An Interview with the Feminist Abortion Network

Amie Newman

Health care reform is the hurricane of U.S. public debate this year. Within that debate, access to abortion has been smack dab in the eye of the storm. Pro-choice advocates are outraged that legislators have sought to strip us of our ability to retain private insurance coverage for abortion services. But what of the women who never had that coverage in the first place? What about the low- income women in our country who, because of the Hyde Amendment (now considered to be “abortion neutral” so to speak), never had equal access to abortion?

Health care reform is the hurricane of U.S. public debate
this year. Within that debate, access to abortion has been smack dab in the eye
of the storm. Pro-choice advocates are outraged that legislators have sought to
strip us of our ability to retain private insurance coverage for abortion
services. But what of the women who never
had that coverage in the first place? What about the low- income women in our
country who, because of the Hyde Amendment (now considered to be “abortion
neutral” so to speak), never had equal access to abortion? Where do these women
go when they need or want an abortion in this country?

If you said Planned Parenthood, you’d only be partially
right. In some parts of the country, the majority of abortions and much of the
family planning services are actually provided by independent, non-profit,
feminist women’s health centers. Health centers that have been in continuous
existence for upwards of 30 to 35 years. 
Health centers that provide the kind of woman-centered, non-judgmental,
empowering care so critical for abortion and other reproductive health related
services.

Lower and middle-income women have relied upon these
independent, non-profit community health centers for years for abortion, birth
control and annual exams. Sure, we think about these clinics when a provider
like Dr. Carhart or Dr. Tiller is targeted, injured or killed by anti-choice
terrorists. We talk around them, discussing the lack of access to abortion
care, the problems with forcing women to view ultrasounds, how many providers
are left in this country and where they are located, how much it costs for a
woman to have an abortion, and how far she has to travel.

But how many of us actually think about our country’s
original basic reproductive health service providers, the architects of the
movement for informed, empowered, self-directed health care? These centers and
the women who staff them (many of whom have been there for 15, 20 and 25 years)
are pioneers quietly existing, on the periphery of our awareness; struggling
for the funding and resources necessary to continue providing optimal care to
mostly lower- and middle-income women in this nation. What many don’t realize
is that most, if not all, of these health centers are not solely abortion
providers. These community centers engage in extensive outreach, community
education, provider education and training, family planning services including
contraception, HIV/AIDS testing and more.

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We can do all of the lobbying, grassroots advocacy and
activism in the world but in the end, if we don’t have providers and centers to
provide women with quality abortion care and related health services, what’s
the point?

Back in 2007, I wrote a two-part series entitled, “Life
Support for Feminist Health Care?”
, during the closure of Aradia Women’s Health Center, the 34 year-old,
non-profit, women’s health center at which I worked for seven years. The
center, like all of the original feminist health centers in this country,
opened its doors in response to community need – i.e., responding to what
women, immediately before and after abortion was legalized, needed and wanted
but weren’t getting in terms of reproductive and sexual health services. You
could say feminist health centers were (and continue to be) both political and
health care related ventures, for sure.

At that time, with Aradia Women’s Health Center closing its doors due to rising
numbers of low-income women as clients with little or no insurance coverage,
decreasing Medicaid reimbursement, as well as the continued difficulty of
finding funding streams, and only fourteen independent, abortion-providing,
feminist health care centers in a similar boat remaining, I was feeling rather
hopeless that these centers would live on.

In 2007, I wrote, “…it is astonishing that so many still
don’t recognize the feminist women’s health movement’s many contributions to
the healthcare landscape in general and to women’s lives in particular. It’s a
shame, because it seems that we may be heading toward the end of an
identifiable era of great value to women in America.” After speaking with two
amazing women who have been doing this work for a combined total of 33 years,
both of whom have been integral to the creation of what’s now called the Feminist Abortion Network (FAN), a
network of these remaining independently operated, feminist health centers, I
am more convinced than ever that there is hope on the horizon for feminist
health care and the non-profit health centers that keep feminist care alive and
well, if we can address some key issues within health care reform, namely
Medicaid reimbursement and the importance of a public option to ensure that all
Americans receive coverage for care.

Kudra MacCaillech of Concord Feminist Health
Center
in New Hampshire and Joan Schrammeck of Cedar River Clinics
in Washington, both agreed to speak with me about the formation of FAN, what
it’s like keeping independent, feminist women’s health centers alive and viable
and their hopes and dreams for the future of feminist care in general.

Kudra and Joan have coordinated their respective feminist
health center’s development, outreach and communications activities for more
than 15 years – one on the East Coast, the other on the West Coast. Both
organizations have been on the front lines providing abortion and many other
reproductive health services over 35-years.

Why did FAN form?

KUDRA:  About five years ago, leaders in our
feminist women’s health centers (FWHCs) from various parts of country started
reaching out to each other, engaging one another in ideas and dreams for our
future.   Though we weren’t
strangers (some of us were acquainted through regional or national initiatives)
we didn’t really consider ourselves “connected.”

I can’t say what inspired the “click” to connect, but that’s
exactly what it felt like.  It was
exciting, but also very focused and coordinated.   Initially, we were brainstorming ways to collaborate
on projects and funding; projects that had not only the potential to impact the
clinics in our own states and communities – but
every FWHC across the entire country
.

Oddly, even we weren’t sure how many centers remained or
where we were located. So, the next logical step was a census of FWHCs in the
U.S.  We sought out clinics that
were nonprofit, feminist in roots and philosophy, independent of a larger
corporate or institutional umbrella and were committed to providing abortion
services.

It is worth mentioning how struck we were by the number of
FHWCs that over the last decade either closed or were left with no viable
alternative other than merger.  In
this relatively short span of time, FWHC’s ceased operations in Burlington, VT,
Tallahassee, FL, Philadelphia, PA, and Eugene and Portland, OR.  [Ed. Note: At FAN’s formation, Aradia
Women’s Health in Seattle, WA and A Woman’s Choice Clinic in Oakland, CA were
operating.  Both centers have since
closed their doors.]

Through this exercise of identifying the FWHCs, we
discovered that despite our organizations operating totally independent of one
another, we were remarkably similar in structure, philosophy and not
surprisingly…challenges. As the group began to take shape, it became clear that
collectively, we possessed an enormous amount of experience, expertise and
resources – we were all on the forefront of social and reproductive justice
efforts in our states and regions.

Tell me about
feminist health centers and what you hope to accomplish with FAN.

JOAN: Each of our
FWHCs has long been committed to notion that independence is the best way to ensure responsiveness to our community’s needs. We also
firmly believe that ultimately, it will be our independence that ensures
abortion services remain affordable and accessible to women in communities
across the country.

Safe, compassionate and professional abortion services will
remain a top priority in our mission and services. In the years after Roe v.
Wade, in true grassroots feminist activism, without waiting for someone to give
them permission– each of our organizations was founded by local women who saw a
need and said, “Let’s start a clinic.” Our priority and promise today is the
same as it was nearly 40 years ago. 
For all FAN clinics, women’s autonomy and
right to abortion is simply not up for negotiation.

Kudra: And, in
practical terms, FAN is our
conduit for connection.  It
celebrates our independence at the same time it supports and encourages our interdependence.  A major focus for this group is sharing resources and
information among members, whereby building stronger, more effective and
responsive FWHCs throughout the nation. 
And of course, in working together we can be that much more effective in
our work informing public health policies, challenging legislative and
regulatory attacks on women’s rights, educating in our communities,
contributing to the national pro-choice conversations and agenda and perhaps
most importantly, raising the voices and experiences of the women who need and
deserve our care.

In current health
reform discussions, we hear about the fact that for many providers (not just
abortion providers), Medicaid reimbursement is too low to maintain providing
care for lower income Americans. How do you all do it and remain viable?

Kudra: In terms
of Medicaid and abortion coverage, it cannot be overstated how acutely
low-income women, struggling single mothers, women of color and young women and
feel the injustice of the Hyde Amendment’s ban on coverage for abortion care.

It is for this very reason that that FAN members uphold a
commitment to never denying a woman an abortion for lack of resources and
maintain internal women-in-need-funds. 
For decades FAN clinics have been waiving and reducing fees,
collectively accounting for hundreds of thousands of dollars in subsidized
health care costs each year.  We do
so with the support of outstanding organizations like the National Network of Abortion Funds, and of course,
generous individuals and foundations. 
Even still, there is a significant unmet need and one that will only
become more problematic, should Congress restrict or deny coverage in the final
health care reform package.

Joan:   Beyond abortion care, there
exists a huge challenge in making a
nonprofit successful when the majority of its clients are Medicaid
recipients.  But with that said, I
believe that the nonprofit model of health care is the best option for the
whole nation.   Primary care should be not-for-profit.

The whole country is looking at this question – where is
for-profit care taking us? It’s already brought about this chasm so that the
wealthy people have insurance and low income people, women needing reproductive
and sexual health care, don’t get it and need to reach into their pockets to
access care or go without.  Our
nation and current health care reforms should be moving more towards the
feminist model of health care delivery. 
This would look like:

  • Sharing
    information in a safe, supportive environment.
  • Ensuring
    that every client has the opportunity to have all her/his questions answered so
    they may give genuine informed consent.
  • Facilitating
    empowered decision making (A.K.A. the client knows her/himself best and is
    capable of making good decisions, if given accurate and unbiased information).
  • And, something that is
    all too rare in health care these days, taking as much time as each person
    needs.

Is feminist health
care a wonderful health care model but not such a great business model? And if
so, is there something we can do to change that? Is there a way to provide
feminist care AND be more profitable?

 

Kudra: I have
thought about this question a lot, and as Joan points out, we believe that the
nonprofit and feminist model is a just and humanitarian approach.  And I wonder if it were widely accepted
and adopted, if we would find that when people are engaged in the decisions
that affect them, and are trusted in the choices they make for themselves, and
are given real options, support and compassion, there would be enormous health
care savings.

For now, I’m not sure that the business struggles of small
feminist health centers are much different than any small health care provider trying to remain independent in this
climate.  In this way, we’re not
unique; there are hosts of challenges that private physician practices or
clinics must overcome in the face the corporatization of heath care.  In my state for example, there are very
few independent OB/GYN or Family Practices physicians able to remain
competitive and similar to FWHCs, are often left with no option but to close or
merge with larger institutions.

It makes me think about the idea of diversity in health care
delivery; the value we place on people having more than one option for where
and how to receive care if they are consumers, or provide the care if they are
health professionals.  Perhaps we
might think of this in the way that we think of biodiversity.  Why is biodiversity to crucial?  Because we know there are significant negative
consequences when a species is lost, and that once we lose it, there is high improbability that we will ever get it
back
.

I think there is a critical role to be played by the diverse
and distinct types of providers we still have in our “health care ecosystem”
and that we should consider what might be the consequences of their
disappearance and absorption into the corporate conglomerate.

Joan, if one out of
three women in this country have abortions, why do we continue to see such
vicious anti-choice legislation on the table? Why don’t women who have had
abortions speak up more?

Joan: The stigma
that the anti-choice people have put on abortion through years and years and
years of horrible, ugly picket signs, calling abortion doctors murderers and
then actually murdering doctors has really put a stigma on anything having to
do with abortion. And the pro-choice side continues to search for a unifying
message and theme to reclaim the moral position as well as to integrate
abortion into the full realm of women’s experiences. It’s important to repeat
the statistic that one out of three women will have an abortion in this
country.  Eighty-five percent of
women will get pregnant and have a baby. Everything
about pregnancy belongs to woman.
Abortion is one of the paths she might
choose but that it’s her decision.

Have you seen a
change in who is accessing the care you provide over the years?

Joan: Most of the
women who access abortion are young – in early adulthood, between twenty and
twenty-five years old. They don’t necessarily have insurance or a full time
career path type of job so they are more than likely reaching into their own
pockets to pay for care (including annual exams, STI testing and treatment,
birth control and family planning). The change, we’re seeing, is that it’s more
and more lower income women who are coming to our feminist community
clinics.

All of our FAN clinics have the reputation as compassionate
safety net providers.  As a result,
we are also seeing a new trend in large numbers of resettled refugee and
immigrant women referred to us.  We
believe that language shouldn’t be a barrier to care, and so next year, Cedar
River Clinics budgeted $70,000 in interpreter fees alone.  This is a concrete example of the
feminist model of care – – and it is this sort of responsive and responsible
approach that we hope to see in the health care reforms.

We hear often that
there are dwindling numbers of medical students or younger providers willing to
provide abortions. Is this true and what can we do about that?

Joan: In terms of
the mid-pregnancy, fetal anomaly services that Dr. Tiller provided and Dr.
Carhart continues to provide, yes, there is
a shortage of people willing to take on those responsibilities. As rare as
those abortions are, we need them in more than one place in country.
In addition, because public health clinics are closing due to state and county
budget cuts, we will see more women for both abortions and for preventive, routine well-woman care and birth control. In
fact, we are planning in Renton to start offering walk-in well woman care next
year to make it more easily accessible.

Is there anything
else you both would like to mention?

Joan: It’s a
value of our organizations to retain our independence from hospitals or
universities or other institutions, because that is how we retain our dedication
to our local community, to the needs of local women. We worry that if we chose
to merge with some other larger institution, abortion services would be the
first thing to get cut. We are here, first and foremost, to serve the women of
our communities. Through FAN we strengthen each of our organization’s abilities
to thrive.

Kudra: I totally
agree. We knew that in discovering each other again, were holding something
special and quite possibly, something irreplaceable
in our hands.  Something that with
a little wit and will, has the capacity to ensure not only that our clinics
thrive, but that the feminist health agenda is advanced nationwide.

Rather than contracting in the face of our challenges, we’re
choosing to clasp hands and expand.
It’s just so exciting to be part of a renaissance happening within our
reproductive justice and feminist movements.

2010
FAN Members:

Blue
Mountain Clinic
– Missoula, MT est. 1976

Boulder Valley Women’s Health Center
– Boulder, CO est. 1973

Cedar River Clinics
– Tacoma, Renton & Yakima, WA & est. Aug. 1979

 

Concord Feminist Health
Center
– Concord, NH est. Oct. 1974

Emma Goldman Clinic – Iowa City, IA est.
Sept. 1973

Feminist Women’s Health Center – Atlanta,
GA est. 1977

Feminist Health Center of Portsmouth
– Portsmouth, NH est. 1980

Feminist
Women’s Health Centers of California
– Chico, Redding, Sacramento &
Santa Rosa est. Feb. 1974

Mabel Wadsworth Women’s Health Center
– Bangor, ME est. 1984

Memphis Center for Reproductive
Health
– Memphis, TN est. 1974

Midwest Health Center for Women
– Minneapolis, MN est. Sept. 1975

Preterm – Cleveland OH
est. 1973

Women’s Health Center of West Virginia
Charleston, WV est. 1976

Women’s Health
Center PA
– Duluth, MN est. April 1981

For more information on the Feminist Abortion Network or to
find a clinic near you, visit the FAN
site.

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.”