Amidst wealth, dire reproductive health needs

Bridgit Adamou

Angola is the seventh wealthiest nation in Africa. It has oil—and lots of it. But maternal mortality is high and the total fertility rate is nearly seven children per woman, on par with some of the world's poorest countries.

It was late morning and we were driving on a busy dirt road on the outskirts of Luanda when our car suddenly stopped. I nonchalantly kept on talking to my colleague who was sitting next to me in the backseat of our pick-up when I noticed her attention had turned to the tanker truck stopped in front of us. By the side of the truck a young boy—about twelve or thirteen—had deftly opened a valve and was collecting the gas that was gushing out into his large bucket and splashing onto the ground.  Shocked, I asked if the driver of the truck should be alerted but was told that you can’t risk it since the boy—who at this point was looking right at us—might have a gun. I kept watching in disbelief as the boy struggled to carry his heavy bucket, which was still filling up even as the truck began moving away.

Mothers wait outside a clinicThis is Angola, a country that ended a 27-year civil war in 2002 and is working to rebuild its economy, government, and society amidst pervasive violence, corruption, and apathy. I recently spent two weeks in the capital, Luanda, providing support to my colleagues in the Pathfinder International/Angola office who are working with the government to improve reproductive health services. Although the image of the boy siphoning the gas is difficult—the images of the women in need are perhaps even more memorable.

At one clinic I visited, it was bustling with mothers, children, and pregnant women waiting to be seen by the nurse. Incredibly though, it had no water. The pump on the underground water tank was broken, so as temporary solution, the Ministry of Health had two water tanks installed. The Ministry paid for water to be delivered by truck, but the driver never showed up; he supposedly sold the water and pocketed the cash. There’s been no follow-up action, so the tanks have been bone dry for months. At another public health facility I visited, the motor on their water pump is also broken, as well as their two generators—but at least they don’t have a corrupt water truck driver and usually have water in their tanks.

The lack of government accountability and action didn’t surprise me, nor did the sight of women carrying heavy loads on their heads and babies on their back, school-aged children playing in the street in the middle of the day, mounds of trash smothering hillsides, and crowded, flimsy homes that look like they might fall apart in a strong wind; these images are all too familiar in sub-Saharan Africa. What’s incredible to me is that you see this despite the fact that Angola is the seventh wealthiest nation in Africa. For better or worse, Angola has oil—lots of it—and diamonds and gold and agriculture. In the short time since the war ended, Luanda has seen an explosion in the number of modern hi-rise buildings that have been built, the number of vehicles (many of them very expensive) on the road, and the number of businesses that have opened to cater to the foreign investors. 

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A young Angolan mother and her childBut as the wealthy get wealthier, the poor, who make up the majority of the population, are still poor.  The average life expectancy is just 43 years. Eight-six percent of the urban population lives in the slums. It wasn’t just my imagination that it seemed like a lot of women, including teenagers, were pregnant. Although birth control is available for free, the total fertility rate is nearly seven children per women, which is on par with some of the poorest countries in the world. There doesn’t seem to be much urgency on the part of the government to improve and promote family planning services even though the lifetime risk of maternal death is 1 in 12. Pathfinder and other organizations are filling in some of the gaps, one crack at a time, which seems encouraging on the one hand, but also quite daunting on the other—we have a lot to do.

Every morning on the drive from my hotel to the Pathfinder office I passed this one young mother in front of a store front selling pineapples and oranges. I noticed her because she had a toddler about the same age as my own child. The woman looked about seven or eight months pregnant and always appeared exhausted. The same thoughts ran through my head every time I saw her: Does she have other kids? Do they have enough to eat? How much is she earning every day selling fruit? How can she afford to live in this expensive city? Will her baby be healthy? Would I be in her shoes if I had been born here? Then our car turns the corner and she’s gone…until tomorrow. 

Women like her, and children like the boy siphoning the gas, can have different lives, but it takes commitment on the part of donors, governments, and organizations to support initiatives that change their lives—ensuring there is water in the health facility, family planning to lower maternal mortality and give women options for a different life, and support for youth to have other opportunities. I know the next time I travel to Luanda I may not see radically different images, but I hope that the road is at least paved for Angolan women to choose their family size, see their babies grow up to be healthy and safe, and enjoy life.

Analysis Environment

Don’t Drink the Water: The West Virginia Chemical Spill as a Reproductive Justice Issue

Emily Crockett

Pregnant women and young families continue to face environmental, economic, and legislative hardships more than six weeks after a devastating chemical spill in West Virginia.

At two-and-a-half years old, Susana Duarte’s son is starting to learn lifelong habits, like how and when to wash his hands. But more than six weeks after a chemical spill contaminated the Elk River near their home in Charleston, West Virginia, the young boy’s routine now includes asking his mother, “Is the water broken?”

Duarte answers yes, the water is still broken—unless they are at her parents’ house, outside the spill zone, where she refills two seven-gallon jugs of water every week. She still only uses bottled water to bathe her son, but she’s considering using tap water to do dishes again since the chemical’s distinctive licorice-like odor has finally left their home. She’s also started allowing herself a brief shower every other day, while her husband takes one every day. “Everyone sort of makes their own rules to make themselves feel comfortable,” Duarte, an attorney, told Rewire. “That is my rule.”

Duarte is also around 16 weeks pregnant.

After the chemical company Freedom Industries spilled a coal-cleaning chemical called MCHM into the Elk River on or before January 9, dumping 10,000 gallons of a substance with unknown human health effects into the water supply of 300,000 West Virginia residents, officials immediately cautioned locals not to use the water for anything other than flushing the toilet or putting out fires.

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On January 13, Gov. Earl Ray Tomblin said that the water was testing below the acceptable levels set by the Centers for Disease Control and Prevention (CDC)—one part of MCHM per million—so residents in the spill zone could start using the water as they chose. But late in the evening on January 15, the CDC recommended that out of an abundance of caution, pregnant women should stick to bottled water until the tap water samples came back with non-detectable levels of MCHM.

“We had potentially more than two days where pregnant women had already been consuming the water,” Dr. Rahul Gupta, executive director of the Kanawha-Charleston Health Department, told Rewire.

Duarte hadn’t used tap water during that window, but she still has concerns about the spill’s effect on her pregnancy. When the spill was announced, she was in her first trimester and hadn’t yet told anyone but close friends and family about the pregnancy. “It was an added layer of stress, to have this good news that you’re not sharing because you’re worried about all the things that can go wrong with a pregnancy normally—and then you’ve added a layer of a significant health concern on top of it,” she said.

The CDC has said since early February that the water is safe to drink for everyone in the region, including pregnant women, because tested water is at “non-detect” levels of MCHM—that is, less than ten parts per billion. Some tests can detect levels as low as one part per billion, and Gupta said he would like to see more testing done at those lowest levels. But he said that there are still many unknowns, especially where homes are concerned.

Officials don’t know, Gupta said, whether the chemicals might have leeched into the materials in home pipes, which are typically made of copper or plastic rather than the iron or PVC found in the kinds of central distribution pipes that have already been tested. The hot water in homes in the region tends to smell stronger than the cold water, which could mean that sediment is forming in hot water heaters.

Even non-detect levels haven’t always necessarily meant “safe,” as West Virginians found out with disruptive spill-related school closings that happened around the same time the CDC lifted its advisory. Three schools closed, and 14 issued complaints to health officials, as students and teachers reported strong odors and symptoms of light-headedness and watery eyes. 

Already, pregnancy is “a very anxious time in people’s lives,” said Margaret Chapman Pomponio, executive director of reproductive rights advocacy group WV Free. “For a pregnant woman to have this kind of anxiety, uncertainty, and financial strain—it’s potentially harmful to her pregnancy.”

WV Free has been fundraising since the disaster to benefit pregnant women in need of relief as a matter of both reproductive and environmental justice.

And some advocates argue that this is not the first time West Virginia’s government has failed to protect the freedom of pregnant women and families to live without fear of environmental hazard.

A Breakdown in Trust

Officials at the January 15 press conference, at which it was announced that pregnant women should avoid tap water, said the precautionary advisory was intended to “empower” pregnant women, but many felt more confused and scared than empowered.

“It was just this frustration, every time a new announcement came out, that they didn’t know enough to support their claims,” Duarte said.

In addition to the pregnancy flip-flop, the state of West Virginia set its standard of what it deems a safe level of the chemical for humans at ten parts per billion, which is 100 times less than the level originally recommended by the CDC (one part per million), after serious questions emerged over how the CDC’s standard was determined and hospitals began seeing an increasing number of patients with rashes and eye irritations. So little testing had been done on the safety of MCHM that no one really knew what a safe level for humans, much less pregnant women, was.

What’s more, on January 23 it was announced that a second chemical had been spilled into the river in addition to MCHM. And then two additional chemical spills were reported in the river in the following weeks.

With the constant mixed messages from officials, many residents have been feeling acutely betrayed by their government. “The public is told one thing one day and another the next,” Chapman Pomponio said. “Trust has been broken.”

Duarte still doesn’t drink the water and doesn’t expect to for some time, but she still worries. What if, say, showering or washing her hands is doing some kind of harm to her pregnancy? “I’ve got an ultrasound coming up, and not that I think anything would show up at this stage from that anyways—but you’re like, what if something is there? It’s the stuff I worried about the first time [I was pregnant], but that I’m worrying about in a different way now.”

If pregnant women are worried, what about nursing women or small children? The CDC’s guidelines never specified anything about them.

“The suggestion is, the water might not be safe for a pregnant woman or an unborn child—but one minute after birth, it’s safe for both of them?” asked Lynn Paltrow, executive director of National Advocates for Pregnant Women in an interview with Rewire.

Gupta, of the local health department, pointed out that extra caution may be appropriate for pregnant women because of all the unknown factors that can negatively influence, or interrupt, fetal development. But a pediatrician told the Kanawha Charleston Board of Health that if the guidelines apply to pregnant women, they should also apply to children under 3 years old. And Gupta said that from a purely scientific perspective, “there is no safe level of MCHM in the water, until and unless a study establishes one.”

“We just have no data to say one way or the other,” Gupta said. “We are only as good as our data.”

A Question of Choice, A Chance for Justice

Sarah Brown, a nursing mother in Charleston, washes all of her son’s baby bottles by hand daily with bottled water. She and her husband have started using tap water for laundry, showers, and some dishes.

“The scariest thing for us is not knowing what the long-term impact may be,” Brown told Rewire. “One of the reasons we’re interested in breastfeeding, and trying to make our own baby food and things like that, is that we know exactly what’s going into [our baby’s] system.” Now, Brown said, she can’t be so sure.

Despite their reproductive health concerns and daily logistical headaches, both Duarte and Brown, also an attorney, know that they enjoy privileges many of their neighbors do not. They each have family members or coworkers in nearby towns outside the nine-county spill zone, the transportation and time to drive there and do laundry or fill up water bottles, and the financial means to buy additional bottled water or other supplies if needed. Neither of the women has taken advantage of the state’s water distribution sites, reckoning that others need them more.

Virginia Gardner is one of those people in greater need, but she has also had great difficulty accessing the water distribution sites. Gardner is one of several petitioners in a lawsuit currently before the state supreme court against the state’s Department of Environmental Protection, Bureau for Public Health, and Department of Health and Human Resources. According to the petition, Gardner is living in subsidized housing on a small fixed income with her 2-year-old son. She doesn’t have a car to access distribution sites, and they are too far to walk to. Even when she did find a walking-distance site (a few days after the spill, when such sites were more plentiful than they were later in the crisis), she couldn’t carry enough water for her son and herself while also pushing his stroller. She once took her son to the hospital with chemical burns to his eyes because her landlord allegedly did not take the proper steps to flush the hot water tank.

“[Gardner] has a lot of fear related to this, and her options and her choices are dramatically limited because of her financial means, and that impacts her ability to be the parent she wants to be,” said Jennifer Wagner, an attorney at Mountain State Justice, a nonprofit law firm representing the petitioners.

Wagner said that the petitioners in the lawsuit are not seeking damages. Rather, they seek to highlight the plight of low-income and vulnerable residents, get the state supreme court to force state agencies to fulfill their obligations to keep the water supply safe, and make sure something like this never happens again.

“The way things are going, and the way things unfortunately have gone in the past, is that we have a disaster, and then we have another disaster a couple of years down the road,” Wagner said. “Our state agencies have been on notice for quite some time that something like this was about to happen, and yet didn’t take any of the actions that they knew they should have and could have taken in order to prevent it.”

One of those actions would have been implementing recommendations from a Chemical Safety Board that was formed in the wake of other accidents, but not followed up on. Pending legislation to fix some of these problems is good and necessary, Wagner said, but it may end up with too many exceptions to placate the state’s powerful extractive industries. A favorable court ruling and a good bill should, even must, work together to prevent future crises.

“It’s your decision,” Gov. Tomblin infamously told West Virginia residents when asked by reporters whether the water was actually safe to drink. “I’m not going to say absolutely, 100 percent that everything is safe. But what I can say is if you do not feel comfortable, don’t use it.”

“This is a false choice low-income people have,” said Ellen Allen, executive director of Covenant House, a day shelter for the working poor that is also a petitioner in the lawsuit. “They can’t afford it. They scrape by a little money, borrow water, we bring them water, and they bathe their children in the bottled water. They’re moms, they look after their kids first, and if there’s anything left for them, they use it—otherwise they just drink [tap water] and don’t know if it’s safe or not.”

For reproductive justice advocates, “choice” has an additional, and bitterly ironic, meaning in this context.

Chapman Pomponio of WV Free said it was “ridiculous” for the House Judiciary Committee to consider a 20-week ban on abortion (which it passed on Friday) when that committee is also tasked with the all-important “water bill.”

“There’s a historical unwillingness to regulate the coal and chemical industries, despite significant evidence of the need for that regulation,” said Paltrow of National Advocates for Pregnant Women. “And yet there is consideration of more regulation of abortion providers and pregnant women, without any evidence of need for that regulation.”

“It’s easier to tell pregnant women not to drink the water than to make the water safer for everybody,” Paltrow said.

The future health and reproductive autonomy of West Virginia residents remains uncertain. Gupta says his office is going to start studying possible long-term health effects from exposure to MCHM. Initial testing on ten different homes in different affected counties, which the governor initially resisted, should be completed in a few weeks, after which more funding will have to be allocated for wider home testing based on those initial results. And an unconstitutional 20-week abortion ban, considered likely to cost the state time and money only to be defeated in court, may well pass both the state house and senate.

Susana Duarte still second-guesses whether she is doing all that she can to end up with a healthy pregnancy. Virginia Gardner waits for justice and hopes to raise her son in a chemical-free Charleston. Sarah Brown, the nursing mother, said that while she plans to stick it out and advocate for change (she works with Wagner at Mountain State Justice, though she is not involved with the lawsuit), she also knows one couple with a toddler who have left town. “It’s something I worry about, people with young kids leaving, rather than staying to revitalize and make a vibrant community. It’ll be hard to retain people,” she said.

And Margaret Chapman Pomponio finds hope in a newly engaged public. “People are really mobilized,” she said. “People who have not considered themselves to be activists before find themselves turning out at multiple community events, coming to the state capitol, lobbying legislators and the governor. So we really are hopeful that with this mobilization we’ll see some positive policy change.”

Analysis Health Systems

What Sandy Wrought, Part 2: In the Wake of Disaster, Reproductive Health Care Falls by the Wayside

Sarah Jaffe

In the year since Sandy hit, reproductive heath care and care for other specific, marginalized populations, has been affected in many communities.

This is part two of Rewire‘s examination of health care in New York City in the year since Superstorm Sandy. Read part one here.

The YANA (You Are Never Alone) Medical Clinic in Rockaway Park, Queens, sprang up in response to the overwhelming need for health care in the aftermath of Superstorm Sandy, which devastated the region in October of 2012. Nastaran Mohit, a labor organizer who helped create the volunteer-run clinic, remembers one young woman who came in about a week after the storm in excruciating pain. One of the volunteer doctors saw her and tried to help her, but shortly after her visit to the clinic, she had a miscarriage.

“She lives in that area, they had substantial flooding in their apartment. Who knows the stress she went through,” Mohit told Rewire. “She didn’t have health care, they were an undocumented family, and who knows how many of those cases there are?”

In the United States, cisgender women’s and transgender people’s bodies are often the sites of political battles, but their everyday struggle for access to health-care services and procedures, as well as the necessities of living, is easily forgotten. In the aftermath of Sandy, as people in flooded areas lived without power for days, as hospitals and clinics closed and transportation was impossible, the specific needs of marginalized people easily slipped by the wayside.

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After Hurricane Katrina devastated New Orleans, researchers from Tulane University’s Newcomb College Center for Research on Women noted that women’s specific physical and reproductive health needs were largely ignored by U.S. disaster managers. When women’s health care was mentioned at all, it was often “within the context of children’s needs, not independently.”

Even in the immediate days after the storm, women and queer and transgender people had specific needs that weren’t always being met, and as the recovery and rebuilding process goes on—and slips from the minds of those whose lives have returned to normal—there are still more problems that require an analysis through the lens of gender.

Who Gets Hit Hardest?

It’s too early for there to be much research on Sandy’s impact on long-term health outcomes, but studies after other disasters have highlighted the ways in which women are disproportionately affected. While Sandy was not Katrina, and New York is not New Orleans, the research done on prior disasters can give us an idea of what to watch out for.

A post-Katrina study of 1,043 adults found 2.7 times more occurrences of post-traumatic stress disorder (PTSD) among women than men, and 1.3 to 2 times more occurrences of other anxiety or mood disorders. Another study, of male and female primary caregivers, found that 46.5 percent of women (compared to 37.5 percent of men) “reported clinically significant psychological distress.” Yet, the report said, only a small proportion of those reporting PTSD and other psychological problems sought treatment.

Mohit spent much of her time in the weeks after the storm coordinating volunteer canvassers in the Rockaways, and saw firsthand the impact the region’s conditions had on residents, particularly women. “How stressful it must be to be living in this environment, scared that someone’s going to knock on your door and rob you, scared that someone’s going to knock on your door and sexually assault you, skeptical of the relief workers that are coming, living for weeks on end without heat, without hot water,” she said. “There were thousands of residents that did not have running water or hot water or were not able to flush their toilets, living in terrible conditions for weeks on end with no options to go elsewhere on the peninsula and shower somewhere else or find heat somewhere else. We had all these promises of these Tide trucks [mobile laundromats] showing up, or these mobile showers showing up; they never showed up. So people just made do, whatever that entails. That might mean not washing your clothes for several weeks. It might mean not showering for several weeks. Our canvassers found several families who were basically living in feces because they were unable to flush their toilets, or elderly folks who weren’t able to clean themselves. That just compounds a number of health issues.”

“I think that the mental health component of that is so enormous, but we don’t have a structure to address those issues,” she added. (For more on mental health and Sandy, click here.)

Rapes were rumored in some of the housing complexes, along with robberies. While Mohit found no hard evidence, she said that even the rumors added stress to people already living in intolerable conditions. “Some of these women weren’t even coming out of their apartment buildings because they were so scared,” she said.

Yet the same communities that were hardest hit by Sandy are also the ones that have longstanding reasons to fear turning to the police in times of crisis. According to WNYC’s stop-and-frisk map, young people of color in Coney Island and Far Rockaway saw some of the most punitive policing under the New York Police Department’s stop-and-frisk policy. As Kristen Gwynne wrote at AlterNet, “For the NYPD’s stats to add up, they’d have to have stopped every young, black man living in the city once—and then some.” Reporting for Truthout in the Rockaways, I spoke with residents Marie Satchwell and Kenyatta Hutchinson, who both told me that the police were more likely to stop and harass residents than offer aid.

For undocumented families, the heavy police and military presence added fear of deportation to the reasons that people were hesitant to reach out for help, leaving young women like the one Mohit met at the YANA clinic dependent on volunteer care. Parents with children born in the United States were eligible for Federal Emergency Management Agency (FEMA) aid, while many others were not.

In addition to race and immigration status, discrimination around gender identity and sexuality will affect recovery. Charlotte D’Ooge, writing about Katrina’s impact, pointed out:

While disasters … strike without regard for race, class, gender, or sexual orientation, how those affected are able to recover in the aftermath of such devastation is profoundly influenced by whether or not the survivors fit into the traditional, heterosexual category of “woman.”

For trans people, this might mean a lack of access to hormones and doctors who treat them well, or who will treat them at all. Even during normal times, according to a 2011 report from the National Gay and Lesbian Task Force and the National Center for Transgender Equality, 19 percent of respondents reported being refused care due to being transgender or gender non-conforming, 28 percent were victims of harassment in medical settings, and 50 percent reported having to teach their medical providers about the care they needed. After a disaster, when one’s choices for help narrow to those within immediate reach, things just get more difficult. In shelters, the chance of being outed multiplies, as does the chance of being refused services or facing violence.

In the days after the storm, the Callen-Lorde Community Health Center in Manhattan, which provides health care to gay, lesbian, bisexual, and transgender people regardless of their ability to pay, was closed through November 5 due to power outages. The 1,800 patients who regularly visit the center in an average week were left without its services. However, the center did set up an emergency prescription line within 24 hours, and saw over 300 calls, and their mobile medical unit, normally dedicated to serving homeless or street-oriented youth, mobilized to provide care in the city. Many other LGBTQ-friendly health providers were similarly closed, leaving people to take their chances with new providers, or, all too often, do without.

Jeremy Saunders, lead organizer at VOCAL-NY, an organization that works with residents affected by HIV and AIDS, the drug war, and mass incarceration, noted that as VOCAL organizers did outreach after the storm, they found that three HIV/AIDS Services Administration centers were closed, they weren’t doing outreach, and no one was addressing the immediate needs of that community. The areas affected by Sandy were also home to many of the city’s nursing and adult care homes and to halfway and three-quarter houses, and it was difficult to find information on what happened to the people in those facilities. VOCAL was on the streets doing condom distribution and syringe exchanges, but few others were addressing those specific needs.

Pat Kane, an operating room nurse at Staten Island University Hospital and treasurer at the New York State Nurses Association (NYSNA), did relief work in Staten Island and told Rewire that she’d seen at least two families with newborn babies, and that she and her colleagues had encountered women who had just given birth or were about to do so. Volunteers, she noted, were able to check back in with them, but she saw many families with small children struggling.

Getting to Care

As Mohit noted, “When you think about how women care for themselves, when you think about reproductive health, so much of it is about access”—access to a doctor, access to birth control, access to an abortion, being able to take time off from work to make it to appointments. In the days after the storm, with power out in huge swaths of the city, pharmacies, bodegas, and grocery stores remained closed, cutting off access not just to prescriptions, but also to tampons, sanitary pads, and over-the-counter medications.

At YANA, Mohit’s canvassers got requests for birth control, tampons, pads, and the morning-after pill. Occupy Sandy and other community groups that were collecting donations put out calls for baby formula and diapers, women’s clothes, and hygiene supplies, and canvassers tried to collect information to fill people’s prescriptions for them. Michael Duncan, medical director at VOCAL-NY, was one of the volunteer doctors writing prescriptions based on what information canvassers could bring back; he told Rewire that it seemed unlikely that many of those prescriptions were filled, as the pharmacies that were open were hesitant to fill them, and many times canvassers didn’t have the correct information.

With the health problems that communities are already facing in the wake of Sandy, from respiratory problems to the flu epidemic, Mohit said, “I can’t imagine in this kind of environment that women are taking care of their reproductive health in any way, because the basic health needs that a population has are not being tended to. I can imagine it’s almost viewed as a luxury. We have women that aren’t being seen by a doctor when they have pneumonia, let alone regular checkups, who haven’t been able to care for their children properly, and we know they’re not caring for themselves.”

Judy Sheridan-Gonzalez, an emergency room nurse at Montefiore Medical Center in the Bronx and vice-president of NYSNA, told Rewire, “I’m sure that things that weren’t medical emergencies just sort of fell by the wayside. There’s probably a lot of unplanned pregnancies that occurred in the last two months. There’s a triage of what people felt comfortable requesting assistance in. I’m sure people felt guilty even asking for stuff like that.”

Some hospitals are reporting an increase in birthrates this July and August, nine months after the storm and ensuing blackout. The Chief of Obstetrics and Gynecology at New York-Presbytarian hospital said that there was a 20 to 30 percent likely increase in deliveries at the end of July and beginning of August.

The storm did have an effect on people who did not want to keep their pregnancies as well. According to Phillip Kim, one of the volunteers who runs the New York Abortion Access Fund (NYAAF) which helps individuals pay for abortion procedures, several clinics that provide abortions were closed after the storm or were shortstaffed as transportation was impossible. Medicaid offices, he said, were having computer troubles and couldn’t process people’s requests, and as clinics reopened they were overloaded and backlogged. That lasted over a month.

One person who lived in the Rockaways was unable to get to a clinic for weeks, increasing significantly the price of an abortion procedure; another had to travel to Maryland because too much time had elapsed (the cut-off for abortions in New York is 24 weeks), raising the cost from $3,000 to $6,000. NYAAF had to go to other funds to get enough money to pay for the procedures.

Though Kim stressed that it’s impossible to extrapolate anything from the number of calls that NYAAF’s funding hotline received, the end of November and beginning of December did see an uptick in calls and pledges of funding. “Abortions are just necessary for so many individual reasons, hurricane or not,” he pointed out.

Moving Forward, Ongoing Issues

The neighborhoods still struggling to recover from Sandy are mostly ones that had fewer resources to begin with. Federal funds—for rebuilding, for homeowners and businesses—began to be released to businesses in late May and to homeowners in June. In late August, the Obama administration’s Hurricane Sandy Rebuilding Task Force released its rebuilding strategy, a jargon-filled document big on “resilience” and “green infrastructure” but with surprisingly little to say about health care. The question remains, as Michael Duncan of VOCAL said, how to push for rebuilding that addresses the problems that already existed—that rebuilds better than before.

Hospitals slowly got back on track; Coney Island Hospital reopened its Women, Infants and Children (WIC) nutrition program February 5, and Bellevue, one of the city’s largest providers of mental health services, resumed full services on February 7. Saunders said that some residents of halfway and three-quarter houses in the Rockaways and elsewhere were back in by the spring, while others, “we’re not entirely sure.” For displaced people in care facilities, it’s a struggle—they don’t get a say in where they go or when they come back. NPR reported on residents of Belle Harbor Manor, an adult home for people with mental illnesses and physical disabilities, coming home in February after three-and-a-half months in crowded shelters, dirty hotels, and a state psychiatric facility—to find their rooms had been looted, their possessions gone.

But now, another crisis has risen up in New York health care: hospitals at risk of closure, and specifically labor and delivery units being shut down. At North Central Bronx (NCB) Hospital, far from Sandy-ravaged areas but a safety-net institution for thousands of lower-income residents, the labor and delivery unit closed August 12 with just days’ notice. The unit’s nurses and patients were transferred to Jacobi Medical Center, nearly four miles away. Nastaran Mohit said that others may be at risk as well.

“We were having a rally at NCB Hospital [August 12], and I’m handing out fliers to community members that are passing by, and I saw at least three expectant moms going in there for their checkups. One of them started crying; she said, ‘What am I going to do? I’m supposed to give birth here in a couple of weeks.’”

Labor and delivery, Mohit explained, is on the chopping block in many places because it’s not profitable. Detox departments, too, are being slashed—in the Rockaways, which have one of the city’s highest drug-dependent populations, the detox department at St. John’s Episcopal Hospital is gone, and in Staten Island, which has one of the highest prescription-drug dependent populations, Bayley Seton Hospital has lost its detox department. And as explored in part one of this series, hospitals around the city, including St. John’s, are at risk of closing entirely.

Most of the cuts that are coming, as well as the slow recovery—signs at an August 14 rally in the Rockaways called to “speed hurricane $$, save our only hospital!”—hit communities that are already underserved and marginalized. Stacy De-Lin is a primary care physician who worked as a resident at St. Vincent’s Hospital in Greenwich Village before it closed, and then wound up at Beth Israel Medical Center, where she worked through Sandy. After the closing of St. Vincent’s, which served a large HIV-positive community, De-Lin said that many of those patients lost access to primary care or had trouble finding doctors who would take their insurance, and began to have complications related to HIV and turn up in much worse shape than they had been. Leaving aside the longer wait times that become the norm at other institutions when one hospital closes, the problem of access is much larger for people with specific health needs.

As studies begin to come out, it’s worth watching for Katrina-like disparities in mental health and other illnesses, for birth rates and problems, and for long-term illnesses that disproportionately affect women, people of color, and poor communities.

“In the social justice community, there’s often a call that people should get out of their silos and all work on big issues,” Saunders said. “We totally believe [in that]—we believe in people with AIDS engaging in the fight for a fair economy—but we often say, ‘Look, the reason silos exist, the reason we have these identity-based models for addressing community needs for building power, is because we found historically that without doing them, there’s a bunch of groups that are going to get left out.’”

In the Rockaways, Coney Island, and Staten Island, there were already people living in less-than-ideal conditions; the Rockaways particularly have more than their share of nursing homes, halfway and three-quarter houses, and public housing for low-income New Yorkers. Imagine that community, then, without a full-service hospital for miles. “When you’re part of the working poor, the thousands and thousands of working poor in the Rockaways who are just on the brink of financial disaster, and then a natural disaster hits, [it] compounds these existing problems. Unfortunately, health care is always placed on the wayside,” Mohit said.

Rebuilding those neighborhoods means looking at what was already missing, whether that be HIV/AIDS Services Administration centers, or clinics where pregnant people can get checkups or abortions. It means thinking critically, as the NYSNA nurses and their coalition partners have with the Alliance for a Just Rebuilding, about the problems with our current health-care system and the people who are not served by it.