The Scholar and the Feminist IV (Connecting Theory, Practice, and Values): Afternoon Workshop 6
- Sally Guttmacher: Why don't we go from this [unclear]. So, I'm at Columbia University School of Public Health. [Laughter] Barbara Carreras: I'm 1/4 of the collective leading the discussion and I come from Health Pact. [Audience laughter]. Health Pact is an independent research communication group. We've been around for 10 years doing research analysis and publishing on the U.S. Health System. Pam Booth: I'm Pam Booth and the founder of Health Right for Women's Health Forum. I'm presently at Columbia School of Public Health. [Kyla Shern]: I'm [Kyla Shern] and I'm a doctoral candidate at the School of Public Health at Columbia and my area is health [lapse in audio]. Speaker 1: --descriptions. Speaker 2: We have the same name. [Laughter] Emwitt [Hyle]: That's right. My name is Emwitt [Hyle] and we're also both working on a task force that's setting up a rape team that [iunclear]. Jo Hartley: I'm Jo Hartley, and I'm the editor and publisher of [Conan] which is a publication on research about women. Marge: I'm Marge [unclear], and I'm a psychologist. Cynthia Schwartz: I'm Cynthia Schwartz, and I'm working on the International Women's Bureau of Health [unclear]. Carla Kessler: My name is Carla Kessler, and I work at [unclear], which is an advocacy organization [unclear]. Victoria Brush: I'm Victoria Brush and I'm here on my own, but I work for the Association for Volunteer [Scout Organization]. Ada [Feldstein]: I'm Ada [Feldstein], and I'm doing a masters at the Institution of Human Research here at Columbia, and next year I'll begin medical school at Mount Sinai. [Ann Anthony]: My name's [Ann Anthony] and I too, am [unclear]. [Laughter] [Miriam Barnes]: I'm [Miriam Barnes]. [Laughter] Pamela [Boolan]: I'm Pamela [Boolan]. I'm the campus minister at New York University. Maria Katz: I'm Maria Katz and I'm a senior at Barnard. Next year I'll be at Columbia School of Public Health and I'm interested in public policy. Terry [Holland]: I'm Terry [Holland] and I'm working on a dissertation on [women's view] in Health Care in 19th Century. Speaker 3: ...elementary schools [Unclear introductions]
- Sally Guttmacher: Okay, what we thought we would do... well, the general outline is we're going to talk for some time. And then hopefully, we will have time for discussion because it seems like there are some issues that have been identified here [unclear]. And then, we would like to have the last half our of this workshop to combine with the workshop on sterilization. They are going to come and join us here to talk about implications with them in relation to sterilization... what's happening around folks with sterilization. So, what we do is that we wanted...well, four of us here are not only interested in women's health issues but we're also radicals, in terms of political orientation. So we're going to get that perspective of the [ring on] of physicians is a left wing perspective. And, we're going to try to integrate that perspective with our understanding of what's happening with [unclear]. We'll probably have Pam start off by talking about the history of the women's health industry, a brief overview about it. I will do some summarizing about what we think within the main accomplishments of women's health now and some of the problems [unclear]. Kyla is going to talk specifically about self help, which is part of the women's health movement in some critical fashion. And then, Barbara is going to bring it all together. [Laughter] I'd like to start off by saying that we've all been involved in the Women's Health Movement and we all work in Women's health. If we sound critical, it's because we are trying to be somewhat analytical about it. But I think that all of us are firmly in support of it, even though some things we talk about here may be critiques of some aspects of it. Is there anything else we should say before we begin? Speaker 4: Should we talk and have questions afterwards or should people interrupt us and we respond to questions? Sally Guttmacher: Well we'll go until...what time is it? [Collective reply]: 4:30. Sally Guttmacher: The sterilization group will be coming so that gives us an hour. If we don't get bogged down, it doesn't matter, [because it depends if we get bogged down and not move to questions]. We'll save the discussion until the end, but let's see how it goes with people interrupting as we go along and see how that works. Does that sound fair?
- Pam Booth: Okay, I should preface this: this is going to be a somewhat thorough history, although an overview, but I'm going to try to be somewhat thorough about it. But there's a problem that comes up in that Women's Health Movement groups are often difficult to trace and are often, in some ways, subject to people's experience of it. There was no particular...it is not based on any particular analysis, per se, many of us became involved in it and was [blessed with specially] it became one of the core issues of our lives. It involved not only personal health, but the political, social, and economic issues that we were grappling with. As [members of the left] any discussion of health has to be seen in that context, we feel, and cannot be separated from [those winged] is a struggle that are of which it is intricately apart of the social, political, and economic structure. A brief history of the sixties out of which the Women's Health Movement grew: there was...to start, Kennedy's aggressive imperialist policy which started in the early 1960s. Before then, it consistently became much more aggressive than [now]. There was the Civil Rights Movement which began long before, but it came to a head in the mid 60s. Out of that, came the community control movements of the [OEO] community action summit that was committed out of the [OEO] community action summit which was going in separate from that. From there came free clinics. There was the Annie War movement and the student movement. There was a quote, and I put it in quotes, a "sexual revolution" which Time Magazine told us all about in 1961. There was the Free Speech Movement in 1963-64 at Berkeley. There were the Beatles that inaugurated a whole new way of looking at things. There were changes in birth control policies. Population control became a major theme during that period and birth control, especially the pill, became more available to the mass population [Plymouth]. Sexual activity of...as part of that quote "sexual revolution" broke down the traditional restrictions on male-female relationships, so that living together was no longer living in sin, or at least that was starting to change. There was, of course, the drugs which was in and out of all of these [unclear]. There was alongside this, a growing state and federal budget, especially in social services. New York City became...[laughs] New York City became one of the prime examples of state -- state welfare budget change at this point, and some people feel this was the peak of the United States quote "prosperity" which was based on some questionable assumptions. Internally in the United States also was a more rapid move to the suburbs [for many families], and an increased level of education on women and minorities [unclear]. All these forces were operating in the 60s [at that time]. The women's movement grew out, some people feel, out of the community control movements, and some people feel the left, some people feel when it's apart from the community control [of] the Civil Rights Movement, and some of those feelings came out of all those movements. But, it was primarily middle class, it was primarily middle class women [moving] to...to form the basis of the Women's Movement. [Unclear], for instance, was established in 1967, this is their 10th anniversary, and just for the record, Betty Friedan published "The Feminine.." [Collective panelists along with Pam Booth]: "The Feminine Mystique..." Pam Booth: ...in 1963. And the women's movement was a combination, as we probably know or remember, of women's realization that they had more to contribute than making the coffee, having children, being the bookie, [ironing] the clothes, and so forth. Furthermore, there was something going on among most women, but what the middle class did was exposing the sham of security, love, prosperity. That something much more was necessary to meet their needs, and they were beginning to look to see what it was that was, what was this breaking down of their lives. And some of that comes out of the suburbs and some of that comes out of the urban condition. It wasn't just the middle class in the suburbs that was experiencing this.
- Speaker 4: Women began out of these interests, and partly out of self-defense. This is the liberal middle-class arena of the Women's Movement and the left, as they began to form in small groups to more or less get themselves together. [Unclear] nobody really knows why they went into these groups, but something -- something about getting themselves together with [beginning indoctrination] and they were to discuss or they wanted to discuss their mutual problems. Those small groups became what we now know as consciousness raising groups and they were named as such, soon after they started in 1968 [the first ones started in the United States]. One of the big issues in those small groups was the personal versus the political, which means a lot among very many people of the left, which was a big step to even question that personal versus the political, or at least for women among the left, the personal was indulge-able and was individualistic, we shouldn't indulge in ourselves in such [unclear]. On the other hand, the middle class women were used to putting their needs aside for the family or for their husband or for their relatives or for the children or the house, so there was some common ground there. Eventually, that personal versus the political evolved into the concept of the 'personal is political,' and that concept becomes the basis of one of the transcendental which emerged from the Women's Health Movement, which was the self help movement, which we can talk a lot more about. Another aspect of that 'personal is political' is the demand for us as women to control our bodies, and to eventually control the technology that is involved in our bodies and our reproductive systems. And we found that these were not separate issues, production and reproduction, or the technology, we began slowly to be aware of this. One of the major areas of discussion in those small groups was sexuality and a reproductive [repression]. The focus was usually on men. This was a very important aspect in these groups, men as fathers, men as husbands, men as bosses, men as lovers, men as doctors. And one of the most revealing, the most traumatic of confessions, that was made in these groups was 'I had an abortion,' and that pretty much opened up the whole thing. It became the basis for being able to understand what those relationships were and breaking down the privatization of those relationships among women. To this day, men are afraid of what women say in those groups about them, but they never dare to ask. [Audience laughter]. All sorts of connections were made out of that issue of abortion. There were other issues and those other issues contributed to that connection, but for many women, it was a major subject. I don't have to go through the details of [having] an abortion [inaudible]. But the talking about this most shameful of experiences, was a very very big step. About that time, the myth of the vaginal orgasm was published, and that too was a tremendous impact on [inaudible] and how they [treated] themselves. I think that was 1970. Around the abortion issue came the realization that equal rights pay, work, control of our body, control of our lives would mean nothing until we could have control of our reproductive cycle and our reproductive lives. It was a very difficult concept to jump from not having control of our reproduction to having control of almost [inaudible]. So for many people, it became a primary focus on abortion, it became a primary focus in the Women's Movement in around 1968. Among the reasons for it as primary focus wasn't shared by all women, imagine it was involved class and race and had [inaudible]. [Unclear audience comment/question] It had a unity of sex involved. It was also a great organizing tool for the Women's Movement. It was terrific for dramatizing what issues were talking about, conforming, even more small groups, discussion groups, and really having an action where women really could begin to organize. That was effectively done. It raises issues about single-issue organizing, but it was an aspect of this play powerful in the late 60s, early 70s. One of the primary banners or demands was 'free abortion on demand.' It was not limited to simply middle class interest. Another was 'Our bodies, our lives, our right to decide.' [Unclear comments and laughter].
- Speaker 5: And in many instances, they used civil rights tactics as forms of organizing. It was a very [beginner's luck] in the city. During that time, women's groups also formed underground [before] abortion services in New York City and Chicago and Los Angeles. One of the famous ones is [Jane in] Chicago, and not only did referral services, but also performed abortions. This was before the [the laws were passed]. New York City had, before, prior to 1970, a lot had changed, a lot [in 1970], New York State which was the first state in the country to repeal its law, its abortion law. Prior to that, there was a network of women operating out of their houses who were doing referral services for underground, sometimes OB/GYN [obstetrics/gynecology], all the time OB/GYNs [obstetrics/gynecology] from this group. Clinics, as a result of the change in the law, July of 1970, there were a number of clinics that were set up, some by [puppeteers], some by women and OB/GYNs [obstetrics/gynecology]. Women did not control those OB/GYNs [obstetrics/gynecology], but they [strived] to a number of demands, which we will talk about in a second. One of the primary groups to do this was the Women's Health and Abortion Project which had its roots in that underground referral system. It established a clinic and referral service. It established a referral service out of a women's clinic, a women's center, in 1970, on 20th Street, New York City. It made arrangements with the doctor out in Westchester to actually do abortions in [term], or training them on how to do paramedical work and how to assist in those abortions. At the same time, they became counselors, [inaudible] and they felt very strongly that the procedure had to be in the context of strong, supportive, consciousness-raising environment. There were other centers that were set up in New York City. The medical center, the Eastern Women's Medical Center and Services, some of these were not so bad in their original days. They since had some problems but they started off with some fairly important struggles, which isn't really the context of this talk. From these clinics and referral services, came to the realization that we were not adequately informed about [much less than] the control of our bodies. We really didn't understand our reproductive systems, we didn't know about vaginal infections or herpes, some of us did, but most of us didn't. We didn't know or understand how birth control operated on us or what forms of birth control were good or what forms of birth control were not good. We didn't understand any of these things. As a result, the move was on really to demystify medical knowledge, gynecologists understood this, but we didn't. 'Know-Your-Body' courses were formed by the Women's Health and Abortion Project began operating [unclear] in early 1970. They combined techniques of education, information, consciousness-raising around how we feel about our bodies, and used all aspects of reproduction [using] sexuality as a subject. It later broke into or broke out into another group called the Health Organizing Collective, which published a number of different pamphlets: vaginal infections, OB/GYN [laugh] [very liberal] [other panelist laughs and says: "OB/GYN checkup"], OB/GYN check up, which is a good one, [other panelist speaks again: "[unclear] abortion"], and vaginal abortions, and [unclear] abortions, and so on. At the same time in early 1970s Boston, the Women's Health Collective started a discussion, a series of discussion groups. Out of that, they recorded the content of those groups, and out of that grew the book, "Our Bodies, Ourselves," which was originally in newsprint, published in 1971, the first copyright date, and published over a hundred thousand copies underground, starting around 10 cents moving up to 25, until Simon & Schuster published it around 1973, and I think you all know the record [history makes in selling]. [Barber Meyer and [unclear] English] which is [utilized] in Jersey in complaints and disorders which was pre-influential in terms of our understanding of what was going on in the health system. Barbara Seaman published "The Doctor's Case Against the Pill," the doctors against the pill, which was a very important document on the problems with the pill, that was in 1970. Later she did [unclear]. Ellen Frankfort did "Vaginal Politics" in 1973. All through that period, a number of books were being published and materials were being published on women and health, generally women and health. 1974, Health Right began publication in September of 1974, which was to become the basic source of information on women and health in the country, nationally. [Valley] and Jean Hirsch meanwhile, were publishing a newspaper called "Monthly Extract" which was in combination with feminist movements and [unclear] which were also emerging at that current [unclear]. Later came women and health journal in January of 1975. [Pause] [Consulting with other panelists] 1976, sorry.
- Speaker 6: Along with those publications, there were actions, we didn't sit and write and read. The medicalization of our reproductive systems became the basis for us to understand that that medicalization process of our reproductive systems became the basis of the reasons why we were kept out of child [unclear]. We began to understand that; why we were not progressing in our jobs. It was the basis for the hierarchy beginning with the medical profession. There were all sorts of aspects and the effects of the male dominated health system and that structure that existed, the structure that existed then, that we felt the effects of. In 1970, the Gaylord Nelson hearings on pill were invaded, and I do mean that in a very positive sense, by the DC women's Liberation Center. There were numerous marches and disruptions of hearings around DES in 1976. There have been a number of marches and teachings and all sorts of work done being around sterilization, which we will talk more. Hospitals also became the movement to [pour] around community housing and local hospitals were also the centers of activity for women in the healthcare movement. In (19)72, 73, a period of the Women's Health Movement started moving towards institutional building and it was kind of an alternative institution, which more will be said. They were alternative forms of service as well as an alternative institution. One of those those primary examples are independent women's health centers and it grew out of, I believe, the concept of personal as political, a desire and demand for the control our bodies and the technology.This was symbolized most dramatically by Carol Downer's publication of the first time that she extracted her menstruation which was in January of 1971.The basis of the technology of menstrual extraction, which has since been used all over the country and in various forms. In April of 1971, they began to discuss the formation self-help clinics in which they would do a number of things. They were talking about self-examination, looking at our cervix, being able to understand our own bodies. We were beginning to talk about use of [unclear] for instance, and feeling the vaginal infections, the certain kinds of vaginal infections [based] on menstrual extraction, which then they were not talking about in terms of abortion, at all. We're trying to work with the concepts of technology and self-help. In October, they went around the country on tour in October (19)71, discussing these concepts with a number of different women's groups all over, and doing the self-examinations and showing the concept of menstrual extraction and so forth. They opened up the first clinic in Los Angeles in February 1972. They combined services with education with consciousness-raising. It, however, were not collectively run. It was run on traditional forms of organizational structure. Other clinics have since built up in other parts of the country: Santa Ana, Tallahassee, Chico, Detroit, Atlanta, so forth. Their influence is quite noticeable. Speaker 7: Was that some sort of policy decision to run it traditionally or did they just not think [unclear]? Speaker 8: They couldn't help it, part of that I'm sure was policy decision. There were [no women in the] discussion at that time about collectivity versus [construction] [unclear]. Other clinics and referral services outside that network also formed over twelve hundred groups by 1973 existed. Some of them were performing actual services, some of them were education and information outlets, some of them were doing newsletters, some of them were publishing pamphlets or leaflets of the basic forms of information around. One or two of those clinics were, I should give you..., were developed by left women and trying to combine the concepts of women's health with the Women's Movement and the left in a clinic in Somerville. Eventually, they worked strongly with the working class community which it grew in developing that clinic and eventually turned that clinic over to the working class people that voted they wanted control of that clinic, and they took control of that clinic. I just heard this week that that clinic had closed. I think it would be very important for us to find out why. But that lasted for several years and it's a very important establishment, I think, in the Women's Health Movement. Health Right, that [happened] in (19)73, also Health Right was formed in (19)73, which had its focus on primarily education and [consumer unclear] with some attempt to deal with left politics. There were also a number of health fairs, 'know-your-body' courses that were spread all over the country, and materials were coming out all of the time. So, the areas of demystifying medical knowledge moved, eventually, into unnecessary surgery, hysterectomies, [vasectomies], became the subject of research and discussion and further work informed consent, which is now a part of our lives and hopefully [unclear]. The use of drugs and the effect of drugs, [unclear] getting more and more involved in that. Prenatal care and nutrition were starting to be researched and discussed. There is a beginning, I think, at this point, or at least in the past few years, to try to place the work of the Women's Health Movement in the context of the healthcare system. I'm going to leave off what happens within [law] because I think that's what becomes the subject of our next workshop. [Laughter]
- Speaker 9: Can we pass this down and [unclear] for a different perspective. Speaker 8: One thing about the financial, how are the self-help clinics funded? How do they keep going? Speaker 9: They charge for their services. Speaker 8: They are not part of -- you know, if you're part of a community situation, Somerville, wasn't charging for the most part... Speaker 10: Somerville was taking Medicaid. I mean, obviously not everyone that came to Somerville was eligible, but Medicaid was relatively generous to low [interest]. So, they were able to cover a lot of their expenses from reimbursement. I think about a third of the people were [unclear]. Speaker 11: I was going to say, the only thing about women's health centers is that they were sort of the first -- they basically started the concept of paying themselves for work as opposed to free clinics where people would [unclear], and they were under much attack for that. Now, it's sort of changed [that way] since [unclear]. [They don't get blamed for how much abortion is] but yeah, they were the first to sort of [unclear]... Speaker 12: Was there any effort at all to, in this [health sympathetic] position, to strictly [unclear] women who didn't have, say, the typical credentials, and were there any doctors who [unclear] separate or? Speaker 10: A few. There are problems with this. There are a number of different health workers if you're talking about the doctors themselves, male and female, at that point, were educated in essentially strictly [biomed]. There were a couple of men OB/GYNs [obstetrics/gynecology] who were feminists and tried very hard to work in concepts [unclear] to see it. Some men tried, some ended up exploiting, and others dropped out. But there was a little help, there was a little help from that profession. There were women nurses. There were health workers involved [unclear], but I would say the majority of people actively for much of this, went out and got that information. One of the interesting aspects is that they could do that [unclear] of their professions.
- Speaker 13: One thing that just reminded me while we were talking about people going out and getting information, at the time, and I think it still is the legal aspect [unclear] illegal by being involved while the doctors were not present for the abortion. Health professionals [unclear] were breaking the law and could be subject to arrest and fines [unclear]. This was hanging over many of these women's self-help groups at the time, so... Speaker 14: They were, in fact, busted. Carol for practicing medicine with yogurt, [audience laughter], and someone else for...speculum. I mean, they were in California, there were laws for what practicing medicine consisted of and one of them was only a doctor could put a speculum up you, and I guess you were not allowed to put yogurt inside yourself. They were busted. And yes, they were. [Audience laughter]. Speaker 15: ...[relations]? Speaker 14: Yes, this was in 19...71. 71. [Multiple voices] Speaker 16: ...the length of the count. Speaker 17: One was fine and one was on probation for 2 years. Carol was put on [unclear]. [Multiple voices] Speaker 18: No, she's not [laugh]. Speaker 19: One of the things that she put up with this whole period, as Pam knows best, it was really infiltrated by the FBI. Also, you've been using the FBI files, right? [Pam Booth]: I should say that [audience laughter] that this is the matter [laughter], this is wonderful, that the FBI knew all those leaflets and flyers that we thought was useless [audience laughter], and a lot of the information besides [Carl] and I brainstormed the importance of the other night, was my sources were the FBI files. Speaker 19: The history, the dates, the places, the history... [Pam Booth]: A lot of that comes from the FBI files. All areas, I don't want to get off too much, but all areas were covered quite thoroughly by the FBI. And all those files do exist, and they do reproduce those files. Don't tell the majority of the court I told you this, or I'll be killed. [Audience laughter]. Speaker 20: They are open to anyone who anyone who wants them. Speaker 21: They are? [Pam Booth]: Yes, also you can get them. You can file for them yourself. You can file for those under the 'Freedom of Information Act' yourself. There's a method to that, and that method is also in the Jordan Report, and they have an issue and I think, a separate flyer that tells you how to get that information. If you want to know the history of the Women's Movement in general, you can certainly go to that. Speaker 22: You can just ask for the file on the Women's Movement? [Audience laughter] Speaker 23: No, you have to cross-index it yourself. Um, I could talk...There are intricacies. You can't just ask for the Women's Movement, you have to ask about specific communal areas, but you ask under your own name and ask also about the various aspects of the Women's Movement. The best person to talk to is Nancy [Gorman]. [Pam Booth]: Nancy [Gorman] from majority report. She can tell you how to get those files, and how to ask for them, cause it's tricky. But she's got it. Speaker 23: The question that Pam should add, and the community paying for the services is also a major issue. [The major issue] is a good question and was an issue in the Women's Health Movement. [Multiple voices]
- Sally Guttmacher: Why don't we [move on]? Why don't we go ahead a little bit? Well, I'm going to try to talk about, briefly, is to...to be a little bit analytical about the Women's Health Movement. To try to talk about it in...using the perspective of the Women's Movement and about the left. It is closely tied to [the Women's Movement], but there's a different aspect about it. And also to try to look at it from a left-wing perspective in terms of where the Women's Health Movement sits in the arena of social change, as a vehicle of social change, what it has done in terms of social change, and specifically where it [transferred] in the demystification of health, healthcare medical knowledge. And a change in terms of decreasing sexism in society. Um, first, what do I see as the most aggressive or positive characteristics in terms of the Women's Health Movement? And some of this is in light in the face of [unclear]. First, it has been the dissemination of knowledge and we talked the movement; there have been lots of publications that Pam mentioned. We talked already about women's health, and 'Our Bodies, Ourselves' and all of this has reached people who aren't even involved with [all of this]. Even in women's magazines, they have now columns about national childbirth and who knows what they talk about, but vaginal infections, I'm sure they do. [Other voices]. Usually much more, yeah. And even though the mass media like 'Good Morning America' has been co-opted to some extent, [unclear], so all that information gets out. And that's very [promising], I think, for women and women's health. Um, secondly of course, and this relates, this is more general as well, the Women's Health Movement is connected to the [unclear] of the Women's Movement. It is the documentation of women's role as [healers] which is a [long run, a long role] and a major role in healthcare delivery. In fact that the knowledge and it was only fairly recently, recent history, that healthcare delivery was taken over by men and I'm trying to make the connection between really, or one can make the connection between the development of the society, the political and economic [output] of society, and a change in the looks with power [unclear] in delivery and healthcare. This [change] became more and more possible, delivery and healthcare became more and more possible, it became more [unclear] the curtain of men. And certainly, Barbara, [Dedra], and some others as well have begun to document that story and that's good for women, the Women's Movement, and for men as well, to see that. Um, also one might add, we now see more women at those pens and next to that, more women at medical school, and we might come back to that. Certainly, the Women's Health Movement itself has been a vehicle for feminist ideology. Everyone's concerned with [unclear], the real, good issues post that, the real good issues [duplicate action now] because everybody's involved with that. So, I think what the Women's Health Movement has done to a lot of people who would not been involved in feminism or thought about Women's Liberation, has and [helps to open it] up for discussion. Its appeal to women who really weren't touched by the Women's Movement, now I'm thinking of third world women, lower class women, who have been brought into the Women's Movement perhaps more by health then any other aspect, is through thinking about the problem of sterilization and certain problems of abortion. We might want to come back to that. We will come back. We will talk about the Women's Movement in terms of the class represented, but certainly the Women's Health Movement has the ability to reach people who might not be reached by some of the other aspects of the Women's Movement. Now, it also has implications in terms of demystifications of the social relationships that exist in medicine, and specifically, I'm thinking about the relationships between the patient and the physician. It's a very peculiar relationship, doctor-patient, it is one which has a very unequal distribution in terms of power. If you're a patient, one aspect of being a patient is putting yourself in the hands of the physician, trusting the physician, believing what they will do for you will make you better, and to add to that, the fact that physicians are almost always, have been almost always, male. That just sort of adds on to the problems that such a relationship in terms of people beginning to take charge in their own healthcare. What the Women's Health Movement, I think, has done to demystify that relationship to some extent by teaching women about health, allowing them to begin to question some of the procedures that have gone on within the doctor-patient relationship by [later] bringing people into the feminist health clinics. By changing the structure of those clinics, that has also demystified the doctor-patient relationship because those physicians who work in those clinics must relate to those patients somehow by bringing more women... Well, how many, what I think of the major [house investments] was what I think in terms of some of the problems, and now I'm thinking more, I guess, in relation to the Marxist perspective or the Leninist perspective for some of the essential problems and some of them are problems we are seeing now. The first one is actually related just to medicine. Medicine health. On the whole, and there are sections, but on the whole of the Women's Health Movement, there has been a rather narrow one. There has been a focus on sexism in the delivery healthcare. Sexism, in terms of the doctor-patient relationship, and it is looked at the problems of illness that happens to women, the ones that come [unclear] and what goes on in the one-to-one entity of the healthcare system, but it has not really touched on the larger issues such as the social causation of disease and what is it about the society itself that is [unclear] and the role, relationship to the places that we work in, the environment. All of these are larger issues, but they affect...they have a separate health status before we even reach the hospital. Some of these are women's issues, and some of these are more general [qualifications], but if we are worried about health and disease, then we are worried about our health [unclear]. Then, we have to, I think, change our focus to a broader one that considers the many. Secondly, the focus has largely, although not entirely, been on sexuality and not on other aspects of women's health. For example, well obviously the focus has been on abortion and control on our reproduction, and that's important but there are other issues that are also [important to know]. Women have a higher rate of mental illness, a much high rate of mental illness in some categories; you can break it down. And there's a current controversy about sexual and mental illness but on the whole, the Women's Movement, the Women's Health Movement, has not been concerned about identifying [mental illness]. The next major area [of]...See, what happens is that the Women's Health Movement has grown up without a theoretical base and that's a reflection of the Women's Movement, as it reflects the Women's Movement. The base is largely a general sort of fearing sexism and a vague, sort of fearing of patriarchy. There are exceptions. There are people who try to divide the Women's Movement into a theoretical framework, but on a whole, the movement [unclear] doesn't have a theoretical basis. So it becomes difficult to then explain events and it becomes difficult to develop a real strategy for change if you do not have a theoretical base. I think something we want to talk about later today is what's happening to the Women's Movement, what's happening to the Women's Health Movement. A lot of people are saying that, in fact, they are becoming weaker. That may or may not be true, but one of the reasons that could be true is that we don't really have a strategy. We don't really have a [plan]. Perhaps, we should or what I would like to talk to, or what I see, is the connection to left-wing theory and [unclear] and that possibly bringing those things together, could be a [unclear] strategy and a vehicle for change. Third, I wonder what the revolutionary potential is for a movement that is basically a reform. I see the Women's Health Movement as basically reforming something, not a movement that wants to radically change social institutions, but basically reform them. And the evidence for this is that on the whole the Women's Movement has been a middle class movement [unclear] in the discussion, may disagree about that. It's certainly not strange that the Women's Health Movement has been a woman's [struggle and a middle class movement] as a reflection of the people who found this movement. And I think one of the reasons in terms of health is that the concern with healthcare and shaping healthcare, is largely a middle class concern that people are really poor, and often can't afford to be concerned about health the way middle class [people can]. We think of health as being extremely important, but if you don't have a t.v. [television] and cannot afford food for your kids, and have a lousy apartment, and don't get heat, people believe that health services are a minor concern and don't have a top priority. And there's some interesting evidence about that. They go out on interviews where people ask people who walk around with kinds of diseases that we would not be tolerant of, such as tumors, hernias, and they just say 'well, [unclear] t.v. [television] and I just can't afford [unclear] healthcare.'
- Speaker 24: I think there's also another dimension to it. I've worked in a maternity clinic in Philadelphia and this clinic provides free service. There there was a problem, not so much now as five years ago, of also, this is a cultural dimension of regular healthcare, of getting patients to come regularly to the hospital, finding babysitters for kids, [carting them in,] and then following on doctors' instructions about diet and [unclear]. I was administering a food supplement from a [rich] diet of milk, cereal, eggs, and juice. A lot of times, that wasn't a normal part of the diet, and they really weren't interested in it. Sally Guttmacher: So the kind of concerns that we take for granted of women's health issues, I argued [unclear] are a reflection of our middle class. Because the Women's Health Movement, I think, is largely a middle class movement, as I think the Women's Movement is, it has great potential for being co-opted and reabsorbed into the mainstream of our society. And I'm the [unclear] editor of "Women's Health" which is a [unclear] and we view this in a book where what comes across my desk now is shiny, but books on yoga, childhood, and women as winners, that's what I said. [Audience laughter] You can see that [laughter] that women as winners [offhand comment with laugh] is a program book [unclear], so that... Speaker 25: So, what do they win? Sally Guttmacher: Well. What? [A's for the quiz]. I see this as evidence of how the movement can be co-opted and sold back to us and we buy it and as a society we buy it. And it's packaged. It confuses any potential that we have as a revolutionary social change. Again, the assumption that women -- just because we have more women in medical schools, we are going to produce more women physicians that are going to make major changes in the healthcare system, that's an erroneous assumption. Those women can be reached probably better than men can on women's health issues, but I think we shouldn't assume that the healthcare system is going to change just because there's more women. In fact, what may change is the social status of physicians will become lower [scattered audience giggle] which tends to be happen when women go into [unclear] than the actual system which doesn't change at all. So, I think that for the Women's Health Movement, and again for the Women's Movement, I think that the real movement for social change has to heal at all societal levels. Again, I would argue that since the Women's Health Movement relies a lot on the self-help ideology, that the self-help ideology probably does not have a tremendous appeal to poor people who have been cut out of the healthcare system altogether. And I know that from my experience from doing some work in Cuba that shortly after the revolution, there was a tremendous [run] in Cuba on psychiatrists, everybody wanted a psychiatrist, not because everyone had gone crazy, [scattered audience laughs] but that was the representation of affluence. Before the revolution, rich people wanted psychiatrists, poor people were cut out of that system altogether, and I think that you can draw that example here. People who are cut out of the system don't want self-help, don't want alternative services, they want their own physicians, like everybody else, and they might even want a male, a man physician [unclear]. So, that's another problem. I think I'll leave it at that, and perhaps come back to it when we have another discussion about the Women's Health Movement as the first step to social change and it has the potential to change in it. As a feminist women's movement, it can be considered as one branch of that. We are perhaps right now, in a position, at a good point, to assess what has gone on, in terms of the Women's Health Movement, and develop some kind of unified strategy. Now, [unclear] talk about self-help. [Multiple voices]
- Speaker 25: ...what I'm frustrated by [unclear]. I have trouble imagining how, what approach is used to [unclear] cereal and juice for your kids, [unclear]. Somehow, I feel like that's not where I can start in talking about social change and revolutionary [unclear]. It has got to come from someplace else. When somebody is starving, they really cannot give a damn about nutritional value. Food and [unclear] and I was wondering if you thought there was a way of making inroads through public health. Sally Guttmacher: Well, I think public health is a good place to work for change because one, everyone gets sick, although people on the whole aren't concerned whether they won't or they will, well, middle class people aren't concerned about whether they won't or they will, but I think working class are concerned, poor people are concerned. So, everybody gets sick, everyone comes and gets involved in the healthcare system. The healthcare system mirrors all of the investment of society, stratified with limited healthcare, stratified in the way society is stratified. Distribution [unclear] in relation to dental health, healthcare in society in general. So, it is a good example, it is a good, concrete example of what is going on that people can relate to and people can understand. So, I do think it is a good place to work from. To begin to educate people that, and begin to tell people that health is present and health should be broadly defined. There's no point in bringing a starting plan into a -- it probably [unclear] in the United States but a friend of mine [works in Brazil and does] nutrition there and [people keep coming] who are starving to death and she feeds them, shoots them up with vitamins, [unclear] and send them back out and they come in the same state, two weeks, three weeks later. So, health is something else than shooting people up with vitamins and [unclear] immunization, and teaching people how to [unclear]. Speaker 26: [Unclear], another aspect of it that we haven't really talked about is how many people are employed by the health system in the U.S. [United States]. When you come to think about it, is a thirty billion dollar industry, and of those five million people, three hundred and sixty thousand of those physicians are at the top of it [in that minority] and there are literally millions of people whose everyday lives are vested in thinking about and dealing with what goes on in the health system. And, I think, implicitly [aligned with hedonism] is the notion that the Women's Movement has established, has some notions of what is wrong with the health system but it has been very unsuccessful in communicating those to the people who work in the health system. Not all of them, but a mass majority of them, have no vested interest in [unclear]. There's really been a roadblock there and the only place where it's transcended that is the very top, among the physicians. For the mass majority of people, it has a minimal [process].
- Speaker 27: Just thinking of supporting what you said, that women's healthcare and men [unclear]. We are not, we are not understanding that the U.S. [United States] is not made up of [unclear] to punch and that type of program, has that program understood its target? Could it have made [unclear] in Philadelphia [unclear] and was more successful in more than one neighborhood [unclear] in those types of programs. So, I think, that is very much a result of [unclear] who are pushed down. Two other cons: my sister works in a special federal income project in one of Philadelphia's [tough] neighborhoods where they provide lunches for kids and not only lunches but other [unclear] that kids would need. The other side of the coin is, I discovered through my research, certain ideas I had about proper nutrition really aren't so as far as pregnancy and good health. For example, I always thought that pregnant and nursing mothers should have lots of milk. Well, doctors said to me, 'Do cows drink milk?' They really do not have to have milk in order to... [Multiple voices and laughing] Speaker 28: Women and cows... Speaker 27: I mean milk is useful for the cows, but eat a balanced diet and you don't need to have that three glasses of milk a day, whatever your prescribed. And there was also a study [at Brown] found out that we have a local bank and tasty cakes that are distributed all over the country. Anyway, tasty cakes are sort of junk foods but they taste good. There was a study done to showing that if kids eat these tasty cakes regularly instead of cereal, this is something they like to eat, sweets, they are just as well off nutritionally and energy-wise than eating the standard meal. So... [Multiple voices and laughter] Speaker 27: So, the chart you learn to figure health out, the greens and oranges and everything else, that is not necessarily true so... [Unclear exchange between two speakers (panelists) and laughter] Speaker 29: I think there's an addictive element in those things, the sugar... [Laughter] Speaker 27: No, so I definitely agree that women in healthcare today should be trained to open their eyes to all the different [doctors] that there are in the U.S. [United States]. And, you know, we're not [unclear] in the television and watching the [unclear] nor will we all eat Kellogg's corn flakes, and that's just one point of nutrition. Speaker 30: A couple of other hands... [Multiple voices and laughter]
- [Kyla Shern]: I wanted to pick up on the aspect of self-help of women helping women talking about emerging from women's health, but look at the broader context of the health movement because it is much broader than that now and it's really invaded every aspect of the health system and probably even much broader than the health system. I don't know if you read The New York Times on Sunday where there was an editorial about the commissioner, the State Commissioner of Health, on health starts with the eyes. [Multiple voices and laughter] [Kyla Shern]: [Laughter]...something, "eyes". [More laughter] [Kyla Shern]: What I mean is the capital "I", which is me, and starts with us. This is someone in public health and has history of being in public health and being a public health nurse, and seeing the State Commissioner of Health coming out and saying "It's what we do for ourselves that really determines an [elastic] amount, and it's what our health is, and who we are." On the surface, it may not seem to be alarming, but I find it very frightening actually that someone who is supposed to be in charge of the health of the state is saying that 'I'm turning it over to you people to take care of yourselves.' Now, it's a failing in some ways because we all do want to take care of ourselves, but it takes more than...huh? Takes more than yogurt. Tasty cakes. But there's not enough yogurt and tasty cakes to go around, that's the problem, but it takes more than just passing on the responsibility. The public health system traditionally has been responsible for those who cannot have access to the private health system and we're very well aware that this country's health system has been sharply divided between its private and public sectors. It has been the public health sector that has been responsible for those who cannot afford the private sector. Now, the public sector is saying you've got to take care of yourself. They're not saying it to us. The State Commissioner [Wayland] is not saying it to us. At least the message is not as important to us as it is to people who are relying on his health setups or care. Because for us, we can take care of ourselves. We have [Blue Cross Shield], we have coverage, we do have access to the private health system where other people have been going to the public health clinics. When he says to 'you take care of yourself, I cannot offer my clinic services anymore,' then that really cuts them off pretty dramatically from the health system. Speaker 31: There is also a total denial from Con Edison and all the other industries who take responsibility for our health. It's like when Con Edison pays for an ad that says,'you're responsible for the environment, don't litter.' I want to throw candy wrappers on the ground, but it's not candy wrappers that aren't as bad as the [crap that we eat]. [Kyla Shern]: So this is, as I was saying...do you want to say something else? Speaker 31: Yeah, I think there's a paradox involved here because on the one hand, the self-help movement is kind of a way of taking the power away from the institutions and bringing it back to our own control of our own destinies. On the other hand, the dangers of it are, which you were getting into, which is blaming the victim. I don't know the way out of it, the paradox, because in some ways [unclear]. [Kyla Shern]: Well, that's exactly what I was going to say. [Laughter]
- [Kyla Shern]: But let me say it my way. I'll say it with my accent. So, I think we can understand this, it becomes logical. It's not happening in isolation of other changes that are going on in our society right now. There are reasons why self-help is becoming more and more popular. The literature on it, if you walk in to any drug store or book store right now, it's just becoming overwhelming. It's everywhere. The medical establishment is right on the bandwagon with this as well. So what I wanted to emphasize this afternoon is to understand the popularity of this concept, that we have to look at where we are right now with the health system in respect to the larger society and what is happening in the socio-political sphere. I find -- I think that what is supporting the emergence of self-help as a concept is that now we are so caught within a contradiction where the diseases within a society are becoming increasingly identified as socially caused. We know now that, according to studies that have recently been done, about 90% of cancer comes from the environment and the environment including the workplace environment. A lot of the other diseases, like hypertension and cardiovascular diseases, are linked to stress and stressful lifestyles. Some other things, like there are other economic indicators, that have an impact on our health, such as unemployment. The more studies are being done, there's a relationship between unemployment and illness. We begin to develop more of an understanding of the social causes of disease, and less of a focus on what famously is biological causes of disease. That is, an organism is affected in some way that these diseases are a defect of the organism and the organism has to be treated. For the most part, well a lot of people now, even in mainstream medical literature, are beginning to talk about the limitations of our scientific medicine to deal with diseases people are faced with today. We have been able to get rid of communicable diseases, but we are now faced with chronic diseases and they are arguing such that people you may know of [unclear, a medical nemesis], that the medical profession and the scientific management cannot effectively deal with these health problems. So, we are faced with that. At this time, our medical system is not taking care of the health problems when it is a hundred and thirty billion dollar business. If we spent over five hundred dollars per capita last year on healthcare, health expenditures, and we are still not making that much progress, we are making some progress, that's for sure, but we are not the healthiest population in the world. At the same time we are faced with that, we also faced with this increasing burden to pay for it, that I just need to [recount]. This burden is now beginning to put constraints on how much we're willing to invest, how much more we are willing to invest to put into the health system. At a time when we are faced with fiscal prices and problems throughout the economy, the expenditures and health services become a very vulnerable target and place to cut. There are massive cuts going on which you're very well aware of in the city and other cities as well, particularly older urban centers that have a 10-15 a [year] increase in fiscal problems. So, this cutting that comes then has to be explained; it has to be accompanied by an alternative that the system offers.
- I am proposing that that alternative is a self-help and self-care ideology because what it does, it can resolve that contradiction. It can say that the health system is not effective and we have a cost efficient way for you to solve that problem. If you take care of yourself, you don't have to pay -- we don't have to pay for health services, which are more and more publicly financed. The healthcare that you get anyway is not helping you. Everyone should take care of themselves. In that way, the contradiction is solved. At the same time, as we were alluding to before, it does justify shifting the cost back to the individual. That may be okay in some situations, but it is that individual that starts out with an inability already to survive on the amount of income that he or she has, then that shifting back the cost comes at a much greater burden. It can virtually mean that they have no access to healthcare, except in extreme cases like emergency care. In essence, it is an individualistic solution to what we should, or could identify as a social problem. Health is a social problem. It comes from a social environment to a large extent, but now we are being told that it is our own individual problem and that we must seek our own individual solutions to it. One reason that this can have appeal right now is that one of the problems that are being -- one of the justifications for this is that we have too much, we're too affluent. It has become crystal clear this week in the message [unclear], that we've been indulging ourselves, and that shame on us now we must pay the price and we have to cut back. When you use the argument of affluence, you are automatically obfuscate the class nature of our society because not all of us are affluent and have used too much. Not all of us either are in a state, in a situation where we can seek the alternative self-help. There is a very good relationship between class, social class, and illness. We know -- we have a lot of information about that. How low income is correlated to high infant mortality. How, probably been hearing more, about the diseases that come from poor nutrition. Even in this country, as late as 1973, there were 26 million people who could not afford sufficient nutrition and a little over 11 million of those people were not eligible for federal aid. So, I would think the situation would be even worse now because the federal aid has been cut back. Also, 22 of affluence, well, going to affluence to obfuscate the class nature of the society, but also ignores the social pressures people have on them to indulge in bad health habits. We mention some of those today. The advertising business is one very good example. I mean if you just stop and look at them around the city, and you just realize what that means to young people who are searching for their own self-image or want to be seen as beautiful, active, gorgeous people on the signs, smoking cigarettes, as well as the food industry. The food industry is certainly not helping. The hook here, the Wonder Bread, the cookies, if you ever watch morning t.v. [television] shows, the children's, you just want to cry. If you think if you were a parent, how would you fight that? How do you convince your child that they shouldn't eat that junk food when all the happy children and all their stars and heroes are holding them up and eating them? So, the advertising and the social pressures, the lack of alternatives, reasonable alternatives as healthy food is great but very expensive, and people...it's just not accessible. When the income is low, your alternatives are not very good. Also, pointing to affluence, and also ignores the lack of control that people have over their working environment. Occupational health -- I mean occupational disease and death is a tremendous public health problem and it's one that is overlooked consistently, and except by unions, who haven't been as active as they should've been in this area. Cutting back in the spirit of saving costs has a lot of meaning for occupational health and safety. It means that an environment which is now very unsafe for people who are exposed to toxic substances and hazards and stress, that they will likely become more unsafe and more hazardous because the cost of making a safe working environment has got to be considered in any program in the part of management to take such actions. During a time of fiscal constraint it's unlikely that any of those occupational health and safety programs will be enacted. We do by the way, have a very good occupational safety and health legislation in this country from the past, 1970, and it has been miserably funded from the first day and it's totally inadequate staff is that it was under during the Ford administration it was attacked, and from that administration it has been not able to solve the occupational health problems because they say there's really been no change. Of course there's been no change, there's been no change since the law was passed. There were not sufficient resources so that it could change. So, I guess that and I was putting forth an understanding the self-help movement and its appeal that we have to understand our total socio-economic context and we are in a period where we have to reevaluate and to re-establish our priorities as a nation. We are also in the period after the 60s when it was becoming apparent that the Great Society program was not really taking care of the problem, and when combined with that need to cut back on the state financed expansion of that period, and then the idea of people taking care of themselves becomes very appealing and a very good way to try to solve the problem of meeting the demands for the social services and at the same time not having to pay for them. So, if you can convince people that they should take that responsibility themselves, should you avoid throwing it on the government to take it for them.
- Speaker 32: I just wanted to add a comment in terms of the cause, and [unclear] it's a social cause. Traditionally, women have been caretakers and health providers, often [unclear] in an informal way. One of the problems that I'm seeing is that traditionally [unclear] are our mothers and our wives or whoever to take care of us and be responsible for telling us [unclear]. And that in terms of self-help for others [down south], it might be an additional burden placed on the traditional role upon woman to be responsible for that instead for everybody to take responsibility for that. [Multiple voices] [Kyla Shern]: I have a few more comments I would like to make, if you have anything else you'd like to say. Speaker 33: I just think it's a very good example right for New York City and how the government is really trying to stifle, well I don't know you would categorize this as self-help but if you're familiar with the maternity center on East 92nd Street. Fifteen years ago they started out as a child-bearing center and they went about it in a very traditional way, you know what kind of regulations are they going to have to be under and who's going to have to give us their permission to do this. While they set it up, Blue Cross is covering it and it's a safe, viable, and cost-effective alternative to delivering in the hospitals. The state gave its approval for Medicaid, and the city [unclear] always gives out the vendor number as soon as the state gives their okay, but the city will not give it the Medicaid vendor number. While interning in the [unclear] office, I'm interested in it and I'm figuring well, it'll just be a phone call and call the city commissioner and well, say you know give the number. Why haven't you given it? There's a particular [unclear] of the commissioner in the city health department and there's a woman, who's a pediatrician, who will not give that number. She will not have [directed] a maternity center there for meetings. It's outrageous because there's no reason, it's the only case in city history that when the number was not given when the state said okay, you should give it. We brought it up to [HEW], the regional commissioner, and he's going to try to work on this. But, the city's also making the maternity center give all kinds of statistics which was never asked of by any other kind of institution. They're really being harassed. Now that they're operating they are really getting a lot of trouble from [unclear]. Before they started there was no problem, they said it was okay, go ahead, but now that they are under [right], and women wanted them there, they were really thriving and everything, but they backed up and now the city won't give them the number. I've spoken to some other city officials and said 'you know I can't come in, it's too explosive of an issue, and I'm worried about my job.' [Kyla Shern]: You know, you're one of thousands of examples I can give because the city is really [done here] as elsewhere. It's typical there because their federal money gets cut off so they have to start cutting. I just want to say a few concluding remarks because I want to get on to give Barbara a chance to pull it altogether for us, what y'all have been waiting for. The self-help movement although having great advantages that Sally pointed out some of them, and I do agree. I think the justification of the medical knowledge is a terrific step forward and a progressive step. At the same time, it does not challenge the basic and equitable distribution of economic resources. As long as people do not have sufficient resources, economic resources, or even control over themselves and what makes them well and have a healthy life such as basic nutrition, good housing, and sufficient wage to provide all of those things, then self-help is really not going to improve the health problems of the majority of the population. It will help some, and I do agree that it is an important step in making people think that knowing and understanding your bodies is not such a big deal, anybody can do it, it does not take four years of medical school and several years in a residency or internship, that that knowledge should be accessible to everyone. So, in as much then, as the self-help reproduces or at least allows the reproduction of the existing class relationship, then I think that it itself becomes a class strategy. If you look at the people promoting at the farthest, at the Rockefeller Foundation, and other types of foundations on healthcare, then without being conspiratorial you do see that this becomes very consistent. They move into what you see now as protecting their interests, which is more money into private investment around wasting public expenditure. I think that also we have to be careful as middle class women that we do not let our experience, I'll be generalized and our potential to be generalized to the public, because the Justice Horatio Alger myth is reinforced by just enough individuals who can achieve mobility, who can achieve success, it that makes that myth believable, that is possible, so the self-help gains, what people gain from self-help and this can be the same way. We can realize it because other people we know can realize it. Then, because people who have access to the media, who have access to publication, to teaching schools of Public Health because they can realize those gains, then they can be promoted and make it seem like a possibility for everyone. Then, they can caution us about making that pretty big step. Speaker 34: Just one brief -- I certainly agree with everything you said, that I think we also need to remember that the self-help movement is [unclear]. In another spirit, it is much more lower, working class followers such as the community branch center and things like how these groups [pay] some of those older kinds of self-help existing are not [unclear]. [Multiple voices]
- Barbara Carreras: I'm going to try and [approach] to something here. Obviously, I could sum it up, but I think that in the implicit critique of the health system as to why [unclear] felt different. I think one of the things to just point out is we've all had trouble saying Women's Health Movement, and often said Women's Movement, is a part of both the problem and its genesis. In a lot of ways the Women's Health Movement does not derive from this affection for the health movement so much that the perception that health is one of those things that women need control of for themselves since [we've] always been perceived as controlling our bodies, not so much as changing health systems. So, in the process of thinking about self-control, using that term both ways, there's an implicit critique of the U.S. [United States] health system. One of them is as Sally talked a little bit about, is the health system's function as an agency of social control. When you talk about the doctor-patient relationship, you're really talking about [unclear] inequitable sexist relationship, which puts women in their place. It can be explicit: no matter how experienced we all are, the experience of a gynecological exam, which perhaps is an extreme of the inequitable in that power relationship. So there is a [peak] of the essential control aspects in the health system, implicit in the movement. A second critique...