Commentary Human Rights

Beyond Birth Control: Recent Reproductive Justice Stories That Fewer People Are Talking About

H Kapp-Klote

Many advocates have understandably focused on the Supreme Court in recent weeks. But what gets lost in that focus are the stories that show the right to basic bodily autonomy is at stake for sex workers, trans people of color, and those who are disproportionately incarcerated.

Recent Supreme Court rulings have not been great for reproductive justice. If the destruction of Massachusetts’ clinic buffer zone law wasn’t enough of a gut punch, the Hobby Lobby decision was a solid finish.

The list of ways that these decisions will hinder access to effective, safe reproductive health care seems endless. But while reproductive justice advocates focused on the Supreme Court steps these past several weeks, reproductive justice was being challenged on the West Coast, where two events had implications for reproductive justice: The FBI shut down MyRedBook.com, a Bay Area website for sex workers, only days after queer activists’ protest of Kink.com’s prison-themed party. In both cases, bodily autonomy—the keystone of reproductive justice—was at stake, for sex workers, trans people of color, and those who are disproportionately incarcerated.

Both events demonstrated that reproductive justice—the right to make healthy and safe decisions about one’s body—is being infringed upon beyond the Supreme Court’s rulings restricting access to abortion and birth control, and those who live at the intersections of oppressions are the most under attack.

On June 25, the FBI shut down MyRedBook.com, a website where sex workers could screen clients and negotiate rates online. The Bay Area chapter of the Sex Workers Outreach Project (SWOP) mourned the shutdown as the loss of “a private, discreet venue for negotiations that otherwise often happen in a public venues or on the street.”

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As Truthout reports, the loss of MyRedBook.com “not only cut off a source of income for sex workers, but also a source of information and community.” In the message boards archived by the Electronic Frontier Foundation, MyRedBook users ask for advice regarding health concerns, financial affairs, and safety tips for meeting with clients. “MyRedBook.com [was] the only accessible advertising and community forum for sex workers of all income levels,” said Kristina Dolgin, Bay Area SWOP organizer, in a phone interview. “When you criminalize sex work, you’re driving sex workers underground. Now that MyRedBook.com is gone, people will still do what they need to do to survive—but without that community they are more at risk for exploitation.”

Dolgin highlighted a desire to stop sex trafficking as one of the reasons why law enforcement targeted sex worker resources—the shutdown has been hyped by CNN “as a move made as part of a broader crackdown on the sex trafficking of minors.” But the charges filed against MyRedBook.com proprietors were unrelated to human trafficking or child prostitution. According to news reports, they were charged with interstate travel in aid of racketeering.

Dolgin also noted the disappearance of harm reduction resources that provide information and community for sex workers (such as Craiglist). “This is a trend that is happening across the United States,” she said.

Late June also saw queer and trans organizers in the Bay Area challenge a prison-themed Pride event thrown by Kink.com, a fetish website. The queer activist groups Gay Shame and LaGai organized a protest against the “Prison of Love” party. Promotional material for the party boasted of “solitary confinement [and] showers” and asked, “What kind of trouble will 3000 of the world’s hottest men get into when in lockdown?”

In an open letter to the party’s organizers released by the Transgender Gender Variant Intersex (TGI) Justice Project, signatories explained they were “appalled by the casual use of the Prison Industrial Complex, which destroys the lives of millions of people and kills thousands every year, as a party theme. At a time when public discussion and media finally has an eye toward the daily systemic violence against trans and queer people, your party theme and promotions are especially harmful and trivializing.”

Trans and queer people, particularly trans women of color, experience extremely high rates of incarceration: According to the National Transgender Discrimination Survey, “Black and Latino/a risk for incarceration due only to gender identity/expression were much higher than the overall sample’s experience, at 41% and 21% respectively.” Comparatively, only 2.7 percent of the U. S. population reports being incarcerated in their lifetime, according to a 2003 study. Trans people of color also experienced substantially higher rates of sexual assault and harassment while incarcerated than both the white trans people surveyed and the general population.

The protest culminated in the arrest of at least seven people, including a National Lawyers Guild legal observer; three queer people of color arrested were held for three days. As one person who was arrested remarked at Gay Shame’s press conference after their release, “[jail] was nothing like that party.”

For those who gathered in protest, the party theme was a flippant symbol of disproportionate incarceration rates for people of color and trans people. “[C]olonialism and white supremacy value some bodies and drastically dehumanize other bodies— [incarceration] and [policing] are part of the process of exerting control over those bodies,” said danielle west, an organizer with the TGI Justice Project, who was present at the protest.

That these two incidents occurred within days of each other, in the same city, is coincidental, but what they reveal about law enforcement, incarceration, and the boundaries of the reproductive justice movement are revealing in conjunction. Both events are symptomatic of structural injustice in everything from policing to incarceration. Both went largely unreported by national media. Both affected those targeted, be they sex workers or incarcerated queer people, along lines of race, gender, and class.

Due to discrimination, LGBT people are disproportionately involved in the sex trades, or profiled by law enforcement as involved in the sex trades, intimately linking issues of incarceration, policing, and sex work.

But most importantly, both events were related to issues of bodily autonomy: bodily autonomy for those who contend with structural oppression based on multiple forms of identity. Sex workers were stripped of the resources they needed to operate safely, there was no disruption of the systemic incarceration of trans and queer people, and even more queer and trans people were subject to arrest and involvement with the justice system. These are not unusual occurrences, but both cases demonstrate how the criminalization of sex work is used as a tool to confine and limit the autonomy of some individuals based on racist, misogynist, and transmisogynist ideology.

Reproductive justice, at its root, is about bodily autonomy—for all people, without stipulations or caveats. When we ignore the infringement of that autonomy on some bodies—particularly the bodies of those who are most marginalized, including sex workers, people of color, and trans women—it is not an accident. Rather, it is a reflection of the imposition of structural power on all bodies.

Without emphasis on how mass incarceration and targeted policing infringes on the bodily autonomy of sex workers, trans women, and Black and brown people, there can be no reproductive justice for all. A movement that ignores these things reifies the patriarchy and the systemic racism and transmisogyny we seek to reject.

To focus only on bodily autonomy only in certain places or for certain people is not justice. To disregard the way that bodily autonomy is prioritized for certain issues, without acknowledging how control over one’s body is a right offered in the current system based on meeting certain parameters of normativity, whether in need or in identity, is not justice either. The protest of the prison party and the shutdown of MyRedBook.com show that challenges to bodily autonomy will come from all sides, and those who are most affected will be those whose autonomy is already infringed upon as a matter of course. In order to build a reproductive justice movement that is as strong and multifaceted as the people working as part of it, these issues must move from the periphery to front and center.

Commentary LGBTQ

Trans? Good Luck Accessing Reproductive Health Care

s.e. smith

Trans patients now stand to access health care more easily, but enacting policies against discrimination isn't quite the same as actually eliminating it.

Dominick, a disabled transgender man, started making the arrangements for a hysterectomy at age 30. The experience turned out to be a living nightmare—and not just because being disabled had previously presented obstacles to medical care, like being unable to access his gynecologist’s office.

“The doctor,” he says, “sent me home while internally bleeding after the surgery because he needed more beds. He ignored my concerns and dismissed my symptoms as overblown.” He says he almost died when he started hemorrhaging at home.

The horrors of that experience led Dominick to shy away from follow-up care and had profound psychological consequences. “I was afraid to leave my house, for fear I’d start bleeding out. I remember being on a bus to school, completely alone, and having a complete meltdown. I called my girlfriend and was crying and shaking and begging her to come get me.”

While he survived the experience, the trauma lingers to this day—and he’s not alone. For many trans men, dismissive treatment in the gynecologist’s office is part of a larger framework of harmful health-care practices that include verbal and physical abuse and denial of care. Thanks to the finalization of an Affordable Care Act (ACA) rule banning discrimination on the basis of gender, trans patients now stand to access care more easily, but enacting policies against discrimination isn’t quite the same as actually eliminating it. Trans people often face obstacles to care in health-care fields, unless they’re lucky enough to live in a region with a well-organized and structured clinic. Doctors who are ignorant about trans needs, like the imperative of surgical transition for some transgender people, can become dangerous roadblocks. And self-advocacy—including standing up for one’s immediate needs or asking for additional support in cases like Dominick’s—can be exhausting or impossible when continuously faced with such experiences.

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Reproductive health care in particular cuts to the heart of bodily autonomy, something trans people are often already denied in other settings. Yet trans men are frequently left out of the discussion when it comes to accessing services, even as the Women’s Health Network and other organizations, like the American Congress of Obstetricians and Gynecologists (ACOG), argue that the health needs of people who are assigned female at birth, no matter their gender, are indeed matters for reproductive rights conversations.

When it comes to seeking medical care in general, trans people say they often face ignorance or outright prejudice from medical professionals. A 2011 study conducted by the National Center for Transgender Equality and the National Gay and Lesbian Task Force found that 20 percent of survey respondents were denied health care due to their transgender or gender-nonconforming identity—and people of color experienced even more profound disparities. Twenty-eight percent of all respondents said they had been harassed in physicians’ offices, and 2 percent experienced physical violence.

Chillingly, when care providers discovered that their patients were transgender, the incidence of discriminatory attitudes increased. Many didn’t understand the needs of the transgender community, forcing half of the respondents to provide basic education about managing transgender patients. While proactive self-advocacy—being educated about your own health, self-assured at the doctor’s office, and ready to speak up for yourself—can help everyone achieve better health-care outcomes, this goes far beyond advocacy. In a medical culture where people may have difficulty obtaining providers, trans patients can be forced to repeatedly discuss sensitive medical information that can trigger dysphoria and frustration. And gender dysphoria is fatal if untreated: A staggering 41 percent of the trans community has attempted suicide.

While all aspects of medical care are important, reproductive health care sits at the axis of many important oppressions: It determines whether people are able to have families, whether they receive treatment after rape and sexual assault, if potentially serious sexually transmitted infections (STIs) are treated in a timely fashion, or if they can obtain compassionate and appropriate abortion care. And here, too, trans people have reported difficulty when it comes to requesting and receiving breast and cervical cancer screenings, STI testing and treatment, fertility care, contraception, abortion and pregnancy care, and other reproductive health needs. When such care is provided, it may come with detrimental comments and practices like misgendering patients or making assumptions about their personal lives.

These are especially important issues for trans people: While transgender women are far and away the most likely to have HIV, with skyrocketing incidence rates thanks to poverty and other social factors, transgender men are also more at risk than the general population. They also have difficulty accessing pregnancy care. Approximately 50 percent of transgender people experience sexual violence, and insensitive care providers managing rape survivors can cause further trauma at a time when patients are particularly vulnerable. Denial of services ties into much larger human rights issues for the transgender community: We are in a climate, after all, where trans women risk bladder infections because they cannot use public restrooms.

But whether people are transgender men, along the nonbinary spectrum, agender, or along other axes of gender and experience, if they aren’t cisgender women, they say their reproductive health needs are often dangerously ignored.

“My first gyno, who was an older woman with all kinds of vocalized homophobic, transphobic, racist, and HIV-ignorant ideas,” says K., “left me so uncomfortable I wouldn’t let anyone touch me between my legs with their hands for a good ten years!” K., who is nonbinary, had a traumatic experience when seeking abortion care, and, like Dominick, wasn’t provided with counseling on the subject of egg storage before starting hormone therapy. “I personally never want to be pregnant again,” K. says, but the very option of freezing eggs and using a surrogate in the future was denied.

And this has real consequences: Trauma in reproductive health services, like that Dominick experienced, can drive transgender people into fearing the health-care system as a whole. Between discrimination and the fear that keeps people out of doctors’ offices, trans people are less likely to get preventive care—like HIV counseling and screening—and more likely to develop complications from delayed care. That includes vitally needed reproductive health services.

Discriminatory practices in gynecological care take place within the framework of another problem for trans people: Even with the ACA’s theoretical increased access to health care, substantial barriers to health-care access remain. Transgender people—particularly women and people of color, but also men to a lesser extent—are four times more likely to live in poverty, thus driving a disproportionate use of Medicaid coverage. As Rewire has reported, 16 states explicitly deny transition-related services under Medicaid coverage. Although the ACA explicitly bans discrimination on the basis of sex and gender, with additional protections for gender-nonconforming individuals now that the Department of Health and Human Services (HHS) has finalized its ruling on Section 1557, that doesn’t always work out in practice. Coverage of transition-related treatment, including hormones and surgery, may be denied as “elective” or “aesthetic” under insurance exclusions. For example, a hysterectomy may be deemed “not medically necessary.” Trans people can be instead forced to sue for their care, as in 2014, when Illinois woman Naya Taylor demanded access to hormones. This is especially true in cases where people have successfully changed the gender markers on their identifications, thereby creating a situation where Medicaid may deny coverage for activities like Pap tests for men or prostate cancer screening for women.

“I’ve got many stories about things that have gone wrong in my interactions with medical professionals,” remarks Everett Maroon, a transgender man who lives in the Pacific Northwest with his wife and family. “I’ve gotten inappropriate medical advice, incorrect therapies, seen medical and cultural incompetence, dealt with shitty care, not been provided options I should have gotten.” His issues are the health-care system’s issues, and they are a subject that should be of critical concern to everyone fighting for reproductive rights.

Fortunately, that’s growing to be the case more and more. As OB-GYN Cheryl Chastine wrote for Rewire last year, “How can providers or activists dare to presume that every patient we can’t ‘read’ as trans is cis?,” she said, adding “When those in the reproductive justice movement prioritize trans inclusivity, more trans individuals feel comfortable publicly identifying as such.”

Her commentary was just one example of the growing chorus of support from the reproductive rights and justice community as people come to understand that reproductive health needs are complex, and some populations have historically been left out of the equation.

Combating that oversight includes taking on challenges like providing competency training to health-care providers in medical school and beyond—including the recommendations ACOG is putting forward. Trans-competent health training should allow clinicians to put their patients at ease. At minimum, it should include discussions about gender identity and presentation, how to handle medical issues that may trigger dysphoria, how hormones might affect other prescriptions and the patient’s general health, and why trans patients may feel distrustful and uncertain around health-care providers.

It also includes passing comprehensive legislation to affirm that transition care and related medical treatments are covered by private insurance, Medicaid, and Medicare. And it includes robust third-party investigation—regulated by the HHS, whose Office of Civil Rights is responsible for enforcing the ACA’s nondiscrimination protections—of grievance complaints filed by trans patients, such as those made directly at clinics and hospitals in addition to those filed with state licensing boards.

It’s time to take trans health care seriously. Doing so will create a world of radical inclusion where people can feel safe seeking health care wherever they go.

Commentary Politics

Populism Doesn’t Always Mean Progressivism—This Election Is Making That Clear

Lisa Needham

Shaking up "the establishment" by focusing solely on economic issues is no guarantee that other progressive priorities will follow suit.

We’re in the middle of a wave of populist rhetoric from candidates and supporters on both sides of the aisle this election year. Both Donald Trump and Bernie Sanders speak in classically populist terms, positioning themselves as an everyman who appeals to the masses.

Populism focuses only on its great enemy standing in the way of the average person and power; vanquishing that enemy, the thinking goes, solves everything. But a myopic focus is troublesome no matter which side of the political spectrum you are on. What does this mean for those of us that need a candidate who focuses on a wide variety of issues like reproductive health, racial equity, and LGBTQ rights? Populism does not necessarily equal progressivism—a point which seems obscured in the 2016 election landscape, particularly where Sanders supporters are concerned. And shaking up “the establishment” by focusing solely on economic issues is no guarantee that other progressive priorities will follow suit.

Modern scholastic discussions of populism typically say it requires four things: on one side, morally upright common people; on the other side, an elite enemy; a corrupt system; and a call for a cleansing battle. Populism has a simple and vigorous appeal: People that feel powerless or disconnected can band together and have a voice, potentially overcoming those whom they see as having unfairly and disproportionately accumulated power.

Sanders-style populists tend to concentrate on the super-rich as “elitists.” Sanders himself centers his speeches around this, asserting that he and his supporters will “not allow billionaires and their super PACs to destroy American democracy” and railing against “all of the new wealth and income generated in America … going to the top 1 percent.”

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Trump-style populists, by contrast, often focus on a cultural elite: the latte-drinking, Subaru-driving, gay-marriage-loving liberals too consumed with niceties like polite discourse. Trump rails against those elites when he decries “political correctness.” He doesn’t have time to worry about things like not disparaging women, because “this country is in big trouble. We don’t win anymore. We lose to China. We lose to Mexico both in trade and at the border. We lose to everybody.”

At best, such an extreme right-wing populist worldview portrays reproductive health issues and bodily autonomy as superfluous. At worst, anti-choice conservatives see them as direct threats to their beliefs and something worth mobilizing over in violent ways. Their tactics, as Rewire covers often, are basically mob rule: Throwing bodies at a clinic to block access to a legal service is the quintessential example. They believe deeply (though wrongly) that were there to be a nationwide referendum on abortion, the majority would choose to outlaw it. Thus, they see those judges and legislators who see women as having constitutional rights as “resisting” this perceived majority view.

Trump has now decided to embrace this stance enthusiastically, hiring an anti-abortion warrior, John Mashburn, to appease and appeal to the anti-choice forces. And though he certainly has well-heeled backers, he also makes an effort to speak to working-class whites who feel any economic recovery of the last several years has passed them by. Those same working-class whites often feel like their economic opportunities and their social capital have been reduced by people of color and immigrants. Other people, the thinking goes, are getting what is rightfully “theirs.”

Trump speaks to all of this in the most craven but effective way. He’s rich and successful, which leaves him uniquely positioned, he explains, to fight the elite economic caste currently dominating politics. He is pugnacious about the judicial branch, and has made clear he’ll appoint judges to overturn social gains like marriage equality. Though his hiring of Mashburn may signal a more decisive anti-choice shift, when he speaks of reproductive health, he does so in a dismissive way: Planned Parenthood does great things, but, paradoxically, he’ll defund them. He’s claimed he will be the best candidate for women, though he won’t say how or why. In short, he’ll make things better economically, appoint judges that will get rid of things his supporters hate, and he’ll be great for women, trust him.

Bernie Sanders, meanwhile, appeals to the some of the same demographics that Trump does, with the same very simple message: Other people have taken what is rightfully yours. Other people have hoarded opportunities you should also have. If you elect me, I will give you what you deserve. As with Trump, he is sure he is the best candidate for women, he’ll make things better economically, and he will appoint judges that will get rid of things his supporters hate—in this case, Citizens United.

Sanders voters that are entirely driven by economic concerns are often flippant about women, with surrogates like Killer Mike declaring “a uterus doesn’t qualify you to be president of the United States.” To be fair, Sanders has always aligned himself with a variety of progressive causes, including reproductive health. However, that alignment is often passive or lacking in real strategy: Though he made recent statements about using the Department of Justice to roll back state-level abortion restrictions, such a promise is, in reality, likely impossible to uphold. (Governing by executive action is rarely as successful as presidents believe it might be.) He framed Planned Parenthood as “the establishment,” which is a stance shared by some reproductive health, rights, and justice advocates. Sanders has not, however, displayed any particular desire to align with organizations separate from Planned Parenthood. And this stance may speak to some of his followers’ existing notion that reproductive rights are either settled law or unimportant or both, especially when considered alongside what they see as the paramount issue at hand: economic equality.

Perhaps as a result, a narrative has emerged of those voters who intend to stick with the candidate who hammers on economic issues, regardless of party affiliation. Of course, this does not apply to all Sanders supporters, or even the majority of them. But over the past several months, we have seen a spate of declarations from Sanders enthusiasts explaining they will never vote for Hillary Clinton should she win the nomination. Elizabeth Bruenig, writing in the New Republic in January, explained the potential Trump-Sanders crossover appeal, should Sanders not prevail in winning the nomination:

Both Sanders and Trump complain about American resources being squandered abroad, while many Americans do without at home. They mourn the outsourcing of jobs to workers overseas, and promise to return jobs to American shores.

In March, the Huffington Post ran a piece about people who have declared themselves “BernieorBust”; 50,000, it reported, have signed an online pledge to write in Sanders or a Green Party candidate—in short, anyone but Clinton. A McClatchy-Marist poll earlier this month found that one in four of the 1,000 Sanders backers it surveyed say they won’t vote for Clinton.

Finally, in the week Trump became the presumptive nominee and it became clear that the math will very likely not work for Sanders to win the nomination via pledged delegates, we saw the #HillaryDropOut hashtag arise. Even before that, Trump’s campaign manager had indicated Trump might pursue a strategy of trying to capture those Sanders supporters who feel they are disenfranchised by the current political system, of which they perceive Clinton is a part.

Clinton has her own failures as a progressive. She famously called Black people “superpredators” and supported a bill widely seen to have created a generation of mass incarceration. She championed welfare reform, which was deeply harmful, disproportionately so to Black and Latino families. These things cannot simply be overlooked. But, given Trump’s expressed policies, voting for him solely because he appeals to economic concerns would not address those issues either.

Will those voters that cross over to Trump or refuse to vote entirely be explicitly voting against abortion rights? No. Instead, they’ll be voting—either directly or indirectly—in favor of smashing the economic system, which is the root of all evil, hoping other rights stay intact or spring from economic betterment.

Populism focuses on a simple solution: a great clash of the common people versus the elites that heightens the contradictions, destroys a rotted, broken system, and allows the common people to emerge victorious with new opportunities available. Progressivism, by contrast, doesn’t rely upon one solution. A multi-faceted approach to our ills, one that recognizes that racial and class equity, bodily autonomy, and economic opportunity are all equally necessary parts of a solution, is a lot of work.

Believing that addressing a single issue, will solve everything is the key appeal—and hazard—of populism. Progressivism, on the other hand, requires us to realize there is no “one size fits all” solution, and that we must push politicians to address economic issues as part of a complex, larger set of priorities that include standing up for racial equity, LGBTQ rights, and reproductive justice. That, unfortunately, is always a tough sell, but it’s a critical one for those of us that give primacy to those issues too.