President Obama and the Future of Women’s Health

Marcia Yerman

Along with the rest of the country eagerly anticipating the inauguration of Barack Obama, the majority of American women will be reveling in the fact that those who wanted to curb a woman's right to choose didn't make it to the Oval Office.

Along with the rest of the country eagerly
anticipating the inauguration of Barack Obama, the majority of American women
will be reveling in the fact that those who wanted to curb a woman’s right to
choose didn’t make it to the Oval Office. 

However, after the warm glow subsides, the
reality of working to regain traction on ground that was lost during the Bush
administration will set in.  With a
president in the White House who understands and accepts a woman’s right to
reproductive justice, the focus will now entail a reexamination of the
multitude of factors that are part of the larger picture.  

As the economic crisis looms large, women need
to be able to connect the dots from financial empowerment to their health care
issues.  In two recent events sponsored
by the American Association of University Women,
I was able to hear speakers define the picture.

At the first, Rep. Jan Schakowsky (D-Ill.) was
the featured guest.  The incoming
Democratic chair of the Congressional Caucus on Women’s Issues, she clarified
that "We have to undo some things."  She
enumerated the "global gag rule, family planning money, and the conscience
clause
."  The latter she compared to
"hiring a fire fighter that won’t go into a burning building."

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With the goal of expanding paid and medical
leave, childcare resources, and retirement issues…it all comes down to
money.  That conversation was taken up in
a press call sponsored by AAUW featuring women’s advocate, Rep. Rosa DeLauro (Dem-Ct.).  While the Lily Ledbetter Act
has received a lot of recognition, the Paycheck Fairness
Act
– which ensures women a second avenue to pursue discrimination claims –
is not as visible to the general public. Both bills just passed in the House, but an
outspoken advocacy push will be needed for passage in the Senate.  Advocacy links
have been set up to facilitate contacting Senators.

So how does this connect back to reproductive
justice and women’s health care? Do the math. 
Women account for 50 percent of the work force.  One fifth of women are without health
insurance, and half of women are in jobs without retirement plans.  When you read the statistic that women are
earning 77 cents on the dollar, there is another set of figures beneath the
surface.  Those tell the story about
women of color.  Black women earn 67
cents on the dollar; Hispanic women are at the low end of the scale at 58
cents.

As Schakowsky noted in a 09/23/08 op-ed in The Hill,
"Women are disproportionately affected by higher medical costs that eat up more
of their wages."  Women require more
health care, but have fewer financial resources to pay the bills. They pay 68
percent more than men for out-of-pocket expenses.  As a result, one in four women is unable to
pay her medical bills. 

This can boil down to lethal consequences.  Schakowsky gives the figures of almost one in
five women in the nation as being uninsured, and therefore at risk of being one
of the 22,000 Americans who will die annually due to lack of coverage. Women of
color, those who hold the lowest paying jobs, and those who are living in
poverty are most adversely affected.

When converted into women’s medical realities
the results are:

  • Uninsured women with breast cancer are 30
    to 50 percent more likely to die from the disease.
  • Uninsured women are three time less
    likely to have had a Pap test in the last three years, setting them up for a 60
    percent greater risk of late-stage cervical cancers.
  • 13 percent of all pregnant women have no
    insurance, and

therefore are less likely to follow a
course of prenatal care.

  • Breast cancer can be treated as a
    pre-existing condition

In tandem with the work of the 111th
Congress to institute safety nets for women on the economic front and in the
reform of healthcare, The
Prevention First Act
has been introduced to specifically deal with issues
including Family Planning, Teen Pregnancy, Sex Ed programs, and Emergency
Contraception for Rape Victims.

It should be noted that reproductive justice has
different meanings across the board.  To
a young woman in college it can be access to low-cost birth control.  To a mother-to-be it can translate as
affordable pre-natal and follow-up infant care. 
To a woman living in poverty, it can be the resources to travel to a
health care provider or clinic.

It is worth reflecting on the fact that in 1969,
President Nixon stated in a message to Congress:

"It is my view that no American woman should be denied access to
family planning assistance because of her economic condition. I believe,
therefore, that we should establish as a national goal the provision of
adequate family planning services within the next five years to all those who
want them but cannot afford them. This we have the capacity to do."

 

On December 26, 1970, he signed Title X into law.

It’s been a long eight years, but we have
survived the badlands of the Bush administration.  Good intentions on the part of the Obama
administration towards women’s concerns are a start, but not a guarantee.  For that assurance, women need to look to
their own resolve.

 

Commentary Contraception

The Promotion of Long-Acting Contraceptives Must Confront History and Center Patient Autonomy

Jamila Taylor

While some long-acting reversible contraceptive methods were used to undermine women of color's reproductive freedom, those methods still hold the promise of reducing unintended pregnancy among those most at risk.

Since long-acting reversible contraceptives (LARCs), including intrauterine devices and hormonal contraceptive implants, are among the most effective means of pregnancy prevention, many family planning and reproductive health providers are increasingly promoting them, especially among low-income populations.

But the promotion of LARCs must come with an acknowledgment of historical discriminatory practices and public policy related to birth control. To improve contraceptive access for low-income women and girls of color—who bear the disproportionate effects of unplanned pregnancy—providers and advocates must work to ensure that the reproductive autonomy of this population is respected now, precisely because it hasn’t been in the past.

For Black women particularly, the reproductive coercion that began during slavery took a different form with the development of modern contraceptive methods. According to Dorothy Roberts, author of Killing the Black Body, “The movement to expand women’s reproductive options was marked with racism from its very inception in the early part of [the 20th] century.” Decades later, government-funded family planning programs encouraged Black women to use birth control; in some cases, Black women were coerced into being sterilized.

In the 1990s, the contraceptive implant Norplant was marketed specifically to low-income women, especially Black adults and teenage girls. After a series of public statements about the benefits of Norplant in reducing pregnancy among this population, policy proposals soon focused on ensuring usage of the contraceptive method. Federal and state governments began paying for Norplant and incentivizing its use among low-income women while budgets for social support programs were cut. Without assistance, Norplant was not an affordable option, with the capsules costing more than $300 and separate, expensive costs for implantation and removal.

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Soon, Norplant was available through the Medicaid program. Some states introduced (ultimately unsuccessful) bills that would give cash rewards to entice low-income women on public assistance into using it; a few, such as Tennessee and Washington state, required that women receiving various forms of public assistance get information about Norplant. After proposing a bill to promote the use of Norplant in his state in 1994, a Connecticut legislator made the comment, “It’s far cheaper to give you money not to have kids than to give you money to have kids.” By that year, as Roberts writes, states had spent $34 million on Norplant-related care, much of it for women on Medicaid. Policymakers thought it was completely legitimate and cost-effective to control the reproduction of low-income women.

However, promoting this method among low-income Black women and adolescents was problematic. Racist, classist ideology dictating that this particular population of women shouldn’t have children became the basis for public policy. Even though coercive practices in reproductive health were later condemned, these practices still went on to shape cultural norms around race and gender, as well as medical practice.

This history has made it difficult to move beyond negative perceptions, and even fear, of LARCs, health care, and the medical establishment among some women of color. And that’s why it’s so important to ensure informed consent when advocating for effective contraceptive methods, with choice always at the center.

But how can policies and health-care facilities promote reproductive autonomy?

Health-care providers must deal head on with the fact that many contemporary women have concerns about LARCs being recommended specifically to low-income women and women of color. And while this is part of the broader effort to make LARCs more affordable and increasingly available to communities that don’t have access to them, mechanisms should be put in place to address this underlying issue. Requiring cultural competency training that includes information on the history of coercive practices affecting women of color could help family planning providers understand this concern for their patients.

Then, providers and health systems must address other barriers that make it difficult for women to access LARCs in particular. LARCs can be expensive in the short term, and complicated billing and reimbursement practices in both public and private insurance confuse women and providers. Also, the full cost associated with LARC usage isn’t always covered by insurance.

But the process shouldn’t end at eliminating barriers. Low-income Black women and teens must receive comprehensive counseling for contraception to ensure informed choice—meaning they should be given information on the full array of methods. This will help them choose the method that best meets their needs, while also promoting reproductive autonomy—not a specific contraceptive method.

Clinical guidelines for contraception must include detailed information on informed consent, and choice and reproductive autonomy should be clearly outlined when family planning providers are trained.

It’s crucial we implement these changes now because recent investments and advocacy are expanding access to LARCs. States are thinking creatively about how to reduce unintended pregnancy and in turn reduce Medicaid costs through use of LARCs. The Colorado Family Planning Initiative has been heralded as one of the most effective in helping women access LARCs. Since 2008, more than 30,000 women in Colorado have chosen LARCs as the result of the program. Provider education, training, and contraceptive counseling have also been increased, and women can access LARCs at reduced costs.

The commitment to LARCs has apparently yielded major returns for Colorado. Between 2009 and 2013, the abortion rate among teenagers older than 15 in Colorado dropped by 42 percent. Additionally, the birth rate for young women eligible for Medicaid dropped—resulting in cost savings of up to an estimated $111 million in Medicaid-covered births. LARCs have been critical to these successes. Public-private partnerships have helped keep the program going since 2015, and states including Delaware and Iowa have followed suit in efforts to experience the same outcomes.

Recognizing that prevention is a key component to any strategy addressing a public health concern, those strategies must be rooted in ensuring access to education and comprehensive counseling so that women and teens can make the informed choices that are best for them. When women and girls are given the tools to empower themselves in decision making, the results are positive—not just for what the government spends or does not spend on social programs, but also for the greater good of all of us.

The history of coercion undermining reproductive freedom among women and girls of color in this country is an ugly one. But this certainly doesn’t have to dictate how we move forward.

Commentary Violence

When It Comes to Threats, Online or on the Campaign Trail, It’s Not Up to Women to ‘Suck It Up’

Lauren Rankin

Threats of violence toward women are commonplace on the internet for the same reason that they are increasingly common at Donald Trump rallies: They are effective at perpetuating violence against women as the norm.

Bizarre and inflammatory rhetoric is nothing new for this election. In fact, the Republican presidential candidate has made an entire campaign out of it. But during a rally last Tuesday, Donald Trump sunk to a new level. He lamented that if Hillary Clinton is elected president in November, there will be no way to stop her from making judicial nominations.

He said, “By the way, and if she gets to pick her judges, nothing you can do, folks. Although the Second Amendment people, maybe there is, I don’t know.”

For a candidate marred by offensive comment after offensive comment, this language represents a new low, because, as many immediately explained, Trump appears to be making a veiled threat against Clinton, whether he had intended to or not.

Sen. Elizabeth Warren (D-MA) called it a “death threat” and Dan Rather, former CBS Evening News host, called it a “direct threat of violence against a political rival.” Former President Ronald Reagan’s daughter Patti Davis said it was “horrifying,” and even the author of an NRA-linked blog initially tweeted, “That was a threat of violence. As a real supporter of the #2A it’s appalling to me,” before deleting the tweet as the NRA expressed support for Trump.

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This kind of language is violent in nature on its face, but it is also gendered, following in a long line of misogynistic rhetoric this election season. Chants of “kill the bitch” and “hang the bitch” have become common at Trump rallies. These aren’t solely examples of bitter political sniping; these are overt calls for violence.

When women speak out or assert ourselves, we are challenging long-held cultural norms about women’s place and role in society. Offensively gendered language represents an attempt to maintain the status quo. We’ve seen this violent rhetoric online as well. That isn’t an accident. When individuals throw pejorative terms at those of who refuse to be silenced, they are attempting to render public spaces, online or on the campaign trail, unsafe for us.

There is no shortage of examples demonstrating how individuals who feel threatened by subtle power shifts happening in our society have pushed back against those changes. The interactions happening online, on various social media platforms, offer the most vivid examples of the ways in which people are doing their best to try to make public spaces as uncomfortable as possible for marginalized populations.

Social media offers the opportunity for those whose voices are routinely ignored to hold power in a new way. It is a slow but real shift from old, more traditional structures of privileging certain voices to a more egalitarian megaphone, of sorts.

For marginalized populations, particularly women of color and transgender women, social media can provide an opportunity to be seen and heard in ways that didn’t exist before. But it also means coming up against a wall of opposition, often represented in a mundane but omnipresent flow of hatred, abuse, and violent threats from misogynist trolls.

The internet has proven to be a hostile place for women. According to a report from the United Nations, almost three quarters of women online have been exposed to some form of cyber violence. As someone who has received threats of violence myself, I know what it feels like to have sharing your voice met with rage. There are women who experience this kind of violent rhetoric to an even greater degree than I could ever dream.

The list of women who have been inundated with threats of violence could go on for days. Women like Zerlina Maxwell, who was showered with rape threats after saying that we should teach men not to rape; Lindy West received hundreds upon hundreds of violent and threatening messages after she said that she didn’t think rape jokes were funny; Leslie Jones, star of Ghostbusters and Saturday Night Live, was driven off of Twitter after a coordinated attack of racist, sexist, and violent language against her.

And yet, rarely are such threats taken seriously by the broader community, including by those able to do something about it.

Many people remain woefully unaware of how cruel and outright scary it can be for women online, particularly women with prolific digital profiles. Some simply refuse to see it as a real issue, declaring that “It’s just the internet!” and therefore not indicative of potential physical violence. Law enforcement doesn’t even have a solution, often unwilling to take these threats seriously, as Amanda Hess found out.

This kind of response is reflected in those who are trying to defend Donald Trump after the seemingly indefensible. Despite the overwhelming criticism from many, including some renowned Republicans, we have also seen some Trump supporters try to diminish or outright erase the violent aspect of this clearly threatening rhetoric. Sen. Roy Blunt (R-MO) and former mayor of New York City Rudy Giuliani have both said that they assumed Trump meant get rid of her “by voting.” Speaker of the House Paul Ryan (R-WI) said that it “sounds like just a joke gone bad.”

The violent nature of Donald Trump’s comments seem apparent to almost everyone who heard him. To try to dismiss it as a “joke” or insist that it is those who are offended that are wrong is itself harmful. This is textbook gaslighting, a form of psychological abuse in which a victim’s reality is eroded by telling them that what they experienced isn’t true.

But gaslighting has played a major role in Donald Trump’s campaign, with some of his supporters insisting that it is his critics who are overreacting—that it is a culture of political correctness, rather than his inflammatory and oppressive rhetoric, that is the real problem.

This is exactly what women experience online nearly every day, and we are essentially told to just suck it up, that it’s just the internet, that it’s not real. But tell that to Jessica Valenti, who received a death and rape threat against her 5-year-old daughter. Tell that to Anita Sarkeesian, who had to cancel a speech at Utah State after receiving a death threat against her and the entire school. Tell that to Brianna Wu, a game developer who had to flee her home after death threats. Tell that to Hillary Clinton, who is trying to make history as the first woman president, only to have her life threatened by citizens, campaign advisers, and now through a dog whistle spoken by the Republican presidential candidate himself.

Threats of violence toward women are commonplace on the internet for the same reason that they are increasingly common at Donald Trump’s rallies: They are effective at perpetuating violence against women as the norm.

Language matters. When that language is cruel, aggressive, or outright violent, it doesn’t exist in a vacuum, and it doesn’t come without consequences. There is a reason that it is culturally unacceptable to say certain words like “cunt” and other derogatory terms; they have a history of harm and oppression, and they are often directly tied to acts of violence. When someone tweets a woman “I hope your boyfriend beats you,” it isn’t just a trolling comment; it reflects the fact that in the United States, more women are killed by intimate partners than by any other perpetrator, that three or more women die every day from intimate partner violence. When Donald Trump not only refuses to decry calls of violence and hate speech at his rallies but in fact comes across as threatening his female opponent, it isn’t just an inflammatory gaffe; it reflects the fact that one in three women have experienced physical or sexual violence.

Threats of violence have no place in presidential campaigns, but they also have no place online, either. Until we commit ourselves to rooting out violent language against women and to making public spaces safer and more accommodating for women and all marginalized people, Trump’s comments are just par for the course.

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