More Than Medicine. Jennifer Nelson
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members who could help shape health center offerings to best meet their community’s needs.
Multiple studies support the contention that NHCs had many successes. One national study found that Boston, Chicago, and Portland hospital admissions were lowered for target populations. Researchers also noted a reduction in hospital stays as well as a reduction in the number of hospital days per capita. Several other studies showed a reduction of hospital admission up to 44 percent and a reduction of hospital days per capita from between 25 and 62 percent in communities with NHCs. Other studies of Medicaid users revealed that those using NHCs had 50 percent lower hospital rates than nonusers and reduced infant mortality rates, particularly among African Americans. These studies revealed too that when NHCs reduced hospital admissions, costs also fell in comparison to hospitals that employed high-tech solutions to low birth weight and premature births, such as neonatal intensive care units.149
There is less agreement about precisely which factors contributed to these improvements. Was it the geographical location of clinics in poor neighborhoods, the low cost to patients, the use of community outreach workers, or the use of community boards? It is outside the scope of this chapter to attach particular successes to specific reforms. It is also necessary to consider to what extent the NHC model really transformed health care delivery. Although health care and health improved markedly in neighborhoods with federally supported health centers, the solution was still hospital centered, technical, and entrepreneurial. Geiger, too, is critical of the form community health centers took over time as they lost their focus on community empowerment. He wrote, “After too few years the window that was open to expanded programs and community development began to close. This happened in part because of program costs and in larger measure because conservative national administrations were (to put it mildly) not overly interested in community empowerment and social change.” He explains that health centers became more traditional in their delivery of medical services rather than focusing on ending poverty or transforming social inequalities.150 Other critics of NHCs argued that although power was no longer held by individual physicians, it shifted to hospital corporations and insurance companies that made decisions about patient care rather than being distributed to community residents. Certainly, with the end of the War on Poverty, the gradual shift away from federal spending on social services in the 1970s, and the more onerous cuts in the 1980s during the Reagan presidency, community control of social programs no longer had many federal champions.151 Yet neighborhood health centers have continued to be a fundamental part of health care provision for the poor and uninsured in the United States. Today there are twenty million people each year who use community health centers. Twice as many will probably use the centers, with eleven billion new dollars from the Obama health care plan (the Affordable Care Act) and $2 billion in stimulus monies going to health centers. With this sort of long-term and future investment in community health centers, it is imperative that we attend to how and why health centers were created nearly a half-century ago and how and why they succeeded, even though success may have been uneven.
In the next chapter I turn to the feminist women’s health movement that grew, in part, from the health reform efforts of the civil rights and the New Left NHC movement. Feminists also built neighborhood-based health centers with local, federal, and private support, but they also challenged what they viewed as socially embedded gender hierarchies in health care delivery that were connected to a larger context of uneven social power between men and women. With less federal support than that garnered by NHCs, feminist women’s health centers also struggled to survive through the decade of the 1970s. When they provided abortions, their survival was threatened by a burgeoning and passionate anti-abortion movement.
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“Thank You for Your Help . . . Six Children Are Enough”
The Abortion Birth Control Referral Service
Community and neighborhood health clinics, grounded in the civil rights and New Left movements, provided intellectual, political, and practical experiential precedents for the women’s health movement. By the early 1970s, with the explosion of Women’s Liberation participation in cities around the country, feminists began to create new health institutions for themselves and other women. The feminists who built these institutions perpetuated the earlier health reform commitment to reaching people without access to health care. At the same time, they also wanted to expand women’s sexual and reproductive autonomy and dismantle sexual and reproductive double standards that seemed natural and normal to many but actually stemmed from deeply entrenched, yet socially constructed, gender roles. As women met and discussed which social mechanisms perpetuated sexist gender roles, they came to the conclusion that gender inequalities could not be transformed unless sexual and reproductive autonomy were also secured.
With Women’s Liberation, women’s increasing expectation that they be able to freely explore sexual feelings and desires became linked to the need to dramatically improve abortion and birth control access. Women’s Liberation groups across the country were demanding free, legal, and easily accessible termination procedures performed in safe and nonjudgmental environments. Yet, even as abortion became legal in a handful of states, including Hawaii, Alaska, California, New York, Washington State, and Washington D.C., many women still found it difficult to locate providers of safe abortions in supportive environments. As Carole Joffe has shown, abortion was still not commonly available in U.S. hospitals or other medical institutions even after Roe v. Wade made abortion legal in 1973. For this reason, feminists created abortion referral services to help women secure abortions both before and after Roe.1 This chapter traces the history of one feminist abortion referral service, the Abortion and Birth Control Referral Service (ABCRS), founded by feminists who were members of the University of Washington YWCA (U of W YWCA) in Seattle. It also examines some of the varied attitudes towards abortion in the 1970s expressed by women who used the service and reported their feelings after their abortions on feedback forms collected by the ABCRS.
Washington State, after a two-year campaign led by Washington Citizens for Abortion Reform, became one of the first states to legalize abortion before Roe, and the first to legalize abortion through popular referendum. On November 3, 1970, 56 percent of those who voted agreed that abortion should be legal up to sixteen weeks’ gestation. Leading up to the vote, there had been broad political support for the referendum from the Republican governor of the state, Dan Evans, Republican state senator Joel Pritchard, who helped draft the referendum, and other lawmakers. The law required that abortion be performed by a doctor in a licensed medical facility, that the patient reside in the state for ninety days, and that minor patients notify their parents and married women notify their husbands of the abortion.2
Yet, the new law didn’t provide any mechanism to help women access abortion, just as it did not require doctors or hospitals to provide abortions. Feminists associated with the U of W YWCA realized that women still needed help figuring out where to acquire a safe, legal, and compassionate abortion. Jan Krause, then program director of the U of W YWCA, recalled working with Planned Parenthood director Lee Minto to compile a list of medical doctors from the Planned Parenthood Medical Advisory Committee who would be available to an abortion referral service housed and funded by the YWCA.3 Since hospitals were not quick to establish abortion services after legalization, it fell to individual doctors to provide them after the law changed. Many individual doctors were also reluctant to provide abortions after legalization, often because of religious reasons but also because those who performed abortions were still stigmatized as “quacks” or as greedy, a legacy of the pre-Roe era. Those who did provide abortions often did so only for their private patients, making abortion less accessible to poor and young women who did not have an established relationship with a physician. Freestanding clinics eventually became the most common abortion providers and helped make abortion both affordable and easily accessible.4
According to Patricia Valdez, a volunteer coordinator for the ABCRS referral service, the purpose of the service “was to try to give women a good, safe, and reassuring referral to a good, safe, and reassuring practitioner who would be sensitive to their needs and all the negative projections about abortion at the time.”5 Some of these women would also be traveling to Seattle from out of state because abortion was not yet legal in their places of residence or because it was expensive and difficult to access. The ABCRS volunteers acknowledged the residency