When I walked into the Autism revolution, about four years ago, I had a lot to learn about co-advocacy. I had to learn to co-advocate with people who believe something different than I believe, either because they come from different values, or because they interpret the same data as me, but they do so through different lenses. Some of these were other professionals, but adding onto this, I had to learn to co-advocate with parents (who, unlike me, actually have kids with autism) and autistic self-advocates. One particularly difficult thing was to co-advocate with people who believe vaccines cause autism. The evidence does not support this claim, in spite of extensive testing. I think there’s a limited hold out for a complex relationship between autism and vaccines*, but a gross one – in which vaccines cause autism, appears unlikely.

What did I do? Well, primarily, I respected differences, and asked for respect for differences. When parents ask me about vaccination (e.g., for the younger or not-yet-born sibling of a child I evaluate), I tell them that, while there is a lot we do not know, all the evidence we have says that the risk of not vaccinating is much, much worse than the risk of vaccinating, and if/when I have to make this decision for my child, at this point my plan is to follow national recommendations for vaccination. In return, I don’t fight or argue about vaccination. I don’t insult parents who are using the information available to them to make the best decision they can, although I tell them what I think if I am asked. Although I do believe in herd immunity, at least for the time being, I take the nuanced decision, most of the time, to not be a partisan in this argument, e.g., about legal regulations that increase pressure to comply with vaccination (I do think this needs to be resolved somehow). And I focus on what we believe in common – that kids with autism are crawling or walking around, right now. Most of the anti-vaccination parents I know respect my desire to do everything I know how to do (and figure out new things I don’t know how to do, yet), to help the kids we have now develop the ability to identify, chase, and catch their dreams, whatever they may be.

Why this digression into autism? Tuesday, at the annual meeting of the American Association of Children’s Residential Centers, I got to go to some excellent workshops on commercial sexual exploitation of children (CSEC). What is that? Well, it is a broader definition of whenever children are used in the sex trade. It includes prostituting children, or selling sexual access to them. It includes trafficking them for the purpose of sexual slavery. It includes child pornography. So CSEC is a wide net. The best available information we have is that about half of people who end up in the sex trade do so by age thirteen**, and so it also means that CSEC is big business, with an estimation of 200,000 children in the US caught up in this. 

There is increasing visibility to this issue (incidentally, as many as 1/3 of CSEC victims are boys… their visibility is only just beginning…)

One interesting (but potentially heart-wrenching) complication of this conversation is that it poses child/youth welfare advocates (like me) and people who identify as victors over CSEC or survivors (like the brave and fierce woman who gave part of the plenary) potentially at odds with feminist sex workers (including some friends and allies). They have been gaining significant visibility within the national feminist conversation, in the last couple of years. They emphasize a point with which I unconditionally agree: feminism must be for all girls and all women. If I want to stand proud and tall as a woman, feminist sex workers should be able to do the same, and if I should be celebrated as a proud, tall woman, so should they.

This conversation probably isn’t just going to go away…

Feminist sex workers, as adults in an industry, including some personal friends, are trying to make inclusionary inroads, as well as to fight for women as subjects and not just objects of the sex trade. What they seek is the ethical commercial use of sexuality. In fairness to them, the use of sexuality commercially is pandemic and arguably endemic to the commercial economy***. If commerce can even be de-linked from sexuality, this is a long-term fight for the sisterhood, and not one that will be won today. In the meantime, ethical use of sexuality commercially, and particularly ethical use of adult women’s sexuality, commercially, thus remains a vitally important fight for all women (yes, all women). This is especially in an American Life where sexual messaging is getting much more pervasive over time. See for instance this, which came across my Facebook wall just today.

In the meantime, I am honestly somewhat ambivalent about the idea that at least some elements of commercial use of sexuality  – pornography, prostitution, and I don’t really know what I think about things like sex hotlines or professional dominatrices – can be ethical for either men or women, but particularly when it is women who are being sold or selling themselves. And my ambivalence is a moderate position – many voices in the CSEC world, if asked this abstract question, say that this is like asking how to make slavery ethical. And I think their point deserves more than to be brushed off, since they are not talking abstractly but from personal experience.

So there’s the dilemma – we are all advocates for women and children, but how do we advocate for helping girls and young women “escape” from sex work, rescue themselves, survive and become victors over their captors, alongside people who advocate for an ethical sex trade?

Well, first, we start with common ground. I’m a libertarian in my moral philosophy (apparently, just today, I found another hero, Madeleine L’Engle, was, too!), and I believe strongly in work and diligence. I think having a job (and I get to have not just a job, but an overarching passion) is a good thing, and I want to see all people working and being productive citizens. Well, I want to see all adults working and being productive citizens. Just because I believe work is ethical (and I’m proud to work) does not mean I believe child labor is ethical. So if my feminist sex worker friends turn out to be right, and they can create an ethical system, maybe we’ll end up fighting for a future world where CSEC does not happen, at least in the sense that child labor is greatly reduced or eliminated here****, and in the sense that we are relatively aligned on the goal of eliminating it everywhere, without any suggestion of eliminating work or productivity or self-sufficiency for adults, anywhere. Feminists who want an ethical sex trade should not want children in the sex trade, for all the obvious reasons why this will never be ethical. So this aligns us in a powerful way.

I’m late to the party… this Krishnan is way more fierce than I am, although hopefully the more Krishnans we get in on this, the better. Click the pic to listen to Sumitha’s TED talk.

And certainly, CSEC survivors, victors, whatever identity they choose for themselves – these women (and men) are all about being proud of themselves and owning their own dignity. So, second, we respect each other. I am a radical feminist who is not sex-worker exclusionary, and will not be sex-worker exclusionary – whether those sex workers are victims or agents of their own destiny. My road to helping the victims of CSEC is not via fighting feminist sex workers, and although working in the CSEC space is still something I don’t understand well, I don’t think it’s any place for anyone who believes in a feminism that doesn’t have room for all women. I ask back for respect for my very clear, consistent, and credible stance of being a sister who fights for all the sisters, not just the sisters who look like me.

This is a good thing. Like my experience with autism, which made me a better neuropsychologist, a better leader, and a better supporter, this makes me a better woman, a better feminist, and a better ally. I’m so thankful that I had this conversation as part of my experience at AACRC, really glad I got to meet a victor of CSEC and get to know her story a little bit*****, and glad that this will make me a better ally. When it comes to sex work – a thing I haven’t experienced, even if I have tools and abilities and visibility that I could leverage as an ally to help end CSEC – I’m going to have to be corrected by both victors over exploitation and feminist sex workers, because I’m sure I’m ignorant. I am going to have to be warned, harken, and correct, when I overstep my ally role. But being together, and running into the arms of all my sisters who are part of this conflict, and not away from them, is going to be crucial if I am serious about making this world a better place … for kids with autism and their families, for my wizards in training, for all girls, for all women, and for all people.

Yet another heroine of mine.

And serious, friends, is the kind of princess I am.

* The hypothesized pathway here is immunological, which makes some potential sense based on the fact that immunological response regulates cortisol levels, which in turn regulate testosterone, and, as I’ve pointed out before, spiking fetal testosterone is the best available mechanistic pathway for not why, but how autism happens. The holdout I have in mind is the possibility that some children, who are already autistic, have a catastrophic immunological response to vaccination. This does not cause autism, but it takes the child’s situation possibly from one where autism is associated with relatively limited disability, to one in which it is associated with severe deficit. There is not current evidence for this, excepting the anecdotal stories of children regressing after vaccination, but in fairness, this is not the hypothesis the vaccination studies have generally been evaluating, so it cannot be ruled out, yet (versus the existing “null hypothesis,” that the timing of regression and vaccination is a coincidence).

** The methodology at arriving at some of these numbers is tricky. I was asked an interesting question on Twitter about the median number being this low, and there is some data that suggests that there is a big clustering of youth with CSEC onset around 12-14 years of age. On Twitter, I didn’t want to get overly technical, but the technical response to the claim that the numbers are unlikely to be true due to the assumption that median and mean are close together in large samples, and the median in this range indicating a large population of very young children in prostitution is not necessarily true for two reasons, namely that the distribution is not Gaussian and is also likely leptokurtic (the point about the 12-14 year old population). To the former point, about Guassian distribution, there is clear heterogeneity in this population – child pornography and victimization by pedophiles usually occurs at younger, prepubescent ages, whereas youth victimized by pimps or otherwise prostituted are typically older. But to say this in another way, adults in the sex trade are victims of CSEC something like 80% of the time.

*** Echoing the aphorism / joke that the sale of women’s bodies to men is the oldest profession.

**** Which is not good enough – it still happens all too often in developing countries, and not in an abstract sense, but often contributes directly to the economies that make our iPhones and our body con dresses and our statement necklaces.

***** Without side-tracking this story, one of my favorite things about this, which I tweeted, was that when she was introduced, the psychiatrist from Devereaux who introduced her explicitly and firmly stated that we would not start by asking her to “share her story,” because this is objectifying, gratuitous, and can be re-traumatizing. This totally made my conference – I talked to this sister after the program and we gave each other a big hug. I shared with her how, as a transgender woman, I loved this so much, because often times, I feel paraded out to tell a story or narrative that isn’t the one I want to tell, to satisfy the gratuitous needs of others. This is exactly in line with why I don’t do before and after pictures, I rarely, if ever, talk with cisgender people about my medical transition decisions, and I insist on owning a narrative in which I am proud to be transgender, in which I love who I am, I love what I am, and I love my life. For real – I go into work everyday to do the job of a lifetime, leading a passionate, creative, loving, and talented group of young professionals, and I come home every night, to lie in the arms of my once in a lifetime love. I could not have written a work of fiction that I love more than my actual life.