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Indias experimentations with fertility control programs go all the way back to the period preceding its Independence. In fact, it was one of the first countries to introduce an official programme of birth control intended to reduce the rate of population growth, but to this day the relative population size and fertility rates remain a contentious issue in electoral politics.

In July 2019, a Population Regulation Bill, proposing to introduce a two-child policy per couple, was introduced in the Rajya Sabha by BJP MP Rakesh Sinha. However, the Bill was withdrawn earlier this year following intervention by the Union health minister Mansukh Mandaviya who argued that NHFS and census data to show the positive impact of government-led awareness campaigns rather than force on indicators such as the Total Fertility Rate (TFR).

Experts too agree that at this juncture there is no requirement of a population control bill or any policy that enforces a fixed number of children a couple can have. Whatever goals that the latest population policy, NPP 2000, had set have been achieved and the fertility level everywhere is going down, reasons K Srinivasan, Emeritus Professor of International Institute of Population Sciences. If we take the case of Tamil Nadu, the fertility levels there are well below replacement levels for the last 10-12 years. Its population is going to decline from 2031. Keralas population will also decline soon after, he explains.

The idea that the population of the Indian subcontinent was a problem emerged only from the third decade of the 20th century. Much of the time that the British were in control, right up till the 1860s and 70s, they often took the view that there were not enough people, says Tim Dyson, Professor Emeritus of Population Studies at the London School of Economics.

Srinivasan in his book, Population concerns in India: Shifting trends, policies, and programs (2017)notes that the population of India within its present geographical boundaries in fact declined between 1911 and 1921 from 252.1 to 251.3 million on account of the global influenza pandemic of 1918-19. It is only from 1921 that the population rose due to measures undertaken by provincial governments. Concerns over this rapid rise in population arose from four quarters: intellectuals, social reformers (especially those interested in improving the status of women), the Congress party (the leading political party that spearheaded the movement for political independence) and the government, he writes.

The role of the Indian intellectual elite was particularly strong in this regard during the first two decades of the century. A large majority among them visited England for higher education and for training in posts for the Indian Civil Service. There they were introduced to Malthusian theories of population and Neo-Malthusian Leagues across Europe.

Historian Matthew Connelly in his article, Population control in India: Prologue to the Emergency period (2006) notes that the Indian elites, and particularly the Hindu upper caste elites, were active participants in international conferences on population, and were the most vocal proponents for population control as they remained concerned that differential fertility would increase the relative size and power of the lower-caste and Muslim communities.

The Western gaze towards India, citing it as a case where overpopulation led to checks like famines, war and epidemics went a long way in shaping the Indian elites response to the countrys population. Westerners preferred to make an example of India when developing their own theories and deriving lessons for policy, writes Connelly in his article. In the 1920s, when American and British authors began to warn of a Rising tide of colour, India was once again the most oft-cited example- even though there was not yet any evidence that its population was growing rapidly. American birth control activist Margaret Higgins Sanger and her Birth Control Information Centre in the 1930s focused on opening clinics in India.

There were Western economists who came up with economic arguments about why India needed to control its population, says Leela Visaria, Honorary Professor at the Gujarat Institute of Development Research. The burden that a country like India would be for the world got articulated in many ways such as advocating methods of family planning to women mostly, and carrying out studies.

The first public expression of the need for family planning in the country was carried out by Pyare Kishen Wattal with the publication of a book, The Population Problem in India in 1916 in which he advocated family limitation. A pioneering effort was led by Professor Raghunath Dhondo Karve when he opened the countrys first birth control clinic in Bombay in 1925. Karve was a professor of Mathematics and an activist on womens rights. He advocated widow remarriage and the practice of artificial methods of family planning. However, his writings and speeches on the subject were met with severe opposition and he was asked to resign by the authorities of the Christian Missionary College where he worked. The next attempt in this direction was the forming of the Madras Neo-Malthusian League in July 1929, which published a propaganda journal called Madras Birth Control Bulletin.

The humble beginnings of population control that started in Bombay and Madras, however, did not spread rapidly because of Mahatma Gandhis strong opposition to artificial methods of birth control. For Gandhi, sexual abstinence was the only ethical means of birth control. In his magazine Young India he wrote in 1936: Sex urge is a fine and noble thing. There is nothing to be ashamed of in it, but it is meant only for the act of creation. Any other use of it is a sin against God and humanity. Contraceptives of a kind there were before and there will be hereafter, but the use of them was formerly regarded as sinful. It was reserved for our generation to glorify vice by calling it virtue. (As cited in Srinivasans book).

Gandhis views on birth control were strongly challenged by western activists, particularly Edith How-Martyn and Sanger, who advocated family planning as a means of liberating women from child bearing and improving their status as individuals in society.

The womens movement in India and voluntary organisations continued to advocate for artificial methods of birth control despite Gandhis opposition. The annual meeting of the All India Womens Conference in 1935 focused on birth control and invited How-Martyn and Sanger. How-Martyn and Sanger took this opportunity to meet with Gandhi to discuss the use of artificial methods of family planning. Despite their efforts to convert him to their side, Gandhi stood firm in his conviction and rejected the use of artificial methods of family planning, writes Srinivasan.

Jawaharlal Nehru, however, had an opposing view to Gandhi on the matter. He was influenced by the prevailing views on population in the west and was of the opinion that as modern technology made their way to the east, a significant population increase would result in India. Therefore he perceived the rising population of India as a burden that needed to be properly organised. As early as the mid 1930s the National Planning Committee under Nehru set up a subcommittee on population that recommended the gradual increase in age of marriage, the teaching of contraception in medical colleges, the establishment of birth control clinics, provision of free contraceptives and local manufacture of contraceptives, the education of people on the issue of population and the introduction of a eugenic program for sterilisation of people suffering from communicable diseases.

The efforts at population control was halted briefly with the onset of the Second World War in 1939. With the end of the war in 1945 and the Independence of the country in 1947 a new and more invigorated phase of population control plans was ushered in.

One of the earliest efforts at birth control was the formation of the family planning association of India. Its members included pioneers such as Professor Karve, Dr A. P. Pillay, Lady Dhanvanthi Rama Rau, Mrs Vembu and Mrs A. B. Wadia, who were active in family planning programmes before the war and had shown keen interest during the All India Womens Conference held earlier in 1935. Founding of the association was a milestone moment both in the history of family planning in India and the world.

In 1952, during the first five year plan, the government assumed that rapid population growth would be a hindrance in the socio-economic development of the country. Accordingly, it adopted a family limitation and population control programme, arguably the first such attempt anywhere.

However, the programme made negligible progress, partly because there was very little experience to draw from. Moreover, its goal was defined in rather vague terms as that of reducing birth rate to the level necessary to stabilise the population at the level consistent with the requirements of the national economy. But it also reflected continuing reservations about modern birth control methods, writes Dyson in his book, A population history of India: From the first modern people to the present day (2018). Indeed in the late 1940s and early 1950s Rajkumari Amrit Kaur- a former secretary to M K Gandhi- was the countrys minister of health. Although she later changed her views, at that time she favoured family limitation through the practise of sexual abstinence. Much of the budget kept aside for family planning programme at this phase was spent on doing research on the rhythm method(a form of natural contraception by which sexual intercourse is restricted to the times of a womans menstrual cycle when ovulation is least likely to occur) which was largely unsuccessful both in the west and in India.

The second five-year plan involved the opening of 1,430 family planning clinics and birth control services also began to be provided at private healthcare systems (PHCs). Family planning and health came under the jurisdiction of the states and in this regard we see a significant progress in birth control initiatives in the south. In particular, there were efforts at providing sterilisation services. In 1959, for instance, the Madras state government introduced a scheme by which people who were sterilised were given a small amount of money. There were restrictions on who could be sterilised though. By 1960, the states of Mysore, Maharashtra and Kerala also introduced similar schemes.

Influenced by the progress made by the southern states, the third five-year plan made sterilisation services available in PHCs as well. Several sterilisation centres were also established, mainly in the bigger cities. Dyson notes that the number of sterilisations carried out in India rose from 64,000 in 1960 to about 1.8 million by 1967-68.

A notable event in this regard took place in Ernakulam district of Kerala in December 1970 at the instigation of the districts chief administrator, S.S. Krishnakumar. A sterilisation camp was established with much fanfare and quick and safe vasectomies were made available with sizable cash payments to those availing the service. About 15,000 vasectomies were carried out in the event. When a similar event was held once again in July 1971, once again in Ernakulam, it resulted in 63,000 vasectomies. Following this, similar camps were held in most states across the country. It is estimated that about 91 per cent of the contraceptive protection (i.e. against pregnancy) provided by the family planning programme in 197273 derived from sterilizations. Moreover, vasectomies accounted for 84 per cent of the sterilizations performed during 197273, notes Dyson.

However, the 1971 census made clear that despite the many efforts, much to the frustration of policy makers, population growth had continued unabated during the decade. The population of the country rose from 439.2 million in 1961 to 548.2 million in 1971, which was a 24.8 per cent increase as compared to 21.5 per cent rise in the 1951-61 period. This was because the government of the day had fixed very high targets to be achieved in a short period of time. The targets for each earlier five-year plan failed but the government kept keeping higher targets in the consecutive plan, says Srinivasan. Moreover, by diverting so much of time and money to sterilisations, we lost out on resources that should have been used to improve health infrastructure instead, he adds.

In the period between 1960 to 1976 the international emphasis on family planning increased significantly with funding from the United States Agency for International Development (USAID), Ford Foundation and Rockefeller Foundations. Among all Asian and Sub-Saharan African countries, Indias family planning programme received the largest chunk of international aid. The international push was so extreme that in 1965, President Lyndon B. Johnson refused to provide food aid to Indiaat the time threatened by famineuntil it agreed to incentivize sterilization, writes Prajakta R. Gupte in her article, India: The Emergency and the politics of mass sterilisation (2017).

The mass sterilisation campaign that took off during the Emergency declared by then Prime Minister Indira Gandhi needs to be seen in context of this international pressure on India. These were based, with a hindsight, on the fear of the large populations of India, Pakistan, Bangladesh and Indonesia increasing very rapidly and posing a global threat to peace and prosperity of the Western world, writes Sreenivasan. In the history of population control in India, this was the only period which saw the use of force.

With the opposition behind bars and the press silenced, several atrocities were carried out during the period of Emergency that lasted from June 1975 to March 1977. The most talked about among them was a forced sterilisation campaign, spearheaded by Gandhis son, Sanjay Gandhi, who held no official post in the government at that time. He came up with a five-point programme which included family planning, tree planting, a ban on dowry, an adult education programme and ending of social caste. In the opinion of Sanjay Gandhi, family planning was to be a way of life in India and he wanted rapid results. For instance, he wanted to control the population within a year, beautify the city in weeks, and virtually end poverty overnight, writes Gupte.

A National Population Policy (NPP), the first of its kind in India, was passed in the Parliament in April 1976. Sterilisation and in particular vasectomy was to be the core of this programme. States such as Uttar Pradesh, Bihar, Madhya Pradesh, Rajasthan, Orissa, Haryana, Punjab, and Himachal Pradesh also came up with their own sterilisation policies, and all of North India came to be known as the vasectomy belt. Each of these states began competing with each other to achieve the highest number of sterilisations.

Vasectomies were held in many government offices, railway stations, and schools. Sreenivasan notes how the vasectomy booths set up in the Churchgate and VT stations in Mumbai became notorious because of its ruthless nature: they gathered the young male passengers getting down the electric trains and made them pass through the vasectomy booths and sterilized them, unless they have a card for already being sterilised.

Further, the government issued circulars to employees stating that their promotions and payments would be held back unless they got sterilised or got an assigned quota of people to sterilise. People had to produce a certificate of sterilization to get their salaries or even renew their driving/ rickshaw/scooter/sales tax license. Students whose parents had not undergone a sterilization were detained. Free medical treatment in hospitals was also suspended until a sterilization certificate was shown, writes Gupte. Those who suffered the most were the poor and illiterate people, picked up from pavements, railway stations, or bus stops and forced to undergo the process.

As a result, the family planning programmes performance in India during the 1976-77 period was the best that any country had ever achieved, with 8.26 million sterilisations. It is worth noting that it was during this period that China too officially adopted the one child policy, and one can assume that Gandhi and her son thought that a similar attitude of force might work in case of India too. However, as Sreenivasan notes, China used UIDs to achieve its goal, which was reversible unlike the case with sterilisations.

Soon enough violent revolts broke out in several parts of India in response to the forced sterilisations. Gupte writes that in Uttar Pradesh alone 240 cases of violent resistance were reported. In Muzzaffarnagar, for instance, people resisted by pelting the police with stones. Again, the police opened fire, killing twenty-five people. After this incident, a curfew was imposed, and law enforcement officers killed violators, she writes. A significant opposition to the programme came from the poorest areas and from the Muslims who thought it was the majoritys way of diminishing their community.

In an attempt to prove her popularity, Indira Gandhi called for fresh elections in February 1977. This was the beginning of the end of her power. The Congress party incurred huge losses both at the centre and in most of the states and one of the key election issues was the governments imposition of a coercive family planning program. A popular saying among the people at that time was that the compulsory sterilisation program brought down the government instead of the birth rate, says Sreenivasan. This is a lesson for any government in India.

Looking back at the approach to population control during the Emergency, Dyson says that what it did was weaken the commitment to family planning. The Australian demographer Jack Caldwell had argued that if Mrs Gandhi had continued with the Emergency then India would have achieved replacement fertility, that is two births per woman, by the 1980s. He may well have been right since India is only slightly above two births per woman now, says Dyson. There was a huge difference in Indias demographic trajectory as a result of Mrs. Gandhi losing the election. Had she won the election, it is interesting to speculate what she would have done with the family planning programme.

The biggest change that took place after the 1977 general elections was that Indias population control policy shifted focus to voluntary efforts. The Indian government now put more emphasis on incentives to attract people to accept family planning instead of coercive measures although the government still gave priority to the rapidly growing population problem, writes sociologist Gabe T Wang in his paper, Population control policies and implementations in India (2019). The name of the programme was changed from family planning to family welfare under the pretext that any population policy would put greater emphasis on maternal and child healthcare as well as nutrition.

A working group on population policy was set up under the planning commission in 1979. The group recommended a long term demographic goal of reaching a net reproduction rate of one by 1996 for the entire country and for the states by 2001. The government also emphasised on indirect measures such as spreading awareness through the use of media, education, giving larger share of central governments assistance to states performing well and the like.

Further, states came out with policies of their own. Some states such as Assam, Odisha, Rajasthan, Maharashtra, Telangana and Andhra Pradesh, for instance, have some form of two-child policy in place to be eligible for certain government jobs. The Uttar Pradesh Law Commission in July 2021 submitted a proposal for barring any person with more than two children from contesting in local polls, applying for promotions in government jobs and from receiving government subsidy.

Visaria says that one of the biggest impacts of the forced sterilisation campaign carried out during the Emergency was that vasectomy or male sterilisation was put on the back burner. Female sterilisation became more popular as women came forward despite it having a negative effect on their health, she says. We came to a stage when Indian doctors, for several years, were not even trained in the performance of vasectomy.

All kinds of incentives for sterilisation needs to be stopped immediately, suggests Sreenivasan. Not only does it impact womens health but also it makes such a dent in fertility that cannot be restored later. China could reverse its one child policy because it did not have so many sterilised people. But in India, a majority of family planning efforts continue to be through female sterilisations he says.

Despite the variegated efforts in Indias family planning initiatives, population continues to be seen as a problem in the country. A 2019 report released by the United Nations predicted that Indias population would surpass that of China by 2027 and that it would remain the most populous country of the world till the end of the century.

That is bound to happen since its built in the momentum of the population. We had until very recently very high fertility levels and all those children born in the 1970s and 80s will want to have one or two children and till that phase of transition is completed the population will continue to grow in absolute numbers, says Visaria.

However, she believes that despite the growth in population the country does not need a population control policy. The latest NHFS data clearly indicates that the total fertility rate is now two, which is slightly below replacement levels. The NHFS surveys have demonstrated that no Indian couple want more than two children, she says. What we need is to ensure that good quality services are available to all regardless of rural, urban, caste or religion.

Srinivasan believes that the condition of population India at present with its demographic diversity is in fact at an advantageous stage. At present different states are at different levels of demographic transitions. For instance Bihar, Madhya Pradesh, Uttar Pradesh, Rajasthan are still slightly above replacement level of fertility. Whereas Tamil Nadu, Kerala, Andhra Pradesh, Karnataka, Goa, Pondicherry are well below replacement level of fertility, he says. This is an advantage for a country because the labour shortage in one state can be filled up by surplus labour in another state, provided we facilitate internal migration.

He also suggests that any population policy at this stage is bound to recoil because it will appear to be directed towards a particular community. The only form of family planning that he says must be advocated is the kind that was advocated by Margaret Sanger: wherein couples have babies by choice and not by chance.

Further reading:

Krishnamurthy Srinivasan, Population concerns in India: Shifting trends, policies and programs, Sage Publications, 2017

Tim Dyson, A Population History of India: From the first Modern People to the Present Day, Oxford University Press, 2018

Prajakta R. Gupte, India: The Emergency and the politics of mass sterilisation, Association for Asia Studies, 2017

Gabe T. Wang, Population control policies and implementations in India, Journal of Sociology and Social Work, 2019

Matthew Connelly, Population control in India: Prologue to the Emergency period, Population and Development Review, 2006

Read more:
Why experts say India does not need a population policy - The Indian Express

Question: Our practice is fairly new, and we are in the process of developing internal processes to follow going forward.What is the purpose of an audit and how can that help our practice?

Answer: An internal medical coding and billing audit is a process that examines and evaluates the effectiveness and reliability of clinical documentation and the overall medical billing process. This process thoroughly checks health records maintained by the practice and reviews medical billing data submitted to the payors to help ensure that the practice identifies, monitors and corrects inappropriate billing practices.

When going through a coding and billing audit, the auditor collects clinical records, which may include medical records, x-rays, and lab reports; financial records such as entered charges, explanation of benefits (EOBs), and accounts receivable ledger; and policy-related documentation as required by providers or the government.

Audits can be conducted either before claims are sent out to the payors (prospective) or after the fact (retrospective). Some practices follow the rule of conducting new provider audits prospectively, and current provider audits retrospectively.

Scope of Medical Billing Audit

Medical billing audits have a more comprehensive approach than coding audits. Medical billing audits cover all the areas of the medical billing life cycle starting from insurance verification processes, ICD-10-CM and CPT coding, claim submission, payment posting, follow-up, and denial management processes.

Advantages of Medical Billing Audit

Coding compliance: Billing audits provide a way to identify and correct problem spots before the government or insurance payors challenge inappropriate coding. You can rely on billing audits for identifying inaccuracies, providing instructions on ways to correct issues, building confidence among the coding staff, and ensuring to use of up-to-date procedure and diagnosis codes. Those conducting the audit can identify areas where staff education and training are needed to make sure that proper coding protocol isfollowed.

Administrative Benefits: The administrative staff benefits from medical billing audits by confirming that claims are true and accurate and are correctly submitted. Audits set the standard for the office staff and spare them unnecessary frustration by creating a positive, stable work environment and culture of compliance that attracts and retains talented personnel. Under- and over-coding, code overuse, and improper unbundling habits are replaced with appropriate billing for services and procedures. When policies and procedures are set in place and followed correctly, the chance of a visit from an external auditor decreases significantly.

Ensure compliance: Through medical claims audits, the practice can help protected itself against fraudulent billing activity and claims. The audit may identify reimbursement deficiencies and reveal ways in which the practice varies from the national average due to inappropriate coding. Areas for increased reimbursement may be revealed and, in turn, boost revenue. Additionally, the practice benefits when files are processed efficiently, improper payments are reduced and claim payment is optimized.

ReneeDowling is a compliance auditor for Sansum Clinic, LLC, in Santa Barbara, California.

Link:
What is a medical coding and billing audit? - Medical Economics

On the morning of 25 August 2014, a 16-year-old girl arrived at the University of Texas Southwestern Medical Center in a baffling condition. She was short of breath but had no chest pain. She had no history of any lung condition and no abnormal sounds in her breathing. But when the emergency room doctor on duty pressed on her neck and chest, he heard noises like Rice Krispies crackling in a bowl of milk. Spaces behind her throat, around her heart and between her lungs and chest wall were studded with pockets of air, an X-ray confirmed, and her lungs were very slightly collapsed.

The doctors were confused until she said that shed been screaming for hours the night before at the Dallas stop on One Directions Where We Are Tour. The exertion, they hypothesised, had forced open a small hole in her respiratory tract. It wasnt really a big deal she was given extra oxygen and kept overnight for observation and she required no follow-up treatment. But the incident was described in all its absurd, gory detail in a paper published in the Journal of Emergency Medicine three years later. The lead physician wrote that such a case had yet to be described in the medical literature. Doctors were familiar with military pilots, scuba divers and weightlifters straining their respiratory tract, but this case presented the first evidence that forceful screaming during pop concerts could have the same physical toll.This was a novelty news item: an easy headline and a culturally salient joke about the overzealousness of teenage girls. It was parody made real and recorded with the deepest of seriousness, for all time, in a medical journal. I know nothing else about the girl who loved One Direction so much that she collapsed her lungs over it. Her doctor wrote to me that hed asked, at the time, for her permission to tweet at TV host Jimmy Fallon about the incident hed argued that maybe she would get to meet One Direction. But she was too bashful!!!! Classic teenager, he said, adding a laugh-crying emoji.

Ill never know who she is or hear her personal explanation of what made her scream so much. In this specific circumstance, thats because of medical privacy laws, which are good. But its also emblematic of a bigger lack: we have seen so many screaming girls. Every time we see them, were like, Theyre screaming. And thats it. Yet the screaming fan doesnt scream for nothing and screaming isnt all the fan is doing. It never has been.

At Harryween, Harry Styless fancy dress party at Madison Square Garden last year, fewer girls dressed to impress in the fancy sense than in the meme sense, signalling fandom knowledge of in-jokes and stories more than a desire to look attractive. My sister dressed as Harry Styles working in a bakery in England in the 00s, while I dressed as the shrine that one fan erected at the site where Styles vomited beside the 101 freeway in Los Angeles in 2014. Of course, part of my costume was confiscated by arena security because if you let one piece of posterboard into the arena youll end up letting a chaotic amount of posterboard into the arena and no one will be able to see the show.

Reports about screaming girl fans like those from Styless current tour, which kicked off last week in Glasgow have rarely, if ever, noticed these kind of subtleties. When the Beatles visited Dublin for the first time, in 1963, the New York Times reported that young limbs snapped like twigs in a tremendous free-for-all. When they arrived in New York City in February 1964 a little more than a month into the US-radio-chart reign of I Want to Hold Your Hand there were 4,000 fans (and 100 cops) waiting at the airport and reports of a wild-eyed mob in front of the Plaza Hotel.

Nearly all of the writing about the Beatles in mainstream American publications was done by established white male journalists. Al Aronowitz, the rock critic best known for introducing the Beatles to Bob Dylan and to marijuana (simultaneously) in the summer of 1964, reported that 2,000 fans mobbed the locked metal gates of Union Station when the Beatles performed in Washington DC. Then, when the Beatles came to Miami, 7,000 teenagers created a four-mile-long traffic jam at the airport and fans shattered 23 windows and a plateglass door. A plateglass door!

Being a fan is very much associated with feminine excess, with working-class people, people of colour, people whose emotions are seen as being out of control, Allison McCracken, an associate professor and director of the American-studies programme at DePaul University, told me. Everything is set up against this idea of white straight masculinity, where the emotions are in control and the body is in control.

McCracken is an expert on the history of the crooner in American culture and her 2015 book, Real Men Dont Sing, credits Rudy Valle and Bing Crosby with making the blueprint for a pop sensation in the late 1920s and early 30s. McCracken visited the American Radio Archives, in Thousand Oaks, California, to see Valles personal archive of fan letters, dating back to 1928. She was fascinated by the way the women who were writing to him were surprised by their own emotional reactions to his music and were confused by the idea of falling in love with a voice theyd heard only over the radio. They were responding to his voice and saying, I dont understand why Im so happy and joyous and why youre moving me so much, she said. They were writing to him and saying, Can you explain whats happening to me?

Though psychologists had in the early 1900s started describing adolescence as a unique stage of life, the word teenager itself wasnt widely used until the late 1940s, McCracken explained, and the most eager speakers of the term were also marketers. They realised in the postwar boom years that far fewer kids were dropping out of school to earn money for their families and that far more were being given allowances and plenty of leisure time. The 1950s and 60s saw more and more products marketed explicitly to teenagers, often reinforcing the idea that they were a distinct group of people with a separate identity from their parents and with the rise of teen-marketed products came teen-oriented TV shows during which they could be advertised.

So long as teens existed as a lucrative market category, the industry would supply them with a teenybopper idol. When these idols were written about by journalists and critics, it was often with full acquiescence to their marketing, tinged with disdain. This was the case as recently as 2010, when the idol was Justin Bieber. When he performed his first sold-out show at Madison Square Garden that September, the New York Times music critic Jon Caramanica titled his review Send in the Heart-throbs, Cue the Shrieks and wrote that Bieber teased the crowd with flashes of direct emotional manipulation.

Two years later, One Direction were battling Bieber for the No 1 spot on the US charts, and in the hearts of American teenagers, and Caramanica started reviewing the bands output with equal attentiveness. He called their 2012 second album, Take Me Home, a reliable shriek-inducer in girls who have not yet decided that shrieking doesnt become them. He panned the bands 2013 album, Midnight Memories, writing: They play the part almost resentfully, with the mien of people who know better Whether this is transparent to the squealers who make up their fanbase is tough to tell.

This idea that fans are an amorphous mass and that culture is something that happens to all of them in the same way can be traced back to Theodor Adorno, whose 1938 essay, cited in the New York Timess coverage of Beatlemania, described fans at live music performances as empty vessels: Their ecstasy is without content. Adornos work has been the starting point for the past 70 years of pop culture analysis, perhaps right up until the 1990s when cultural historian Daniel Cavicchi spent three years interviewing Bruce Springsteen fans about where their love of Bruce had come from and how it had coloured their lives for his book Tramps Like Us. At the time it was still up for serious debate whether the adoration of a pop star turned a person into an idiot. The cultural anxiety around popular culture then which has relaxed now, even if it hasnt totally disappeared was that it was a homogenising force that turned every participant into a mindless consumer. But in speaking to hundreds of fans, Cavicchi found something different. These people were exploiting the ultra-popular things they loved in order to become more completely themselves. Springsteen fans do not indicate that popular culture is shaping their identity but rather that they are shaping their identity with popular culture, he wrote.

What many commentators couldnt or wouldnt see was that fans have not just passively enjoyed or loudly desired the objects of their fandom. Theyve also edited them and recirculated them and used them as the inspiration for a range of creative works on and offline. The art, the stories, the fan fiction and the in-jokes are as much a part of what it means to be a fan as staking out an airport or memorising dozens of songs. Fans transform their own image by playing with expectations and flouting the rules; dress themselves up in the spirit of Harry Styles indulging in elaborate cosplay as an expression of devotion that is also a prolonged creative exercise. When Styles started wearing blouses and pearls and high-waisted trousers, so did they. They bought old-school rocker platform boots or knitted their own sweaters in the styles of his expensive, designer ones and expressed their fandom through aesthetic iteration.

Theres something else the critics didnt realise: fan girls are funny. In 1964, a group of girls in Encino, California, founded an organisation they called Beatlesaniacs Ltd. It was advertised as group therapy and offered withdrawal literature for fans of the Beatles who felt that their emotions had got out of hand. In a 1964 issue of Life magazine, the group is covered credulously. (The spread on Beatlemania features a full-page image of a girl kneeling on the ground, grass clenched in her hand, tears streaming down her face whether or not she was actually thinking, Ringo! Ringo walked on this grass!, that is how the photo is captioned.) The club is mentioned in a small sidebar, entitled How to Kick the Beatle Habit. What Beatlesaniacs Ltd offers is group therapy and withdrawal literature, it reads. Its membership card immediately identifies the bearer as someone who needs help.

The club was obviously a joke. Its rules included such items as Do not mention the word Beatles (or beetles), Do not mention the word England. But nobody is primed to see self-critique or sarcasm in fans. Seeing them toy with their own image or recognise their own condition contradicts the popular image that has circulated for the past 100 or so years.

Take the story of the shrine to Harry Styless vomit. The facts are these: in October 2014, Styles went to a party at the British pop singer Lily Allens house in Los Angeles. The next morning, riding in a chauffeured Audi, in his gym clothes, on the way back from a very long hike, he requested that the driver pull over. On the side of the 101 freeway, just outside Calabasas, he threw up near a metal barrier, looked up and locked eyes with a camera.

The day they were taken, the photos circulated in tabloids and online, and a few hours later, a Los Angeles-based 18-year-old named Gabrielle Kopera set out to find the spot and label it for posterity. She taped a piece of posterboard to the barrier: Harry Styles threw-up here 10-12-14, she wrote in big letters. The grainy photo she posted first to her own Instagram circled the globe. It is referenced in articles about the moment Harry Styles knew hed made it, which was supposedly the moment someone told him his vomit had been scooped off the ground and was up for sale on eBay.

At the time she took the shot, Kopera was bored: she didnt have the money for a four-year university course so shed stayed home to work and to study at a local community college while most of her friends moved away. Being a fan of Styles and One Direction made her feel as if she had something to do that wasnt a chore.

She was surprised and confused by the way her photo was covered in the media, as if it was something more bizarre than a comedy routine she was performing, primarily with herself as the audience. It was more a joke about my life than his, she told me.

By the end of One Direction, the medias treatment of the bands music and its fans had changed significantly. In part, this was because of a rise in the estimation of pop music among critics and a new focus among content makers on womens websites for celebrating almost everything any girl did as inspiring and empowering. Guilty pleasures were to be enjoyed, not insulted, and it was rude to call them guilty pleasures at all. It is inappropriate now to make fun of girls for screaming or boybands for existing or anybody for liking anything.

You could argue Harry Styles helped drive this cultural change when he appeared in spring 2017 on the cover of Rolling Stone, interviewed by the music journalist and Almost Famous writer-director Cameron Crowe. Whos to say that young girls who like pop music short for popular, right? have worse musical taste than a 30-year-old hipster guy? Thats not up to you to say, he told Crowe. Young girls like the Beatles. You gonna tell me theyre not serious? How can you say young girls dont get it? Theyre our future. Our future doctors, lawyers, mothers, presidents, they kind of keep the world going. He really went for it. Teenage-girl fans they dont lie. If they like you, theyre there. They dont act too cool. They like you and they tell you. Which is sick.

Im happy that he said that, because I know it meant something important to a lot of people. But its hard to celebrate the fangirls coming of age the way Id like to, because it is also being celebrated by the sort of people who will use it to make more money out of us. And its being celebrated by well-meaning people in sort of embarrassing ways as if liking a boyband is a radical political act, the same way wearing well-designed T-shirts with punchy slogans on them is a sincere expression of feminism and Pantone creating a shade of red called Period is empowering for anyone who menstruates. Not all women are our future doctors, lawyers, mothers, presidents, I would love to tell Harry Styles. Not all women keep the world going!

But alongside the overenthusiastic acceptance lies an essential truth: the little indignities and the big disappointments of being young, of not finding the love you want or of not becoming the person youd hoped these things are tempered by fandom. Fandom is an interruption; its as simple as enjoying something for no reason and its as complicated as growing up. It should be celebrated for what it can provide in individual lives. What this is, exactly, is hard to know if you dont bother to ask. Its generally much more than a scream.

Kaitlyn Tiffany is a writer at the Atlantic. This is an edited extract from her book Everything I Need I Get from You: How Fangirls Created the Internet as We Know It, published by Farrar, Straus and Giroux (13.99). To support the Guardian and Observer order your copy at guardianbookshop.com. Delivery charges may apply

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The Texas Republican Party on Saturday voted on two new party platform planks aimed at barring the teaching of sex and sexuality in schools while simultaneously calling on Texas schools to teach the dignity of the preborn human and that life begins at fertilization.

One policy proposal called on state lawmakers to prohibit the teaching, exposure, and/or discussion of sexual matters (mechanics, feelings, orientation or gender identity issues), as well as remove related books or materials from schools.

The issue of gender has nothing to do with education, said Cindi Castilla, president of the Texas Eagle Forum and who served on the party platform committee. Education is about reading, writing, math, science, history and fine arts. Maybe some foreign language and PE. Schools arent the social educators of our kids.

Elsewhere, the GOP platform also added that Texas students should learn about the dignity of the preborn human and that life begins at fertilization.

That goes back to biology, back into teaching sex as biology, said Julie Pickren, who told The Texas Tribune that sex education has a place only if it follows state health education standards and is age appropriate. If it has a heartbeat, it's a human, right?

Pickren, a Republican, is running for the State Board of Education District that represents Southeast Texas. Incumbent Matt Robinson is not running for reelection.

The platform plank does not specify which grades should get these lessons, except to say that high school students should read the Womans Right to Know booklet. Critics say that booklet, written by the state, includes scientifically unsupported claims and shames women seeking abortion care.

The platform plank also states that students should witness a live ultrasound and watch a Miracle of Life type video. The 1982 film documents the human reproductive process from conception to birth.

Kristen Ylana, executive director of The Texas Womens Health Caucus, said the push to teach public school students that life begins at fertilization represents a broader push by the Texas Republican Party to broadly establish a legal foundation to claim a fetus is a person with constitutional rights.

They want to get to the point where we can say, Well, no, this is a person. So they require legal protections, criminal protection, constitutional protections. They have rights that are just as valid and equal. So therefore, you cant do certain things, Ylana said.

During the last regular legislative session, Rep. Steve Toth, R-The Woodlands, filed a bill that defined personhood at fertilization and would provide due process to a fetus. The bill died in committee.

The State Board of Education recently wrapped up its review of health curriculum standards, which include requirements to teach about fertilization in fifth, sixth, seventh and eighth grades.

My thought is to leave well enough alone. What we put in the standards is factual and balanced, Patricia Hardy, a Republican board member from Fort Worth, told the Tribune Saturday after the platform vote.

Many delegates at the convention argued that young children dont need to learn about issues of gender and sexuality, including conversations and lessons about people who are transgender. Those delegates said Saturday they prefer such conversations happen at home. Under Texas law, parents currently must provide written consent for their children to attend sex education classes, which are required to emphasize abstinence.

Some womens health advocates and public education leaders criticized the policies as harmful and discriminatory and questioned the legality of barring the teaching of gender and sexuality in schools.

The Texas GOP is out of step with the majority of Americans who believe in equality, said Zeph Capo, president of the Texas chapter of American Federation of Teachers. Capo said the platform plank banning the teaching of sexual matters appears to violate Title IX, which protects against sex-based discrimination, including discrimination based on sexual orientation and gender identity.

Parents may try to restrict what their own kids read or who they love, but they do not have the right to restrict others, Capo said, not in a truly free society.

The newly approved Texas GOP party platform broadly places the culture wars at its core, as the party adopted a slew of new platforms that shift the party further to the right on Saturday.

Delegates Saturday voted on 275 platform planks, which will now need to be tallied and certified in Austin. It is rare for a plank to be rejected, Texas GOP party spokesperson James Wesolek said. In addition to the platform, the delegates voted to choose 8 among 15 legislative priorities to be shared with Republican lawmakers ahead of the legislative session that starts in January. Which 8 were selected will not be known for several days.

Party platforms are often more aspirational than practical and, in Texas, they have long reflected the opinions of the most activist wings of the parties. Elected officials are not bound to adhere to their parties platforms.

The additions to the state GOP platform related to teaching Texas students about sex and sexuality come months after Gov. Greg Abbott directed the Department of Family and Protective Services to investigate parents who provide gender-affirming care to their transgender children as child abuse. The state also has seen a push from far-right lawmakers and conservative parents to remove obscene content from school libraries and classrooms. The book bans often have targeted young adult literature with racial and LGBTQ+ themes.

The platform also calls for lawmakers to remove an exemption in the Texas Penal Code that allows children access to harmful, explicit or pornographic materials under the guise of educational materials.

Castilla said the exemption allows schools to use educational materials she considers to be obscene pornography.

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Texas GOP platform calls for ban on teaching sexual matters, while requiring students to learn about dignity of the preborn human - The Texas Tribune

I commute 35 miles each way to work. In my comparatively compact and fuel efficient car, that works out to a gallon of gas each way. At current fuel prices, it costs me about $12 each day to get to work.

It adds up. Its frustrating.

Im not the only one with fewer, less experienced coworkers sharing the same work. Im not the only one looking at the rising cost of everything rent, fuel, food, and so on and wondering when it will stop. Yes, wages are higher, especially for entry-level employees, and thats great, but the constant shortages of basic goods and services since the pandemic started a couple of years ago has been irritating. Violent crime is increasing as well no, the Bronx isnt burning, but just as we shouldnt wait for live-action reenactments of the Laramie Project before we take white nationalists showing up to violently disrupt Pride events seriously, we shouldnt wait for American cities to look like hollowed out war zones again before we take crime seriously, either.

Im also not the only one whos noticed that the people in charge dont seem to have any fixes for these problems.

I understand, then, why so many political analysts believe Republicans will have a banner year this year. Democrats are currently in charge (for whatever definition of in charge any political party can be said to be in our famously fractious country) and things are a little rough at the moment and getting rougher. Naturally, many voters will likely conclude, rightly or wrongly, that throwing todays bums out might make things better at least until tomorrows bums either wield political power effectively enough to create other problems or are unfortunate enough to be in power while we create entirely new and novel problems for ourselves.

What I dont understand is what Nevadas Republican primary voters, especially in Washoe County, think theyre doing about any of this.

Start with the gubernatorial primary, which produced one of the more comparatively sane outcomes. Whether you agree or disagree with Lombardos positions or policies, nominating a sheriff for governor is a logical thing to do if youre a voter whos worried about crime. Whats less logical, however, is nominating a conspiratorial former boxer and current ambulance chaser who thinks the establishment is conspiring to deny him his place on the general election ballot and consequently refuses to concede his race despite receiving nearly 30,000 fewer votes than the victor never mind how many Democratic political organizations, including here in Nevada, spent millions of dollars propping candidates like Joey Gilbert up.

But that ambulance chaser is exactly who a plurality of Republican voters in several counties including our state capital wanted for governor. Even in Washoe County, Gilbert was fewer than 300 votes away from Joe Lombardo. If Clark County Republicans didnt think so fondly of their sheriff, Sisolak would have needed to recruit Ross Miller as a stunt double in the next gubernatorial debate.

What made Joey Gilbert appealing? It wasnt his willingness nor perceived ability to solve Nevadas problems it was instead his willingness to fight reality itself. According to his headcanon, Donald Trump was still president, COVID-19 wasnt real (and, if it was, it was a plandemic anyway), and Nevadas students cant read because they dont say the Pledge of Allegiance often enough. Does any of that have any relationship with reality? Well, no, but reality left Joey and his supporters behind years ago.

Then theres Jim Marchant. Marchant is running for secretary of state on a platform of replacing every voting machine with thousands of bleary-eyed precinct captains hand-counting every ballot, handwriting their tallies with fountain pens on parchment, then delivering election results by Pony Express. If you ask him, every election result since Mark Twain published Roughing It has been fraudulent, including every primary and Assembly seat he ever won. Hes running because, as he readily admits, QAnon organizers the sort who are waiting for John F. Kennedy Jr. to arise from his watery grave off the coast of Marthas Vineyard so he can run as Trumps running mate in 2024 saw him as a kindred spirit and asked him to.

Is he a delusional crank spouting unhinged nonsense? Absolutely. In a just world, would he file as a paper candidate, pick up a couple thousand votes statewide from voters who had no clue who he was, then die in obscurity? You bet. Is he instead the Nevada Republican Partys general election candidate for secretary of state this year? By a landslide. Will electing him secretary of state make Nevada a better place or address a single meaningful problem faced by residents of our state? No, but if Otero County in New Mexico, a jurisdiction which refused to certify its own election results, is any indication, hell at least keep our judicial system gainfully employed.

Perhaps Nevadas Republicans had more sense when it came time to select their candidate for Treasurer. Surely surely they wouldnt support someone with a history of failed businesses, sweetheart deals for family members, constant out-of-state distractions, bullying and fighting fellow Republicans, and a scrambled misunderstanding of germ theory to manage the states money.

Dont call them surely. Fiore was the most popular candidate on the Republican statewide primary ballot. More than 125,000 Republicans voted for Fiore thats more votes than Adam Laxalt or any statewide candidate received.

Does she know what the job of a state treasurer is? Does she know how to balance a checkbook? Is she self aware enough to realize shes actually the angry racist aunt instead of the fun-loving party girl at every family gathering? The answer to all of these questions is almost certainly no. Did that stop Republicans from putting her on our general election ballots? The answer to that question is also no.

What about the position of attorney general the chief prosecutor for the state? Did Nevadas Republicans select someone who will be tough on crime? Or did they select someone who jokes about lynching people and is an open embarrassment in court? Does thirty men breaking into a local jail to kill a man while the local constable is asleep sound like law and order? As Republicans selected Sigal Chattah to run against Aaron Ford, it seems we have four more months to find out.

Then there are the races further down the ballot.

Washoe County Republicans the same bunch which used to reliably produce moderate Republicans like Bill Raggio, Brian Sandoval, Jill Tolles, Ben Kieckhefer and Heidi Gansert instead chose to replace an incumbent Republican county commissioner with a county assessor whos still not allowed in his own office. Instead of ensuring county properties were assessed fairly and equitably, Mike Clark used his time and resources to obsess over a picture of one of his staff members in a bikini a picture which he bundled in 162 novella-length mailers he sent to elected officials and county employees, each labeled as if they came from someone elses address.

Nothing says moral courage like trying to pin your mailed rants on someone elses head.

Then theres Jeanne Herman. Ive written about Washoe County Commissioner Herman before shes the one who wanted to deploy the Nevada National Guard to every single precinct in the county to shoot voter fraud because a Californian cryptocurrency lottery winner told her to. Did the Republican residents of Renos exurbs use the ridiculous press she generated from her buffoonery to select someone who will do the job of county commissioner quietly and effectively? Or did they double down on the election denial and Bircher-grade conspiracy theory spinning?

Take a guess.

Finally, we have the elections for Washoe County School Board. Districts B, C, D and F face election this year. Each of them face incumbents who, at the time of the writing of this piece, are leading in their races Ellen Minetto, Joe Rodriguez, Beth Smith, and Adam Mayberry, respectively. Three of those four, however, will face a general election against candidates handpicked by Save WCSD, a far-right organization obsessed with the notion that Critical Transgendered Race Theory (or whatever) is being taught in Renos famously progressive classrooms Beth Smith handily dispatched her Save WCSD-anointed opponent, Ed Hitti, in the primary.

As I pointed out fairly recently, the Save WCSD candidates sincerely believe Washoe County students will read better if they have the power to control which books Washoe County students read just dont ask them which books your students will be able to take home. Either theyd rather we found out which books were fit for reading and which books were fit for their Suberung by surprise, or the Californian cryptocurrency millionaire funding their organization failed to furnish them with his list of forbidden books before they were interviewed by local media. Whether these candidates are mendacious or ignorant, its extremely unlikely electing any of them to my countys school board will have a positive effect on any childs education.

***

Will pretending Donald Trump was actually elected in 2020 resolve our nations supply shortages? Will electing an innumerate bully with a gun fetish make our states finances more sound? Will lynching political opponents make our streets safer? Will banning books raise Nevadas educational results? Will throwing every election machine into the nearest river reduce inflation? Will electing a disgraced assessor with a temporary restraining order against him as county commissioner make Washoe County great again?

I dont see how.

Are any of these candidates offering a single tangible policy solution that can be delivered by our existing political processes that might concretely benefit Nevadans?

Not that I can see.

Thats a shame. We have real problems in this state which call out for real solutions. There was a time when voters in Nevadas second-largest political party took itself seriously enough to address them and selected candidates accordingly. Unfortunately, last week's primary has demonstrated theyd rather add their collective delusions to the list instead.

David Colborne ran for office twice and served on the executive committees for his state and county Libertarian Party chapters. He is now an IT manager, a registered nonpartisan voter, the father of two sons, and a weekly opinion columnist for The Nevada Independent. You can follow him on Twitter @DavidColborne or email him at [emailprotected].

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Nevada's Republican voters have lost their collective minds The Nevada Independent - The Nevada Independent