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Pressure Mounts to Curtail Surgery on Intersex Children

NEW YORK – Children whose sexual characteristics don’t neatly align with the norm have for decades faced surgery to rearrange their anatomy to resemble that of more typical boys and girls – long before they were old enough to have a say in the decision.

But now the practice is under assault, as never before. The American Medical Association is considering a proposal discouraging it. Three former U.S. surgeons general say it’s unjustified. And on Tuesday, Human Rights Watch and InterACT a group advocating for intersex youth – are releasing a detailed report assailing the practice and urging Congress to ban it.

“The results are often catastrophic,” says the report, asserting that the surgeries “can inflict irreversible physical and psychological harm.”

“The pressure to fit in and live a ‘normal’ life is real,” said Kyle Knight, a Human Rights Watch researcher who wrote the report. “But there is no evidence that surgery delivers on the promise of making that easier.”

One of multiple reasons for the concern: Some intersex children may undergo surgery aimed at assigning them as male or female, yet grow up to identify as the other sex – a potentially traumatic situation.

Intersex is an umbrella term encompassing various conditions in which internal sex organs and external genitalia develop differently than for a typical boy or girl. Experts say roughly one of every 2,000 newborns has so-called differences of sex development that might prompt a doctor’s recommendation for surgery or other medical intervention.

Internationally, there’s been vocal opposition to such surgeries. In 2015, they were condemned by several United Nations agencies, and Malta became the first country to ban them.

Major U.S. medical associations haven’t gone that far, but the Human Rights Watch/InterACT report urges them to toughen their policies. The American Academy of Pediatrics says it’s reviewing the issue, and wants parents to understand the risks and benefits of any course of action. The AMA’s Board of Trustees is proposing a new policy statement urging doctors to defer intersex surgery on infants and young children “except when life-threatening circumstances require emergency intervention.”

Adding to the momentum was a statement in June from former surgeons general Joycelyn Elders, David Satcher and Richard Carmona, who said the surgery “is not justified absent a need to ensure physical functioning,” they wrote. “We hope that professionals and parents who face this difficult decision will heed the growing consensus that the practice should stop.”

There are no comprehensive statistics on intersex surgeries. The new report says most of the 21 health professionals who were interviewed suggested that medically unnecessary surgeries were becoming less common, but none said their clinic had stopped doing them altogether.

Even as the new report was being compiled, it came under fire from the CARES Foundation , which advocates on behalf of families with children born with abnormal genitalia due to a condition called congenital adrenal hyperplasia, or CAH.

Girls with this condition sometimes undergo reconstructive surgery, often to reduce the size of the clitoris. The foundation, which has more than 20 physicians as advisers, asserted that the new report represents an unwarranted attempt to eliminate that option.

“The choices available to parents and patients should not be limited,” the foundation said. “Medical decisions are difficult enough for parents without having to contend with the moral and philosophical agendas of certain movements.”

The new report includes input from an unidentified 20-year-old woman with CAH who said she was glad her parents made her “look like all the other girls” her age when she was growing up.

However, Kyle Knight said there’s no evidence that this type of abnormal genitalia poses a health threat.

“There are limits to what parents can do to their kids,” he said. “Medically unnecessary irreversible surgery that carries a risk of lifelong harm should be one of those things.”

For families with intersex children, one welcome development has been the formation of specialized teams at some hospitals that address a wide range of physical and psychological concerns.

Among the acclaimed programs is the SOAR Clinic, created in 2012 at Children’s Hospital Colorado near Denver. Its team – which includes specialists in urology, genetics, psychology and other fields – develops an individualized treatment plan for each family, and encourages parents to participate in decision-making.

The issue of surgery for infants and young children is one of the toughest facing the team.

“These are really difficult, challenging decisions,” said Dr. Jennifer Barker, who specializes in hormonal and glandular complications affecting children. “We’ve seen families decide to move forward to surgery, and some who choose not to.”

Barker guessed that most of the team’s physicians would feel unduly restricted by a ban, even as early surgery becomes less common.

The clinic deploys intersex people as patient advocates who can offer support based on personal experience. The most active volunteer is 40-year-old Noi Liang.

At birth, Liang appeared to be a normal baby girl. As she grew older, doctors discovered that – because of a rare chromosome condition – she lacked a uterus, and had internal testes rather than ovaries. When she was a teenager, doctors removed the testes, telling her they were removing potentially cancerous ovaries. Not until her early 30s did she discover the truth.

As a patient advocate, she sees parents worrying whether their children will be accepted by their peers.

“Isolation is a big piece of what they struggle with – they feel like there’s no one else to talk to,” Liang said. “They say it gives them a feeling of relief to speak with someone like me who more fully understands what they and their children are going through.”

Several parents of intersex children have become activists, advocating against early surgery. Among them is Dr. Arlene Baratz, a Pittsburgh-based radiologist with two adult daughters born with the same condition as Liang.

“If there is a secret to raising healthy children,” Baratz contends, “it is to accept and focus on what they are, instead of what they’re not.”

 


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Marine Le Pen’s National Rally Wins the First Round in France 2024 Election

Marine Le Pen's far-right National Rally (RN) party scored historic gains in France

Exit polls in France showed that Marine Le Pen’s right-wing National Rally (RN) party made huge gains to win the first round of election on Sunday. However, the final outcome will depend on how people trade votes in the days before next week’s run-off.

Exit polls from Ipsos, Ifop, OpinionWay, and Elabe showed that the RN got about 34% of the vote. This was a big loss for President Emmanuel Macron, who called the early election after his party lost badly in the European Parliament elections earlier this month.

The National Rally (RN) easily won more votes than its opponents on the left and center, including Macron’s Together group, whose bloc was predicted to get 20.5% to 23% of the vote. Exit polls showed that the New Popular Front (NFP), a hastily put together left-wing alliance, would get about 29% of the vote.

The results of the exit polls matched what people said in polls before the election, which made Le Pen’s fans very happy. But they didn’t say for sure if the anti-immigrant, anti-EU National Rally (RN) will be able to “cohabit” with the pro-EU Macron in a government after the runoff election next Sunday.

Voters in France Angry at Macron

Many French people have looked down on the National Rally (RN) for a long time, but now it is closer to power than it has ever been. A party known for racism and antisemitism has tried to clean up its image, and it has worked. Voters are angry at Macron, the high cost of living, and rising concerns about immigration.

Fans of Marine Le Pen waved French flags and sang the Marseillaise in the northern French district of Henin-Beaumont. The crowd cheered as Le Pen said, “The French have shown they are ready to turn the page on a power that is disrespectful and destructive.”

The National Rally’s chances of taking power next week will rest on what political deals its opponents make in the next few days. Right-wing and left-wing parties used to work together to keep the National Rally (RN) out of power, but the “republican front,” which refers to this group, is less stable than ever.

If no candidate gets 50% of the vote in the first round, the top two candidates and anyone else with 12.5% of the registered voters immediately move on to the second round. The district goes to the person who gets the most votes in the runoff.

France is likely to have a record number of three-way runoffs because so many people voted on Sunday. Experts say that these are much better for the National Rally (RN) than two-way games. Almost right away on Sunday night, the horse trade began.

Macron asked people to support candidates who are “clearly republican and democratic.” Based on what he has said recently, this would rule out candidates from the National Rally (RN) and the hard-left France Unbowed (LFI) party. Leaders on the far left and the center left both asked their third-placed candidates to drop out.

Minority government

Jean-Luc Melenchon, leader of France Unbowed, said, “Our rule is simple and clear: not a single more vote for the National Rally.” But the center-right Republicans party, which split before the vote when some of its members joined the RN, didn’t say anything.

The president of the RN party, Jordan Bardella, who is 28 years old, said he was ready to be prime minister if his party gets a majority of seats. He has said he won’t try to make a minority government, and neither Macron nor the communist NFP will work with him.

“I will be a “cohabitation” Prime Minister, respectful of the constitution and of the office of President of the Republic, but uncompromising about the policies we will implement,” he said.

A few thousand anti-RN protesters met in Paris’s Republique square on Sunday night for a rally of the leftist alliance. The mood was gloomy.

Niya Khaldi, a 33-year-old teacher, said that the RN’s good results made her feel “disgust, sadness, and fear.”

“This is not how I normally act,” she said. “I think I came to reassure myself, to not feel alone.”

Election Runoff

The result on Sunday didn’t have much of an effect on the market. In early Asia-Pacific trade, the euro gained about 0.23%. Fiona Cincotta, a senior markets expert at City Index in London, said she was glad the outcome “didn’t come as a surprise.”

“Le Pen had a slightly smaller margin than some of the polls had pointed to, which may have helped the euro a little bit higher on the open,” she noted. “Now everyone is waiting for July 7 to see if the second round supports a clear majority or not. So it does feel like we’re on the edge of something.”

Some pollsters thought the RN would win the most seats in the National Assembly, but Elabe was the only one who thought the party would win all 289 seats in the run-off. Seat projections made after the first round of voting are often very wrong, and this race is no exception.

On Sunday night, Reuters reported there were no final results for the whole country yet, but they were due in the next few hours. In France, exit polls have usually been very accurate.

Voter turnout was high compared to previous parliamentary elections. This shows how passionate people are about politics after Macron made the shocking and politically risky decision to call a vote in parliament.

Mathieu Gallard, research head at Ipsos France, said that at 1500 GMT, nearly 60% of voters had turned out, up from 39.42% two years earlier. This was the highest comparable turnout since the 1986 legislative vote. It wasn’t clear when the official number of people who voted would be changed.

 

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Pakistan Seeks US Support for Counter-Terrorism Operation Azm-e-Istehkam

Pakistan

(CTN News) – Pakistan’s Ambassador to the United States, Masood Khan, has urged Washington to provide Pakistan with sophisticated small arms and communication equipment to ensure the success of Operation Azm-e-Istehkam, a newly approved counter-terrorism initiative in the country.

The federal government recently approved the reinvigorated national counter-terrorism drive, which comprises three components: doctrinal, societal, and operational.

Ambassador Khan noted that work on the first two phases has already begun, with the third phase set to be implemented soon.

Addressing US policymakers, scholars, and corporate leaders at the Wilson Center in Washington, Khan emphasized the importance of strong security links, enhanced intelligence cooperation, and the resumption of sales of advanced military platforms between Pakistan and the US.

He argued that this is crucial for regional security and countering the rising tide of terrorism, which also threatens the interests of the US and its allies.

“Pakistan has launched Azm-i-Istehkam […] to oppose and dismantle terrorist networks. For that, we need sophisticated small arms and communication equipment,” said Ambassador Khan.

Pakistan–United States relations

The ambassador observed that the prospects of Pakistan-United States relations were bright, stating that the two countries “share values, our security and economic interests are interwoven, and it is the aspiration of our two peoples that strengthens our ties.”

He invited US investors and businesses to explore Pakistan’s potential in terms of demographic dividend, technological advancements, and market opportunities.

Khan also suggested that the US should consider Pakistan as a partner in its diplomatic efforts in Kabul and collaborate on counterterrorism and the rights of women and girls in Afghanistan.

He stressed that the bilateral relationship should be based on ground realities and not be hindered by a few issues.

“We should not base our engagement on the incongruity of expectations.

Our ties should be anchored in ground realities, even as we aim for stronger security and economic partnerships. Secondly, one or two issues should not hold the entire relationship hostage,” said the ambassador.

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China Urges Taiwanese to Visit Mainland ‘Without Worry’ Despite Execution Threat

China Urges Taiwanese to Visit Mainland Without Worry Despite Threats

China has reassured Taiwanese citizens that they can visit the mainland “without the slightest worry”, despite Taiwan raising its travel alert to the second-highest level in response to Beijing’s new judicial guidelines targeting supporters of Taiwanese independence.

Last week, China published guidelines that could impose the death penalty for “particularly serious” cases involving “diehard” advocates of Taiwanese independence.

In response, Taiwan’s government urged the public to avoid “unnecessary travel” to mainland China and Hong Kong, and raised its travel warning to the “orange” level.

However, Zhu Fenglian, a spokeswoman for a Chinese body overseeing Taiwan affairs, stated that the new directives are “aimed solely at the very small number of supporters of ‘Taiwan independence’, who are engaged in malicious acts and utterances”.

She emphasized that “the vast majority of Taiwan compatriots involved in cross-strait exchanges and cooperation do not need to have the slightest worry when they come to or leave mainland China”.

“They can arrive in high spirits and leave fully satisfied with their stay,” Zhu added.

What’s Behind The China-Taiwan Tensions?

The tensions stem from the longstanding dispute over Taiwan’s status. Mainland China claims Taiwan as part of its territory and has refused to rule out using force to bring the democratic island under its control, while Taiwan sees itself as a sovereign state.

Beijing has not conducted top-level communications with Taipei since 2016, when the Democratic Progressive Party’s Tsai Ing-wen became Taiwan’s leader. China has since branded her successor, President Lai Ching-te, a “dangerous separatist”.

“The DPP authorities have fabricated excuses to deceive the people on the island and incite confrontation and opposition,” Zhu said in her statement.
Despite the political tensions, many Taiwanese continue to travel to mainland China for work, study, or business.

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