Why Being a Poor Kid in America Is Particularly Awful

One measure of how much governments prioritize children and families is how much they spend on things like child allowances, daycare, and child-tax credits. Inside a longer report on global child well-being, out this week from the nonprofit Child Trends, lies this surprising tidbit: The U.S. has a higher proportion of children living in poverty than most other high-income countries, and it spends just 0.7 percent of its GDP on benefits for families—a fraction of what other middle- and high-income countries spend.

“Among 21 countries in the study,” the organization writes in an accompanying statement, “the U.S. ranks second-to-last in the percentage of its GDP spent on benefits for families, despite one of the highest relative child poverty rates of the comparable high-income countries.” (Turkey technically ranks last, but only because its data is missing.)

Spending on Family Benefits by % of GDP, by Country

As this map shows, Western European nations spent the most of all 21 countries in the study on things like cash transfers to families with children, tax benefits, and public services for families. The U.K. leads the way, spending more than 4 percent of its GDP on these benefits—much higher than the average for all the OECD countries.

Israel spent 2 percent, despite its large military budget. Even certain poorer countries managed to find the cash: Chile devotes 1.4 percent of its GDP to family benefits.

The U.S. comes in near the bottom, devoting less than one percent of its national income to perks for kids and parents. (Child Trends used data from the OECD and other sources.)

At the same time, the report suggests that American children are in dire need of this funding. A higher proportion of them live in poverty than do kids in most other industrialized nations. According to the report, 20 percent of American children live in households that earn less than half of the median household income. In Canada, that figure is 14. In Germany and Ireland, it’s 10. In the U.K., that great grantor of daycare subsidies and cash payments to moms, it’s only 9.

The country America comes closest to, in terms of the prevalence of child poverty, is Spain—yet Spain spends twice as much as the U.S. does to help parents.

As I’ve written previously, as many as a third of American moms find themselves struggling to afford diapers at some point. Studies like this reveal one reason why that might be.

The #LuckyGirl’s Lie

It’s rare for a social-media meme to inspire a book title, but for Jessica Knoll the hashtag “lucky girl” captured something fundamental about TifAni FaNelli, the twentysomething acerbic, status-conscious, and very insecure protagonist in Knoll’s novel, Luckiest Girl Alive. To Knoll, who is 31 and a former editor at Self magazine, #luckygirl, which has been used over a million times on Instagram, is a commentary on the split self that pervades social networks.

“There’s the image we present to the world—where we have the perfect wardrobe, the perfect body, the perfect fiancé—but inside we are just miserable or harboring some dark secret. That’s Ani in a nutshell,” Knoll said in a telephone interview. In this way, #luckygirl reflects something deeper—and perhaps pernicious—in contemporary culture: the pressure young women feel to be “effortlessly perfect,” as a landmark 2003 Duke University study coined it.  You have to have it all together, but don’t let them see you sweat.

Cosmopolitan.com opined that #luckygirl is “weirdly distancing in its annoying refusal to take any credit. It’s like the girl you graduated with who just explains her amazing job with a shrug: ‘I just got lucky.’” Instead of telling you she had three grueling summer internships, networked every day for months, and cold e-mailed 283 random people.

The “lucky girl” hashtag tells the world that everything just happened easily, without lifting a finger. For instance, the woman who writes #luckyat32 underneath the picture of her two adorable children might not have said that she had children after seven wrenching, expensive rounds of IVF. But social media isn’t a place for hashtags like #triedforyears; it’s an alternate universe where everything is attributed to good fortune.

Socality Barbie Hits Uncomfortably Close to Home

Love is the pinnacle of good fortune, at least on Instagram. But appearances, as we all know, are deceptive. “The ‘lucky girl’ hashtag makes it appear like you were walking along and simply got proposed to, not that you worked really hard to meet the right person and prioritized a relationship and actively tried to bring that into your life,” said Simmons.

Modern-day romance, particularly for straight people, might be closer to what Knoll describes: “You have all these discussions, wait for him to take action, and probably acted like a total wench in the process,” said Knoll. (Try conceiving a clever hashtag for that process.) “No one wants to admit having to work for love,” Knoll observed.

Still, maybe sometimes we really just are lucky. You show up a party and meet the love of your life. And, of course, effort doesn’t always beget love or the plum job.  But it doesn’t make the hashtag any less grating for its blatant envy baiting.

So why is there so much reluctance, or downright refusal, to acknowledge the blood, sweat, and tears most of us expend behind the scenes to end up with photos that we stamp with a tag that basically says “effortless”? On social media, we all want to be seen as ducks, a term researchers at Stanford University came up with to convey how, like the animal, young women want to be seen as gliding serenely along, but in fact under the surface are paddling ferociously.

called Luckiest Girl Alive, which is so far the number one best-selling debut of 2015, “a millennial guide to femininity” for its searing description of how young women are forced to perform, especially on social networks.

In reality, though, most of our jobs, relationships, and accomplishments are hard won. So wouldn’t it be refreshing if we talked more openly about how much effort—the antipode to luck—we exert to hold it all together (or even just moderately together)?

Perhaps in the first inkling of a cultural shift, the actress and writer Mindy Kaling said last year when talking about her appearance: “It takes a lot of effort to look like a normal/chubby woman.” And in her new book, Why Not Me?, Kaling, who is 36, writes, “I work a lot. Like a lot a lot … Hard work is such a weird thing. As children and teenagers you are told it’s a really good thing, but for adults it suddenly becomes the worst thing in the world.”

Can Game Theory Help to Prevent Rape?

One in five women who attended college during the past four years say they were sexually assaulted, according to a Washington Post-Kaiser Family Foundation poll published this summer, but only 11 percent told police or college authorities.

The reasons for the underreporting vary, but there seem to be four main pitfalls: Victims don’t want to draw attention to themselves or their assailants, don’t know if the incident truly constituted “rape,” are worried they won’t be believed, or don’t know whom to report to.

A new site, Callisto, aims to make it easier for college students to document—and report, if they wish—their sexual assaults. With Callisto, a student can fill out a timestamped record of the incident and then choose between three different next steps.

First, they can send it directly to their campus Title IX coordinator, the point-person for student investigations. The writing process helps, Callisto’s creators believe, because it might reduce the odds that college administrators will handle the matter insensitively.

“Our hope is that … the Title IX coordinator will be able to have a more nuanced conversation,” said Tracey Vitchers, director of development and operations for Sexual Health Innovations, the nonprofit that designed Callisto. “That way the survivor won’t be in a position where they have to tell and tell and retell what happened to them.

Second, the student could simply save it and decide whether to file it later. Finally, the student can put the report into “matching,” meaning the report will only be filed if someone else reports an assault by the same perpetrator.

It’s this last option that makes Callisto unique. Most rapes are committed by repeat offenders, yet most victims know their attackers. Some victims are reluctant to report assaults because they aren’t sure whether a crime occurred, or they write it off as a one-time incident. Knowing about other victims might be the final straw that puts an end to their hesitation—or their benefit of the doubt. Callisto’s creators claim that if they could stop perpetrators after their second victim, 60 percent of campus rapes could be prevented.

This kind of system is based partly on a Michigan Law Review article about “information escrows,” or systems that allow for the transmitting of sensitive information in ways that reduce “first-mover disadvantage.” According to the article, economists also refer to this as the “hungry-penguin problem:”

Hungry penguins gather at the edge of an ice floe, reluctant to dive into the water. There is food in the water, but a killer whale might be lurking, so no penguin wants to dive first.

With Callisto, no one has to be the first penguin. And as game theorist Michael Chwe points out, the fact that each person creates her report independently makes it less likely they’ll later be accused of submitting copycat reports, if there are similarities between the incidents.

Callisto is being piloted at Pomona College and the University of San Francisco this year, with plans to expand it further if it’s successful.

No One Really Understands How to Treat Menopause

For men, middle age brings the promise of little blue pills and little clear gel packs—Viagra and testosterone to combat the indignities of aging. For women, when things get hot, complicated, and fuzzy, turning to hormones for relief is a trickier proposition.

“It’s like my brain is on spin,” says Kathy Kelley, the founder of the website Hyster Sisters, which offers resources for women going through hysterectomy and early menopause.

Kelley had her uterus and ovaries removed when she was 41, and though she took estrogen to replace the hormones her ovaries used to produce, she says she felt an almost immediate change, a sort of brain fog. Among the community of users on her site, the stories were worse for those who decided to go off their hormones.

“We’ve seen it create some devastating effects for women [who are] afraid of taking hormone therapy when that’s exactly what they need,” says Kelley.

Menopause is the term for the end of a woman’s menstrual cycle, which occurs on average at age 51. In the years leading up to and after menopause, a whole host of symptoms can crop up as a consequence of the slowing flow of hormones (less than 30 picograms per milliliter of the hormone estradiol in the blood usually indicates a woman is postmenopausal, according to the U.S. National Library of Medicine). Symptoms include hot flashes, insomnia, memory problems, anxiety or depression, and weight gain. Replacement hormones can ease those symptoms, but the choice to use hormone therapy is not that simple. There are compelling reasons why women might not want to take hormones including a greater risk for stroke and breast cancer. And, given the dubious history of treating menopause, it’s not surprising confusion still reigns.

If a woman were lucky enough to live to middle age in the previous centuries, she really wouldn’t want to try any of the then-available treatments for menopause. Prior to the 18th century, physicians thought that menstruation was a way to rid the body of toxins. To that end, menopause treatments meant attempting to restart the flow of blood, using leeches on genitals or other forms of bloodletting.

The symptoms of menopause were only recognized and named in the 1800s. By the early 1900s, crude experiments attempting to relieve the symptoms included transplantation of ovarian tissue into a uterine cavity and the sale of ovarian extracts or desiccated tissue for ingestion. Scientists were starting to understand that there was some important substance in the ovaries, but it took another 30 years to develop estrogen pills.

at 90 million.

This Is How Doctors Treated ‘The Menopause’ in 1953

Then came the results of the Women’s Health Initiative, a multi-year study on long-term use of hormones to prevent chronic diseases such as cognitive decline or cardiovascular disease. One trial ended early in 2002 after it was found that the combination progesterone and estrogen therapy caused an increased risk for invasive breast cancer. The second trial, which examined the use of estrogen on its own, ended early in 2004 because it found an increased risk for stroke, despite the estrogen being linked to lower risk for coronary heart disease. The results offered a complicated intersection of risks and benefits that were difficult to interpret. For instance, while progesterone plus estrogen was found to increase risk for invasive breast cancer, it also lowered risk for endometrial cancer. Another complicating factor is that the risks changed as people aged. Only 10 percent of the participants in the WHI study were younger than 55. The younger the woman, the less risk involved in taking hormone therapy (depending on their personal history). Likely because of this confusion, the results were misinterpreted when applied to menopausal symptom management, says JoAnn Manson, a professor at Harvard Medical School and one of the principal investigators for the WHI.

The goal of the WHI trial was to assess the balance of benefits and risks when hormone therapy is used for chronic-disease prevention in postmenopausal women, says Manson. Researchers were studying if long-term use of hormones after menopause would help cut risks for cardiovascular disease, cognitive decline, hip fractures, different cancers, and diabetes. The trial did not evaluate use of hormones for hot flashes, which tend to occur in the early stages of menopause. For younger women (late 40s, early 50s) going through early stages of menopause and using hormones to treat hot flashes, the risks for stroke, blood clots, and cancer are lower compared to someone using hormones over decades as they age into their 60s and 70s.

The misinterpretation of the findings “led to many women mistakenly being denied treatment for their hot flashes and night sweats,” says Manson.

The threat of cancer and stroke is scary, scarier than hot flashes. The WHI sent many women back to “natural” remedies—not leeches but cold wash cloths, flax seed, herbs, and untested “natural” sources of hormones like soy, black cohash, and yams (a precursor to progesterone was originally isolated from Mexican yams). Use of hormone pills plummeted from almost 20 percent of women 50 and older in 2000 to 5 percent in 2009.

The basic conclusion of the WHI still stands: It’s not advisable to use hormones to prevent chronic disease. There are cancer and cardiovascular risks that come along with hormone treatment for postmenopausal women, depending on their health and family history and the dose and combination of hormones. But that doesn’t mean women shouldn’t use hormones for early symptoms of menopause. That message still needs to get out, according to Manson.

first to be officially approved for hot flashes. Its approval was controversial, since the clinical trials showed only minimal improvement in participants’ symptoms. A majority of the FDA advisory committee that oversees approval of reproductive-health drugs voted against Brisdelle’s approval, but the FDA took the rare step of going against the committee’s recommendation.

Kelley says she, too, has heard mixed reviews of Brisdelle. She hasn’t used it herself, but she is open to the idea of using an antidepressant.

“I used to laugh and say, I don’t care if it’s bat wings and the eye of snakes,” she says. “If it’s going to make me feel better, I need to take it.”

The choice to do hormone therapy is not just about taking estrogen or nothing. Women may also fare better with transdermal patches that can offer lower doses of estrogen than pills do, and the estrogen from patches bypasses the liver, which lowers the risk for blood clots.

Recent studies have also found that different formulations of estrogen, like estrodiol, have less risk for cardiovascular disease than the traditional estrogen formulations called conjugated equine estrogens (CEEs).

There’s also another class of drugs available, called selective estrogen-receptor modulators (SERM), that can provide hot-flash relief and symptom relief for osteoporosis (estrogen loss is linked with bone density loss) without as high a risk for blood clots or breast cancer. A SERM paired with estrogen can offer the benefits of decreased endometrial cancer risk without the risks of increased breast-cancer risk that come with the combination of  estrogen and progesterone.

Confused yet? To help with this complicated terrain, there is now an app for menopause.

The North American Menopause society has put together a free app called MenoPro that crunches the various factors in a woman’s health history and risks for menopause treatments and can offer guidance for what women should do.

“There are many more options [now],” says Manson. “I think it’s really important that women be actively involved in the decision-making process.”

Kelley is almost 60, and she’s been taking estrogen over the years, in smaller and smaller doses to replicate the slow decrease of hormones in natural menopause. But she’s now in that age group where risk factors for cancer and stroke come more into play. Kelley says her heart is in good condition, and her bone density is good. “I don’t want to give that up for a frail body, just yet, but that’s a decision that we all have to make. I’m still taking my estrogen, they’re going to pretty much have to pry it out of my hands.”

Why ‘Manic Pixie Dream Girl’ Won’t Go Away

In 2014, the movie critic Nathan Rabin publicly apologized for coining the term “Manic Pixie Dream Girl” and called for the world to stop using it. The world has not listened. The Oxford Dictionaries recently canonized the phrase, defining it as “a type of female character depicted as vivacious and appealingly quirky, whose main purpose within the narrative is to inspire a greater appreciation for life in a male protagonist.” And now, the actress who played one of the most famous MPDGs ever has endorsed the term as useful.

On a panel before the Toronto Film Festival, Natalie Portman was asked about MPDGs in relation to her role in 2004’s Garden State, in which she plays Sam, a whimsical and mentally troubled young woman who teaches Zach Braff’s character to love the Shins:

When I read [the Garden State script] I was like, ‘Oh, this is a character that’s wacky and interesting, and no one’s ever given me a chance to play something like this. It’s this sort of unusual girl. So that was my incentive to make it. But of course I see that trope and I think it’s a good thing to recognize the way those female characters are used. I mean, I appreciate that people are writing characters that are interesting and unusual, rather than some bland female character as the girlfriend in a movie, but when the point of the character in this movie is to, like, help the guy have his arc, that’s sort of the problem, and that’s why it’s good that they’re talking about it, because it certainly is a troubling trope.

Maria von Trapp: The Preeminent Manic Pixie Dream Girl

It’s a nuanced point of view, one that helps clarify a term whose status has become so contested. In his renunciation, Rabin wrote that the phrase had become too commonly used to demean any and all quirky female characters rather than to encourage better screenwriting. The filmmaker and actress Zoe Kazan went further, calling the term “basically misogynist.”

But Portman, helpfully, parses the difference between an individual character and a trope. The story of Sam in Garden State, she said, was appealingly “wacky,” unique in its universe and in the universe of roles that Portman has been asked to play. But evaluated next to other female storylines in movie history, it fell into a tradition that, intentionally or not, reinforces the idea that women exist to please men. Talking about the cliche, Portman suggests, is a way of fighting it. At The Guardian last year, Ben Beaumont-Thomas made much the same argument: “By lampooning it in a tangy phrase like MPDG, a trope which has creeped along suddenly gets the light shined on it, and its ridiculousness becomes so well articulated that it’s difficult to get away with it again.” It’s likely, then, that those four catchy words won’t go away until the thing they describe does.