seized. And in the US this falls way short of the definition of obscenity…
I mentioned this to Alice Miller; she was less concerned with nuisance slap suits (which I think might be a concern), than say a govt. like Bangladesh, using some excuse to shut down a women's/health rights NGO, using possession of the journal to make trouble for them.
Mindy Roseman, Academic Director, Human Rights Program, Harvard Law School, USA
Examining the cover and the document sent, I see no possibility of the cover be considered a violation of public morality in Brazil and, accordingly, suffer a restriction order… In Brazil, the right to free expression is a fundamental right from the Constitution of 1988. But every law has limits and conflicts between the freedom of one vs. the other are common, which requires a balancing of the interests and rights at stake, and the circumstances involved in the action.
The Brazilian legal doctrine that has been consolidated is to give maximum support to fundamental rights, and include respect for human dignity as a limitation… Thus, for example, something that reinforces racism or sexism can be considered a violation of human dignity and restricted by the court. In relation to sexual morality, we know that with some issues there is less of a consensus and they are problematic. For example, if pornography, eroticism and other images/manifestations of this nature can be considered artistic expressions or not, what are the limits and possibilities of their publication, considering “medical ethics”, on one hand, and the effect on “immature people” (such as adolescents and children) on the other.
The legal response has to consider the purpose of publication, the audience and all the circumstances surrounding it. In this regard, my evaluation is that this picture on the cover of a journal whose aim is academic discussion of objective and subjective aspects of vaginal aesthetics, is appropriate to the theme and the audience, and that that has been understood for human dignity. In other words, I see NO risk of legal penalties or restrictions in relation to the journal for their exposure. Congratulations! The artwork was very interesting.
Miriam Ventura, lawyer, teacher, independent consultant on human rights, health policies (HIV/AIDS, sexual and reproductive health), bioethics, and civil and constitutional law issues, Brazil
Use it or not?
…We think of RHM as being on the cutting edge and pushing the boundaries, but it is still constrained by its own effectiveness – the fact that it is a multicultural group operating in very different contexts means that it is accountable to that group (it has chosen to be); and the fact that it (has chosen to be) published by an establishment publisher similarly creates constraints. I think it's the right decision to change the cover (even though I loved the cover… but having read everything, I think changing the cover is the right thing to do, strategically speaking, because it allows the journal and its issues to travel further).
So what does this mean for RHM tackling sexuality? Taking one step backwards, conceptually and strategically I think RHM should be tackling sexuality and sexual rights and sexual health because a) it is what comes before reproduction…; that, however difficult, one has to surface sexuality in order to take on some of the underlying challenges of reproductive rights and health and b) so much of the work on sexuality at the moment is not pushing us to think about and understand sexuality across the board – much of the commitment to this issue comes out of people addressing abuse of LGBTI people, and hence is focused on sexual orientation and gender expression, rather than on sexuality per se. RHM could help create bridges between the cutting edge thinking and strategising around sexual orientation and gender expression and the broader dimensions of sexualities – in relation to youth, ageing, disabilities and so on. It could also be playing an important role in bringing a wider brief to sexuality work, and in bringing sexuality and sexual rights and health to its traditional reproductive health/rights audience.
So, having said that, because some of RHM's audience is not that stretched and comfortable with sexuality, this has to be done in a way that brings people in; and bringing them in is more important than shocking or challenging through a visual… Now that it's clear that the cover was too much (if not for the board then for the constituencies they're trying to bring into RHM, or for their legal contexts), that means being aware that RHM's role has to be strategic in weaving these issues into its work in a way that's educative and seems inevitable and appropriate.
Barbara Klugman, South Africa
Why this image: the editor's defence
In August 2008, I watched a documentary called The Perfect Vagina. The presenter had decided to do the programme because she became convinced that dissatisfaction with vulval appearance is becoming widespread. Waxing away pubic hair has led to women's vulvas being more visible, which has led women to feel insecure about whether their vulvas are beautiful. This insecurity is apparently compounded by a lack of access to images showing how diverse vulval appearance naturally is. A woman professor interviewed on the programme thought that women knew what was popular but not what was normal. Moreover, many women are apparently being exposed to possibly distorted images in popular women's magazines and pornography videos (an extremely common pastime these days, particularly among the young) that make them believe their genitals are imperfect or even abnormal, or do not conform to what is currently considered fashionable and beautiful.
It was through that programme that I first encountered the plastercast sculpture of 40 different women's genitals by Jamie McCartney from Brighton, UK, a section of which I decided to put on the cover of the journal, precisely because it shows in a simple, quiet, clear way what normal female genitals, in all their diversity, actually look like. It is extraordinarily educational – and was intended by the artist (and by me in using it) to be just that.
Why on the cover?
I decided to put it on the cover as well as inside the journal not only because it is educational, but also because it is beautiful, as a piece of art. And perhaps most importantly, because it has led to a fantastic discussion of the very issues covered in the journal – with everyone I have shown it to, starting with the weeks-long e-mail exchange above amongst the journal's staff, consultants, trustees, editorial board members and authors, when I sent the cover design to them and asked for their opinion. The relevance of the image to the theme and the articles was, I thought, obvious. However, that was because I was already so steeped in the issues that I thought everyone else was too.
I made the same mistake with them as I made when I sent it to our publisher Elsevier for an opinion. I did not give them the table of contents of the journal nor any information as to why I wanted to use it. Even so, I got back a huge range of views, which corroborated my belief that this cover is indeed provocative and a fantastic contribution to the debate on cosmetic surgery that I hoped this journal issue will contribute to.
In 18 years of editing Reproductive Health Matters, I have never come close to finding a cover that has caused so much instantaneous, impassioned debate, and I doubt I ever will again. That is something no editor would willingly pass up.
In response to their views, I wrote a defence of the cover, hoping this might change their minds. (Mostly, it did not.) In defence of the cover, I said they must remember that this cover would not arrive to subscribers on its own, as it did to them, but would be attached to a journal known and respected for its coverage of reproductive and sexual health and rights, and aspects of sexuality related to these. This particular journal issue is primarily about body image and the role of surgery on genitals and breasts in altering body shape and thereby (people hope at least) self-image. Jamie McCartney's plastercast sculpture is about body image and body shape as well. It was a perfect fit with this theme because it would lead readers to reflect on their perceptions of what is normal.
“…Vulvas and labia are as different as faces – many people, particularly women, don't seem to know that. Men tend to have seen more than women, who have often only seen their own, and many have never looked that closely. Hence the exposure of so many, showing the variety of shapes, is endlessly fascinating, empowering and comforting. For many women their genitals are a source of shame rather than pride and this piece seeks to redress the balance, showing that everyone is different and everyone is normal… The sculpture is serene and intricate and it works on many levels.” (Jamie McCartney, Brighton Body Casting, from his website)
RHM is not the first publication to put this image into the public domain. Several authors of papers in this journal issue have used it in academic presentations, put it on their websites, and shown it to journalists, e.g. in the USA, UK and Sweden. The Channel 4 documentary showed the whole plastercast and even showed the artist making a cast of someone's genitals.
Would this cover be considered obscene or pornographic? Would it get anyone into trouble?
These questions, raised initially by several RHM board members, were the only ones that I thought might lead me as an editor to hide this cover from the eyes of customs officials by using an opaque mailing envelope, or leave the image off the cover entirely and put it inside the journal.
I certainly don't want to get anyone into trouble, leastways myself. But I have to say that if a few copies of the journal were seized because of this cover, I don't think that would be reason enough not to use it. Efforts to censor the publication of art and literature depicting or discussing the human body for purposes of education have a long history and must be resisted. Particularly when the world is swimming in films, videos and magazines filled with seriously pornographic and obscene images, which no one is censoring. So it was important to obtain expert opinions as to whether this cover was likely to be considered pornographic or obscene, and likely to be seized, or not, rather than to act based on fears and personal reactions.
The opinion that the cover would not be considered obscene or pornographic was corroborated, as seen above, by Jo Glanville, Mindy Roseman and Alice Miller from the USA, an Irish lawyer who Mindy consulted, and Miriam Ventura, from Brazil, all lawyers with expertise in these issues. They also said that we would be highly unlikely to lose a “nuisance” suit given that this image is not harmful in any way. However, concerns such as that a conservative government in a developing country or a university administration could use possession of the journal to sack someone from their job or close down an NGO it wanted to get rid of anyway, still needed to be considered.
Would it cause offence?
Some loved the cover; several disliked it; a few were offended. Some were shocked, and for everyone it was unexpected. The most common concern was that it might cause offence; even that didn't bother me. Most, however, worried that others would be offended or that it wasn't “acceptable” in their contexts, or that people might get into trouble for displaying it or showing it to others if others were offended by it. Almost everyone thought it should appear inside the journal, in the context of an explanation. Can we assume that it will not cause any problems inside? I don't know, but we will see.
For a legal opinion on causing “offence to public morality”, which could be used against individuals possessing a copy, Alice Miller sent me a copy of the text of an amicus brief prepared by Article 19, the Miller Institute for Global Challenges and the Law (University of California Berkeley School of Law) and Human Rights Watch. It was written in support of an appeal being brought to the European Court of Human Rights by a Turkish-based LGBT organisation, whose director was prosecuted in Turkey for publishing in a magazine a photograph of a painting of a nude man/doubled (reflections on homosexuality). The brief says:
“The idea that a state can justify repressive measures merely by pointing to a “public morality” without evidence, definition, and elaboration has been largely discredited. Council of Europe member states, countries around the world, and international and regional bodies have recognised – expressly or implicitly – that “public morality” arguments are acceptable only where some real and specific harm to society can be shown. In the face of this growing international trend, authorities may not criminalise and confiscate publications without demonstrating what harm it causes to what part of the “public” when, and where, and tailor any restrictions to any specific harm.”Citation1
Conclusion
To my surprise and great disappointment, the majority of RHM's board members did not, when it came to it, support my using this image on the cover, even though they do support my publishing articles on subjects that are at least as controversial, including cosmetic surgery. The concern about offending or shocking people, especially in settings where intimate parts of the body are considered very private, was strong. At the same time, this image also took many of them out of their own comfort zone. On the other hand, a good number recognised the value of being provocative, in support of the intended message, and that this is part of RHM's mission – to be on the cutting edge. The positive response of many of the younger board members, and those whose work is more closely related to sexuality issues, was encouraging as well.
Less surprising but also disappointing, our publisher, among the most powerful on earth, was not willing to risk any negative publicity or consequences for themselves from this cover. Are the risks as high as their dire warnings predicted? Only publication would tell. For me, however, the risk of harm from cosmetic genital surgery, which is practised almost entirely unregulated in most countries, e.g. the non-therapeutic surgical tightening of vaginas, cutting of labia and clitoris, enlargement of penises, is far more offensive than a work of art showing a few women's vulvas, whose message is: “Confront the shame you feel about your own body”.
I expressed my disappointment to Elsevier that they had not offered to stand up for the journal if necessary in the name of freedom of the press, scientific and artistic freedom, and the right to use such an image in an educational manner, including on the cover. I also strongly disagree with those who felt that the reputation of RHM would have been damaged in any way by this cover, quite the contrary. In any case, I would have defended it, and my right to use it, and I believe both Elsevier and RHM's boards should have said they would do so as well. The repressive forces that might have attacked us over it deserve to be challenged at every step.
The lack of consensus about the cover among RHM's board members has implications for the future. We agreed some time ago that it was important for us to move beyond reproductive health and rights and take up sexuality and sexual rights in the journal. Visual images have been and will continue to be central to any messages we wish to put across as we do this.
What now? Perhaps censorship was not, in most of my colleagues' minds, what they were supporting – but it was certainly the outcome. The only thing worse than censorship is acceding to it voluntarily. Publish and be damned? I certainly would, but I don't work alone. Where does all this shame and fear come from? I thought to use a blank cover as a statement about being censored, but that would have had only negative value. To my great good luck, after a month in which I fought a raging battle within myself about what I should do, I serendipitously found an abstract image, created by Susan Lyman, an artist and friend who loved my cover too, that I was happy to use for the cover instead.
Acknowledgements
Thanks to Jamie McCartney, the artist who created the plastercast, for his understanding and support throughout this process. Thanks also to Carol Brickley of Boldface, RHM's designer and production manager, for her patience and commitment, who created no less than 23 cover designs, many of them aiming to hide the image while keeping it in place, while this discussion evolved. Lastly, thanks to everyone who responded in this discussion for their articulate and passionate involvement.
Notes
* Respondents are either RHM staff, board members or editors of RHM in translation, unless otherwise identified.
References
- Article 19, the Miller Institute for Global Challenges and the Law (University of California Berkeley School of Law), Human Rights Watch. Third Party Intervention in the European Court of Human Rights. Application No. 4982/07 Between KAOS-GL applicant and Turkey respondent. Written Comments, 2 November 2009. p.4.