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    For most Americans, protecting free expression means countering threats from government. Private corporations are not usually seen as threatening free speech. But as private technology companies increasingly mediate access to information and services, the distinction between governmental and private censorship becomes less clear. Concepts of free speech and freedom of expression may need to be revised and enlarged to take account of new threats in the age of digital communications – and policies to protect freedom of expression may need to counter threats, often subtle, from the private sector as well as government.

    New Censorship Technologies and Practices

    Since the invention of writing, heavy handed governmental forms of censorship targeted ideas or words deemed dangerous by authorities, but at the risk of drawing more attention and public debate to the ideas or words targeted for suppression. Contemporary threats, barely recognizable as censorship, more often come from steering or soft censorship. Using new communications technologies, corporations – and government agencies operating indirectly through corporations – are able to intervene in expressions before they happen. Search engines, auto-predictive keyboards, machine learning algorithms and filters originally designed to keep children safe on the Web have become tools for modifying citizen behavior and altering communications. A few examples help to illustrate these worrisome practices:

    • A recent update from Apple to the iPhone keyboard made it difficult for users to enter the words abortion or suicide into their smartphones. Whatever the intentions, this can make it difficult for iPhone users to take perfectly legal or constructive actions such as searching for abortion clinics or finding information about suicide prevention.
    • The source code of a recent Android handset update made by Google contains a dictionary of over 165,000 words users would not get help to complete from the auto predict or spell-check functions built into their devices – including terms like preggers, intercourse, lovemaking, butt, geek, thud, pizzle, and other supposedly dirty words.
    • In mainland China, searches for “human rights” on Google often return the question “Did you mean hunan rice?” and a series of rice-based recipes.
    • Edward Snowden’s revelations about digital surveillance by the National Security Agency suggest that U.S. technology companies have been surprisingly amenable to surrendering user data to intelligence authorities, with companies like Microsoft providing government easier access to its services through Skype, Outlook email, and SkyDrive cloud storage.
    • Blocking or tracking taboo words or language is a particularly useful way for understanding next-generation censorship. Many of these soft censorship technologies interfere with people’s use of certain words or expressions – or enable surveillance actors to track ideas or communications defined as threatening or undesirable.

    Tracking and Steering Citizen-Users

    Digital communications technology has also proven to be useful for collecting information about users in order to predict their needs and desires and steer their behavior. Unlike media manipulation or propaganda, which focuses on changing popular beliefs and social behaviors on a large scale, digital approaches aim to track, predict, and manipulate the behavior of individual users. For instance, Facebook’s “News Feed” has long tried to shape users’ choices by algorithmically predicting which content is most likely to keep people on the site and automatically removing content that users might find uninteresting or objectionable. For this company and many others, there is little need to challenge or change user beliefs in overt ways when more subtle forms of steering are possible given the ease of collecting and analyzing digital data on what individuals are doing or what they might find attractive or unappealing.

    Protecting Free Expression in a New Era

    Given the subtlety of contemporary forms of censorship and steering often practiced by private corporations, freedom of expression and choice can no longer be construed simply in terms of protection against governmental infringements. By better understanding the newest mechanisms for regulating language and steering citizens, we become better able to make informed policy decisions. Several new ways to protect free expression should be considered for the digital age.

    • Independent auditors may need to review search engines and algorithms, given their enormous power to shape what can be found on the Internet and how findings are ranked. Private companies have a legitimate interest in protecting their private intellectual property, but it should be possible for auditors to certify that search engines are not biased or designed to be coercive without divulging any details that amount to true trade secrets.
    • Users should not be regarded as disinterested in the possible biases of steering devices. Terms of service agreements could be simplified and rewritten so as not to discourage users from peering into the operations of the services they use.
    • New public technology services may also be needed. Instead of a proprietary search algorithms like Google, open-source search engines could be created along the same lines as Wikipedia, with users contributing to the creation and operation of searches. Algorithmic gatekeepers could be opened up and made intelligible to people with little technical knowledge. Universities might be best equipped to administer public knowledge platforms, because they are present in many countries and regions, enjoy academic freedom in many parts of the world, and have access to advanced research resources and technical experts not dependent on corporations for employment.

    Well-designed new policies and institutions could help democratic nations – and peoples aspiring to freedom – to parry manipulative uses of digital technologies. Optimal policies must be future-oriented and able to accommodate rapidly changing technologies. Of course, new technologies and the companies that devise and deploy them deserve to prosper in coming decades – but only in ways that protect vital public interests in transparency and full freedom of expression.

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    Rex Troumbley is a Postdoctoral Fellow at Rice University. His research deals with how taboo language – cursing, swearing, profanity, obscenity, and racial slurs – is managed by medical, legal, and technical institutions in the United States. This article was written in collaboration with Scholar Strategy Network.

    Health

    The Case for Ending the Anonymity of Egg & Sperm Donations in the United States

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    Egg and sperm donations in the United States have long proceeded under the cloak of secrecy. Twenty-five years ago, when I first started interviewing patients who used donors to conceive a child, many intended parents struggled with whether eventually to tell their child about the nature of his or her conception. While some professionals in the fertility industry advised that this was a parent’s personal decision, others encouraged disclosure, and still others recommended never telling a child how they were conceived. The last approach dovetailed with the industry standard that required donor anonymity. In subsequent years, my research has led me to conclude that mandatory donor anonymity is problematic – not only for the children conceived with donor help, but also for donors themselves and the people who created their families with donor assistance.

    After a boom in the late 1980s and 1990s, the use of donor sperm and eggs continues to expand in the United States – and increasing numbers of donor-conceived adults are going to want access to their biological information, including access to the identities of the people who helped create them. The United Kingdom has abolished donor anonymity. Why has the United States not followed suit?

    How Does Anonymity Affect Donors and Donor-Conceived Children?

    Many professionals in the fertility industry maintain that mandatory open donor identity would reduce the number of people willing to come forward to provide eggs and sperm. In countries that have national registries and have abolished donor anonymity, these fears have not borne out. In the United Kingdom, the Human Fertilisation and Embryology Authority reports that the number of sperm donors has increased since anonymity was banned; and since ending donor anonymity, Australia and Sweden have also seen increases in donors volunteering.

    In the United States, given that donors are compensated – indeed, egg donors are substantially compensated – the financial incentive alone is enough to ensure that people will still come forward to provide gametes for other people’s children, even if their identity is revealed to the children born from their gametes. Many donors prefer an end to anonymity. In my current research project, I have to date interviewed over 90 donors and collected 190 online surveys. Only a handful of egg donors, I find, want to remain anonymous in perpetuity – yet the majority reported they were told anonymity was their only option.

    Many sperm and egg donors go to great lengths to meet their genetic children, turning to DNA tests, online registries, and ancestry websites in their searches. Meanwhile, the first generation of children conceived via banked sperm or donated eggs are now young adults, who have their own feelings about donor conception and their own desires for forging connection, or not, with their donors. Some experienced emotional fall-out from being told later in their childhood they were donor-conceived or discovering it themselves after having the truth was concealed for of their lives.

    In my conversations with donor-conceived people, those who seemed most at ease were told at a young age and continued to hear their conception story as they matured. People who were told as adolescents or later, or discovered the “secret” on their own, report feeling a sense of betrayal at having been lied to by the parents they were supposed to be able to trust. For families who decided not to inform their donor-conceived children, the secrecy appears to have been largely rooted in the stigma and shame many people feel about infertility and the inability to have a biological child.

    Dealing with the Downsides of Anonymity Falls to Individuals

    In a quest for identity, many donor-conceived adults report using a combination of techniques to find their donors. Some sign up on registries, such as the Donor Sibling Registry. This service charges a $200 lifetime fee for donors and donor-conceived people to sign up and search for matches, using the donor identification numbers that clinics, sperm banks, or egg donation agencies assign. Others have turned to free online sites – such as donorconception.com – that help donors, donor-siblings, and donor-conceived children find each other by combining donor information, direct-to-consumer genetic tests, and ancestry registries.

    Essentially, anonymity is already obsolete; U.S. policy simply has not caught up with modern technology. The rise of direct-to-consumer genetic testing increases the likelihood of donor-conceived children finding their genetic parents, whether the donor wants that to happen or not. If anyone in a donor’s family does a test and registers on a website like ancestry.com, chances are good a donor-conceived child can find them. While such consumer testing and ancestry sites do raise privacy concerns about the public availability of genetic information, they make it virtually assured that anyone can be found.

    The Need for a Donor Registry

    Many fertility industry professionals have voiced concerns about how a registry would function given U.S. patient privacy law. The industry’s fear that registries reduce donors has not borne out in other countries that have implemented them. And by now, offering anonymity as an option misleads prospective donors into believing that their privacy can be guaranteed, when it cannot. With anonymity increasingly a non-viable option, it is time to consider establishing a national registry for egg and sperm donors. Not only would such a registry make it easier for people to find biological kin, it could also provide other advantages:

    • A registry could keep track of the number of live births per donor in the same geographic area, to reduce the risk of unions between donor-conceived biological siblings.
    • For egg donors, a registry could track completed egg donation cycles to reduce the risk of donors going through more cycles than is considered safe.
    • A registry would allow researchers to track egg donor health to better understand complications and give women considering egg donation more information for their decisions.
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    Justice

    Partnering with Clergy to Prevent Domestic Violence

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    Domestic violence remains a serious and widespread problem in the U.S., particularly for women from racial or ethnic minorities, who experience higher rates of abuse than the national average. Now, a team of researchers from the University of Georgia have developed an online training that leverages the influence of religion to prevent intimate partner violence in Korean American communities.

    The CDC defines intimate partner violence as physical or sexual violence, stalking, or psychological harm caused by a current or former partner or spouse.

    “For many immigrant communities, the commonality that I witnessed, and that research bears out, is that religious organizations and religious leaders are a very important piece of the puzzle to prevent partner violence because they have so much power in the immigrant communities,” said project lead Y. Joon Choi, an associate professor in UGA’s School of Social Work.

    While some religious traditions have at times reinforced gender inequity and norms that discourage women from seeking help, religious leaders have the power to shape attitudes and behaviors within their communities and promote new norms that support healthy relationships and reject partner violence.

    Aware of this critical influence of religious leaders, Choi wanted to not only educate clergy on the problem, but empower them to speak out against violence and support parishioners who come to them for help.

    Choi collaborated with Pamela Orpinas, professor of health promotion and behavior in UGA’s College of Public Health who also studies intimate partner violence, and instructional designer ChanMin Kim with Penn State University, to build a program comprised of four interactive case simulations that guide clergy through real-world scenarios. The program is called Religious Leaders for Healthy Families.

    The researchers worked with domestic violence prevention groups and gathered feedback from Korean American faith leaders to present cases that were culturally appropriate and supported the clergy’s ability to be domestic violence prevention advocates.

    “What we wanted to see was behavior change,” said Orpinas. “After this training, are faith leaders going to be able to help victims when they suspect abuse? Are they going to be involved in the prevention of partner violence within their congregation?”

    The key, say the researchers, is to build confidence within faith leaders that they could take action to promote healthy relationships and connect domestic violence service providers to parishioners who need their support. The interactive case simulations allow clergy to practice responding to victims who are experiencing different types and degrees of partner violence in a safe space.

    “We wanted to make sure that through this medium, they were able to practice how they are going to interact,” said Choi, “and also they are going to learn what are good responses versus dangerous, unsafe responses for the victims. We are hoping to increase their self-efficacy through this intervention.

    Though this project is focused on Korean American clergy, the team designed the modules to be easily translated to other communities.

    “Much of what they need is there,” said Orpinas, “in terms of asking open-ended questions and supporting and believing the survivor. The case simulation helps clergy practice how to talk about those things.”

    The team is eager to see the program be adopted more broadly by immigrant communities or any community where faith leaders are trusted and influential resources.

    The full development of the online program, including theoretical underpinnings, community feedback, and performance objectives, is described in a paper published in Health Promotion International. It is available here.

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    Health

    Challenging Assumptions About the Use of Contraception by U.S. Muslim Women

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    By Henna Budhwani and Kristine Ria Hearld

    Contraception is complicated. Reproductive health scholars can comfortably weigh the protective benefits of condom use compared to the convenience of intrauterine devices. However, for most people, contraception continues to be a sensitive subject not appropriate for casual conversation – and consequently many Americans lack an adequate understanding of their contraception options. Likewise, even the best-intentioned clinicians know little about how minority communities engage with reproductive healthcare and utilize contraception. Due to these knowledge gaps, providers of contraceptive services often struggle with how to approach family planning with individuals from minority populations, particularly those belonging to highly stigmatized groups that are underrepresented in scientific research. This can be especially true for “culturally conservative” populations of clients, among whom sex itself is stigmatized and sexual health is not freely discussed in the home or the doctor’s office.

    Knowledge gaps are especially prevalent about the reproductive health behaviors of Muslim women, arguably one of the most understudied populations in the United States. This dearth of research is not surprising, given that Muslim women are part of a religious minority group that experiences ongoing intersectional stigma and discrimination in American public life. Because past studied have sometimes taken advantage of minority and marginalized populations, groups such as Muslim women may be suspicious of researchers and wary of divulging personal information, particularly on sensitive topics like contraception use.

    Nevertheless, good research is needed, because in its absence, pernicious assumptions can take the place of actual evidence – and myths can misinform clinicians and policymakers as well as the general public. Social scientists therefore have a pressing calling to conduct research that may ultimately dispel harmful myths and give voice to a group of women missing from academic discourse. Our work examines this set of issues, contraception use and reproductive health preferences, in Muslim women in the United States. We collected information from Muslim women themselves about their lives, and our findings refute presumptions that women in this population typically experience low bodily autonomy and high sexual risk factors.

    Path-Breaking Research from the Muslim Women’s Health Project

    In 2015, the Back of the Envelope mechanism at the University of Alabama at Birmingham School of Public Health funded a grant to collect exploratory data from Muslim women across the United States. Our research team developed an online survey that included measures of stigma, mental health, and contraceptive use among participants. Respondents were women who self-identified as Muslim and who were at least eighteen years old and current residents of the United States. To be sure, online surveys have limitations – for example, American Muslim women who did not have a computer in their home or did not regularly use the Internet would likely not have been exposed to the survey at all. Nevertheless, one major benefit of online surveys is their ability to engage difficult-to-reach populations, including respondents in stigmatized populations, minority enclaves, and groups fearing persecution. Data from our respondents, including participants from Muslim subgroups, were analyzed to identify notable barriers and facilitators to various kinds of contraception use – namely use of oral contraceptive pills, condoms, intrauterine devices, and reliance on withdrawal during sex.

    In the United States as a whole, some national estimates suggest that 62% to 75% of women of reproductive age use contraceptives. Rates of contraception use by women in Muslim majority countries varies widely, from a low rate of use by 38.5% of reproductive-age women in Pakistan and to a high rate of use by 62.3% of such women in Indonesia. Because of these statistics, we assumed Muslim women in the United States would use contraceptives at a higher rate than their counterparts in Muslim majority countries, but at a lower rate than other women in the wider-population of Americans.

    Results from our survey showed that our hypotheses were wrong. We found that almost 80% of eligible Muslim respondents used some form of contraception. As we delved further into characteristics of our sample, we realized that the women who responded to the survey tended to be highly educated (over half had completed graduate or professional school) and had relatively high incomes (43% had a household income of over $100,000 annually). They also had high rates of health insurance coverage, given that fewer than six percent were uninsured. A deeper investigation through multivariate analysis showed that education and income were more important to understanding contraception use than religion, ethnicity, or even immigrant status (whether a respondent was born in the United States or elsewhere).

    Essentially, our inquiry found was that when the social playing field is leveled through higher education, increased income, and full access to health insurance, contraceptive utilization increases – even among populations that are predominantly foreign-born and where people may be religious or hail from culturally conservative communities where women hold a secondary social status. Such factors are typically associated with low contraception use, but in our study, we found these factors could be counteracted by positive social conditions associated with empowerment.

    Why Policymakers and Advocates Should Further Overall Improvements

    When officials or advocates aim to boost contraceptive use by racial and ethnic minorities in order to reduce unintended pregnancies and sexually transmitted infections, it may be valuable to address community conditions holistically. Working patient by patient in health care settings can be helpful, but this approach is limited in scope, costly in time, and influences only the identified, targeted health behaviors. The better approach may be to expand women’s overall access to advanced educational opportunities that can lead to socioeconomic success and improved quality of life – even for women who belong to culturally conservative communities. Overall empowerment, we conclude, is the best way to increase rates of contraceptive use and ensure better life choices and opportunities for women in all communities.

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