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“If a 5-year-old black kid came into the clinic and said he wanted to be white, would we endorse that?” he told me. “I don’t think so. What we would want to do is say, ‘What’s going on with this kid that’s making him feel that it would be better to be white?’”

Zucker says that in 25 years, not one of the patients who started seeing him by age 6 has switched gender. Adolescents are more fixed in their identity. If a parent brings in, say, a 13-year-old who has never been treated and who has severe gender dysphoria, Zucker will generally recommend hormonal treatment. But he considers that a fraught choice. “One has to think about the long-term developmental path. This kid will go through lifelong hormonal treatment to approximate the phenotype of a male and may require some kind of surgery and then will have to deal with the fact that he doesn’t have a phallus; it’s a tough road, with a lot of pain involved.”

When they reversed course, they dedicated themselves to the project with a thoroughness most parents would find exhausting and off-putting. They boxed up all of John’s girl-toys and videos and replaced them with neutral ones. Whenever John cried for his girl-toys, they would ask him, “Do you think playing with those would make you feel better about being a boy?” and then would distract him with an offer to ride bikes or take a walk. They turned their house into a 1950s kitchen-sink drama, intended to inculcate respect for patriarchy, in the crudest and simplest terms: “Boys don’t wear pink, they wear blue,” they would tell him, or “Daddy is smarter than Mommy—ask him.” If John called for Mommy in the middle of the night, Daddy went, every time. When I visited the family, John was lazing around with his older brother, idly watching TV and playing video games, dressed in a polo shirt and Abercrombie & Fitch shorts. He said he was glad he’d been through the therapy, “because it made me feel happy,” but that’s about all he would say

According to a study released by the World Bank in October, South Korea is the first of several Asian countries with large sex imbalances at birth to reverse the trend, moving toward greater parity between the sexes. Last year, the ratio was 107.4 boys born for every 100 girls, still above what is considered normal, but down from a peak of 116.5 boys born for every 100 girls in 1990.

The most important factor in changing attitudes toward girls was the radical shift in the country’s economy that opened the doors to women in the work force as never before and dismantled long-held traditions, which so devalued daughters that mothers would often apologize for giving birth to a girl.

The government also played a small role starting in the 1970s. After growing alarmed by the rise in sex-preference abortions, leaders mounted campaigns to change people’s attitudes, including one that featured the popular slogan “One daughter raised well is worth 10 sons!”

Unlike in more developed countries, sex education is not part of the school curriculum in India. In fact, as of late 2007, 12 out of India’s 29 state governments had banned sex education claiming the course material led to sexual experimentation among students and was against the Indian culture.

The Ladder of Participation is a model for thinking about youth participation developed by Roger Hart. The bottom three rungs describe youth involvement that is not true participation whereas the top five rungs describe true participation.

shared decisions

Youth-initiated and directed

Microbicides have long been high on the wish list of grass-roots activists, who see them as the most promising way to prevent AIDS for heterosexual women at high risk of infection from unfaithful husbands or partners, especially in Asia and Africa.

Yet to date, research related to their development represents only 2 percent of all AIDS spending by the National Institutes of Health

One mathematical model, which focused on Johannesburg, South Africa, predicted that if 75 percent of area residents were to use a 40-percent-effective microbicide in half of the sexual encounters in which they didn't use condoms, the local incidence of HIV infection would drop by 9 percent. That may not sound like much, but across countries and continents, similar percentages could translate into millions of saved lives.

While this portrait of Iranian sexual experimentation may be shocking on its surface, it has grown familiar to most people who have visited Iran or followed cultural developments there in the past decade. Less well known is that, for all their promiscuity and seeming sophistication, many of these young Iranians suffer from a lack of sexual education and resources that fits the official culture of pious abstinence rather than the actual one of looseness and risk. The birth control method of choice among Mahdavi's informants is withdrawal. Women who take the pill frequently lack the most basic information and take it only erratically, depriving themselves of almost all of its effect. Condoms are considered so filthy and embarrassing that even people who share florid details about their sex lives with Mahdavi blush at their mention, and no one wants to be seen requesting them at a pharmacy. AIDS, educated young Iranians tell Mahdavi, is transmitted through visits to the dentist or hairdresser, and other STDs come only from a certain unsavory sort of woman. While wealthy women can obtain abortions--illegal in most cases but common, thanks to poor contraception--from sympathetic doctors at vast expense, poorer women acquire on the black market pills or injections meant for animals. Mahdavi went to a back street where dealers sell these medications, just to see how easily they could be acquired. A dealer sold her a vial of pills without the least instruction on what to do with them. Physicians she interviewed told her that they see a great many women seriously injured or rendered infertile by self-administered abortions meant for animals.

Yet there is good news in Mahdavi's study. Close to the ground, where it counts, Iranian doctors, parents, educators and even institutions are bending to the forces of change. For example, since 2000 the Islamic Republic has required Iranians who seek marriage licenses to attend state-administered classes on family planning. One that Mahdavi attended in Tehran's central business district sounds perfectly appalling. A chador-clad woman shrilly lectures a room of gum-snapping, nail-filing, indifferent young women, offering the following counsel: "You must always be ready for your husband's sexual needs. If perchance he is watching a football game on television, you should be resting to prepare yourself, or else preparing your bed for the evening. If you should feel overcome by fatigue yourself, make sure always to ask your husband, 'Is there anything else you need from me?' or 'Would you like to have me later?' before retiring."

But then Mahdavi attends another such class, this time in the city's north, in the upscale shopping district near the Tajrish bazaar. This class covers disease transmission, contraception, fertility, mental health, marital relations and even female sexual pleasure. The teachers wear the less forbidding hijab--head scarf and fitted thigh-length coat--common among their students, and the women attending these classes, Mahdavi reports, confide freely to the teachers about their relationships and their sex lives. Here, and in her chapter about the older generation's response to the sexual revolution, Mahdavi shows us a society beginning to shake off its denial and rigidity out of the sheer necessity of serving the burgeoning needs of its young--a generation of adults who have either grown sympathetic to young people's yearnings or, like Mrs. Erami, recognize that they risk greater losses than they can bear.

the U.S. Agency for International Development ordered six African countries to ensure that no U.S.-funded condoms, birth control pills, IUDs or other contraceptives are furnished to Marie Stopes International, a British-based aid group that operates clinics in poor countries.

The irony and hypocrisy of it is that this is a bone to the self-described 'pro-life' movement, but it will result in deaths to women who just want to space their births

the result will be at least 157,000 additional unwanted pregnancies per year, leading to 62,000 additional abortions and 660 women dying in childbirth.