More Than Medicine. Jennifer Nelson
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the empowerment of the poor to help forge solutions to their own problems.
Geiger, MCHR activists, and many feminists, both international and those in the United States, and particularly many women of color feminists, have understood that health rests on the “social determinants of health—housing, and food, and income and education, and employment, and exposure to environmental danger—and their consequences.”11 Thus, while medicine and technical intervention to cure disease is important, it is also fundamental to transform social formations and hierarchies that disempower certain groups on the basis of race, class, sex, sexual orientation, and/or gender so that all humans have access to the means to live healthy lives. All of the activists I write about in this book recognized that social transformation also required the involvement of individuals and communities in their own health promotion. Geiger wrote of this fundamental lesson learned from his work creating Community Health Centers designed to address complex causes of sickness and health in poor communities. “[C]ommunities of the poor,” he explained, “all too often described only in terms of pathology, are in fact rich in potential and amply supplied with bright and creative people. . . . [and] health services which have sanction from the larger society and salience to the communities they serve, have the capacity to attack the root causes of ill health.”12 In other words, Geiger believed the solutions to public health problems often existed within communities themselves.
In 2012 Eli Adashi, Geiger, and Michael Fine wrote an article that appeared in the New England Journal of Medicine in which they argued that Community Health Centers will continue to play an important role in the successful implementation of the Affordable Care Act (ACA). The ACA will probably insure thirty-two million more Americans with primary care needs. Many of these people will need more than primary medical care, however. Fortunately, the legacy of the civil rights commitment to addressing problems of social inequality is still embedded in Community Health Center (CHC) delivery of health care. The authors note that “CHCs pride themselves equally on providing community-accountable and culturally competent care aimed at reducing health disparities associated with poverty, race, language, and culture. Indeed, CHCs offer translation, interpretation, and transportation services as well as assistance to patients eligible to apply for Medicaid or the Children’s Health Insurance Program (CHIP).”13 Yet, there is concern that the underwriting of the CHCs by the federal government may also narrow health delivery to medical care (combating disease) with reduced emphasis on social transformation.
As CHCs were established across the country to address social inequality as a primary cause of ill health in the 1960s and early ‘70s, women, both patients and organizers, noticed that many practitioners at free clinics (both federally funded in the CHC network and independent clinics) still failed to treat women’s health problems seriously or to listen to women when they asked questions about their bodies. Private physicians and hospital staff could be even worse. Women’s health activist Barbara Ehrenreich explains that women were often told by doctors that their concerns were “trivial,” and those concerns were dismissed. In 1973, in the widely distributed Women’s Liberation pamphlet Complaints and Disorders, Ehrenreich and Deirdre English wrote that they understood “medical sexism as a social force helping to shape the options and social roles of all women.”14 One of the ways women’s “social roles” were shaped was through definitions of the female body as inherently sick if middle class or sickening to others if working class. In both cases women’s bodies were managed, although upper-class women were defined as weak and perpetually infirm whereas working-class and poor women’s bodies were represented as vectors of disease.15
In response to their personal experiences with medical sexism, women involved in a burgeoning Women’s Liberation movement began building clinics—literally with their own hands and tools—devoted to women only and began to define health care delivery for themselves in ways that challenged sexed and gendered hierarchical power relationships, which in turn impacted both medical delivery and health. As historian Judith Houck points out, “At issue . . . was the question of professional authority, not between professional groups, but between health care professionals and laypersons without specialized training.”16 These women began what is now termed the “feminist women’s health movement,” which continues to be a vibrant part of feminist activism to this day.
Illegal abortion stood as one of the primary challenges confronting early Women’s Liberation activists involved with the women’s health movement at the end of the 1960s and beginning of the 1970s. Women who acquired abortions in the “illegal era” reported a variety of experiences, from hospital abortions doled out by panels of physicians to illegal but relatively safe procedures performed by physicians and other practitioners to dangerous self-abortions and abortions that led to complications and even death. As abortion gradually became legal and more readily available in the states and, after Roe v. Wade in 1973, legal nationally, feminists felt they had achieved a large step towards sexual equality.17 Yet, they still wanted to ensure that abortions were accessible and provided in safe and caring environments, particularly since the Supreme Court decision directed that abortion needed to be provided by physicians. Many feminists did not trust physicians to provide abortions in a feminist setting. As Ehrenreich and English wrote in 1973 in the context of a feminist narration of the development of a medical profession that marginalized women’s traditional healing practices, “women’s dependence on doctors . . . may have increased since 1900. Doctors moved in on each sexual or reproductive right as soon as it was liberated: they now control abortion and almost all reliable means of contraception.”18
Feminists also fought to relieve the stigma associated with abortion. Abortion has been the single most debated and controversial health care necessity demanded by feminists. It has also remained a stigmatized procedure—even among women who have abortions. Feminists involved in campaigns to legalize abortion and those active in the women’s health movement in the early years of abortion legality wanted women to understand that abortion was a legitimate choice and also that those who made the choice should not feel ashamed. In order to relieve the stigma, they discussed abortion in consciousness-raising groups and held speakouts where they publicly told stories of their abortions.19 Campaigners against legal abortion, referred to as the “Pro-Life movement,” fought to make abortion both illegal and shameful as they emphasized the importance of fetal “life” separate from the lives and bodies of women. Women who had abortions, they argued, were either victims or careless, promiscuous, and responsible for killing their children. Recently the Pro-Life movement has developed a new strategy that blames women for damaging the health of the fetus through drug use or rejection of court-ordered medical interventions such as cesareans.20
While feminists involved in the women’s health movement and abortion rights campaigns acknowledged that class and race framed health disparities, and often had an impact on who could access a safe abortion or who was subjected to population control measures like sterilization, their emphasis often rested on discriminations associated with sex, sexual identity, and gender. As Michelle Murphy astutely noted in her book, white women in the movement often focused on sharing knowledge about an “already ‘healthy’” body, whereas black feminists “repeatedly characterized the collective biopolitical conditions of black women using the words of the civil rights activist Fannie Lou Hamer . . . ‘sick and tired of being sick and tired.’”21 Women of color involved in early feminist organizing pointed out that race and class profoundly shaped which issues were prioritized in any political mobilization around health, reproduction, and the medicalized body. Issues of sterilization abuse, other medical abuses, poverty, and welfare rights were particularly relevant to women of color and often marginalized by white feminists who focused on abortion legality. Women of color feminists fought for legal abortion as well, and improved access to abortion that included state and federal funding, but, at the same time, they insisted that abortion and reproductive rights be understood as fundamentally linked to a campaign for intersecting social justice demands.22 For example, Beatrix Hoffman, historian of the history of health care rationing in the United States, writes that the National Welfare Rights Organization, an organization comprised of mostly black female welfare recipients, formed a Health Rights Committee in 1970 and demanded, “Just as all people have welfare rights, we believe they also have health rights.” They claimed that health care should be provided on the basis of need as a fundamental right rather than on the basis of income. They also demanded that physicians