This article first appeared in On The Issues Magazine and is reprinted here with permission from the editors.
Why care about women’s health in health care reform? I think it’s
critical for reproductive justice advocates to also become health care
advocates in today’s world, but the reasons why were best captured by
the 19th century Swiss poet and philosopher
Henri Frederic Amiel. He wrote: “In health there is freedom. Health is the first of all liberties.”
justice advocates have a unique opportunity to bring together disparate
social justice movements to forge a compelling case for health care
reform that meets women’s needs.
The Cost of Fittin In 2009; ©Helene Ruiz
This is a tall order. Health care is a matter of life and death,
especially for our most marginalized communities. The U.S. health
system is broken. It is hard to access, it is expensive to use, it is
profit driven, it leaves vulnerable communities without a safety net.
It will take quite a lot to get it where it needs to be, but without
the voices of reproductive justice advocates, it will never fulfill its
promise: to keep us healthy.
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Adversaries Play With Women’s Health
When I heard President Obama’s call to action
on healthcare in February 2009,
I thought about what true health care reform would mean for the
communities that I live in, work in and advocate for. The potential, of
true reform, seemed limitless.
The discussion over health
care began with five reform plans, each emerging from a relevant U.S.
House or Senate committee that has jurisdiction over health care in
some way. These will be drawn down into one bill from each house and
then, ultimately, one bill from all of Congress that the president will
either sign or veto.
In fact, the House of Representatives passed its bill, H.R. 3962, last weekend and the Senate is expected to begin deliberations on its final version of reform soon.
In this entire process of bill writing, there is
only one health care service, deemed both safe and legal, that is being
targeted for explicit exclusion in some of the bills. That is, of
Since this debate began, an onslaught of
opposition to reform has emerged. Opponents have made a clear target
out of women’s reproductive health care needs.
The National Association of Evangelicals (NAE)
says, “Abortion is not health care. Any health care plan which includes
coverage for elective abortion should be rejected. This includes
abortion referral, payment for abortion, or the training of medical
personnel for abortion practices.”
care. It writes: “Persons who engage in behavior which adversely
affects their health, such as smoking, drug and alcohol abuse,
promiscuity and over-eating, should be responsible for the additional
masquerading as the ethic of personal responsibility. The behaviors
noted by NAE are a means of differentiating between those communities
that “deserve” health care and those that do not. This pattern has
occurred before — in the “War on Drugs,” in “Welfare Reform,” and in
countless other efforts to paint low income people, people of color and
poor people as not deserving of social services through some fault of
their own. It should not taint the effort for health care reform.
Health and Justice
What does it mean to be healthy? Why is it, as Amiel asserted, “the first liberty?”
A measure of health is often made by assessing physical needs. This is central and inexorable. But, as reproductive justice advocates know, it is more, as well.
woman’s ability to control her body and its reproductive capacity is
central to securing overall health. Access to abortion and
contraception are the tip of a very large iceberg of needs.
a history of eugenics and population control, the reproductive justice
approach aims to ensure that women have all the medical and social
resources they need to have children, or not, as well as the right to
control if, when and how they become mothers. This awareness, while
including access to abortion and contraception, extends to other needs,
1. Maternity care, including pre- and post-natal care and infertility treatment;
2. A range of birthing options including midwives, doulas and alternative care providers;
3. Mental health services;
4. Preventative care, including but not limited to, Pap smears,
vaccinations (such as HPV), childbirth education and mammograms;
5. Services that are ethnically and culturally competent;
6. Care that is sensitive to people of all different genders and sexual orientations and addresses their unique concerns;
7. Health care services that are economically and physically accessible to women and their families.
The reproductive justice
movement thinks more broadly about the political, cultural, economic,
racial, institutional and environmental factors that pertain to bodily
health. A reproductive justice-based approach considers not only what
illness a woman might have, but also the social factors (environmental
toxins, access to preventative care, community health education, and so
on) that make her more or less prone to getting sick and more or less
able to afford treatment.
This comprehensive approach
changes the meaning of “health” rather dramatically. “Health” no longer
simply refers to whether or not a person is sick or whether or not a
woman can get reproductive health care. Instead, it diagnoses the
factors that contribute to, or detract from, overall wellbeing, not
merely for a single woman, but also for her family and the community in
which she lives. This is what Amiel means, I believe, when he says that
in health there is freedom.
From Our Archives: Spring 1994
Reaching Out to Social Justice Partners
A vision of
women’s health that utilizes the reproductive justice framework
incorporates the leadership of women of color, poor women and young
women who can determine their own needs and decipher a course of action
based on their lived experiences.
mean advocating for health care that is not exclusionary on the basis
of race, gender, age, sexuality, ability or citizenship. Expanding the
current healthcare systems will not be sufficient — we must
acknowledge and actively address the disparities that exist, mobilizing
people from allied social justice and human rights organizations to
think of “health” as expansively as possible. Finally, we must
integrate broad-based grassroots organizing into advocacy and use it to
inform our legal strategies.
The past eight years have been
tough, and reproductive justice advocates have been stemming the tide
of anti-women legislation, holding back the onslaught of regressive
Looking ahead requires a shift in perspective, one
that I am just beginning to make myself. It is a shift from defense to
offense, from protection to progress.
I consider that we
have an opportunity to be visionaries. To actually make changes in the
service of our vision. To hold our legislators accountable to our
needs. To secure health care as the first of all liberties.