This article was originally published in the Guardian.uk
Finally, a feminist health campaign
telling it like it is: American women are being thrown under the bus
for an insurance industry-friendly motion towards "health reform."
Enough with the handwringing, Jane Fonda seems to say in this video for the "Not Under the Bus" campaign. It’s time for women to stop that bus and start driving it.
The healthcare bill
currently headed for conference committee station in Congress is
troubling to progressives on several accounts, but for women, it will
have the ironic effect of making a medical procedure less accessible.
The Senate’s abortion "compromise," extorted by Ben Nelson
of Nebraska (along with a pile of cash for his state), ostensibly means
that women who want full coverage will have to write two checks: one to
cover abortion, and one to cover everything else.
Analysts worry this will amount to a Stupak-like ban
on all insurance coverage for abortions – how many insurers, not to
mention employers, are going to put up with separate checks? And that’s
only a question for "blue" states that won’t ban abortion coverage
entirely. If the expected happens, it will mean that women will have to
pay more out of pocket and travel even longer distances to exercise
what Roe versus Wade supposedly codified as a "right."
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month, feminists were shocked at Stupak-Pitts, then outraged. Now, Jane
Fonda is looking outright panicked on Youtube: "Help end discrimination
against women," she pleads. It may well turn out that the decade’s
greatest threat to abortion access wasn’t George Bush, but Obamacare.
as it is to say, I find Fonda’s panic somewhat comforting. In both its
boldness and its generality, it signals the women’s movement to regroup
at square one, to focus on women rather than on a procedure. After all,
the right to abortion is based on broader Constitutional rights to
autonomy and bodily integrity and the privacy to make decisions about
what happens or doesn’t happen to one’s body. And if we apply these
rights broadly, not only to a woman’s "right to choose" to terminate a pregnancy
but also her right to choose to carry that pregnancy to term, and her
right to choose what happens or doesn’t happen to her body at the time
of childbirth, then we would see that all pregnant women are being
denied these rights.
Case in point: Joy Szabo of Page, Arizona,
pregnant for the fourth time. In order to exercise her rights, she
sought long and hard for a provider and had to travel 300 miles away
from her family for care. But Szabo wasn’t seeking an abortion; she was
seeking a vaginal birth. You see, Szabo gave birth previously by
cesarean section. She is among the hundreds of thousands of U.S. women
who seek vaginal birth after caesarian
(Vbac) each year, though nearly half of hospitals won’t allow it. Szabo
was denied the right to deliver at her local hospital unless she
delivered surgically. She was even threatened with a court order. You
thought abortion was controversial? Ask a nurse about Vbac.
also told it like it is: "Page Hospital: Enter my body without
permission, sounds like rape to me," she wrote in lipstick on the back
of her minivan. Szabo’s ordeal ended happily on 5 December, when she
gave birth vaginally in Phoenix. But the majority of American women in
this situation are scheduling repeat surgery — either on their doctors’
recommendation or insistence — though research has shown it is more
likely to result in a baby’s admission to neonatal intensive care for
prematurity and breathing problems, to say nothing of the risks to
The Vbac ban is only a subset of a much larger problem.
Decades of research tell us that optimal maternity care is something
very different from what most American women receive. Optimal care
means that the physiological birth process is supported with minimal
intervention: labour begins spontaneously, women are free to move
around and push in upright positions, and providers avoid surgical
intervention unless absolutely necessary.
Meanwhile, the majority
of labouring women are confined to hospital beds, strapped to mandatory
but ineffective fetal monitors, induced or sped up with artificial
hormones, and consequently experiencing unnecessary pelvic trauma and
the highest cesarean section rate on record, at 32 percent (10-15 percent is
considered the maximum we would expect for health reasons). If you
question whether this has anything to do with women’s bodily integrity,
talk to a woman who’s had an infected caesarian scar or an episiotomy that tore into her perineum.
the biggest loss for women’s health reform is that with all the drama
over abortion, maternity care has remained a huge blindspot — and a
costly one, at that.
The US spent $86 billion on maternity care in 2006
and another $26 billion caring for babies born preterm, now also at a record
high of 12 percent. Prematurity is a leading cause of infant death, yet the
majority of premies are induced or surgically delivered too early. This
over-medicalisation means that childbirth costs Americans more than
twice per capita what other countries with better outcomes spend.
Medicaid picks up nearly half the bill in the US. If we gave just a
little attention to improving care, we could literally save billions.
quality and reduce costs" — this has been Obama’s mantra for health
reform. How is it that instead of addressing real threats to women’s
and babies’ health, "reform" has led us toward rolling back abortion
access? Advocacy groups have been defending "abortion rights" and, to a
lesser extent, "birthing rights," but it’s possible that such a
single-issue focus has helped to marginalise. To what other bodily
system or medical procedure do we attribute rights? We don’t have
endocrine rights or MRI rights; men don’t have testicular rights or
Viagra rights. Rights belong to human beings. We have rights.
do we? A society that would force a woman to carry an unwanted
pregnancy would also force her to have major abdominal surgery. Women
won’t get real health reform until we reform this fundamental lack of
respect for women. The bus stops here.