Women Democratic Senators Take On Reform, Show Their Male Colleagues What it Means to Have Cojones

Jodi Jacobson

On the Senate floor and on Larry King Live, Democratic women Senators' expressed their obvious frustrations with the slow progress of health reform legislation, and vowed to ensure women's needs are addressed (2 videos).

Changes were made in this article at 6:47 pm Friday, October 10th to correct formatting mistakes and typograhpical errors introduced during formatting.

As the manipulation, posturing and bickering over health reform led primarily by conservative male congressional leaders, pundits, anti-choice organization leaders and "anti-reform town hall" groupies drones on, the Democratic women of the Senate stepped up yesterday and in the words of Senator Patty Murray (D-WA) said: Enough is enough!

The Senators’ obvious frustrations–and even anger–at the slow progress on health reform legislation, the fact that untold numbers of Americans continue to become ill or die due to lack of timely health care, and the political games being with played reproductive health services was refreshing, frank, and long overdue.

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Eight women senators spoke strongly and succinctly about the disparities in access to affordable health care in the United States, each one hitting on separate but related issues.  The Senators also appeared the same evening in a brief segment of Larry King Live.  Though King consigned them to a couple of minutes at the end of an otherwise largely vacuous show, the Senators nonetheless made clear that the practice of denying women coverage based on the "pre-existing condition" of being a woman would no longer fly.


Senator Barbara Mikulski (D-MD) provided context to the statements of her colleagues by stating:

We the women of the Senate have fought for equal pay and
equal work…and now we are fighing for equal coverage.  We want equal benefits for equal premiums.

Senator Murray made clear that while they were standing up for women, they were standing up for all Americans: "The rising cost of health insurance is hurting women and our
country." 

But, she continued, it is critical to fix existing disparties in health care coverage that are affecting women. 

Why specifically women?  Every day in this country the health insurance industry denies
women access to coverage……we want to make sure that in the health care [reform effort] women get equal access to insurance.

The Senators statements shed light on the various ways in which the high costs of health care and the lack of insurance coverage disproportionately affect women….as women, as mothers, as employees, and as caregivers to aging parents and familiy members.

"Women must shoulder the worst of the health care crisis,
including outrageous discriminatory practices in care and coverage," said Senator Kirsten Gillibrand (D-NY).

"But it is shocking to think," said Gillibrand:

that [unless we are proactive] in today’s America over
half of the population of this country could be discriminated against in one of
their most basic life’s needs.

All other things being equal, for example, women still pay more for health insurance coverage than men.  Gillibrand cited data compiled by the National Women’s Law Center showing that:

under our current system a 25 year-old woman pays up to  45 percent more for the same or identical
coverage [than her male counterpart.]  And yet, some of  the most essential services required by women are not covered by many insurance plans…[services] such as childbearing, pap smears and mammograms.

Moreover, where women can find affordable insurance, stated Senator Jeanne Shaheen (D-NH), the "actual coverage is woefully inadequate" to their real needs.

Today, the majority of those on Medicaid and Medicare are women and providing sufficient funding for those programs is critical to the health care safety net on which millions depend.  

In addition, the toll taken by the recession has had dramatic effects on women’s access to health care.  On Larry King Live, Senator Barbara Boxer (D-CA) cited statistics showing that 52 percent of women delay going to the doctor because of the cost of care and stated:

I get letters from women that they simply pray they don’t get sick, or that they are waiting to turn 65 to enroll in Medicare. Is this the only form of health insurance they have, prayer?

And…without reform the senior population will not get the care they need.

In their floor statements, the Senators made clear that health reform must address discrimination in insurance costs and in access to care based on sex, especially the refusal to cover basic needs such as sexual and reproductive health care, labor and delivery care, and other essential health needs.

Standard in-hospital deliveries, for example, cost between $5,000 and $10,000, and much more if  there
are complications.  But Senator Boxer pointed out the irony of the fact that in a country that ostensibly "puts family values first…only 14 states…require insurance companies to
cover maternity care."

In fact, as Senator Debbie Stabenow stated with a mix of frustration and incredulity:

Some insurance companies treat pregnancy or the intention to adopt as
a reason to reject someone for a pre-existing condition.

Pregnancy should never be a pre-existing condition," said Gillibrand, "and such
discrimination is unacceptable and is contrary to our
core values of equality and equal rights."

Both Shaheen and Senator Amy Klobuchar (D-MI) focused on the exclusion of women victims of domestic violence from insurance coverage because of the pre-existing condition of having been abused.  “This is unbelievable," said Shaheen, " insurance companies can deny coverage to a woman for having been a victim of domestic
violence.

Gillibrand also took on those opponents of health reform using reproductive health care and abortion as a means of attacking health reform.


Senator Kirsten Gillibrand argues on the Senate floor to ensure coverage of reproductive health care in health insurance reform.

"As we address inadequacies in our health system," said Gillibrand, "we must safeguard the women’s health
clinics that are essential points of care for millions across the
country."

Gillibrand continued:

Their work is being politicized….[but] politicizing health care delivery endangers young women
putting them at risk for teen pregnancy, STDs, or cervical or breast cancer.

Women’s health clinics provide critical services to women every day. In my own state, over
400,000 New Yorkers receive health care from Planned Parenthood each yearAbout 50 percent of them are working adults whose jobs do not offer health care benefits.

"Our strategy for reform," she continued, "must protect the critical services
that these clinics provide and
expand upon their success."

On Larry King Live, King asked Stabenow how these "women’s problems" would be addressed.  In response, Stabenow said the Senators planned to make sure that women can get affordable and equitable coverage; that pregnancy is not a
pre-existing condition and that maternity coverage is included.

We also need to provide additional help to pay for prescription drugs, strengthen Medicare and Medicaid, and take other steps to eliminate disparities.

Gillibrand agreed:

We must reform our broken system…end disparities [based on] race and
gender and make quality affordable health care affordable for every single
American.

SEIU has further information on statements by women policymakers on health reform.

Culture & Conversation Abortion

The Burden Is Undue: What I Have Learned and Unlearned About Abortion

Madeline Gomez

For all 29 years of my life, the right to abortion has been under attack. In early March, I slept at the Supreme Court overnight, waiting for oral arguments, and had time to reflect on the experiences that have made me an advocate.

Thirteen years before I was born, the Supreme Court declared abortion a fundamental right in Roe v. Wade. Despite this, for all 29 years of my life, the right to abortion has been under attack.

In the past six years alone, states have enacted 288 provisions restricting access to abortion care. Three years ago, the Texas state legislature enacted HB 2, an omnibus anti-abortion bill. And on Monday, the Supreme Court ruled two provisions of that law are unconstitutional.

I am a Texas native, a Latina, a lawyer, and a reproductive justice advocate, so this case, Whole Woman’s Health v. Hellerstedt, naturally hits close to home.

In the years since HB 2 has passed, I have heard from friends who have waited weeks and been forced to drive hours just to get an appointment at a clinic. And, as my colleagues and I wrote in an amicus brief the National Latina Institute for Reproductive Health filed with the Supreme Court, women of color in Texas, particularly the 2.5 million Latinas of reproductive age, have been disproportionately affected by the clinic closings resulting from the expensive, onerous, and medically unnecessary standards HB 2 imposed. For example, if the law had been allowed to go into full effect, residents of my birthplace, El Paso, Texas, where 81 percent of the population is Latinx, would have to drive over 500 miles to San Antonio in order to get an abortion in the state.

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In early March, I slept at the Court overnight, waiting for oral arguments. In the 24 hours I spent outside the Court, I had time to reflect on the experiences that have made me an advocate.

***

I am 12, with my mother and her dear friend at the dinner table. As the three of us sit together, I regale them with stories of a teacher I deeply admire. She’s been telling us about how she prays the rosary and speaks to women entering abortion clinics, urging them to “choose life.” I believe this is a good act, something I want to be part of, and I’m proud of my righteousness. My mother’s friend says to me simply, “There are a lot of reasons women have abortions.” Almost 20 years later I will learn that this friend had an abortion, which makes sense statistically speaking, since one in three women do.

I am 14 and sitting in high school religion class. The male instructor tells us that pre-marital sex and contraception are forbidden by our Catholic faith. He says the risk especially isn’t worth it for women: It is, according to him, physically impossible for women to orgasm. At the time, and still, I despair for this man’s wife, and for him. Shortly after this lesson the class watches a 45-minute “documentary” about “partial-birth abortion.” This concludes my sexual health education.

I am 18 and counting 180 seconds, waiting to see whether one or two lines appear on a white stick. In a few weeks I am moving to New York to begin college. In those 180 seconds I decide with little fanfare that, regardless of the number of lines, I will not be pregnant when I go. One line appears and I move, able to begin the education I’ve dreamed of and worked for.

I am 19 and talking with a friend. We get to a question that often comes up among women: What would you do if you got pregnant? She tells me calmly and candidly that she would have an abortion. She is the first person I’ve heard say this aloud. Her certitude resonates with me. I know that I would too, and that though I always felt I should be sorry, I would not be. I feel the weight of the shame I’ve been carrying and I stop apologizing for what I know.

I am 20 and teaching sexual education classes to high school students. More than one young woman tells me that she believes she can prevent pregnancy by spraying Coca-Cola into her vagina after intercourse. We talk about safe and effective methods of contraception. Years later, I still think about the damage and danger inflicted upon young women out of fear of our sexuality and power.

I am 21 and lying naked in bed next to a man I’ve been seeing. We’re discussing monogamy. I’m on the pill and he’d like to stop using condoms. He wants me to know, though, that if I become pregnant he won’t let me have an abortion. Because I am desperate to be loved and because I don’t yet understand that love doesn’t mean conceding your autonomy, it will take another year before I leave him.

I am 22 and my friend—the first I know oftells me she is having an abortion. After the procedure I do not know the right thing to do or say or how to comfort and support her. We will lose touch. Like 95 percent of women who have abortionsshe will not regret her choice. When we reconnect years later, we will talk about her happiness and success and about how far we’ve both come.

I am 24 and reading about Congress making a budget deal contingent on “defunding” Planned Parenthood. I understand that though I now refuse to date men who believe they have a say in my reproductive choices, I’m stuck with hundreds of representatives and senators who think they do and who will use my body and health as a bargaining chip.

I am 26 and in my home state of Texas, Wendy Davis is filibustering an anti-abortion bill with two pink tennis shoes on her feet. I watch her all night, my heart swollen with pride at hundreds of women screaming in the rotunda, refusing to be ignored. Despite their efforts, Texas HB 2 will pass. Within three years, over half the abortion clinics in Texas will close.

Today I am 29 and five justices of the Supreme Court have declared the burden imposed by two provisions of HB 2 undue. Limiting abortion and lying about the effects of these laws hurts women’s health, and now the highest court in this nation has declared these actions and these laws unacceptable and unconstitutional. I am in Washington, D.C., 1,362 miles from the home where I grew up, the day the decision is announcedbut it is not just about me and it’s not just about Texas. It is about the recognition and vindication of our worth and rights as human beings. All 162 million of us.

Commentary Health Systems

Your Voice Matters: What I Learned Before Having Fibroid Surgery

Janna Zinzi

Since fibroids are a common experience for many women, especially Black women like myself, I want to share some learnings about navigating the health-care system so others facing a similar prognosis can feel empowered instead of frightened.

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

Having my uterine fibroids removed was one of the best things I’ve ever done for myself. Don’t get me wrong: I was scared when I went to my gynecologist to get an intrauterine device and instead was told I needed surgery. It took me almost two years to move forward with surgery and to actually find a gynecologist I trusted. I’m not casual about surgery, and I admit I’m often skeptical about the U.S. medical system. So I tried numerous alternative remedies to avoid surgery, but my fibroid tumors were too large for any of those alternative therapies to work effectively.

After my procedure, I realized how I had accepted ongoing physical discomfort due to deep fear and mistrust of the U.S. medical system. Since fibroids are a common experience for many women, especially Black women like myself, I want to share some learnings about navigating the health-care system so others facing a similar prognosis can feel empowered instead of frightened.

Despite the fact that uterine fibroids are pretty common, they aren’t discussed in high school health class; women often learn about fibroids from other women in our lives who have experienced them. The U.S. Office of Women’s Health reports this is especially true for African-American women, who are three times more likely to have them than their white counterparts.

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So what exactly are uterine fibroids? As WebMD puts it, fibroids are composed of “renegade muscle cells that come together to form a fibrous ‘knot’ or ‘mass’ within the uterus.” They are often benign, noncancerous growths that develop during childbearing years and especially after age 30. Doctors categorize them based on their location within the uterus: submucosal fibroids are located just under the uterine lining, intramural fibroids lie between the muscles of the uterine wall, and subserosal fibroids extend from the uterine wall into the pelvic cavity.

According to the National Institutes of Health, about 70 percent of white women and 80 percent of African-American women have fibroids by age 50.

Symptoms can vary but frequently include heavy periods, prolonged bleeding, bloating or fullness in the abdomen, painful sex, and even constipation. All of these factors play a role in the affected person’s decision on whether to have the growths surgically removed, and what type of surgery is best.

Medical research organizations and doctors themselves admit that the medical establishment is still learning about fibroids and trying to understand what causes them and why Black women are disproportionately affected. I was particularly interested how a provider approached those unanswered questions when choosing a gynecologist to help me understand all of my options.

A gynecologist first diagnosed me in 2010. Specifically, my doctor told me that I had multiple fibroid tumors, including an orange-sized one that I should monitor. When I returned to her four years later, once I had health insurance again, I was shaken up by her advice to get a myomectomy (surgical removal of fibroids from the uterus). Since the orange-sized fibroid had tripled in size, I was concerned about making sure it didn’t come back post-surgery, but there was no discussion of that. While surgery was commonplace to her, I was scared about having my uterus cut open, the six- to eight-week recommended recovery period, and what all this would mean for my fertility and my work and personal life.

I was 33 at the time, so I resolved to give myself a year to see if I could shrink them without surgery. If nothing improved, I’d get them removed by age 35, when fertility typically starts to decline. I have my own mistrust and skepticism in the way Western medicine is practiced in the United States, where it’s based in capitalism and not always in people’s well-being. Thus I take surgery very seriously and want to be sure I’ve tried everything else in my power to manage my health before choosing that option.

Also, I didn’t have a gynecologist whom I trusted to hear my concerns or was open to my use of holistic methods. My family and friends listened and let me talk through my feelings and worries, but I was still afraid. I researched what surgery would mean for my body, especially my reproductive health, and spoke with herbalist and healer friends. Over the course of the year, I drank weekly herbal infusions and took numerous daily supplements like DIM and vitex. Then I made specific dietary and lifestyle changes after seeing Dr. Michelle Gerber, a naturopath doctor and midwife. I made a significant out-of-pocket investment for these things that weren’t covered by health insurance. Dr. Gerber tested my estrogen levels, which none of my providers had requested up to that point, to see if that was causing fibroids, but my levels were normal.

Although I didn’t have severe symptoms like pain and heavy bleeding, I felt full and uncomfortable like I was carrying something that wasn’t healthy. With the support of my naturopath doctor, I began to look for a gynecologist who could help me figure out my surgery options and also would listen to my concerns. This is when I realized that we as patients need to know what questions to ask.

When faced with a major health decision, it’s crucial to make sure you’re getting all the information you need to make an informed choice. Sometimes it is so overwhelming that you don’t know what you need to know or what you should ask your doctor. Issues like our reproductive health and fertility can bring up a lot of emotions because they have implications on our future plans and desires. Facts can help inform the emotion.

According to Dr. Caryn Johnson, an obstetrician and gynecologist in Atlanta, the most important questions to ask your gynecologist are: “Do I need to have treatment for the fibroids, and what treatment options are available?” (Full disclosure, she is my cousin.) Caryn told me that many women with fibroids are asymptomatic, and observation may be all that is necessary.

“Women should be clear [with themselves and their provider] about what their fertility desires are in the short term and long term,” she said. “For women with symptoms, the conversation should be about fertility and preservation of the uterus so that a more focused discussion on treatment option can be made.”

Caryn also said that size, location, and symptoms are all important factors that are used to guide treatment because “it’s not one size fits all.”

There are numerous surgical options such as myomectomy, uterine fibroid embolization, and endometrial ablation. If surgery is recommended, Dr. Gerber suggested to me that women ask how important it is to have surgery immediately to assess if there’s time to explore other options for treatment. She also recommended that patients ask how large their fibroids are, how fast they are growing, and if there’s a minimally invasive surgery that will preserve fertility, if that’s desired.

“As any surgery can affect your health in terms of scar tissue or infection, and if fertility is important to you, then you have to ask how leaving it or removing it will affect fertility,” Caryn said.

I also learned that it was important to do your own research, in addition to asking doctors about what each surgery entails, including the pros, cons, and risks.

Armed with these questions scribbled on paper, I felt prepared when I visited my new gynecologist. She started our conversation by saying matter-of-factly that because one of my fibroids was very large, I could hemorrhage during surgery and need a hysterectomy (complete removal of the uterus). I cried. While I appreciated her honesty, her delivery did not comfort me. Needless to say, I didn’t see her again.

Fortunately, the next doctor I saw, via a friend’s recommendation, answered my questions and listened to my concerns. She also was honest about the risks of hysterectomy but was clear that she never had to perform one during a myomectomy. She also talked to me about the scar, where it would be, and what it would look like, which was important to me. I eventually scheduled my surgery with her—with a bit of fear, but mostly confidence.

That experience taught me that it’s our responsibility as patients to advocate for ourselves. We have to ask questions and state our concerns. There’s no shame in walking away from a doctor who isn’t listening or isn’t treating you with respect. And particularly as a Black woman who knows the history of unwanted or coerced sterilizations that have plagued communities of color, I have learned how important it is to have honest and clear communication with my doctors. Peace of mind before major surgery is important to healing.

I also must note that I was able to get this procedure thanks to my excellent health insurance. It was frustrating trying to find a gynecologist randomly from a list of those in my area, but I was blessed to get a good recommendation. However, even after I scheduled the surgery, I still had to advocate for myself.

On the day before my procedure, I got a call from the hospital that my surgery needed additional approval. My doctor’s office had confirmed weeks before that I didn’t need this additional authorization, but the insurance company misspoke. I was angry and frustrated because I’d taken time off work, flown my mother across the country to help take care of me, and done all the “right” things. Though I was able to get the surgery a week later, had I done it over, I would have asked the insurance company to confirm that all the necessary authorizations were handled.

Additionally, it’s important to have a gynecologist who will advocate for you. My doctor shared with me that during the surgery, her assisting surgeon wanted to cut me vertically down my stomach as opposed to the bikini line incision promised to me. The assisting surgeon said that the fibroid was too large to approach it any other way. My doctor told him that she would not do that because it was not necessary and furthermore wasn’t what she and I talked about. Who knew that would even be a conversation in the operating room?!

Make sure that you have had clear communication with your doctor and that you are in agreement of the details of your surgery. Make your wishes known even if they are cosmetic. Your doctor should always let you know what the potential complications are, but be clear about what they will do to honor your safety and wishes should those arise.

One of the best resources I found when preparing for my myomectomy is this blog post from a woman in the United Kingdom who had a similar procedure. Her tips were invaluable, particularly her essential shopping list, including oversized “granny panties,” and peppermint tea. Her experience helped me know what to expect as I recovered after surgery.

When speaking with other women who have had various types of fibroid removal surgeries, one major final piece of advice I received was to give myself time and space to recover. I agree; recovery looks and feels different for everyone. So make sure you have someone there to look after you, and that you don’t try to rush the process. Sleep and rest is not negotiable! It also helps to have good doctors and nurses (and family and friends) who care about your recovery and check in on you. Make sure you have someone who can help you with basic things like getting out of bed, showering, and eating for the first few days at least. Create a Netflix queue, and get some coloring books to make lying in bed more fun. Have someone cook you nutritious meals with fruits and veggies, or set aside some money to have them delivered. Be kind to yourself.

I was blessed to have a smooth surgery and quick recovery. My fibroid was the size of a small watermelon and weighed 2.5 pounds, so good riddance! I attribute the success to my gynecologist; my naturopath doctor; my mother, who cared for me after surgery; and my meticulous preparation.

I recognize that I am one woman with one specific story. However too many women, particularly Black women, are affected by fibroids but are nervous about what to do. We suffer in silence even if we have the means to take care of our health. Sometimes it’s fear that stops us from taking care of our health, but often the fear is much worse than the reality.

Know that you are not alone. Know that your desires and your voice matter. Know that with patience and knowledge (and, admittedly, health insurance), it is possible to get the care you deserve.