What I didn’t get to say at the town hall meeting

Alison Cole

Many questions were asked about how to pay for health care reform.  I want to share some ideas with you. 

Emailed to WA Congressman Adam Smith after attending his Lakewood town hall this evening:

 

I attended your Lakewood town hall tonight, and appreciated your
intelligent answers and support for a public option in health care
reform.  Many questions were asked about how to pay for reform.  I want
to share some ideas with you. 

* INCREASED ACCESS TO MIDWIVES
AND OUT OF HOSPITAL BIRTH.  Medicaid pays for a lot of births, and
requiring federal Medicaid to reimburse a Certified Professional
Midwife in an out of hospital setting reduces costly intervention,
including Cesarean section.  The WHO recommends an optimal 15%
c-section rate and the US rate is now 31%.  These surgeries are costly,
many are unnecessary, and could be prevented with midwifery care for
healthy women.  Please watch this video:  www.reducinginfantmortality.com.

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INCREASED ACCESS TO ALTERNATIVE/COMPLEMENTARY PREVENTIVE CARE.  I
listened to a round-table on preventive care held by the
administration, and many medically-trained providers lamented the fact
that they did not get adequate training in disease prevention. 
Naturopaths, massage-therapists, acupuncturists, midwives, etc. all
provide low-tech preventive and wellness-promoting care.  This also
solves the problem of lack of adequate providers while expanding
patient choice.

* INCREASED ACCESS TO FAMILY PLANNING. 
Preventing unintended pregnancy reduces costs to insurers.  If everyone
had access to services provided by state family planning waiver
programs (like the Take Charge program in Washington), people would be
able to control their reproductive lives and save the state money.

*
REPEAL THE BUSH TAX CUTS AND INCREASE TAXES FOR THE WEALTHIEST
AMERICANS.  We all benefit from the great things the US has to offer,
and the ones who benefit the most need to give back the most. 

Thank you so much for the work you do for us.  Keep it up.

Sincerely,

Alison Duren-Sutherland
Medical Insurance Biller
Homebirth Mom
Apprentice Midwife

Commentary Media

Duke Students’ Objections to Reading ‘Fun Home’ Aren’t About Trigger Warnings

Dianna Anderson

Regardless of whether the freshmen's objections are legitimate, in my own estimation, co-opting this particular controversy at Duke into a discussion of trigger warnings is to compare apples to oranges.

Each year at Duke University, incoming freshmen are required to read a book together as a class, which will then be discussed in a required literature and culture course that all freshmen take. In past years, the students have read Americanah by Chimamanda Ngozi Adichie, Let the Great World Spin by Colum McCann, and A State of Wonder by Ann Patchett.

In April, Duke announced that Alison Bechdel’s award-winning graphic novel, Fun Home, had been chosen for the upcoming year. In the book, Bechdel—the only female author on the shortlist of potential picks—is a lesbian who writes autobiographically about her father’s suicide shortly after she came out at the age of 19. Fun Home contains two drawn sex scenes between women.

Last week, Duke’s student newspaper, the Chronicle, reported that several freshmen were refusing to read Fun Home because they are conservative Christians who object to its content. Although the incident has been and will continue to be conflated with a broader discussion about giving students “trigger warnings” about potentially upsetting material, that is not the case in this instance—and it’s important to make the distinction clear in both media and institutional responses.

In statements taken by the Chronicle from a closed Facebook group for the Class of 2019, freshmen commented that when it came to Fun Home, they felt they would “have to compromise [their] personal Christian moral beliefs to read it.”

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One student commented to the Chronicle that he probably would have read the book if it was a traditional novel but that the nature of a graphic novel turned the experience, well, graphic—pornographic to be specific. Another said she refused to even look at the pages that contained nudity. In an op-ed to the Washington Post, one freshman, Brian Grasso, agreed, writing, “I think there is an important distinction between images and written words. If the book explored the same themes without sexual images or erotic language, I would have read it.”

He argues that the problem is not the LGBTQ content, but the “pornographic” nature of the images within the graphic novel—meaning the two depicted sex scenes. His argument seems to be solely restricted to images, arguing, “Professors should warn me about such material, not because I might consider them offensive or discomforting, but because I consider it immoral.”

Objections to content in curricula on school campuses is nothing new, though the debate has increasingly moved from behind closed doors at faculty meetings to longform essays in mainstream publications. Jonathan Chait caused a stir in January when he argued in New York Magazine that the “new” rise in so-called political correctness on college campuses hampered the academic explorations necessary to a leftist point of view. More recently, a psychologist and an academic jointly argued for the Atlantic that the “coddling” signaled by the advent of trigger warnings for material in college classrooms was mentally unhealthy and prevented exposure to ideas and events that are important for a person’s recovery from post-traumatic stress or anxiety.

There is a vast amount of feminist objection to this kind of handwringing. Trigger warnings initially developed as a tool on online feminist message boards for the purpose of creating safe spaces for trauma survivors. The extension of these warnings out into the classroom comes from increasing awareness of the traumas of rape and violence in the lives of American children. Trigger warnings, feminists argue, are a basic level of human decency in the classroom, allowing students to process and engage with material without experiencing uncontrolled exposure to potential triggers of traumatic flashbacks or panic attacks.

This incident at Duke is being roped into this ongoing discussions of trigger warnings and a supposedly overly sensitive culture, in which an individual student’s feelings are more important that the educational value of the material. The difference here, however, is not that the students are trauma survivors who are requesting time and space in which to process their feelings, but right-wing purity culture Christians who insist that not looking at nude images is something they should be free from as part of their religion. Traumatic flashbacks impede classroom discussion by preventing students from participating fully. Objections to nudity in texts for religious reasons, by contrast, could actually inspire deeper discussions of that material if the student still chose to engage in dialogue about it. One is a physiological response; the other is a choice in the practice of religious belief. How the political left responds to this discussion is vital to the consistency and understanding of public narrative about trigger warning and PTSD in the classroom.

It can be very hard to navigate this kind of discussion as freshmen in college, with many of these students likely stepping out of their Christian bubble for the first time. I can see their objections, as I stood in their position once, privately objecting to swear words and inappropriate material in our freshmen composition courses, which were at a Christian liberal arts university. But Grasso’s objections indicate that he doesn’t necessarily see his objection to visually graphic materials changing at any time—which seems particularly naive.

Angus Johnston is a professor at City University New York who frequently comments on the trigger warning debate at his blog, Student Activism. He told me that he doesn’t necessarily object to the student’s decision in this case—sexually explicit images, he feels, should not be displayed in the classroom. However, context does matter: Johnston comments that he takes his students to museums to view art that has nudity in it and such excursions fit within the context of his classroom.

But in his editorial, Grasso commented that his beliefs extend to pop culture and Renaissance art, creating a potential conflict between professor and student. To that, Johnston says, “If a student objects to reading or viewing a work that a professor considers intrinsic to a class the student has signed up to participate in, the two of them have a dilemma that needs to be resolved, and resolving it in an academically rigorous way may require compromise on the student’s part.” But, Johnston says, he doesn’t believe that’s what’s happening at Duke: As Fun Home is a mandatory book assignment for all freshmen, rather than an optional one, Grasso’s objection may actually hold some weight—at least, it does for Johnston.

Regardless of whether Grasso and the other freshmen’s objections are legitimate, in my own estimation, co-opting this particular controversy at Duke into a discussion of trigger warnings is to compare apples to oranges. Trigger warnings and content notes allow students to engage with the texts safely and in a healthy manner, allowing for controlled exposure to those elements of discussion that may trigger an uncontrollable panic reaction in a person who has suffered trauma. In a case of trauma, engagement with the text still happens. A student still reads and engages with the ideas—but does so with caution and a hope for safety rather than being blindsided by texts.

On the other hand, a student objecting to material on religious grounds, as these Duke students have, does not engage with the text as a text and is not requesting special methods of engagement. They are simply refusing to engage at all. If anything, this Duke University incident exemplifies that it is not the leftist desire for content notes and care for trauma survivors that is quashing academic discussion and freedom, but the objections of conservative Christian students who refuse to engage with ideas that may challenge their preconceived notions about sexuality and the human experience.

To be sure, there is a very real fear amongst college teachers, especially vulnerable graduate students who do not have much real power, that a student’s complaint about their work may lead to the demise of their academic career before it even starts. We see this kind of fear in the backlash against trigger warnings, such as in a piece by an anonymous professor for Vox, who wrote that he is afraid of his liberal students.

But often, those complaints come not from those in recovery from trauma but rather from the privileged few who object to reading stories on moral or religious grounds. While working on my first master’s degree at Baylor University, I was charged with teaching two semesters of freshman composition. Our supervisor vetted every single resource we brought into the classroom to ensure that our conservative Christian student base would not be offended or object to the material presented, even if that material would challenge student perspectives. That meant my Jon Stewart clips in the unit on logical fallacies had to be carefully vetted and censored. We had to know exactly where the line was between pushing the envelope and outright breaking it open. To this end, we were instructed during orientation that teachers’ assistants who violated these rules about “clean and safe” classroom materials might find themselves without an assistantship in coming years.

In the discussion of academic freedom and college classrooms, it’s important to recognize that every classroom is different, and that every college has a different mix of students and student needs and ideas. The urge to treat students as a consumerist monolith is strong, but it does not account for the varying ways in which students will approach a text and contribute to the academic discussion. A student who refuses to engage with the discussion inside the classroom altogether is far more dangerous to the continuation of the robust academic environment than the student who requests a little more time and warning to prepare herself before engaging with a text.

Commentary Abortion

Abortion Rates Alone Don’t Tell Us What We Need to Know About the State of Reproductive Wellness

Steph Herold

While a new Associated Press report suggests the abortion rate is declining in almost all states, we still don't know whether there's been an increase in reproductive wellness. Focusing only on a lowered abortion rate as metric of health and well-being is both inaccurate and stigmatizing of abortion.

Earlier this week the Associated Press released a report that found the abortion rate in the United States is declining by about 12 percent in almost all states. Across mainstream media reporting on this new statistic, abortion rights advocates argue this decline may be a combination of increased access to contraception and decreased access to abortion, while anti-choice advocates claim it’s a sign that their restrictive laws are having their intended impact and that the American people in general are rejecting abortion. Given these varying interpretations and the limitations of the data, it’s hard to know what a declining abortion rate really signifies.

So what’s really behind the declining abortion rate? And why do we care so much?

The documented decline in abortion rates seems to be linked to both worrisome trends and encouraging ones. Alarmingly, abortion is becoming significantly more difficult to access, especially for people in the South and Midwest and for people at or below the poverty level. The AP report states that at least 70 abortion clinics have closed since 2010, limiting access to reproductive health care for people across the country. We also know that insurers and employers are increasingly restricting coverage of abortion care. This means that more and more people have to choose between paying their rent and paying for an abortion. At the same time, the Affordable Care Act stipulates that insurers must completely cover contraception without co-pay, so more people than ever are able to access birth control options without the hurdle of affordability.

Taken together, these data present an incomplete picture. The “good news” may be that more people are having the pregnancies and births they want when they want: Unintended pregnancy rates are mostly falling The bad news? People are likely not able to access the abortions they need. Various factors can impact the abortion rate, and some of these factors suggest that the existing need for abortion is going unmet: new targeted regulation of abortion providers (TRAP) laws; new patient hurdles like increased waiting periods; meager emergency savings both overall and among women; and fewer insurance plans covering abortion. The frustrating truth is that we don’t yet have specific data that can help us know for sure which factors are most responsible for the current change in abortion rates.

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It is tempting to focus on lowered abortion rates alone as a metric of success, especially for legislators and anti-choice activists with a stake in this claim. Here’s the question we should be imploring ourselves and others to ask: Does a lower abortion rate truly signal an increase in reproductive wellness? Reproductive wellness might mean people being able to avoid unintended pregnancies; having access to good quality, shame-free preventive care, abortion, contraception, and prenatal care; and receiving the community and institutional support they need to achieve their reproductive hopes and dreams. We can’t really know if we’re achieving those goals without understanding what other events are happening in people’s reproductive lives.

Focusing on abortion rates alone can’t tell us what’s really important about the state of reproductive well-being, and also has the dangerous possibility of stigmatizing abortion. Highlighting this decreased abortion rate as a “success” suggests that abortion is happening more than it should, and that there are some conditions for which abortions should and should not occur. It also implies that there is something wrong with abortion, that the abortion rate should be low because abortion is inherently “different” from other parts of health care. As sociologist Tracy Weitz states, advocating for a lower abortion rate also sets up an unrealistic expectation that there’s a magic number of abortions that are acceptable, and once we reach that number, abortion will cease to be a divisive issue in U.S. culture. What we want is a decrease in the political and cultural conflict over abortion, not a decrease in abortions themselves.

Instead of focusing on the lowered abortion rate, let’s ask more complex research questions: What social and emotional factors contribute to people’s decision making related to an unintended pregnancy? How do people’s perceptions of their community’s social norms around pregnancy impact what they think they should do about an unintended pregnancy? A lower abortion rate in and of itself doesn’t tell us much without placing it in the social, cultural, and emotional context of people’s lives. Focusing only on a lowered abortion rate as metric of health and well-being is both inaccurate and stigmatizing of abortion.

Author’s note: Thanks to Roula AbiSamra for her help with this piece.