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Content Warning: We use some explicit sexual language in this episode, so if you're listening with little ones, be prepared to either answer a lot of their questions after, or perhaps flip to a different episode and come back to this one when you can listen without little ears.
In 2019 I interviewed Alex Fine, founder of Dame Products, for my podcast, sharing with her how shocked I was to have recently reached the platform level of a NYC subway station with my grandkids only to be bombarded by HIMS and Roman ads for erectile dysfunction products, with aggressively sized giant cacti, too – obviously positioned horizontally, even rivaling the obviously phallic Amazon logo.
But where were the ads for female sexual health products? Censored!
Alex had just courageously sued the Metropolitan Transportation Authority (MTA) for violating Dame’s rights to free speech, due process and equal protection. She has since won the MTA battle for equity in advertising rights. But while that battle was going on, similar bias and censorship has been alive and well on the Internet, limiting women’s access to the information and products that we can benefit from for our sexual well-being.
Though women’s sexual wellness represents a large market, companies trying to address it have faced barriers that businesses aimed at the sexual wellness of men have not, with rejection of ads and even deletion of social media platforms.
Women’s sexual health is not a market for no reason: Three out of four women experience pain during intercourse at some point in their lives, nearly half of all women 18 to 35 have trouble reaching orgasm with a partner and many menopausal women are not supported to maintain or achieve sexual health as natural hormonal changes affect their sex lives, and often with it, self-confidence, issues I discussed in a recent podcast episode, On Vaginal Dryness and Painful Sex in Menopause.
And censorship of women’s sexual health information is also not new. The Comstock Act of 1873 made it illegal to send “obscene, lewd or lascivious,” “immoral,” or “indecent” publications through the mail. The law also made it a misdemeanor for anyone to sell, give away, or possess an obscene book, pamphlet, picture, drawing, or advertisement.
My guest today, Jackie Rotman, the Founder and CEO of the Center for Intimacy Justice (CIJ), a nonprofit that works to expand equity and wellbeing in people’s intimate lives, is taking on the status quo to make sure we all have access to the information and products we need and want.
Jackie is an activist and creative, not new to creating nonprofits. She founded her first one at age 14. Everybody Dance now, now called Creative Network, which has offered free dance programs as a platform for self-esteem and community to more than 30,000 youth across the United States, She also now holds an MBA from Stanford Grad School of Business, an MPA from the Harvard Kennedy School and a MBA in Public Policy with university distinction from Stanford. During her MBA, Jackie worked in women's health investing with reaves then called Reproductive Health Investors Alliance and for a Silicon Valley venture capital fund on investments in contraceptive technology and online sex education.
Jackie’s writing and investigative journalism work on women’s sexuality have been featured in The New York Times three times – including an investigative op-ed she wrote in 2019, “Vaginas Deserve Giant Ads, Too,” which was the Opinion section’s display piece in print.
Jackie led an investigation that was published in 2022 in The New York Times and 80 media outlets, illuminating that of 60 women’s health businesses interviewed or surveyed, 100% of them experienced Facebook or Instagram rejecting their ads. Within months of this investigation being published, Meta changed multiple of its global advertising policies on sexual health.
Jackie speaks around the world on topics including digital censorship of sexual and reproductive rights, and other topics at the intersections of sexuality and technology. She regularly briefs US Senators, state Attorneys General, and other technology and human rights leaders on the findings of CIJ’s investigations.
Jackie: Thank you so much. You're such an amazing writer. I love how you pieced together the things happening in our world in your description.
Aviva: Oh, you're welcome. Thank you for that. You're an amazing writer and you gave an incredibly eye-opening and also really personal talk about your work in digital censorship, and that was where I encountered you first. I knew of your work online, but I met you at the Women's Health Innovation Summit, which was really exciting. Listening to your story and the focus of your work, I knew I had to have you on the show, so thank you for being here and also the incredible work you're doing to shine a light on discrimination against women's sexual health.
Jackie: Thank you so much. I'm so glad we can have this conversation.
Aviva: I am, too. All right. You're a woman with a formidable educational background who clearly could have gone into and excelled in any field. I want to just dive into the deep end with you. What was it about your work or your personal experiences that inspired you to take on sexual health bias and censorship as sort of your life's work for right now?
Jackie: It started in 2017. I was a graduate student at the Harvard Kennedy School studying public policy, and I took a class taught by Ron Heifetz, which was about leadership. People shared really personal stories in that class and a few of my comments were about my dad, who was a very empowering and quirky man. One of the things about my dad is that ever since my grandfather, the men in my family have given their sons a scientific medical information-backed talk about the female orgasm. So my dad had this talk from his dad and my brother had it from my dad, and they dispelled myths – like what does it look like. Sex is all about intercourse, but actually it's really important to know about the clitoris. And I actually got that talk from my dad because my Catholic mother wouldn't give it to me. He just thought that's what parents did.
Aviva: Wow, okay. What's your dad's background that he did this? This is very unusual.
Jackie: He is a reformed Jew. <laugh> He used to be conservative, and then my parents had an interfaith marriage, and I don't know where the background came from. My grandfather was, I think he was a lawyer who became a judge.
Aviva: But they're not gynecologists or in medicine…
Jackie: No, they just cited the Kinsey Report that I think must have come out in the sixties or so and just were sharing the information.
Aviva: And what was it about the course you took that also moved you in this direction?
Jackie: In the course, I shared a couple of stories about my dad and so many people had these responses of asking me to coffee to talk about parenting with their kids, or asking me questions about their sex lives with their partners. And it was the first time that I realized that our intimate areas of our life are such an important space where you can create a positive impact. I never knew going to undergrad at Stanford that you could make a career that had to do with sex or women's sexuality, but I realized I wanted to create an innovative business model that could close the orgasm gap for women after taking that class and seeing people's responses.
And then completely serendipitously, just as I was starting to become really passionate about topics around women's pleasure and equality, I experienced a major trauma where I was at the Harvard Law School taking a class – the first week of classes – and met somebody who I ended up going on a date with and experiencing a traumatic sexual assault. But just as traumatic as the assault was, the institution's response of silencing me, doing everything that these different deans at the law school who were women, could do to try to get me to not report it. They just wanted to brush it under the rug, help him get his diploma as easily as possible.
I experienced so much trauma. I had a lot of difficulty. Every weekend I was calling urgent care. Just the year after the assault, I was just glad that I had survived that first year because what people who are undergoing that kind of sexual trauma face is so incredibly painful and so far reaching, and once I experienced that, it felt so urgent. This was still seven or so months before the #Me too movement, but I realized that every single one of my best friends had been raped and it's just this pervasive problem across all socioeconomic backgrounds. And so I became very passionate about sexuality being a space of joy and freedom and equality in all of the areas that we aspire to in every other aspect of our political or business or personal lives. I felt like this area of intimacy is a realm where we can create more joy and more justice. That was my motivation for starting this work. And then I met a lot of other women and learned about other issues that helped me form how to do that through technology and policy.
Aviva: Well, thank you for sharing that story. I want to pause a minute because I also want to honor the moment for anyone who's listening also who has had trauma for themselves or the daughter, sister, friend, and just say thank you for being here and using your voice and sharing your story and to all of you – we're just honoring that healing process in you also as listeners.
So you were censored – and by other women too. I want to also focus, on the work that you've chosen to focus on, but before we go there, are you okay if we talk for a few more minutes just about your healing process from that trauma?
Jackie: Yeah, I would love that.
Aviva: Okay thank you.
Because I don't want to just sort of be business as usual and then jump into something else as if that earthquake didn't just happen in your life or in this conversation. Since that time, has there been any change in on-campus policy or justice at Harvard within the law school?
Jackie: It's really interesting. I worked with a law firm that represents most of the survivors that go through Harvard's Title IX investigation process and they told me that every single person they'd represented in the years before they represented me had – every case except for two – had a finding of the person who had caused harm not being responsible, basically saying it never happened. And the two only instances where that wasn't the case were either somebody didn't speak English, English was not their first language and they said something or they were poor and didn't have the ability – there was a language or major socioeconomic issue for the person who was being accused of causing harm. But in every other case, Harvard was finding almost a hundred percent that the rapes never happened and that data hasn't been published because they aggregate it with other information and I think that's very common, not just at Harvard, but in other areas. So I haven't seen a lot of changes.
More nationally, one of the areas I was really passionate about at the time was transforming our justice processes to be in Restorative Justice, which is a completely alternative kind of way of responding to sexual harm, where actually the person who caused harm starts with a responsibility acknowledgement saying, “I realize I did this,” and you start from the place of this happened, how can we repair harm instead of just the entire process being about arguing about what happened.
At the time in 2017, I tried to create what would've been the first facilitated response that was restorative justice response for campus rape. And it didn't work. The variety of legal and policy issues really disincentivized it and didn't make it something that systems supported. But since then, there have been several universities that have started to offer that in just one year. University of Michigan offered it for 30 students, and both the people who caused the consent violation and those who experienced it are having very positive experiences with it. It's a nuanced challenging process that you don't want administrators to abuse, but I think has potential. We're seeing a few campuses that are doing things differently, but I think that for most universities that are doing these other kinds of investigations, I don't think there's been a lot of changes.
Aviva: Thank you for sharing all of that. And then one, question is, for listeners who have gone through sexual assault themselves, any words of wisdom for the healing process that you've gone through that you think may be helpful for someone else to hear?
Jackie: Yeah, I think I remember in my first year of processing that it felt like you'd never heal. It felt like it was such a gaping, huge wound that it just felt impossible to be happy. And I had a conversation with somebody, Sujatha Baliga who works on restorative justice with sexual assault at Impact Justice, and she's now this healer leader policy advocate. When she described her work, she said that it was less than a scrape. She had done so much healing and it was inspiring to see her talk about this thing that for me was this huge bloody open wound. And just to know that it's a scrape and that is how I feel several years afterward with regard to that. So just knowing that healing is possible for me, I did cognitive processing therapy that Stanford actually provided completely free of charge. And then I also worked with a lot of different healers that do these alternative really fascinating methods.
But just I got a lot of help and I really prioritized it. It was like doing my homework because I wanted to feel free and I think for me, the part that made me the most angry was actually the impact on my sexual life of having gone through that trauma. It impacted my academics and my mental health and my career for a time. But the part that made me the most angry was realizing that intimacy was really hard for a long time, and that made me be like, “No, you're even infecting even affecting this sacred aspect of my life.” But over time, that got more joyful as well. And I think just knowing that for those that are earlier in your healing journey that there are ways of really processing it and transmuting that energy in a way that can be expansive.
Aviva: It seems like a natural kind of connection between that line between silence and internalizing things, taboo, and censorship.
Jackie: Yeah.
Aviva: Let's talk about censorship because you created the Center for Intimacy Justice (CIJ) in part to rewrite business policies that are censoring, that discriminate against sexual health for women and also people of diverse genders. So your work and the work of the Center has really sought to address disparities in what's considered allowable and appropriate sexual content. And then in January of 2022, CIJ published this report describing Facebook's censorship of sexual health and wellness ads for women and people of diverse genders. Can you start by telling us about the censorship and disparities that have existed historically in online health ads in this internet era?
Jackie: Yeah, from my understanding, I think that censorship has existed since the social media platforms existed. There's someone in our space, Rachel Braun Scherl, who in 2011 publicized that I think over 90 platforms had rejected her ads for an oil that was supporting women's sexual desire. And since the beginning of these platforms, ads have been rejected.
But I'll start by, since you're so beautifully tying this censorship to my own experiences, I’ll share it as a story of discovering what was happening in 2017. It was February that I had experienced this assault. I started business school in September, 2017. This was about three weeks before the #Me Too movement broke out, and I was in the throes of my trauma. I was still having to lock myself in my dorm room on a regular basis to process this trauma and I was in business school asking, how can we use technology and business to create systemic change related to women's intimate lives?
I started interviewing entrepreneurs because so much innovation happens through entrepreneurship. And I had read a New York Times article called Women of Sex Tech Unite about Al Fine, Polly Rodriguez, and this generation of women just a few years older than me, starting in their twenties now thirties, but also multiple generations of entrepreneurs who were starting businesses in a very courageous way to improve women's intimate lives. They were the people who were going through menopause, were starting vaginal dryness products, people were selling vibrators, people were inventing alternative kinds of dental dams for oral sex and making women feel more comfortable. And I was so inspired by these women who I thought were so brave, and I started just meeting all of them. I would travel to New York every break that I had from school to meet with them, where a lot of them were. Every single one of them told me that the biggest barrier to their business was that they couldn't advertise on Facebook.
This was 2017-18, so now TikTok has become more popular and other tech platforms are rising in their importance. But at the time, Facebook and Instagram were the most affordable and most targeted ad platforms, but they couldn't advertise. Facebook was misclassifying them as sexual. I mean, they did have to do with sexual health, but products that weren't even about pleasure, I learned, that were also being blocked. At the same time, in 2017, two erectile dysfunction startups were created Hims and Ro. They raised lots of money, hundreds of millions of dollars quickly, at huge valuations. And they got exceptions to be allowed to advertise on Facebook since their inception because investors that had an interest in that had strong relationships at Facebook. So there were these “Get Hard or Get Your Money Back” ads online, Super Bowl ads eventually, and then giant, like 30-foot horizontal penises in the New York City subways, and yet you couldn't advertise a tiny clitoral vibrator that had a statistic that could help improve women's intimate lives.
Every single one of them faced this problem, but it wasn't seen as a policy issue or an equality issue. It was just these women, who in my view were heroes and brave and helping us, were being treated like they were just doing something wrong and they were obscene. And so that was the start of learning about this issue. Then in 2022, the Center for Intimacy Justice we partnered with a pelvic health company called Origin on the survey aspect of this. We put all the data together, we found that of 60 businesses at the time, all led by women or non-binary people, and founded by women and non-binary people, every single one of them had their Facebook ads rejected and 50% of them had their entire account suspended.
So just putting that information out in the New York Times and the media outlets that followed, having that truth led to a lot of changes organically or a lot of policymakers adding onto it.
But we know that while that focused on Meta, we are seeing that TikTok, Google, Amazon, LinkedIn, and other platforms all have both algorithmic issues and policy issues where women's sexual health and reproductive health is censored either because it's considered sexual or in certain cases there are certain types of health that are seen as political where we have a stifled information ecosystem. And then if somebody is going through a huge life change like menopause where they could be getting information to help them, it's blocked. Or if someone's experiencing endometriosis, which one out of 10 women experience and it causes painful sex among other painful things, it takes them seven to 10 years to find out that they have a diagnosis and the advertising ecosystem by women who have often experienced that and are trying to help others is blocked. So censorship has major implications on our health in other areas.
Aviva: So there's this conflation of anything that has to do with a uterus, a vagina, menstrual, reproductive health with adult content.
Jackie: Exactly.
Aviva: I know you've talked about some of the other types of ads. So we're talking about an oil or a lubricant or a product that could help a woman who actually has a medical condition like endometriosis or, I don't want to call vaginal dryness so much a medical condition, but sort of a fact of a transitional phase in life. They're fairly subtle ads – they're not these aggressive ads, they're things like grapefruits and papayas. They're generally fairly subtle. And yet an ad where there was a video of a banana and a bed, it wasn't subtle; it was something like banging into a bed, which is overtly sexual content.
Jackie: Yeah, There are Hims’ ads of a bed banging against a wall that are very much about pleasure or start your new year with improving your sex life. These male health ads are explicitly about pleasure. They seem to be getting around this rule that all these other businesses are having to adhere to. And then what's also happened, there's a major double standard where men's sexual pleasure is just seen as a fact of life. It's like, you know, just grow up and you breathe and you can have an erection- – society supports you to have commercials about your erections. So they're quite explicit. Facebook has never answered as to why they were not considering erectile dysfunction ads to be pleasure when they said that all pleasure ads were banned and these ads talked about pleasure.
To be clear, we want ads to be allowed. I think it's so beautiful, the de-stigmatization of erectile dysfunction and the education about it. Before Hims and Ro, none of my friends knew what that was, and I think it was really hard for men who were experiencing it, especially in their thirties or younger. This has expanded information and now people know a lot about it and can get help for it or are just using these products when they don't even really need them. But it was just the double standards.
In the nineties or earlier, women fought, women had been fighting for 40 years to get birth control to be covered by insurance. It was considered a quality of life drug, so women had higher medical bills to pay for birth control, but Viagra came out and was right away covered by insurance. And that actually is what led women to be able to successfully get birth control to be covered because there was such a clear double standard.
Similarly, the fact that ED is allowed we feel like it should expand what else is allowed. But interestingly, when Facebook rewrote its policies in October, they continued to say that pleasure ads were not allowed, but in the same exact policy update they expanded the examples of allowed ads to include premature ejaculation and erectile dysfunction ads, which were already allowed, but now are explicitly part of the policy. The same policy adds that our products are used for women's pleasure, they just said weren't allowed and didn't acknowledge the gender double standard.
Aviva: My corpus callosum is like a switchboard lighting up right now. To what you were saying about birth control access via insurance, a lot of listeners might not know that it was a long time between when married women could get access to birth control and when unmarried women could get access. The idea was that it could be used for contraception in a family setting with the husband’s permission. But that for single women using birth control was an overt admission of having sex for pleasure or sex outside of marriage. So there was a big gap there.
Can you talk about what you mean when you talk about the male female pleasure gap and why you feel this exists? And when I was saying my corpus callosum was firing, for those of you who don't know, that's the connector part of the brain between the right and left hemispheres. What was coming to mind as we were talking about drugs for male erectile dysfunction or premature ejaculation and male pleasure being allowed and female pleasure not being acknowledged, how that actually fits into a rape culture narrative. Women's pleasure doesn't matter. Women's satisfaction doesn't matter. Women aren't necessarily complicit sexual pleasure partners, but men can do what they need to do. It feels very wrong in the back story of all that. But switching to just the male female pleasure gap, talk to me about that.
Jackie: So there's a statistic, there's a study that was done, and actually I'll share a couple, but essentially for men who have sex they report, I'm not going to get this data exactly right, something close to 98% have an orgasm either always or almost always when they have a sexual interaction. Lesbian women actually have orgasms at a pretty similar rate. They're having orgasms most of the time. Women who are having sex with men, the statistic of how often they're having an orgasm is something like 68% of them say that almost or always, which to me still feels really high. I feel like it's not 68% of women who are having sex with men who are always having an orgasm or almost always, I think that the gap just anecdotally, it feels quite large.
And it seems that in our culture, male sexual pleasure is treated as, there's a lot of ways that it's privileged. But for a lot of women, our pleasure is incidental, it's secondary. And we're more in these other roles of supporting other people's desire instead of our own actual desires.
So there's these scientific-based discussions – one of my favorite researchers is someone named Sarah McClellan. Sarah McClellan coined the term intimate justice that of course is close to intimacy justice. And Sarah McClellan did research on satisfaction where she studied that women were on six measures of sexual wellbeing. On five of the six, women were having worse outcomes. They were having less orgasms, more pain and all these other factors. The only one of the six that women reported that was the same as men's sexual experiences was satisfaction. They were just as satisfied as men, even though all of these measures of their sexual wellbeing, they were having painful sex, they weren't having pleasure, but they were just as satisfied.
So Sarah McClellan did this follow-up study saying, okay, people have, they're having lower expectations – what is the culturalization and what political forces are at force? There she coined the term intimate justice saying that we have these inequalities in the world that actually seep into what we believe we can be deserving of and what we believe we're we experienced and can experience in our intimate lives, which I thought was amazing that she really dug into the satisfaction research and she didn't just say, “Yeah, women are having such just as good of sex as men.” Actually our expectations were much lower.
I find that really interesting. I noticed the disparities more in the first year that I was healing from my sexual assault where I might have just taken it for granted. Before that I wasn't really prioritizing me, but when I felt this huge inequity of my university stifling me and the laws being broken, then if I was in a partnership where our sex life was totally equal, then it mattered to me more and I felt like less of an equal human. And so I started to care about those disparities in our intimate lives, including in consensual relationships.
And then on the topic of consent, there have been a lot of people as the #Me Too movement was starting that were who were saying that if we don't have a notion of women having pleasure, then how can we have a notion of consent? How can we be opting into saying, yes, I want to participate in this experience if we don't even believe that women can have pleasure. And freshmen in college sometimes show up to Stanford, not even knowing that it's possible for women to have an orgasm. They just thought sex looks one particular way and they have to learn, “Oh my goodness, I'm capable of pleasure and I'm worthy of pleasure.” I think pleasure is integrally related to consent.
I believe that consent should be enthusiastically desiring to participate in an interaction and something that you can with revoke at any time. But our culture only has a few states in the United States that have that standard.
Aviva: How do you think changing the advertising milieu on Facebook, and it's not just advertising – we've been focusing on advertising, but there are also sites that have been temporarily restricted or shut down for information, not just advertising. Even on my Instagram, we've learned when I'm talking about vaginal dryness, sexual health, we don't spell sex s-e-x because we know the algorithm is going to ding those posts and not get them out. So we do workarounds, like S*X or SEGGS is what some people do. This has been a bigger problem than just advertising. And maybe you could address that too.
Jackie: Yeah, we have my team member, Carol Wersbe, she’s finishing her Master's in Public Health at the University of Copenhagen, and she did her thesis and what she found was that a lot of organizations and individuals are censoring themselves because of the algorithms not allowing them to talk. So we're inventing new languages, new in terms of we're inventing language in terms of new spelling to get through the algorithms. But she also found that when interviewing a company called Laurels, instead of saying oral sex on TikTok, young people are having mouth fun.
Aviva: There's a new one that I just read about today and I just saw the article come into my feed. I haven't read the whole thing yet, but Mascara Wand now has something like hundreds of millions of views on TikTok and it's a euphemism for sexual assault, talking about sex, talking about pain with sex as another workaround.
Jackie: Wow, it's fascinating. And then I've heard that there's all this talk about content moderation, like needing to learn more languages, but local activists in places like Kenya that are sex educators are able to get things through if they speak local sling because the algorithms can't pick up on it. So there's these ways that the sexual information we're saying and the culture we're around sexuality is changing because of the words that can and can't be said, and how is that impacting young people's psyche If mouth fun, it becomes the word of how you think of oral sex or other examples.
So there's a lot of self-censorship going on to fit with the algorithms and then a lot of content information suppression on other platforms besides Facebook. What I've always been passionate about is the cultural impacts of this censorship. We usually talk at the Center for Intimacy Justice about impacts economically, so women and non and non-binary entrepreneurs not being able to grow the same wealth and economic value creation as male counterparts in men's health. And then that's affecting their employees and the ability to employ other women and non-binary people.
We talk about the impact on health information. We talk about technology not being invented or supported as much or incentivized when less investment can go into businesses because they're blocked from advertising.
There are these different systemic effects, but I've always been so passionate about what narratives are allowed to be said. If you have women able to speak with agency and speak freely on the internet about products to help others or about products that they're inventing or stories or information that's going to affect information and that's going to affect culture of women and non-binary people and people of other genders being able to have agency over our own narratives. And right now those narratives are being stifled because of this internet censorship.
Aviva: And it's the same stifling that I think carries over into a woman having a reproductive or gynecologic sexual health problem, discomfort, symptom, then feeling she doesn't have the language, the body agency or literacy to actually speak up in the doctor's office. It's just still stay stays in the dark and stays in shame when we can't use our voices.
I also think if we're not seeing representation of pleasure or of sexual health, and again, we're talking about being free from endometriosis pain or finding ways to manage endometriosis pain, we're talking about menopause, we're talking about things that we're all going to go through. We're not talking about BDSM here. I mean all power to that too, but we're not talking about that. We're talking about the basics of daily living in our bodies comfortably and pleasurable. And I feel like if we don't see the images of pleasure represented across the spectrum of women and people who relate to those images, then we can't know that that is what we should expect.
Jackie: Yeah, there's such, yes, such a needed change in where women are being stifled. Our voices are being stifled in so many ways. The stifling of experiences of sexual violence, the stifling of information about healthcare, the lack of discussions on the internet and in our doctor's offices and even in our most intimate friendships and relationships, female sexuality is stifled in so many ways.
The stifling of women's experiences is so profound, it’s so deep in our culture and so the work that we're doing to free our voices on the internet and also to free our voices in our own culture, we're up against some really thousands of years old cultural and legal systems that want our voices to be silent. But I find that when we speak, we find each other, we find other women, we find other allies, and our voices are so needed.
I just think that this work around censorship is so much broader than just this platform and this algorithm because really we're reclaiming our sexual power, and our sexual power is so linked with our energetic and intuitive wisdom that goes much beyond what's happening in our vagina, but really about our heart and our culture more at large.
Aviva: So when we talk about algorithms, are these human beings who are scanning the internet and saying, okay, we can't let Dr. Romm post that. We can't let Jackie Rotman post that. How does it work?
Jackie: Yeah, it's really interesting. It's actually a black box in many ways. There's very little that we as users or even expert activists can know about the algorithms of Meta and TikTok, and they very much protect that confidentiality, their trade secrets, these algorithms, and the government in many cases cannot find out what actually is happening with these algorithms. In terms of what is actually happening, that transparency hasn't really been revealed to the public of, okay, how does this work and how might we do it differently? And what could be a more democratic process? Right now, it's really a black box.
Aviva: It seems like a big vicious cycle in that when Hims and Ro launched and they had hundreds of millions of dollars of venture capital behind them, which meant they were in the billions in their valuations really quickly, there was this, as you said, sort of locker room thing happening of investors involved in both places, and there was incentivization to allow those ads to happen. It just grew everyone's coffers. If women's products are not allowed to be advertised and women business owners are suffering, I would think that that is also affecting their ability to raise more capital. How is this all playing out?
Jackie: It's so challenging, and one piece of context how challenging it is, is actually before I decided to start Center for Intimacy Justice and to create an advocacy organization, I wanted to start a venture capital fund to invest in women's sexual wellness, sexual health, and potentially even anti gender-based violence solutions that had a market-based opportunities,
What I found was if you start a venture capital fund, but the market you're investing in is blocked from advertising, you can't achieve the hockey stick growth that is required for the venture capital business model. There's this really great tweet that the founder of FemTech Insider retweeted with her commentary on it where someone said, let me explain VC to you. VCs give money to startups. Startups give money to Facebook and Google, and then that's how you make money. Because those are engines for growth. And so when you're stifled from that, there so far hasn't been an alternative. You can do some influencer marketing, but you're not going to grow. And the New York City subways were symbolic, but the New York City subways don't drive a 5 billion valuation business, but online digital advertising does.
So by stifling access to this, I believe that these Meta and other tech platforms are literally withholding billions of dollars from women and people of diverse genders because we also know that women-founded businesses of which many in this health space are employing women at something like six times higher rates. And so we are really having an economic impact that has implications on how much they can reach others.
They're just losing all access to this market and this megaphone. We just published the pictures and the two statistics, and that information being in the New York Times led to a few things. Within about two weeks, Senator Patty Murray from Washington, who was the chair of the Senate Health Education Labor and Pensions Committee, wrote a beautiful open letter to Meta that cited the repot.
And then organically, Hillary Clinton tweeted about this issue at Senator Patty Murray in a multi-tweet back and forth saying that she was thanking the Senator for raising attention to this, and she knew that she would stay on them. We had this beautiful experience where all these entrepreneurs that had felt unseen for a decade now felt like Hillary Clinton sees them, regardless of what your politics are. It was really meaningful. And I met a lot of entrepreneurs who cried when that moment happened, or had that be very transformative for them; there were also some other actions that took place at state government levels. And then we noticed in October that Meta had rewritten and made updates and additions to multiple policies, their adult products policy, and also their nudity policy. The policy said that these certain medical images, for example, there were breastfeeding simulators that were being censored and not allowed and accounts funded for well space.
I think we're also seeing burnout because if you've been at it for 10 years and you come in and you're brilliant and hardworking and you're working around the clock, but companies like Hims are actually now able to sell vibrators, and they were started by men to address erectile dysfunction, but they're now going into the women's health markets or other men's health companies are acquiring the women's health companies and they have this advantage of so much funding and so much growth that started by advertising that you were literally having new founders say, in public to reporters, “We purposely started with men's pleasure and men's health, and we only decided we would only go into women's health later because we knew the advertising barriers would exist, would exist in a disproportionate way for women.” So you're having more businesses address men's needs, but then the businesses that start with men's needs have an advantage. And they're eclipsing women-led businesses that are truly dedicated to menopause or dedicated to the health of people with vaginas.
Aviva: We need a name for this. There's mansplaining. There should be somehow ‘manselling.’
Jackie: Yeah, totally.
Aviva: So you did this Investigative journalism piece that got tremendous play, which congratulations, that's an enormous accomplishment. What would you say were maybe the top three biggest findings that were huge problems and what improved? And then what are still some of the biggest obstacles that we need to next level overcome?
Jackie: First we published examples that visually told the story of, okay, “Get Hard or Get Your Money Back” is allowed. But, “It takes three and a half years to sail around the world, but 10 to seven to 10 years to get an endometriosis diagnosis,” that ad isn't allowed. Or ads with a woman jogging with the words “Reclaim your freedom” and an opportunity for her to talk to her doctor about menopause weren't allowed. So we picked these visual examples to illuminate the problem, and the pictures were published in both our report and the New York Times.
Aviva: It takes three and a half years to sail around the world, but seven to 10 years to get an endometriosis diagnosis. So those two aren't even really directly about sex. The get harder, get your money back is undeniable. So this is the disparity in what you uncovered and the types of ads that were being banned.
Jackie: Yeah. We also showed ads that were allowed that said, WE SAVE BALLS, all capital letters that do,
Aviva: Is this the men intimate grooming stuff?
Jackie: Yeah.
Aviva: I didn't even know that was a thing. I think it is called Ball Grooming or something. I had to look it up. I was like, is this even what I think it is? And it was so a men's intimate grooming products.
Jackie: When I talk to men, if I tell 'em about my work socially, they all know what manscaping is because they're all getting these ads. It's like they learn this, these languages, but we can't, don't learn them for.
Aviva: Manscaping!
Jackie: Yeah, manscaping.
Aviva: What does that say to our teenagers, because our teenagers are also using Instagram and they're seeing these ads or they're seeing television commercials that come on. How is that impacting what their expectations are?
I also find it interesting, and maybe this is me overthinking, but I don't think so. I do a lot of work with women's healthcare, and I've seen all the wonderful, beautiful slides, and I've also seen the numbers of women who have difficult traumas well, I'm going to say difficult trauma, women who have had traumas. And I have to say that when I was in the MTA with my grandkids, the first time I saw the cactus ad, what also really struck me is that even though the spines were off the cactus, it was, yeah, to me, it struck me as actually an aggressive ad. Cacti are not gentle. And they do have spines on them usually. So I found the whole imagery really disturbing,
Jackie: That makes a lot of sense in terms of you're using this product for intercourse, and yet you're choosing something that it would be incredibly painful.
Aviva: I’ve seen many breastfeeding images censored, even the fact that we would have to put kind of a little blackout kind of squares of the little funny pixely things over breasts, or give these trigger warnings. It really says something about our culture,
Jackie: Definitely. But Meta, basically, rewrote their policies to say that these types of ads were allowed, the medical images were allowed if they had to do with education or health. And then the policy was written entirely – the entirely new language, about a third or two thirds of new language in the adult products policy. We were excited because we felt like we just moved the mountain. We got Meta. This policy hadn't been updated in a significant way for as long as we'd been looking at it since 2017 and they rewrote it. We felt like we were heard. Did you look at it? No, we never had a single meeting with them in 2022. They didn't respond to any of our emails. We would see who would read it from Meif. They gave us their address to view the report, but nobody responded to us.
Nobody told us it was coming out. We just noticed, oh, this policy's really different when we went on the page and there wasn't any comment. So we were really excited and we noticed that a lot of the examples that they said were now allowed that had to do with people with vaginas, were the exact examples that we'd written in our report as not allowed. So that also felt like there had likely been an impact there, even though obviously you can't prove it. It was okay. We said endometriosis wasn't allowed, and now they're saying pain relief during sex is allowed. Same with menopause and a couple other examples like sex education. But unfortunately, what we've since found and will soon be releasing is that when we researched and we surveyed companies to see ‘is anything different for you'? And we also surveyed nonprofits. Overwhelmingly people said nothing has actually changed in the technology.
In the technology the policy was written to say that they're allowed, but even the companies that exactly their ads exactly match the language of what is allowed, they're still not allowed. So now we're filing a federal Trade Commission complaint asking the US government to investigate this because of the disproportionate impact that it has and the health and economic disparities. We're asking the Federal Trade Commission as well as state attorneys generals to take action to compel Meta to change because congressional pressure in the public eye and press hasn't yet been enough. We'll continue to make our voices heard on the next steps in 2023.
Aviva: What should folks like myself do, or folks who have products or information sites themselves, what do you think are some of the biggest workarounds that we can be aware of to make sure that we're getting the information out? Not just advertising, but actual sexual and women's health information out without being dinged, if you will, by the algorithm.
Jackie: In terms of workarounds, we recently learned of a new tool that was created in Australia that helps content creators figure out what language they can use that will be less likely to get flagged, changing the spelling of certain words. And it'll be interesting to see if they continue to update that. If algorithms then pick up on those words so we can find out the name of it and share it. That's a workaround within the existing barriers, how can you try to work around it? Hopefully there'll be other toolkits that we could support. But then the other piece is we still are working to actually change the systemic imbalances in these algorithms and their policies. So CIJ will be in collaboration with hundreds of others leading a couple of campaigns this year. We'll have a hashtag #stopthesensor campaign at the same time that we file and publicize our Federal Trade Commission complaint, which is specific to Meta. People can check out or use the hashtag #stopthesensor, and we'll have a petition where we can all bring our voices together.
We'll also then be able to communicate with people who signed the petition about other changes. And then later this year, we're having another campaign, “Big Tech, Big Bias,” which when we release our report on four or more platforms, we'll have other opportunities to be sharing our voices, speaking out in protest on the internet. And so joining those campaigns, using our hashtags and joining our social media page, which is @intimacyjustice and also our newsletter. This feature, ways that we can unite our voices together, because together, we're much stronger and we're building a movement of thousands of people who can be speaking out to tech platforms and to those governments that regulate them and could potentially be on our side to support. I know not all governments support this information being shared, but some do particularly for health information. So we'd love to continue to build a movement together and honor those different platforms to unite in support of these upcoming campaigns.
Aviva: There's so much that can be said about the hazards and harms of the internet, of Instagram, of TikTok for teenagers and their mental and sexual health, and for us as adult women as well. And it's a medium that's not going away. I think that it's a medium that can also do social good if we have freedom. For me, this one in 10 women statistic with endometriosis, the one in 8 with PCOS, the women who take 7 to 10 years to get an endo diagnosis, a thyroid diagnosis, and the list goes on. These aren't statistics. These are real humans who come to my practice for help because they have fallen through the cracks and experienced not just. We talk about sexual pain as if it's like somehow we can't eat chocolate because we're allergic to it. This is something that isn't just about pleasure, it's about release and relaxation.
It's about mental health, it's about connection. It's about self-esteem, particularly as women get older and want to keep that part of themselves vibrant. We also know that women who are sexually active are less likely to have some of the vaginal discomforts with menopause because of lubrication. So there are a lot of really big issues here that, for me. Again, I love the expression stories are data with a soul. So every statistic you mentioned is a real woman who's coming to my Instagram or my social media to look for a real answer that I'm, it's 2023, I'm a EL trained MD and a midwife for 35 years of experience. And I'm having to think about how can I speak in code so that my life work, my life's work doesn't get censored? Or how can I have you or Alex on or talk about all the real things without getting censored?
And this is not just silencing in social media, it's silencing that you experienced at Harvard. It's silencing in the absence of women in medical research data, there's so many ways this shows up. So I can't thank you enough for your work. I'm hoping that as you all at CIJ do next level campaigns. Keep those of us like physicians and midwives and nurse practitioners and doulas and all the women's healthcare providers in mind as advocates for you and allies, and also people who can share our perspective on the importance of what omission does to women seeking information and how these delays in diagnosis happen.
I'm really excited to see what CIJ does next. I hope everyone will read your New York Times articles. We'll certainly link up to those. We'll link up to CIJ.
I have one question that I love to ask each of my guests, and that is, if you could tell your younger self anything, how old would she be and what would you say?
Jackie: Probably when I was 17, when I was probably starting my freshman year of college. I spent so much time in my twenties being smaller and trying to be a less intuitive version of who I am or a less spiritual version or just different to try to fit in with everyone else's reality. And I think the more I grow up, the more I realize that there's such power in just completely being you.
We can just have a leadership style that can be playful. We can be sexual and strategic, we can be smart and intuitive. We can be all these things that society usually tells us you're one or the other, or women have to do leadership in this way, but we have such power and we can create our own ways of doing things playfully, joyfully, lovingly.
Aviva: Jackie, thank you for the incredible work you're doing. Also, thank you so deeply for sharing your story, your full story and your transparency. It's an honor and a privilege to hear and meet all of you this way. We're going to share all the links. We're going to be keeping a close eye on what you're doing. We'll be shouting out the next things. And thank you so much for being here and being you.
Jackie: Thank you so much. Thank you for all that you do. And thank you for this beautiful discussion.
Aviva: Everyone, thank you for joining us. Thank you for walking through the hard moments with us. The listening, the learning. I hope that as you are on social media, if you are on social media, that you're being mindfully aware of some of the things that we've talked about now, you'll probably start to see some of what we're actually discussing and some of these disparities. And I hope you'll continue to use your own platforms for the good of women and the educational opportunities that we have and the connection opportunities that we have to do social media in a different way.
