Feminist Health Center Closes After Thirty Years, What Does It Mean for Women?

Amie Newman

One of Washington State's last remaining independent feminist health centers closes after 30 years. But feminist health care providers vow to keep fighting - with help.

This post was updated on 11/19/10, 11:46am EST

There are over 30 thousand of them – each one with a story. 

The women who received care at Washington State’s Cedar River Clinics’ Yakima clinic (originally called the Feminist Women’s Health Center) over the last 30 years are, as clinic manager Becky Cavender says, “…from all walks of life. They are mothers, sisters, nieces, cousins. They are teachers, students, ministers, doctors, lawyers, farm workers, and home-makers.”

But this week the mothers, sisters, teachers, ministers, and farm workers will have one less option when it comes to choosing a reproductive health provider as the Yakima clinic closes its doors and ends an era.

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Planned Parenthood of Greater Washington and North Idaho which expanded its Yakima center in 2005 and continued to expand the services the clinic offers, will provide a full range of reproductive and sexual health care.

The Feminist Women’s Health Center of Washington State opened its first non-profit clinic in 1979 with $3000 and furniture from the founders’ homes, in the city of Yakima. The center’s aim was to not only offer what they called, at the time, “self help” (personal empowerment through knowledge, ladies!) but also to provide abortion and other health care for women from around the state and throughout the Pacific Northwest. Opening day was delayed because Mount St. Helens erupted, spewing ash across the city but the center eventually opened to women across the state. The reproductive and sexual health care provided was distinctly feminist with a focus on ensuring that each woman retained decision making power over her body and her care – care which was as supportive, woman-focused and non-judgmental as possible. Feminist health clinics were engaging in radical health provision for the time – allowing women to do their own pregnancy tests and offering group counseling sessions.

Over the years the center (renamed “Cedar River Clinics” in 2004) grew to three locations (after one location closed after repeated firebombings) around the state, serving thousands of women each year.

Founders Beverly Whipple and Deborah Lazaldi opened the health center with the intent to provide safe abortion care to local women. Whipple and Lazaldi rode a wave of feminist health care which began to swell after the passage of Roe v. Wade and women awakened to the idea that reproductive and sexual health care could (and should) be based in respect, empowerment and support; even abortion care. Health centers actually run by women, for women, opened their doors and pioneered practices like informed consent promoting the ideals that education, knowledge and access to care were necessary steps towards equality and justice for women. This all came with risks, of course. Over the years, the clinic staff women have received death threats, experienced violent attacks and numerous protests.

For years, the Yakima clinic was the only one of its kind in the area. Yakima County’s primary industry is agriculture; specifically commercial fruit production. The area receives 300 days of sunshine – a very different world from the ever-present rainy, gray weather further to the West. It’s an area that is home to many migrant workers who flood the area each year in search of low paying work. Vineyards and fruit orchards abound and they are need of migrant labor.

Cedar River Clinics’ Yakima clinic offered women migrant workers not only access to affordable health care – but to feminist-centered, supportive, personalized, non-judgmental care as well. But, of course, they offered this care to all of the women they saw. The center provided family planning, contraception, annual exams, sexually transmitted infection testing and more. But the clinic also was the only abortion provider for miles around who offered second trimester abortions – up to 22 weeks.

And while Planned Parenthood will continue to provide care to the women of the region, Whipple says it’s Planned Parenthood which is, in part, responsible for the independent, feminist health center’s closure:

“We would not be closing today if Planned Parenthood had not started providing abortion services in the same town where we have been providing abortion care for 30 years. In starting to provide abortion, they were NOT responding to a local need. Their actions did NOT expand access. We made a difficult decision, one that is responsible.”

Feminist women’s health centers may be a dying breed. Of the over fifty or so operating over the years, only fourteen remain. Six years ago, independently operated, feminist health centers decided to band together as the Feminist Abortion Network (FAN) to provide support and assistance to each other, across the country. In 2007, I explored whether feminist health care centers would be able to survive, after the closure of the clinic for which I worked. In 2009, in an interview with two of the FAN clinic staff women (one of whom, Joan Schrammeck, works with Cedar River Clinics) about the origin of the network, they told me, “It is worth mentioning how struck we were by the number of [feminist health centers] that over the last decade either closed or were left with no viable alternative other than merger.”

But, why? What makes feminist health centers so vulnerable and what does Planned Parenthood have to do with it (if anything)?

The answer is complex and probably not exact either. For many years, FWHC referred local women to the Yakima Planned Parenthood for birth control and likewise, Planned Parenthood referred women from throughout Central Washington to FWHC for abortion. It is when PP added abortion services a few years ago, then expanded them to offer second trimester abortions, that sustaining the FWHC Yakima clinic was untenable, notes Cedar River Clinics. 

Planned Parenthood is, of course, a large entity providing care through health centers operating around the country, to millions of women. They do receive federal funding because, unlike the smaller centers which would need a much more complex accounting system to keep separate any potential government funding for family planning provision from the centers’ abortion provision, Planned Parenthood is able to separate the funding streams.

That said, feminist health centers are locally-grown, small businesses at heart. And just like any small business, they fall prey to a variety of factors from increased competition from larger-sized providers to a challenging economic environment. Of course, feminist health centers face much more than do most run-of-the-mill local businesses. They are, for the most part, political organizations in that they do not only provide care but they must lobby and fight for laws and policies which keep abortion care legal. The centers exist in an embattled environment where they must fight for their very existence – including for the lives of their staff women. They compete in an extremely competitive funding environment; many foundations don’t want to fund smaller, more regional reproductive rights groups – especially not care providers who they may see as not making the impact, policy wise, that single advocacy or large scale, national groups like Planned Parenthood do. Ironically, they are, at the same time, devoted to never turning a woman away for lack of funds, ensuring that all women in the community receive care. While many providers will no longer see Medicaid patients because of impossibly low reimbursements from the government, the mission driven feminist health centers continue to accept women using Medicaid for annual exams, pap smears and more. This all translates to centers literally giving away thousands of dollars in care each year. That’s not sustainable without immense support from the public.

When it comes down to it, the Yakima clinic closure is a loss for women, says Sasha Summer Cousineau, Board President of the CAIR Project, Washington state’s abortion fund for women-in-need. 

“We’re really very, very sad. The CAIR Project works with Cedar River Clinics’ in Yakima regularly because…most of the women we serve are from Oregon, Idaho and the Yakima region.” As an abortion fund which raises money for low-income women’s abortions, the CAIR Project serves “the poorest of the poor women who fall through the hoops. They can’t afford to pay for an abortion and they are not eligible for any other health care assistance,” Cousineau tells Rewire.

For women who are desperately in need of an abortion and cannot afford one without financial assistance, Cedar River Clinics is their best hope. The center, says Cousineau, “still provides high quality care at a slightly lower price [than Planned Parenthood]. The difference between $400 and $450 for an abortion, if you don’t have the money, may as well be a million dollars. For the women we [the CAIR Project] serve, this makes all the difference in the world.”

As well, Cedar River Clinics engages in a great deal of client advocacy. When a woman’s primary language is something other than English or she’s experienced domestic violence or is in need of other resources or referrals, the clinic staff “jump through hoops” to connect her to services.

Cousineau calls Planned Parenthood a “wonderful ally,” though, and looks forward to the organization instituting a more robust “women-in-need” fund of their own so that women from around the Northwest can still access abortion care. 

The Feminist Abortion Network says that you’ve got the women’s health movement to thank if “you participated in informed consent; read a package insert on the risks and benefits associated wtih oral contraceptives, hormone replacement therapy, or another pharmaceutical; your partner or support person attended your medical appointment with you as your advocate; you purchased an over-the-counter vaginal remedy or pregnancy test; or you were offered the opportunity to look at your cervix with a mirror during a gynecological exam.” The women’s health movement leaves a living legacy in its wake but the remaining feminist health centers aren’t about to give up.

Anita Kuennen, executive director of Montana’s Blue Mountain Clinic and president of the Feminist Abortion Network calls the closing, “… a wake-up call to all who support access to choice and access to health care,” and urges those who support this type of care to donate to a local, independent, non-profit clinic. The larger questions, however, remain. Are grassroots, locally-run, feminist health centers still viable? And if not, who will pick up the baton and run with it?

If this most recent closure is a wake-up call, I think we’ve hit snooze one too many times.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

News Abortion

Parental Notification Law Struck Down in Alaska

Michelle D. Anderson

"The reality is that some young women face desperate circumstances and potentially violent consequences if they are forced to bring their parents into their reproductive health decisions," said Janet Crepps, senior counsel at the Center for Reproductive Rights. "This law would have deprived these vulnerable women of their constitutional rights and put them at risk of serious harm."

The Alaska Supreme Court has struck down a state law requiring physicians to give the parents, guardians, or custodians of teenage minors a two-day notice before performing an abortion.

The court ruled that the parental notification law, which applies to teenagers younger than 18, violated the Alaska Constitution’s equal protection guarantee and could not be enforced.

The ruling stems from an Anchorage Superior Court decision that involved the case of Planned Parenthood of the Great Northwest and the Hawaiian Islands and physicians Dr. Jan Whitefield and Dr. Susan Lemagie against the State of Alaska and the notification law’s sponsors.

In the lower court ruling, a judge denied Planned Parenthood’s requested preliminary injunction against the law as a whole and went on to uphold the majority of the notification law.

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Planned Parenthood and the physicians had appealed that superior court ruling and asked for a reversal on both equal protection and privacy grounds.

Meanwhile, the State of Alaska and the notification law’s sponsors appealed the court’s decision to strike some of its provisions and the court’s ruling.

The notification law came about after an initiative approved by voters in August 2010. The law applied to “unemancipated, unmarried minors” younger than 18 seeking to terminate a pregnancy and only makes exceptions in documented cases of abuse and medical emergencies, such as one in which the pregnant person’s life is in danger.

Justice Daniel E. Winfree wrote in the majority opinion that the anti-choice law created “considerable tension between a minor’s fundamental privacy right to reproductive choice and how the State may advance its compelling interests.”

He said the law was discriminatory and that it could unjustifiably burden “the fundamental privacy rights only of minors seeking pregnancy termination, rather than [equally] to all pregnant minors.”

Chief Justice Craig Stowers dissented, arguing that the majority’s opinion “unjustifiably” departed from the Alaska Supreme Court’s prior approval of parental notification.

Stowers said the opinion “misapplies our equal protection case law by comparing two groups that are not similarly situated, and fails to consider how other states have handled similar questions related to parental notification laws.”

Center for Reproductive Rights (CRR) officials praised the court’s ruling, saying that Alaska’s vulnerable teenagers will now be relieved of additional burdensome hurdles in accessing abortion care. Attorneys from the American Civil Liberties Union, CRR, and Planned Parenthood represented plaintiffs in the case.

Janet Crepps, senior counsel at CRR, said in a statement that the “decision provides important protection to the safety and well-being of young women who need to end a pregnancy.”

“The reality is that some young women face desperate circumstances and potentially violent consequences if they are forced to bring their parents into their reproductive health decisions. This law would have deprived these vulnerable women of their constitutional rights and put them at risk of serious harm,” Crepps said.

CRR officials also noted that most young women seeking abortion care involve a parent, but some do not because they live an abusive or unsafe home.

The American Medical Association, the American College of Obstetricians and Gynecologists, and the Society for Adolescent Medicine have said minors’ access to confidential reproductive health services should be protected, according to CRR.