The Right To Choose May Help Choose A Governor In Wisconsin

Robin Marty

The Wisconsin governor's race could drastically effect all of the positive changes that have been made to address teen pregnancy, STIs, and general reproductive healthcare.

A lot of progress has been made when it comes to reproductive health in Wisconsin in the last few years, and much of it has occurred with the help of sitting Governor Jim Doyle.  The Healthy Youth Act made public schools accountable for providing comprehensive age-appropriate sex education well before the Obama administration began advocating for more fact-based and less abstinence-only classes in our country’s schools.  And the state has begun making Medicaid funds available to provide birth control for those who are poor and uninsured, helping to reduce the rate of unwanted pregnancies down the road.

But all of that progress could hinge on one factor — who wins the governor’s race in November.  With Governor Doyle choosing to not run for reelection, residents are being asked to pick between Republican Scott Walker and Democrat Tom Barrett, and their records on reproductive health couldn’t be more different.

Scott Walker, one of the two gubernatorial recipients of and endorsement from Pro-Life Wisconsin, an anti-choice group that supports eliminating birth control, has a long and historic record of pushing anti-choice bills while in the state legislature. Walker attempted to strip all funding for Planned Parenthood for all services, including family planning and birth control, tried to stop insurance companies from covering birth control, and pushed for a conscience clause to allow pharmacists to opt out of providing birth control to patients.

Tom Barrett, on the other hand, received endorsements from local pro-choice groups, including NARAL Pro-Choice Wisconsin, which stated:

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During his ten years in Congress, Tom Barrett voted to require coverage of birth control in insurance plans for federal employees, restore funding for international family planning, rescind the global gag rule, and rescind the ban on abortion for women serving in the military. As Mayor, Barrett has demonstrated his commitment to public health by tackling head-on the challenge of reducing teen pregnancy and STD rates, committing resources to maternal and child health, and investing in public health care programs and services.

Advocates on both sides of the reproductive health issue are making it clear that the governor’s race will have definite repercussions on the landscape of not just choice, but sex ed, family planning and sexually transmitted diseases in the state.  Via the Milwaukee Journal Sentinel:

If Roe v. Wade is overturned, Wisconsin’s ban on abortion, which is currently unenforceable, would take effect. Abortion-rights advocates have tried for years to repeal the ban, and anti-abortion groups see protecting the ban as essential.

The Legislature this year rewrote sex education policies to require schools that teach such classes to tell students the benefits and side effects of birth control and how to use it.Opponents hope to repeal the policies in the next legislative session.

Anti-abortion groups are focused on getting the state to opt out of some requirements under the new federal health care reform law in an attempt to ensure taxpayer funds don’t go toward abortion.

Abortion isn’t the only issue Walker and Barrett disagree on.

Family planning. The state provides birth control and testing and treatment of sexually transmitted diseases to those ages 15 to 44 who earn up to 200% of the federal poverty level. Teenagers don’t need parental consent to obtain birth control or get tested for sexually transmitted diseases.

Walker told Pro-Life Wisconsin he supports raising the minimum age of the program from 15 to 18, according to Matt Sande, the group’s legislative director. Also, Walker’s spokeswoman, Jill Bader, said Walker believes that parents have the right to approve birth control before it is given to their children.

Barrett supports the existing program because he believes it is an effective and safe way to reduce teen pregnancy, his campaign spokesman said.

The program, which serves more than 54,000, was designed to help prevent sexually transmitted diseases and reduce the numbers of births that are paid for by Medicaid, the state-federal health care program for the poor, elderly and disabled.

Contraception. Democrats who control the Legislature passed a law last year that requires pharmacists to dispense birth control to people with valid prescriptions.

As a lawmaker, Walker was the lead sponsor of a 2001 bill protecting pharmacists from being disciplined for refusing to dispense emergency contraception on moral grounds. Barrett said he would veto such legislation to ensure women have access to birth control.

In another vote that’s irked his opponents, Walker in 1999 supported legislation that would have allowed small-business owners to opt out of certain types of coverage. This would have included chiropractic and vision coverage, but the bill also would have allowed an employer not to pay for maternity and mammogram coverage, or coverage of breast reconstruction after a mastectomy.

Walker’s position on the legislation is used in a recently released 30-second ad that was paid for by the Democratic-leaning Greater Wisconsin Political Fund.

But Bader said Walker has supported legislation to make it possible for small businesses to offer health plans to more employees. She emphasized that Walker supported the Wisconsin Well Woman Program, which provides health screenings, including for breast and cervical cancer, for women who can’t afford it.

Sex education. Last session, the Legislature passed a law that required schools that teach sex education to provide comprehensive courses that teach students about birth control and how to use it. Barrett supports the law. Walker opposes it, in part because it does not give school districts the option of providing abstinence-only courses.

In April, Walker told the annual convention of Wisconsin Right to Life that Juneau County District Attorney Scott Southworth “is doing a great job” and called the prosecutor the “100th member of the Assembly,” after Southworth told schools in his county to abandon the new sex education curriculum.

Southworth said the new law, which took effect this fall, could lead to criminal charges against teachers for contributing to the delinquency of minors. Critics called that reading of the law ridiculous.

We need to change the law so we don’t put DAs on the spot,” Walker said at the convention.

In essence, Walker is running on an anti-choice platform that guarantees his main focus will be to roll back every advance that the state had made in trying to curb rates of unwanted pregnancies, sexually transmitted infections, and over all reproductive healthcare.  And if his handling of the Mental Health Complex under his care as Milwaukee County Executive is any indication, it shouldn’t be expected that Walker would value the needs of women above state cost-cutting.

From The Daily Page:

Walker also approved the “money saving measure” of putting violent male patients in with female patients, with the direct result that the incidences of sexual assault skyrocketed – something then-administrator John Chianelli described as an acceptable “trade-off” to help lower rates of overall violence.

I’m not saying Walker is the only one to blame for the serious problems at the facility – there’s plenty of responsibility to go around – but he sure doesn’t act like someone who is at least partially guilty.

It was only after the Milwaukee Journal Sentinel ran a scathing investigative series about the problems at the Mental Health Complex, and an advisory board made recommendations to improve the environment there, that Walker finally conceded to adding more funding for mental health to his budget for next year.

Current polling suggests that the race may be in a virtual deadlock, and as a result both parties are sending their big guns to the state to campaign for their candidates.  Barrett is holding a fundraiser with Vice President Joe Biden not long after a recent visit from President Barrack Obama, and Walker is being propped with visits from Republican presidential hopefuls Haley Barbour, Chris Christie, and Mitt Romney.  Polls have been trending towards Barrett once leaners are included, suggesting that in a year that some expect to be a GOP landslide, Barrett may have a chance to beat the odds.

Still, those who advocate for reproductive health aren’t pinning all of their hopes on a Barrett victory.  They are also making plans on how to keep these newly enacted public health changes in place should Walker win. Most importantly, get them approved and started before the election.

Via Dunn County News:

Family planning advocates hope Wisconsin’s bid to make permanent its expanded birth control services under Medicaid is approved before the Nov. 2 election so the program will be harder to cut if Republican Scott Walker becomes governor.

Wisconsin’s proposed start date for the permanent program is Nov. 1. “It has nothing to do with the election,” said Marlia Moore, a benefits policy administrator for the state Department of Health Services. “It’s just a coincidence.”

But advocates say they hope the federal Centers for Medicare and Medicaid Services approve the bid by then to codify the program before the election.

“There is definitely an advantage to getting as much done as we can while we still have (Democratic) Gov. (Jim) Doyle in office,” said Nicole Safar, legal and policy analyst for Planned Parenthood of Wisconsin.

Getting approval by Nov. 1, or at least before January when Republicans could take control of the governor’s office, would “hopefully ensure that the program will continue,” said Lon Newman, executive director of Wausau-based Family Planning Health Services.

The progress made in Wisconsin has been a true inspiration in the face of so many other states doing all they can to push abstinence only sex ed, veto family planning budgets, and put up road block after road block in the way of a woman’s right to control her own body.  This election will show the state whether it can continue to move forward, or instead start the backtracking process happening all across the country.

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 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.

Roundups Law and Policy

Gavel Drop: Republicans Can’t Help But Play Politics With the Judiciary

Jessica Mason Pieklo & Imani Gandy

Republicans have a good grip on the courts and are fighting hard to keep it that way.

Welcome to Gavel Drop, our roundup of legal news, headlines, and head-shaking moments in the courts.

Linda Greenhouse has another don’t-miss column in the New York Times on how the GOP outsourced the judicial nomination process to the National Rifle Association.

Meanwhile, Dahlia Lithwick has this smart piece on how we know the U.S. Supreme Court is the biggest election issue this year: The Republicans refuse to talk about it.

The American Academy of Pediatrics is urging doctors to fill in the blanks left by “abstinence-centric” sex education and talk to their young patients about issues including sexual consent and gender identity.

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Good news from Alaska, where the state’s supreme court struck down its parental notification law.

Bad news from Virginia, though, where the supreme court struck down Democratic Gov. Terry McAuliffe’s executive order restoring voting rights to more than 200,000 felons.

Wisconsin Gov. Scott Walker (R) will leave behind one of the most politicized state supreme courts in modern history.

Turns out all those health gadgets and apps leave their users vulnerable to inadvertently disclosing private health data.

Julie Rovner breaks down the strategies anti-choice advocates are considering after their Supreme Court loss in Whole Woman’s Health v. Hellerstedt.   

Finally, Becca Andrews at Mother Jones writes that Texas intends to keep passing abortion restrictions based on junk science, despite its loss in Whole Woman’s Health.