Action needed on reproductive tourism


Over the past few months, the media has been abuzz with news and international debate over the story of ‘Baby Gammy’ – the twin with Down’s syndrome who was left in Thailand with his Thai surrogate mother, who was commissioned by a West Australian couple.  While some of the facts of the story remain contested, this is one of many ethically charged cases of reproductive tourism that have surfaced in the past decade.

The demand for third party reproduction – whereby a woman provides her uterus (as in surrogacy), and/or a person provides sperm, eggs or embryos in order to enable a person or couple to have a child – is on the rise. Increasingly, couples will travel to countries where laws are more permissible and/or services are more affordable to seek third party reproduction. Countries including Cyprus, India, and Mexico have become prime reproductive tourism destinations.

With the growing demand for third party reproduction, cases such as this one bring to the forefront questions about the commodification of body parts and the human reproductive capacity. They beg the question: what are the ethics of selling body parts, and reproductive labour? Should we be selling these at all? Additionally, is it ethical to be outsourcing gamete donation and surrogacy to countries, like Thailand, where labour is less costly?

A lucrative market

As this industry continues to grow, we should not close the dialogue on these types of questions. This market, however, is a unique one – at its foundation is the reproduction of life itself. Coupled with a powerful socially constructed notion of a biological imperative, and norms surrounding motherhood, fatherhood and family, it is driven by individuals and couples who will go to great lengths to have a baby. This market is a lucrative one – with the potential for high profitability for clinics and agencies, as well as for donors and surrogates. Thus, operating on the premise that for these reasons the baby business will persist, if we have learnt anything from the Baby Gammy case, it should be that our immediate focus orientates about identifying the pressing issues of this industry at the level of those involved. From there, we can try to minimise any negative ramifications for intended parents and the surrogate.

While I will not attempt to provide an exhaustive list, Baby Gammy and similar cases, give us some insight into what these issues might be. The Baby Gammy case, in particular, highlights those issues surrounding the exchange between intended parents and the surrogate. Both parties are vulnerable to not receiving their ‘goods’ (i.e. the surrogate not receiving full, or any, payment and intended parents not receiving the baby). Additionally, a surrogate may end up with a child, as in the case of Baby Gammy, that she did not intend to have. How do we ensure that contracts are created that protect the interests of both parties, and that these contracts are enforceable?

Second are those issues surrounding consent and care of the surrogate. What steps can we take to ensure that surrogates are well informed about the procedure and risks (both physical and psychological) in order to minimise the possibility of coercion and encourage informed consent. Subsequently, how do we ensure that surrogates receive proper medical care? Thirdly, there are issues surrounding the uncertain legal parentage and nationality of children born through surrogacy. Might we be able to increase transparency surrounding the process of achieving citizenship for children born of surrogacy? Alternatively, could we enable it in some instances, without opening the floodgates for reproductive tourism?

While the Hague Conference on International Private Law is considering drawing up standards and regulations for international surrogacy, this will no doubt be a long-term undertaking.  In the meantime, major fertility professional bodies and leaders in the field need to take a role in promoting acceptable standards of care and addressing issues arising from reproductive tourism.  The case of Baby Gammy has highlighted some of those issues that are pressing. With international attention focused on reproductive tourism, now is the time to harness this attention in order to promote dialogue surrounding this industry and take steps towards reducing harm for those involved.

*Katie Hammond [2011] did an MPhil in Multi-disciplinary gender studies and is currently at Wolfson College studying for a PhD in Sociology at the University of Cambridge. This article was first published on  Picture credit: BBC.


Wisdom from a writing workshop: plans, practices and places to go


On September 24th, I joined with a fellow tribe for a one-day workshop on writing techniques. The tribe: social scientists (PhD students and post-docs) with aspirations of writing longer pieces related to health and illness.

I’m writing to share what I learned.

Multiple pressures confront us. The juggle of two or three research projects running concurrently. A brain divided between managing research and putting pen to paper. The challenge of avoiding poor writing and reaching for our best voice.

To take on these challenges, we used the day to explore ideas and practices related to writing. Matt Lane (Post-Graduate Skills Training Officer for the University of Cambridge) led the morning session with interactive lectures and small group work, with the afternoon focused on our own individual writing projects within a group setting.

A few key pieces of wisdom emerged.

Planning to write

“In preparing for battle I have always found that plans are useless, but planning is indispensable.” – Dwight E. Eisenhower

Eisenhower’s view of battle is apt for writing. Many inputs go into writing a piece: finding a topic, defining a research strategy, executing the research itself and writing smaller, cumulative pieces. Yet taking the time to plan these inputs often escapes us. “Just write!”, says the self.

But a little planning can indeed be indispensable. Lane encouraged us to view our writing projects beyond the completion date: what does wild success look like? What are all the things that need to get done to achieve this success? And perhaps most importantly: what’s the next immediate action you can take? Making this process concrete seems obvious, but is often a step that writers skip.

When it comes to finally composing a piece, Lane encouraged us to “write in layers”. Build the intellectual and rhetorical architecture, whether via an outline or topic and transition sentences. As we build the layers, Eisenhower’s voice returns: earlier plans for the piece often will get replaced with a new sense for direction. As the architecture of the argument and piece is built, attending to the body of paragraphs will come more naturally.

Practices for the moment

Before a run, I usually stretch for a few minutes. But just before starting to write, my usual thought is: let’s get started! Lane encouraged us to use “writing warm-ups” for 5-15 minutes just before digging into a writing project. A warm-up prompt could be what do I want to find out today? What did I learn yesterday? What was I thinking about in the shower or over breakfast? A few minutes of warming-up activates the brain. I’ve been trying this approach, and it’s been working!

The next practice on the list: time management. Often, when thinking about writing a longer piece, many of us imagine blocking out a week and large chunks of time during the day. But this perception can backfire. With the thought of large blocks of time, distractions more easily infiltrate the day. Uninterrupted sitting in front of the computer goes from minutes to hours. A long writing session might end with only a few minutes of real productivity. Instead, write in smaller chunks of time. Take a break after 45 minutes of focused attention. Set micro goals – completing a paragraph or section, for example – and have the discipline to walk away from the writing for a short break before returning to tackle the next goal.

Finally, in the afternoon, we tested “writing groups” to work on our individual projects. Writing in groups allows members to verbalise goals, hold each other accountable and act as a support group to work through road-blocks. While writing alone is the norm, having people around can make the process more fun and productive. I had one of my most productive afternoons of writing in weeks!

Places to go for more resources

Spending intentional time to reflect on writing practices carries many benefits, such as figuring out new practices and habits worth trying out. The other benefit are the new resources that can be used for further exploration and learning. Here are a few places to go:

Check out a Cambridge writing group

How to Write a Thesis, Rowena Murray

The Craft of Research, Booth et al.

Getting Things Done, David Allen

For some inspiration, check out one of my favorite places to go: Brainpickings. Search for pieces on writing, and you’ll be sure to find many gems.

*Victor Roy [2009] is a second year PhD student in sociology and political economy as a Gates Cambridge Scholar. He is also an MD candidate at Feinberg School of Medicine in Chicago as a Paul and Daisy Soros Fellow for New Americans. Picture credit: Sakhorn38 and

Will India and Japan forge a New Asia?


Amid the cheering of nearly 20,000 supporters and the vocal protests of academics and human rights advocates, Indian Prime Minister Narendra Modi’s theatrical appearance in New York on September 28th embodied many of the contradictions of his highly polarising popular mandate. Still, despite the attention understandably being drawn to Modi’s first visit to America (having previously been denied a visa due to accusations of complicity in the Gujarat killings of 2002), his visit to Japan one month previous may prove in the long term to be more significant.

Much has been said about the economic and geopolitical potential of a stronger relationship between India and Japan, widely acknowledged as two of the key powerhouses of the 21st century. On issues of defence, demography and technology both countries complement each other well, with India offering a youthful labour pool and massive market in contrast to Japan’s ageing population and potential for technological investment.

In assessing this relationship, however, some have gone beyond economic analysis, arguing that ‘historic links’ or ‘civilisational’ harmony can provide the glue for a relationship that transcends political pragmatism, with Modi himself saying that his visit to Kyoto “reflects the ancient foundations of our contemporary relations.” As Asia regains its historic role as the economic and geopolitical centre of gravity in a world-system that has become global, it is worth thinking about how these civilisational arguments can be interpreted within a broader context of modern Asian history and political thought.

Interwar Pan-Asianism and why it matters

Following widespread disillusionment with Eurocentric visions of modernity in the wake of the horrors of the First World War, similar arguments regarding the shared heritage of India and Japan were used by thinkers such as Rash Behari Bose in order to present a powerful counter-narrative to the oppressive status quo of Western imperialism. Not to be confused with the more famous Subhas Chandra Bose, Rash Behari Bose was a Bengali revolutionary who gained widespread notoriety when he threw a bomb at Lord Hardinge, the Viceroy and Governor General of India, during a triumphal procession at Delhi in 1912.

Fleeing British authorities in India, Bose lived out the rest of his life in Japan, where he became an important and influential advocate of Asian unity. At Nagasaki in 1926, Bose attended an international conference with representatives from all over Asia, whose stated goal was “to bring about permanent world peace based on justice and equality and secure the freedom and happiness of all races without regard to class, racial, or religious differences.” This ideology, called Pan-Asianism, argued that a new diplomacy centred in a ‘New Asia’ was the solution to an international system suffering from the twin scourges of capitalist imperialism and socialist materialism. 

Despite the enormous potential of the ideology in charting an alternative course for international politics, Pan-Asianism came to be appropriated as a political strategy by Japanese nationalists seeking to enhance the legitimacy of their own imperial agenda in the build-up to the Second World War. Aligning Pan-Asianism with right-wing militarism resulted in a loss of credibility for the ideology, particularly among Korean and Chinese intellectuals suffering under Japanese imperial ambitions, and the New Asia envisioned by Bose vanished into obscurity in the postwar period.

Understanding the global political thought of interwar radicals like Rash Behari Bose can provide a useful framework for charting potential courses for bilateral relations between countries like India and Japan in the

21st century. With the motivations of both Narendra Modi and Japanese Prime Minister Shinzo Abe being questioned by critics wary of right-wing nationalist agendas, the story of interwar Pan-Asianism should be a source of both optimism and caution. If this is the dawn of Bose’s New Asia, the willingness of leaders to learn from the past may play a key role in shaping the course of the future.

*Joseph McQuade [2013] is doing a PhD in History. Picture of Narendra Modi. Credit: Mayur Bhatt and Wiki Commons.

Male allies sought for battle against female discrimination

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In international development, focusing on eliminating discrimination against women and girls has never been more popular. We’re told that the recipe for development is simple: empower women and girls.

UN Women promotes female empowerment as “essential to build stronger economies, achieve internationally agreed goals for development and sustainability and improve the quality of life for women, men, families and communities”. The World Bank sees empowering women as a path to achieving economic stability. The Nike Foundation’s Girl Effect, a movement about “leveraging the unique potential of adolescent girls to end poverty for themselves, their families, their communities, their countries and the world”, describes them as playing “a crucial role in solving the most persistent development problems facing the world today”.

This identification of girls and women as the key to development work was progressive when it evolved during the 1970s.

At the forefront of this shift was economist Ester Boserup, who pointed out that the majority of unpaid agricultural work in developing countries was done by women.

Given this, she argued that the lack of attention paid to women’s issues was not only an issue of gender inequality but also a hindrance to economic development. In 1995 participants at the Fourth World Conference on Women in Beijing declared “the advancement of women and the achievement of equality between women and men are a matter of human rights and a condition for social justice and should not be seen in isolation as a women’s issue”.

The enunciation of the role of girls in development is more recent. It became visible in the mid-1990s with increased campaigning around gender equality in access to education. But rather than solely an issue of social justice, investment in girls – and women – came to be seen as producing high returns on family, community and national well-being.

Unfair burden

That greater attention has been paid to the situation of women and girls, as well as their contributions, is certainly something to be celebrated.

But by now it’s time to question if the pendulum has swung too far. And to ask whether it might be unfair to place the burden of development on just one half of the population – what about more male allies?

The idea that men and boys should figure in to discussions about gender inequality is not new.

The White Ribbon Campaign, which began in 1991 in Canada, is the world’s largest movement of men and boys working to end violence against women and girls and promote gender equity. Recognising that acts of violence against women are overwhelmingly perpetrated by men, the now global campaign sees men as a necessary part of the solution.

Other organisations – Promundo, NOMAS, Men Can Stop Rape and MenEngage, to mention just a few – have been working to engage men and boys.

UN Women’s He for She Campaign, launched in March of this year, is another more recent and noteworthy initiative. Using Twitter and YouTube as platforms, the campaign asks men to speak up for gender equality by posting messages of solidarity to the cause. Hollywood heartthrobs such as Matt Damon and Patrick Stewart, humanitarian luminary Desmond Tutu and UN Secretary General Ban Ki Moon are among the campaign’s supporters.

Any single one of these efforts isn’t a panacea, but they all play an important part in achieving a common goal.

Men missing in UN debate

While these groups seem to be gaining steam, their messages still need more amplification.

Men are largely missing from a major part of the debate around the Post-2015 United Nations Development Agenda. The set of priorities laid out in this agenda will eventually replace the UN Millennium Development Goals, known as the MDGs, a shared framework for global action and cooperation.

This framework is highly influential. International development actors push initiatives that reflect the priorities of the eight MDGs. Variants of micro-finance and conditional cash transfers – popular with all of the aforementioned crowds – are examples of widespread programmes that are used to achieve any combination of MDGs No. 1, 2, 3, 4 and 5, which target, respectively, poverty, universal primary education, gender equality, child mortality and maternal mortality.

In line with the belief in women as the engine of development, low-income women are usually the targeted beneficiaries of these programmes. In the case of conditional cash transfers, for instance, women receive cash stipends that require them to take advantage of prenatal exams and classes on nutrition and hygiene, and for their children school attendance and regular health checks. Evidence for the success of micro-financeand conditional cash transfers in empowering women is at best mixed.

And one thing we do know at this point is this: MDG No. 3, the promotion of gender equality and empowerment of women, isn’t going to be met.

Two changes

To address this, we can’t keep doing the same things. We need to make two changes. First, end the relative absence of men when we talk about and structure initiatives around “gender and development.” Second, acknowledge – and learn from – the organised efforts of men who are already committed to gender equality.

Because we currently fail to sufficiently do these two things men remain largely absent from crucial debates such as the one around the Post-2015 UN Development Agenda.

That men are missing from these conversations has at least three major ramifications. First, we disproportionately burden women with responsibility for development and the reduction of inequality. Second, we foreclose opportunity for men to express that they care about their wives, mothers, sisters and daughters. Third, we’re missing out on the power of half of the population.

We might be several months away from ringing in the new year, but crucial conversations about the post-2015 development agenda are happening now.

This month, at the 68th session of the UN General Assembly in New York, UN Women will be pushing for the inclusion of women’s rights and gender equality. Discussions happening there, as in conference halls and meeting spaces across the globe, could be highly influential.

We are currently at a pivot point – an opportunity to shift the conversation around the achievement of gender equality and who bears responsibility for it.

Some might worry that if men join this conversation women will once again be drowned out. This is valid. Men’s voices often take over and are the loudest in policy circles, upper level management of non-governmental organisations and government everywhere in the world. But disproportionately burdening women isn’t right – nor is excusing male absenteeism.

The male-driven or male-inclusive efforts underway embrace a hard-line assumption that gender equality is not a project for half the population, but for the whole one. If we give them more attention and support that can only boost the flagging global efforts to protect, educate and empower girls and women.

*Tara Cookson [2011] is doing a PhD in Geography. She researches women’s rights and development. She has worked as a project developer with marginalised communities in Canada and Latin America. Find out more about here at This blog was first published on Picture courtesy of

Obesity crisis is not just a lifestyle issue

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The “obesity crisis” has been given much media attention in recent months for two important reasons: there are many more people who are overweight and obese now than a generation ago in most countries worldwide, and there is a rising trend that is more than experts previously predicted. The UK in particular has the highest levels of obesity across Europe which has trebled in the last 25 years, while Mexico has the highest rate of increase in levels of obesity across the globe. Carrying extra pounds has many health consequences which create a heavy burden on the individual as well as their families and society more broadly. So, there is indeed a great need to raise public awareness about the importance of keeping a healthy weight and how governments and care providers can support people in doing so.

The causes reported in the media and elsewhere often focus on an individual’s balance between the energy consumed and the energy expended. And it is the consequences for national welfare, particularly for cost-constrained healthcare systems, that place obesity and its causes high on the agenda of policymakers. However, experts and researchers in the area recognise that the causes of obesity are complex and extend beyond an individual’s lifestyle choices related to diet and physical activity. Both sleep and stress are known to influence a person’s weight, but much less attention is given to these factors and to initatives that tackle them such as stress management.

More importantly, obesity is a prime example of a social inequality in health because not all social groups have the same levels, or rates of increase, of obesity. For example, there are strong and consistent educational differences in obesity levels such that lower educated groups have a higher proportion of individuals who are obese.

Financial hardship

However, even when individuals share similar levels of education (or social class or wealth), they may differ in their experience of everyday financial troubles. One of the largest drains on disposable income, especially for older people, is paying bills and affording adequate food and clothing. Yet both policy and health research give little attention to how financial hardships may be a unique determinant of obesity.

Recent research on British adults aged 50 and over showed that different types of financial hardship were more strongly correlated with the likelihood of obesity than education, social class or home-ownership. Findings also showed important differences between women and men in which type of financial hardship was most related to which type of obesity. In women, both body mass index (general obesity) and waist circumference (central obesity) were most likely to be highest when they reported the greatest level of difficulty paying bills. In men, greatest difficulty paying bills was most strongly related to a higher odds of general obesity while having less than enough money for needs was most strongly related to a higher odds of central obesity. Moreover, among adults employed in the British civil service, women but not men were more likely to gain excess weight (≥5 kg) when they experienced insufficient money for food or clothing at least twice or more over 11 years, after considering their education, employment grade and home-ownership. This study also found the relationship between financial hardship and excess weight gain remained robust to possible explanatory factors such as diet, physical activity, smoking and alcohol consumption.

Overall, current evidence indicates that public health policies need to consider the role of different types of financial hardship as part of strategies to support women’s and men’s effort to achieve or maintain a healthy weight. The research suggests, furthermore, that strategies to tackle obesity must address additional pathways of influence beyond energy balance.

Difficulty paying bills or frequently insufficient money for food or clothing is a bigger problem than simply an everyday financial trouble. A recent Science article indicates that financial concerns block cognitive function among poor individuals and that the impact of consuming more mental resources was comparable to losing a full night of sleep. Thus a considered approach to novel interventions could have significant health benefits.

*Annalijn Conklin [2011] has completed her PhD in Medical Science at the MRC Epidemiology Unit. Picture credit: and Stuart Miles.

The need for an Afghan voice in reform


The Western World is aware that international assistance is required to help rebuild less developed countries – providing institutional reform and capacity building that will, in turn, create a more democratic state. Unfortunately, there is a lack of awareness of what it takes to make these systems work in the different cultural settings. This is especially the case with Afghanistan, which is years behind in progress due to 35 years of conflict, and which struggles to maintain the proper equipment, electricity, literacy and so on needed for success.

Afghanistan is going through a critical period with the combination of the military drawdown and a transition to a new government leader. Therefore, international donor approaches should be realigned to coincide with this changing environment. In order to do this, it is important to speak with the Afghans who will, ultimately, be responsible for protecting their citizens and providing justice on a daily basis. In a recent report by USIP titled Rethinking Afghan Local Governance Aid After Transition, Francis Brown (2014) suggests that now is the time to reconsider donor approaches in order to ensure a successful transition in Afghanistan. In this report, Brown emphasises the need not only to re-examine top-down approaches in international aid, but to also consider bottom-up approaches simultaneously. It is the bottom-up approach, which the international community should recognise is the key to understanding the culture and what is needed for reform measures to be effective. Many scholars have studied the country – they understand the politics, they understand the culture, and they make recommendations for change. However, there may be a difference in the goals of the international community and those of the Afghan people.

For this reason, I have dedicated the last year of my life to understanding perceptions of the criminal justice system in Afghanistan from the perspective of those who are directly involved in the training – including Afghan trainees in criminal justice and their Western trainers. My research involves taking a closer look at criminal justice training programmes in Afghanistan, specifically police officers, lawyers and judges in training. I want to understand what the Afghan trainees believe to be the root of the problem and what they feel is needed most by the international community rather than how Westerners evaluate this. Therefore, I conducted interviews with Western trainers and I arranged for structured interviews in a written format to be distributed throughout Afghanistan, where Afghan trainees would be given an opportunity to speak their mind. I created questions about the rapport and the usefulness of the training and provided them with an opportunity to open up, and anonymously report what they felt was useful and what was lacking in the training and mentoring programmes. I posed questions such as ‘What do you see in the value of international aid?’,What are the challenges you face in delivering justice?’ and ‘What recommendations do you have in order to overcome these challenges?’. 

Tailoring training needs

With this research, I want to understand what prevents reform in transitional countries, such as Afghanistan, from progressing. If the international community opens the channels of communication with the individuals who are perhaps not the decision-makers or the leaders of the country, but rather the ones who are providing justice on a day-to-day basis, perhaps training and reform measures can be tailored to fit the needs of their local community and culture.

After hearing from numerous Afghans in the criminal justice sector and from their Western mentors, it is clear that it will take more than money, education, security and training to overcome the issues facing their criminal justice system. While this is, of course, a good start, successful reform requires participant buy-in. The individuals responsible for helping their country progress must first understand the importance of reform, and contribute to it by speaking up about their needs – whether it is based on training methods, topics or the cultural/religious needs for reform.

I feel privileged to have had the opportunity to talk with numerous individuals involved in the criminal justice reform and even more privileged to have been able to obtain the thoughts and perceptions from many Afghan trainees – including police officers, lawyers and judges. I hope research of this sort can be expanded to other areas of reform and spark interest in the international community to seek out more answers from the bottom.

*Lindsey Murray [2013] has been studying an MPhil in Criminological Research. Photo credit: Salvatore Vuono and

Embryonic knowledge


How does biology intersect with society? A pioneering inter-disciplinary project at Arizona State University is looking at the issue from the perspective of embryo research.

The Embryo Project, directed by Jane Maienschein and Manfred Laubichler, brings together researchers from a variety of disciplines who look at the history, science and various issues surrounding the growing fields of embryology, development and reproductive medicine. The goals of the project include: university education, research and public outreach. One of the major products of the EP is the Embryo Project Encyclopedia. This was the major focus on my recent time at ASU as a visiting scholar and fellow of the project.

The EP Encyclopedia is an online open access encyclopedia with an enormous selection of what are called “found objects” such as photographs and lecture slides. Additionally, it contains thousands of vigorously reviewed articles on topics such as people, technology, concepts, law, you name it, of importance to embryology, development and reproductive medicine. The target audience of the EP Encyclopedia are those with a ninth grade to undergraduate level education. Importantly, articles are written in an accessible way, making science and other technical concepts clear – even to those without a science background.

My time at ASU was spent working amongst a group of individuals from a large variety of backgrounds. Among the five visiting scholars alone, there were backgrounds in history, biology, philosophy and sociology. I was drawn largely to the reproductive medicine emphasis of the project because of my PhD research on assisted human reproduction. My PhD research on Assisted Human Reproduction has made me acutely aware of the importance of understanding the social and regulatory implications of developing science and surrounding technologies. My time at ASU certainly opened my eyes to a new range of perspectives on this interaction. I have begun to consider other issues at this intersection for which the sociology has yet to be explored. For instance, it further peaked my interest in the sociological implications of new technologies of AHR such as oocyte cryopreservation (or egg freezing), a technology that is rapidly growing in popularity since the American Society for Reproductive Medicine declared it to be no longer experimental in 2012. Other issues include the use of embryos or humans eggs for research, such as cloning.

During my time at ASU, I learnt how to write for the EP Encyclopedia, reviewed preliminary drafts of other scholars’ articles, took a course on the review and editing process of the articles, and learnt how to put a reviewed article on the web. My first EP Encyclopedia article was an entry on the Canadian Assisted Human Reproduction, 2004, a piece of legislation that is a predominant focus of my PhD research. Needless to say, writing a comprehensive and accessible EP Encyclopedia article is no easy task. Writing an article requires extensive research. Difficult scientific, legal, and other concepts and processes need to be broken down and articulated in a manner that is accessible to individuals who are not experts in the area.

The past few decades have witnessed much technological advancement in the fields of assisted reproduction, development and embryology. It is crucial for informed public opinion and policy-making that these advances are recorded accurately and that the information is widely accessible. The Embryo Project Encyclopedia is as a useful tool towards achieving these goals.

You can browse the Embryo Project Encyclopedia online here.

*Katie Hammond [2011] is doing an MPhil in Multi-Disciplinary Gender Studies. Picture credit: and dream designs.