How Easy It Isn’t

Heather Corinna

"Young women today have it so much better when it comes to sex than we did... right?" Often women in their forties and above are shocked to hear that younger women are struggling with sex and sexuality...just like we did. Some struggle even more.

[img_assist|nid=2391|title=|desc=|link=none|align=right|width=150|height=225]“Any girl can look glamorous. All you have to do is stand still and look stupid.” – Hedy Lamarr

Young women today have it so much better when it comes to sex than we did… right?

Now and then, when talking about the population I work with and the work I do with them, I will hear or face women in their late thirties or older stating that now that we live in a post-feminist world here in the states, they’re shocked to hear that young women are struggling with sex and sexuality….well, just like we were. And some struggle even more.

Let’s get that post-feminist mishegoss out of the way first. I remember the first time — it was near the end of the 80s, which probably should have tipped me off to the fact that clearly, the end of the 80’s was indeed nigh — I ever heard someone use that phrase, as blithely as if they’d just said the earth were round. I wondered how the heck I missed the final end of sexism, patriarchy and gender inequality.  Surely, if this were so, I’d have heard the long, whining wail of even just one of the Rush Limbaugh’s of the world?

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I’ve found the only conclusions I can ever come to when it comes to those who hold the idea that we’re post-feminist are that they must a) be feeling the membership they have on the other team is so valuable yet so tenuous that any sign of fraternization (as it were) with the enemy would bring their exile, b) that many women are simply either tired from the struggles of feminism or who see how tired other women have become and don’t want to be that worn out themselves, and/or c) be indulging in some seriously wishful thinking and have outrageously low expectations for equality.

I agree: it feels like we should be further along than we are, and should have to wait less long to get there. It feels like we — and certainly younger women than we — should be there already. But we’re not.

I can understand why it can seem like young women have it easier when it comes to sex and sexuality. Their access to many kinds of birth control and to abortion is certainly better than it has been for women in the past, even though that access has had limits imposed upon it in the last ten years and has, at times, been at serious risk. GLBT youth in the U.S., in so many ways, certainly have a more welcoming environment. Many teens and twentysomethings are have information on their bodies and their sexuality available to them which many women not only did not have as easily before, but more of that material available is also being penned by women, for women, and is even truly about women sometimes. Better support services are available for this generation when it comes to rape and abuse than even the generation right before them had, and cultural awareness about rape and abuse continue to increase.  Positive and negative body image are things they hear about. Sex and  exuality are discussed more openly and widely. 

But all those benefits can also pose some not-so-beneficials, and some very real challenges. Young women now have some extra bags to carry that we before them may not have had to, or found quite so heavy, and either overflowing or vacant with scarcity everywhere we turned.

A majority of young American women today do grow up aware that no means no, and told that they have permission to say no. However, many grow up also experiencing that while no may mean no, they don’t always have an easy time saying it or feel the permission to. Too, many young women are more frequently, and at earlier ages — which for some is due to sexual development happening earlier historically than it ever has for women before — finding themselves in the position of responding to sexual invitations and situations. Statistically, the earlier young women become sexually active, the more frequently they report those very early experiences are coerced: saying no in a highly loaded situation, no matter what generation we belong to, tends to be something that is a lot more difficult the younger we are. As well, the younger women are when they become sexually active, the older their partners tend to be, and the less likely it is that contraception or safer sex practices are used.

When they can get past the no, past the maybe, and to the yes, that yes often tends to end in a question mark instead of an exclamation point. The "yes" to sex and sexuality I hear young women often express sounds like the way many of us who took other languages in high school and trying to speak them in the country of their origin in our later years. Like asking with a feigned confidence where the drivel is when we wanted to ask where the bathroom was. Too much of the time, that’s unfortunately what the yesses young women discuss sound like to me. ¿Dónde está la bana?

Sparing emergency contraception, there have not been any new advances in available birth control in the last decade: the female condom and the implant were released in the early 90’s, and even emergency contraceptive pills were given FDA approval ten years ago, though they’d already been around for some time. Mostly, we’ve added a couple new ways of delivering the same old hormones we already had. We’ve had no advances in non-hormonal methods, which is no small deal for teens who may not have access to hormonal methods, or who they may not be so great for, both in terms of their health and their ease-of-use for teens (the typical use rate for the pill drops nearly 10% for adolescents from the adult typical use rate). Too, the use of hormonal methods for menstrual suppression is becoming more popular. With more older women talking about how awesome not having a period is, women in their teens having a hard enough time already accepting the adult changes in their bodies get another message that those changes are as awful and gross as they feel. I’m starting to notice that much in the same way women my mother’s age have talked about how the advent of the pill could make it tougher for them to say no to sex (because "I’m worried I’ll get pregnant" stopped being such an easy out), some younger women seem to feel pressure from peers and partners to suppress periods for greater sexual accessibility to them.

Even EC is only so much of a great advance for them, since in the U.S. it remains out of reach of many women under the age of 18 who cannot buy it over the counter, and who face intense judgment from both their physicians and their pharmacists when they seek it out, and with less chutzpah to draw on to counter that. It also can sometimes result in those same sorts of pressures to provide sex to wanting partners my mother’s generation experienced with the popularity of the pill. While abortion access for women as a whole is indeed better, many people don’t know or forget that for many women under the age of 18, the same rules do not apply. Only three states outright allow ALL minors to consent to terminations. Six have no policy or law about minors and abortion. All the forty-one remaining states carry some restriction for teens adult women do not have. American girls and young women now have also come of age also strongly wedged into a culture war, which often makes making reproductive choices even more loaded for them than many of their older counterparts.

And whooooo doggy, that culture war, all by itself, also has no small effect on every aspect of their female bodies, sexuality, sexual choices as a whole, nor per how others view them. Let’s bear in mind most of us my age also did not grow up hearing about the virginity pledges on the same night we casually flipped the remote past an ad for Girls Gone Wild.

GLBT youth do have more and more avenues of support, greater visibility and every now and then, we seem to come close to getting some actual civil rights. But being visible’s not so fantastic when you’re visible in the middle of rural Alabama, when your boyfriend is only okay with your bisexuality if you’ll screw your best friend for his entertainment, and when you don’t adhere to the "right" ways of being queer in a heterosexist environment, which for many lesbian and bisexual young women, means things like presenting all your same-sex relationships as a sexual lark, never privileging girlfriends over boyfriends, and being sure that if you are going to "look gay," you look like an extra on the set of the L-word, not like you just came home from a rugby match. For trans youth, there is absolutely more awareness and more support, but still no evidence-based medicine on care for trans youth. That’s particularly problematic when some trans youth are also feeling peer pressures to transition earlier and earlier. A colleague of mine shared a story with me about a young trans client who, at 16, said how she needed to know how much surgery would cost because she’s planning it for when she’s 18. She then went on to say how that was "waiting forever" and how she’s "obviously going to transition later in life". I’ve heard similar feelings expressed by questioning women who feel they aren’t allowed time to question their orientation, but need to come all the way out as early as possible.

The Internet is, of course, the big newbie. Most of us had some good measure of time to get used to life without it, before the ever-increasing measure of input started to snowball. Most of them don’t remember a time without it. The Internet, and all its various tools and services, creates a whole host of new challenges, such as trying to figure out how to manage an online relationship and set boundaries in a space which feels as boundless as it is yet pretends to be private; where intimacy is all too easy to misrepresent or misunderstand or navigating the difference between the person you are offline and the persona you get more easy approval for online, especially if you up the ante with sex. The ‘net has changed the nature of their relationships not unlike the way that the steam engine, the car, postal mail, movie theaters, singles or gay bars, the telephone, or personals ads changed the nature of relationships in the past.

With the Internet, for many young women and men alike there exists a far greater and constantly replicating mass of pornography and other representations of sexuality and the body than most of us grew up managing. In our generation, your dad’s porn was something you most often tended to find after a very intentional expedition, not something that popped up in your face before you even had a single, self-compelled curiosity about sex.
In some respect, online pornography and other representations of sexuality have certainly helped diversify concepts of sexuality and what it might look like or feel like to be sexual, and younger women have very much been exposed to more diversity, and more women’s voices in this regard than many previous generations of women. However, it — like every other media — has also continued to more frequently broadcast from and for the lowest common denominator and they are inundated with an even greater volume of homogeneous and sexist sexual messages, beauty and sexual ideals and representations of sex from men and/or for men but dripping over with women in whatever mold they imagine into being for themselves. The feeling that sex needs to be about performance and one-upwomanship — and one young women often express feeling sex-as-competition is not merely between they and friends but they and professional sex performers — rather than personal expression seems to be growing, which is hardly surprising.

Even without the Internet, television alone is a much different critter than in days of yore. In 1985, that average television at home showed just under 19 channels. In 2007, the average home now received over 100 channels. So, even if nothing at all had changed when it comes to the content of television — and we know well it has — we know with absolute certainty that when young women today say that they are faced with pressures and mixed messages everywhere they look, they really aren’t kidding.

When we’re not talking about entertainment, but education, more information doesn’t always equal more knowledge. Yeah, they have more information and greater access to it. But more information is not always better information, nor information that’s really about them, which is accurate, information they can contextualize soundly or even know how to look for in the first place.

With so much available information in such a vacuum, navigating it all can sometimes leave young people feeling like they know less, rather than more. Very few young people have had education in determining credibility or bias in media, after all. Many, when reading, will tend to absorb emotional tonality first and facts second. Young women today are certainly no more savvy when it comes to filtering all of that media through a realistic lens: I’d actually argue that the majority of them are less able to do so. They have, after all, grown up in a culture in which the line between real and ideal, reality and reality media are as solid as a Slushee in August. And when it comes to sexuality, so much sexual information that is available is not only heterosexist, sexist and full of every other kind of -ist you can think of, it’s often intended for a group of people of a different age group, whose sexual issues tend to be different, and who often have better agency and resources as well as more experience with real-life sex and relationships to draw upon.

Speaking of more information, In the 80’s, home video recorders became widely available. Plenty of us likely had our own forays into creating media with them, whether that was a lip-synched video with friends or a videoptaped sexual escapade. But our home videos, even the most explicit of them, were unlikely to present anything close to the same possible risks of impact. We were not likely to find them broadcast to everyone else we went to school with in a matter of minutes, nor then to anyone around the globe who can pull up a page on YouTube. The cultural climate was such that any of us who had adventures in amateur quasi-porn for Beta back when were unlikely to find ourselves or a partner facing child pornography charges. While we may relate to the same possibility of being labeled a slut or a sexual victim, what we probably can’t relate to is hearing that in a chorus which spans the planet or having it put on our permanent criminal records. If you’ve not managed to be spared all the flurry about "sexting," you also know that the activity itself is something a lot of adults are having pretty forceful opinions about (with selective memory, it appears, about those home videos, those tape recordings or those polaroids), especially when the bodies onscreen are female.

All of this en masse exposure and dual celebration and damnation of exposure can result in many young women feeling an expectation to be exhibitionistic, even if that’s not part of their unique personality and nature. Even though it’s a bit of a given that we likely have some underreporting, exhibitionism is not something statistically found to be anything close to as common for women as for men, but you’d never know that if you only observed or listened to teens right now, nor would they.

In print, young women find themselves seeing women more and more commodified, with less on in far more places — and less to cover in the first place. The cult of thin is hardly shiny-new nor is it the first unhealthy beauty ideal we ever had, but I do think we can say it’s gotten more and more pervasive and extreme, and it is an ideal that has ten-year-old American girls trying to starve off womanhood before it can start. A bustle, a muscle or an hourglass daydream this isn’t.

Too, some of women’s new touted "choices," are entirely about not only appearances, but about conformity of appearance, and have resulted in young women facing new pressures. Labiaplasty, breast implants and other cosmetic surgeries, botox and pubic hairstyling have not only come on the scene and increased with every year, they have become increasingly normalized. From 2002 to 2003, the number of females younger than 18 who underwent breast augmentation tripled. So, young women feel an increasing normality and sense of what’s "natural" and the way so many older women continue to rag on their own normal bodies, go under the knife and talk up and glorify cosmetic surgery sure doesn’t help. Don’t even get me started on the way I so frequently hear young women talking about their vulval appearance, and how the push for cosmetic procedures has amplified those body image fears and insecurities.

Better support services are available for them with rape and other abuses, and the rate of rape in the U.S.was on a slow but steady decline since around 1990 when it peaked, though the rate we’re at now is higher than it was in the late 70’s and early 80’s. The rates of sexual, physical and emotional abuses within young adult relationships have been increasing, and plenty of young women have been reared in families or communities where some or all kinds of abuse are still considered "just the way it is." Rape also remains something more women suffer under the age of 18 than those over 18. Plying women with substances as a means to rape them is hardly new, but the date rape drugs of the last decade or two pack a much bigger punch than a shot of gin or a ‘lude, especially when young women already have alcohol or other recreational drugs in their systems. It’s worth mentioning that the growing acceptability of friendships between the sexes, which in so many ways is obviously a positive, can be not-so-positive when a pack of guys who you thought were your "friends" turn out to be anything but, and you didn’t ever see it coming.

Many young American women (as well as young men, which is certainly an issue) also seem to be going without other responsibilities in life which can help prepare them for managing the responsibilities which sex requires. Plenty do not work part-time in high school, do not get themselves to and fro to places by foot, bike or bus, nor have many household responsibilities. For some, things like cars, cell phones or computers aren’t joint purchases or items earned by some kind of show of needed responsibility, but gifts. A great many young people here aren’t leaving home at 18 anymore (and for those who do, sometimes that means going right into romantic cohabitation or marriage, rather than living alone or with platonic roomies), nor do some feel any impetus to do so anytime soon.

While all that may seem like a blessing — how lucky the ones who are so comfortable are! — working out responsibility for the first time when things like pregnancy, STIs and the whole of your heart are on the line without having had practice with things which pose far less risk and are far less loaded? Not so lucky, after all.

The very expectation that young women today should or do have it so much easier, in and of itself, can be a pressure. Many older women expect younger women to be apt at managing all of these issues and more in ways that they themselves were not and may still not be. The notion that younger women should have better sex lives from minute one then their older counterparts — especially if their older counterparts have conditioned them with the same old ideas about sex and women’s place in it — can be a lot to put on them, as can the idea that things like permission to use to birth control, a greater cultural awareness of the clitoris and some measure of sex education will somehow be all they need to have healthy, happy and satisfying sex lives. The idea that because things are so much better for them they need less help, support and information, however need more controlling, is a serious doozy. (Oddly enough, a similar kind of pattern emerged around 100 years ago with girls in the working classes who were beginning to exhibit a freedom with sexuality their mothers did not have. This is the part where we all sing along to "Everything Old is New Again.")

There’s one other thing, though, which many young women also don’t have the benefit of in this arena which many of us also did not, many of our mothers did not, many of our grandmothers did not. It might even be the most important thing. It’s certainly the easiest to remedy.

That’s ongoing, nonjudgmental support, ideally coming from a woman in their life who listens at least as much as she talks. From someone who doesn’t so much show up to "tell it like it is" (read: tells it like she, herself, has experienced it and judged it, and as she, herself, feels is best for others based on her own subjective experiences), but to listen to what it’s like, reflect back and offer support, acceptance, respectful guidance, compassion, information — which they may have to look up anew, as many rely on what they know about sex from only their own lives or outdated information — and no small measure of love. In the essay I wrote for Yes Mean Yes, I talked about this a bit. There are obviously aspects of making thing better for young women that we just can’t provide on our own steam. We can keep working towards them as a collective (which may well be helped by never, ever uttering the term "post-feminist" again, not until after the fat neoconservative sings, anyway), but we can’t often do a whole lot more than slowly chip away at the albatross at hand.

However, we most certainly can earnestly seek to connect with the younger women in our lives and do them the justice of not presuming they have it any easier than we, our mothers or or grandmothers did. We can allow them the same kind of gradual learning curve any of us should be allowed, the same feelings of injustice and frustration, the same occasional notion that things which are substandard are super-great, the same stumbling journeys, the same irritation with all the things which are NOT easier and those which are tougher. We can never tell them that they’re lucky when they’re in a state of crisis or confusion, or that they should be grateful they don’t have it as bad as we did. We can do our best to be sure we’re not making their teenage or twentysomething sexual life and self some sort of Valhalla because ours either was or was not, or because our own sexual lives and selves at our age are or are not as great as we’d like, and check our own feelings, motivations, judgments and choices if and when we are saying there are things we haven’t got but they do. We can recognize — ideally, within earshot of younger women — that we still have our own evolving to do in this arena, our own changes and improvements to seek out, our own revolutions hardly completed, and that we don’t expect them to have it any more together than we do ourselves.

We can do our best to never presume that what might look glamorous is anything but, nor that the person standing still and looking stupid is not the one being looked at, but the one (not) doing the looking.


This piece is part of the blog tour for the anthology Yes Means Yes

 

Culture & Conversation Maternity and Birthing

On ‘Commonsense Childbirth’: A Q&A With Midwife Jennie Joseph

Elizabeth Dawes Gay

Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

This piece is published in collaboration with Echoing Ida, a Forward Together project.

Jennie Joseph’s philosophy is simple: Treat patients like the people they are. The British native has found this goes a long way when it comes to her midwifery practice and the health of Black mothers and babies.

In the United States, Black women are disproportionately affected by poor maternal and infant health outcomes. Black women are more likely to experience maternal and infant death, pregnancy-related illness, premature birth, low birth weight, and stillbirth. Beyond the data, personal accounts of Black women’s birthing experiences detail discrimination, mistreatment, and violation of basic human rights. Media like the new film, The American Dream, share the maternity experiences of Black women in their own voices.

A new generation of activists, advocates, and concerned medical professionals have mobilized across the country to improve Black maternal and infant health, including through the birth justice and reproductive justice movements.

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Joseph founded a nonprofit, Commonsense Childbirth, in 1998 to inspire change in maternity care to better serve people of color. As a licensed midwife, Joseph seeks to transform how care is provided in a clinical setting.

At her clinics, which are located in central Florida, a welcoming smile and a conversation mark the start of each patient visit. Having a dialogue with patients about their unique needs, desires, and circumstances is a practice Joseph said has contributed to her patients having “chunky,” healthy, full-term babies. Dialogue and care that centers the patient costs nothing, Joseph told Rewire in an interview earlier this summer.

Joseph also offers training to midwives, doulas, community health workers, and other professionals in culturally competent, patient-centered care through her Commonsense Childbirth School of Midwifery, which launched in 2009. And in 2015, Joseph launched the National Perinatal Task Force, a network of perinatal health-care and service providers who are committed to working in underserved communities in order to transform maternal health outcomes in the United States.

Rewire spoke with Joseph about her tireless work to improve maternal and perinatal health in the Black community.

Rewire: What motivates and drives you each day?

Jennie Joseph: I moved to the United States in 1989 [from the United Kingdom], and each year it becomes more and more apparent that to address the issues I care deeply about, I have to put action behind all the talk.

I’m particularly concerned about maternal and infant morbidity and mortality that plague communities of color and specifically African Americans. Most people don’t know that three to four times as many Black women die during pregnancy and childbirth in the United States than their white counterparts.

When I arrived in the United States, I had to start a home birth practice to be able to practice at all, and it was during that time that I realized very few people of color were accessing care that way. I learned about the disparities in maternal health around the same time, and I felt compelled to do something about it.

My motivation is based on the fact that what we do [at my clinic] works so well it’s almost unconscionable not to continue doing it. I feel driven and personally responsible because I’ve figured out that there are some very simple things that anyone can do to make an impact. It’s such a win-win. Everybody wins: patients, staff, communities, health-care agencies.

There are only a few of us attacking this aggressively, with few resources and without support. I’ve experienced so much frustration, anger, and resignation about the situation because I feel like this is not something that people in the field don’t know about. I know there have been some efforts, but with little results. There are simple and cost-effective things that can be done. Even small interventions can make such a tremendous a difference, and I don’t understand why we can’t have more support and more interest in moving the needle in a more effective way.

I give up sometimes. I get so frustrated. Emotions vie for time and energy, but those very same emotions force me to keep going. I feel a constant drive to be in action and to be practical in achieving and getting results.

Rewire: In your opinion, what are some barriers to progress on maternal health and how can they be overcome?

JJ: The solutions that have been generated are the same, year in and year out, but are not really solutions. [Health-care professionals and the industry] keep pushing money into a broken system, without recognizing where there are gaps and barriers, and we keep doing the same thing.

One solution that has not worked is the approach of hiring practitioners without a thought to whether the practitioner is really a match for the community that they are looking to serve. Additionally, there is the fact that the practitioner alone is not going to be able make much difference. There has to be a concerted effort to have the entire health-care team be willing to support the work. If the front desk and access points are not in tune with why we need to address this issue in a specific way, what happens typically is that people do not necessarily feel welcomed or supported or respected.

The world’s best practitioner could be sitting down the hall, but never actually see the patient because the patient leaves before they get assistance or before they even get to make an appointment. People get tired of being looked down upon, shamed, ignored, or perhaps not treated well. And people know which hospitals and practitioners provide competent care and which practices are culturally safe.

I would like to convince people to try something different, for real. One of those things is an open-door triage at all OB-GYN facilities, similar to an emergency room, so that all patients seeking maternity care are seen for a first visit no matter what.

Another thing would be for practitioners to provide patient-centered care for all patients regardless of their ability to pay.  You don’t have to have cultural competency training, you just have to listen and believe what the patients are telling you—period.

Practitioners also have a role in dismantling the institutionalized racism that is causing such harm. You don’t have to speak a specific language to be kind. You just have to think a little bit and put yourself in that person’s shoes. You have to understand she might be in fear for her baby’s health or her own health. You can smile. You can touch respectfully. You can make eye contact. You can find a real translator. You can do things if you choose to. Or you can stay in place in a system you know is broken, doing business as usual, and continue to feel bad doing the work you once loved.

Rewire: You emphasize patient-centered care. Why aren’t other providers doing the same, and how can they be convinced to provide this type of care?

JJ: I think that is the crux of the matter: the convincing part. One, it’s a shame that I have to go around convincing anyone about the benefits of patient-centered care. And two, the typical response from medical staff is “Yeah, but the cost. It’s expensive. The bureaucracy, the system …” There is no disagreement that this should be the gold standard of care but providers say their setup doesn’t allow for it or that it really wouldn’t work. Keep in mind that patient-centered care also means equitable care—the kind of care we all want for ourselves and our families.

One of the things we do at my practice (and that providers have the most resistance to) is that we see everyone for that initial visit. We’ve created a triage entry point to medical care but also to social support, financial triage, actual emotional support, and recognition and understanding for the patient that yes, you have a problem, but we are here to work with you to solve it.

All of those things get to happen because we offer the first visit, regardless of their ability to pay. In the absence of that opportunity, the barrier to quality care itself is so detrimental: It’s literally a matter of life and death.

Rewire: How do you cover the cost of the first visit if someone cannot pay?

JJ: If we have a grant, we use those funds to help us pay our overhead. If we don’t, we wait until we have the women on Medicaid and try to do back-billing on those visits. If the patient doesn’t have Medicaid, we use the funds we earn from delivering babies of mothers who do have insurance and can pay the full price.

Rewire: You’ve talked about ensuring that expecting mothers have accessible, patient-centered maternity care. How exactly are you working to achieve that?

JJ: I want to empower community-based perinatal health workers (such as nurse practitioners) who are interested in providing care to communities in need, and encourage them to become entrepreneurial. As long as people have the credentials or license to provide prenatal, post-partum, and women’s health care and are interested in independent practice, then my vision is that they build a private practice for themselves. Based on the concept that to get real change in maternal health outcomes in the United States, women need access to specific kinds of health care—not just any old health care, but the kind that is humane, patient-centered, woman-centered, family-centered, and culturally-safe, and where providers believe that the patients matter. That kind of care will transform outcomes instantly.

I coined the phrase “Easy Access Clinics” to describe retail women’s health clinics like a CVS MinuteClinic that serve as a first entry point to care in a community, rather than in a big health-care system. At the Orlando Easy Access Clinic, women receive their first appointment regardless of their ability to pay. People find out about us via word of mouth; they know what we do before they get here.

We are at the point where even the local government agencies send patients to us. They know that even while someone’s Medicaid application is in pending status, we will still see them and start their care, as well as help them access their Medicaid benefits as part of our commitment to their overall well-being.

Others are already replicating this model across the country and we are doing research as we go along. We have created a system that becomes sustainable because of the trust and loyalty of the patients and their willingness to support us in supporting them.

Photo Credit: Filmmaker Paolo Patruno

Joseph speaking with a family at her central Florida clinic. (Credit: Filmmaker Paolo Patruno)

RewireWhat are your thoughts on the decision in Florida not to expand Medicaid at this time?

JJ: I consider health care a human right. That’s what I know. That’s how I was trained. That’s what I lived all the years I was in Europe. And to be here and see this wanton disregard for health and humanity breaks my heart.

Not expanding Medicaid has such deep repercussions on patients and providers. We hold on by a very thin thread. We can’t get our claims paid. We have all kinds of hoops and confusion. There is a lack of interest and accountability from insurance payers, and we are struggling so badly. I also have a Change.org petition right now to ask for Medicaid coverage for pregnant women.

Health care is a human right: It can’t be anything else.

Rewire: You launched the National Perinatal Task Force in 2015. What do you hope to accomplish through that effort?

JJ: The main goal of the National Perinatal Task Force is to connect perinatal service providers, lift each other up, and establish community recognition of sites committed to a certain standard of care.

The facilities of task force members are identified as Perinatal Safe Spots. A Perinatal Safe Spot could be an educational or social site, a moms’ group, a breastfeeding circle, a local doula practice, or a community center. It could be anywhere, but it has got to be in a community with what I call a “materno-toxic” area—an area where you know without any doubt that mothers are in jeopardy. It is an area where social determinants of health are affecting mom’s and baby’s chances of being strong and whole and hearty. Therein, we need to put a safe spot right in the heart of that materno-toxic area so she has a better chance for survival.

The task force is a group of maternity service providers and concerned community members willing to be a safe spot for that area. Members also recognize each other across the nation; we support each other and learn from each others’ best practices.

People who are working in their communities to improve maternal and infant health come forward all the time as they are feeling alone, quietly doing the best they can for their community, with little or nothing. Don’t be discouraged. You can get a lot done with pure willpower and determination.

RewireDo you have funding to run the National Perinatal Task Force?

JJ: Not yet. We have got the task force up and running as best we can under my nonprofit Commonsense Childbirth. I have not asked for funding or donations because I wanted to see if I could get the task force off the ground first.

There are 30 Perinatal Safe Spots across the United States that are listed on the website currently. The current goal is to house and support the supporters, recognize those people working on the ground, and share information with the public. The next step will be to strengthen the task force and bring funding for stability and growth.

RewireYou’re featured in the new film The American Dream. How did that happen and what are you planning to do next?

JJ: The Italian filmmaker Paolo Patruno got on a plane on his own dime and brought his cameras to Florida. We were planning to talk about Black midwifery. Once we started filming, women were sharing so authentically that we said this is about women’s voices being heard. I would love to tease that dialogue forward and I am planning to go to four or five cities where I can show the film and host a town hall, gathering to capture what the community has to say about maternal health. I want to hear their voices. So far, the film has been screened publicly in Oakland and Kansas City, and the full documentary is already available on YouTube.

RewireThe Black Mamas Matter Toolkit was published this past June by the Center for Reproductive Rights to support human-rights based policy advocacy on maternal health. What about the toolkit or other resources do you find helpful for thinking about solutions to poor maternal health in the Black community?

JJ: The toolkit is the most succinct and comprehensive thing I’ve seen since I’ve been doing this work. It felt like, “At last!”

One of the most exciting things for me is that the toolkit seems to have covered every angle of this problem. It tells the truth about what’s happening for Black women and actually all women everywhere as far as maternity care is concerned.

There is a need for us to recognize how the system has taken agency and power away from women and placed it in the hands of large health systems where institutionalized racism is causing much harm. The toolkit, for the first time in my opinion, really addresses all of these ills and posits some very clear thoughts and solutions around them. I think it is going to go a long way to begin the change we need to see in maternal and child health in the United States.

RewireWhat do you count as one of your success stories?

JJ: One of my earlier patients was a single mom who had a lot going on and became pregnant by accident. She was very connected to us when she came to clinic. She became so empowered and wanted a home birth. But she was anemic at the end of her pregnancy and we recommended a hospital birth. She was empowered through the birth, breastfed her baby, and started a journey toward nursing. She is now about to get her master’s degree in nursing, and she wants to come back to work with me. She’s determined to come back and serve and give back. She’s not the only one. It happens over and over again.

This interview has been edited for length and clarity.

Analysis Human Rights

El Salvador Bill Would Put Those Found Guilty of Abortion Behind Bars for 30 to 50 Years

Kathy Bougher

Under El Salvador’s current law, when women are accused of abortion, prosecutors can—but do not always—increase the charges to aggravated homicide, thereby increasing their prison sentence. This new bill, advocates say, would heighten the likelihood that those charged with abortion will spend decades behind bars.

Abortion has been illegal under all circumstances in El Salvador since 1997, with a penalty of two to eight years in prison. Now, the right-wing ARENA Party has introduced a bill that would increase that penalty to a prison sentence of 30 to 50 years—the same as aggravated homicide.

The bill also lengthens the prison time for physicians who perform abortions to 30 to 50 years and establishes jail terms—of one to three years and six months to two years, respectively—for persons who sell or publicize abortion-causing substances.

The bill’s major sponsor, Rep. Ricardo Andrés Velásquez Parker, explained in a television interview on July 11 that this was simply an administrative matter and “shouldn’t need any further discussion.”

Since the Salvadoran Constitution recognizes “the human being from the moment of conception,” he said, it “is necessary to align the Criminal Code with this principle, and substitute the current penalty for abortion, which is two to eight years in prison, with that of aggravated homicide.”

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The bill has yet to be discussed in the Salvadoran legislature; if it were to pass, it would still have to go to the president for his signature. It could also be referred to committee, and potentially left to die.

Under El Salvador’s current law, when women are accused of abortion, prosecutors can—but do not always—increase the charges to aggravated homicide, thereby increasing their prison sentence. This new bill, advocates say, would worsen the criminalization of women, continue to take away options, and heighten the likelihood that those charged with abortion will spend decades behind bars.

In recent years, local feminist groups have drawn attention to “Las 17 and More,” a group of Salvadoran women who have been incarcerated with prison terms of up to 40 years after obstetrical emergencies. In 2014, the Agrupación Ciudadana por la Despenalización del Aborto (Citizen Group for the Decriminalization of Abortion) submitted requests for pardons for 17 of the women. Each case wound its way through the legislature and other branches of government; in the end, only one woman received a pardon. Earlier this year, however, a May 2016 court decision overturned the conviction of another one of the women, Maria Teresa Rivera, vacating her 40-year sentence.

Velásquez Parker noted in his July 11 interview that he had not reviewed any of those cases. To do so was not “within his purview” and those cases have been “subjective and philosophical,” he claimed. “I am dealing with Salvadoran constitutional law.”

During a protest outside of the legislature last Thursday, Morena Herrera, president of the Agrupación, addressed Velásquez Parker directly, saying that his bill demonstrated an ignorance of the realities faced by women and girls in El Salvador and demanding its revocation.

“How is it possible that you do not know that last week the United Nations presented a report that shows that in our country a girl or an adolescent gives birth every 20 minutes? You should be obligated to know this. You get paid to know about this,” Herrera told him. Herrera was referring to the United Nations Population Fund and the Salvadoran Ministry of Health’s report, “Map of Pregnancies Among Girls and Adolescents in El Salvador 2015,” which also revealed that 30 percent of all births in the country were by girls ages 10 to 19.

“You say that you know nothing about women unjustly incarcerated, yet we presented to this legislature a group of requests for pardons. With what you earn, you as legislators were obligated to read and know about those,” Herrera continued, speaking about Las 17. “We are not going to discuss this proposal that you have. It is undiscussable. We demand that the ARENA party withdraw this proposed legislation.”

As part of its campaign of resistance to the proposed law, the Agrupación produced and distributed numerous videos with messages such as “They Don’t Represent Me,” which shows the names and faces of the 21 legislators who signed on to the ARENA proposal. Another video, subtitled in English, asks, “30 to 50 Years in Prison?

International groups have also joined in resisting the bill. In a pronouncement shared with legislators, the Agrupación, and the public, the Latin American and Caribbean Committee for the Defense of the Rights of Women (CLADEM) reminded the Salvadoran government of it international commitments and obligations:

[The] United Nations has recognized on repeated occasions that the total criminalization of abortion is a form of torture, that abortion is a human right when carried out with certain assumptions, and it also recommends completely decriminalizing abortion in our region.

The United Nations Committee on Economic, Social, and Cultural Rights reiterated to the Salvadoran government its concern about the persistence of the total prohibition on abortion … [and] expressly requested that it revise its legislation.

The Committee established in March 2016 that the criminalization of abortion and any obstacles to access to abortion are discriminatory and constitute violations of women’s right to health. Given that El Salvador has ratified [the International Covenant on Economic, Social and Cultural Rights], the country has an obligation to comply with its provisions.

Amnesty International, meanwhile, described the proposal as “scandalous.” Erika Guevara-Rosas, Amnesty International’s Americas director, emphasized in a statement on the organization’s website, “Parliamentarians in El Salvador are playing a very dangerous game with the lives of millions of women. Banning life-saving abortions in all circumstances is atrocious but seeking to raise jail terms for women who seek an abortion or those who provide support is simply despicable.”

“Instead of continuing to criminalize women, authorities in El Salvador must repeal the outdated anti-abortion law once and for all,” Guevara-Rosas continued.

In the United States, Rep. Norma J. Torres (D-CA) and Rep. Debbie Wasserman Schultz (D-FL) issued a press release on July 19 condemning the proposal in El Salvador. Rep. Torres wrote, “It is terrifying to consider that, if this law passed, a Salvadoran woman who has a miscarriage could go to prison for decades or a woman who is raped and decides to undergo an abortion could be jailed for longer than the man who raped her.”

ARENA’s bill follows a campaign from May orchestrated by the right-wing Fundación Sí a la Vida (Right to Life Foundation) of El Salvador, “El Derecho a la Vida No Se Debate,” or “The Right to Life Is Not Up for Debate,” featuring misleading photos of fetuses and promoting adoption as an alternative to abortion.

The Agrupacion countered with a series of ads and vignettes that have also been applied to the fight against the bill, “The Health and Life of Women Are Well Worth a Debate.”

bien vale un debate-la salud de las mujeres

Mariana Moisa, media coordinator for the Agrupación, told Rewire that the widespread reaction to Velásquez Parker’s proposal indicates some shift in public perception around reproductive rights in the country.

“The public image around abortion is changing. These kinds of ideas and proposals don’t go through the system as easily as they once did. It used to be that a person in power made a couple of phone calls and poof—it was taken care of. Now, people see that Velásquez Parker’s insistence that his proposal doesn’t need any debate is undemocratic. People know that women are in prison because of these laws, and the public is asking more questions,” Moisa said.

At this point, it’s not certain whether ARENA, in coalition with other parties, has the votes to pass the bill, but it is clearly within the realm of possibility. As Sara Garcia, coordinator of the Agrupación, told Rewire, “We know this misogynist proposal has generated serious anger and indignation, and we are working with other groups to pressure the legislature. More and more groups are participating with declarations, images, and videos and a clear call to withdraw the proposal. Stopping this proposed law is what is most important at this point. Then we also have to expose what happens in El Salvador with the criminalization of women.”

Even though there has been extensive exposure of what activists see as the grave problems with such a law, Garcia said, “The risk is still very real that it could pass.”