Unknown Speaker 00:01 This morning, what I gathered was a wonderful panel. So I could spend some time with my children. Picking up from what I gathered was discussed there, I want to say that the name of our session is family planning a historical perspective where we've been where we'd like to go and where the government is taking us. I think because of the urgency of where the government is taking us right now and where we are right now, I'm going to start with the President and then move back and then let's do the ANA talk about the president and future because as a provider of services, she can do a get to brass tacks really give us a sense of how we are going to negotiate in a world where the government is taking us in the wrong direction. Although one that I hope you will use, your understanding follows attack. It's very linear out of our history. And if I can explain why that all is because some some of the confounds even any kind of reasons, analysis, that is such as we have a reasoned analysis, I hope I can give you one. What I want to stress in terms of where we are today is that the kinds of minutes that we just talked about in the welfare panel here and that I gather we're discussing this morning are particularly severe and particularly unfortunate with respect to pregnancy and family planning in America. The truth is, and these are data from the New York Times last week, that's how fresh it is that the illegitimacy ratio is so much talked about so much read about in our politics today in America is actually rocked with it. For the first time in many years, the number of babies being born in America, teenagers, today, another mention of public policy and political state has also declined the fourth year in a row. Young people are in fact using birth control in large numbers, to government financed contraceptive programs. And this public policy, this liberal public policy, which is much like deserves a lot of credit for the change in behavior. It has, for a long time in this country and throughout the world been a debate about motivation versus resources and family planning. Is there no motivation to limit pregnancy among teenagers? Or is it a question it's the absence of resources, sex education and family planning. And this new data according to a report or Beyond Good luck, or Institute, which is one of the most prestigious research organizations in this field shows very much that more and more the issue is becoming resources. But if you provide resources people use them, even teenagers, publicly funded family planning programs presented according to the US mocker recent data, some 1.3 million unplanned pregnancies in the year, two thirds of them involving unmarried payments, and 20% involving teenagers. What's more every tax dollar spent on reproductive health care? Read this data was cost effective, because they take greater Medicaid costs for pregnancy and infant care, particularly severe costs when you're dealing often with teenagers, and be good for them, not to full term babies. And needless to say, this investment in family planning, if you're concerned about these things have roots larger long term welfare dependency and therefore is cost effective in that respect. Now, you would think that with this kind of data available, but a political fate, as we saw last week, we'll talk about it and then say that, given the statistics and our concern about it's not my concern, frankly, but the perceived concern about moral issues in this country we would investigate on the planet. But know, our public policies are not that rational. Unfortunately, because while federal and state funding for reproductive health care exceeds about $700 million, and was in fact held constant in absolute dollars, the title 10 program was not slashed severely as the Republicans originally wanted to clash in this most recent appropriation bill that was agreed upon in the continuing budget resolution of late September. The truth is given in real dollars, there's been a 3% decline in the money spent on family planning since 1980. When we are now seeing the effects of all the scholars that are so positive in absolute dollars we've been held constant, but in the real purchasing value of those dollars. We used to have a 30% decline in investment in family planning programs. To many American women and particularly American teenagers remain at risk of unwanted pregnancies because of the continued conservative assault on family planning and worship programs. And of course, that's just title 10 He is the major provider of public funds for freestanding things like Planned Parenthood for hospital based family planning programs. Because the situation is even worse because of the recent welfare reform bill, it's hard to call it a reform bill, the welfare repeal bill as it was discussed earlier today, passed by Congress and signed into law, ostensibly with great regret by President Clinton, which encourages states to decrease their out of wedlock birth rates. The reproductive dimension of the Family Welfare Bill has not been discussed during that is there are provisions in this field that encourage states to decrease their out of wedlock birth rates for providing bonuses to those states do so. But the bonus is tied to the fact that the abortion rate will not go up. And the that, in other words, this will be done through some either provision of family planning services, except there's no money for that, or some other punitive measures. The welfare the legislation remains silent on the subject of child exclusion bills permit states to enact in other words, family cap provisions that deny mothers on welfare from receiving additional benefits for a new baby's born. So in other words, the idea is that that punitive measure by not giving benefits is going to somehow impact the pregnancy rate. Even though we don't have family planning services, we certainly don't have any money for abortion. And in fact, the only new money $50 million, and this is really an outrage is provided. For abstinence education, that's the only Ema $50 million. Unknown Speaker 06:44 Even worse, the provisions of the bill affecting legal immigrants will make many of them ineligible. And this is a big issue for people like Anna who provide services that are reimbursable. But illegal immigrants may be ineligible for family planning assistance under Title 10, which is a major provider of funds here. So there are many years specific went when President Clinton said that he was unhappy with many dimensions of this donor was going to sign it but hope during that Congress, there is a real agenda for all of this of those of us who are concerned about what we need to do in terms of these very specific provisions in the bill which he may be able to reverse. In fact, we have more amendable political climate. Just to further flesh out the picture of what the government where the government is taking us today. This is not where I usually get lectures. But I really think the urgency is so great that we need to do this and then look back at the history. The assault on abortion rights, it's been even greater than anybody realizes. Porter, President Clinton's and I give him great credit for having Elise taking the publicly recognized position of vetoing the late term pregnancy feel. But even last week, this was in the continuing risk budget resolution theory, this huge number, which is happening September 28 of this year, a huge number of rights Light Christian coalition Catholic inspired abortion restriction, which very few people know about it's gotten very little press coverage. Again, Clinton each out too much publicized restriction on late term abortion, it's still in place it provisions allowing racial restrictions to be denied Medicaid funding for abortion. A provision banning human embryo research a provision banning funding for abortions for women in federal prisons for women in the military. for low income women living in Colombia, this is a very big issue, because the Congress provides funding for Colombia it's not a state and band our abortion fund. Yes. And also, abortions cannot any longer be paid for by government workers enrolled in the Federal Employees Health Benefits Program. And this case, we've exceptions only for life and rate. It's the life of the mother effect or the rate that those female male are very hard issues to debate when you're carrying a child because you want to have pregnancy that you want to turn that around, gives us almost no publicity about any of this. And I again, I think it's it's political climate changes, much of this can be reversed, but not if you don't know what's happened. So what I'm suggesting is that there's a very profound agenda that people who are concerned about reproductive rights need to now grab a seat we have a democratic presidency and perhaps Democratic Congress again next year. Unknown Speaker 10:04 Perhaps the most Unknown Speaker 10:04 severe measures, if these weren't bad enough on the domestic side that we need to talk about are the severe cuts 30% Cut to international assistance in this continuing resolution that was passed in September 28. The measure had passed this funding for international families. And this is the reason why President Clinton apparently signed it if you can get these saved, as trading off in the last minute negotiation on this bill, we are looking for omnibus budget resolution bills, not signed it would have meant another situation like last year, with a government shutting down and so forth and so on. But what you forget about when you read those headlines is what's buried in this bill. And a 30% Hiding international family planning assistance was buried in that bill. And there was a moral victory to the Clinton people in the face. It least save us from having reinstituted the Mexico City Policy introduced it for many years under Reagan and Bush, would you say a policy that did not allow us government funding of any international family planning programs where abortion was provided that was taken out of the bill, but traded off to save us from the reinstitution of that policy was a 30%, cut in dollars for family planning and reproductive health care. So that is another item on the agenda that we need to address. Having said all this, I feel like I should forget the history and just turn you over to Anna, to tell you about the heroes and inspiring work so that you don't need totally defeated, but she does on the ground in New York under the worst conditions. And with continued assaults on her budget, she still manages to provide extraordinary services to deserving women and their children. But I do want to go back and try to give some historical perspective, in a very condensed fashion as to why it is that we're still fighting this battle. It's the Millennium terms as the century term that Margaret Sanger began fighting in a public way in 2012, in this country. And I think what we're talking about here is exactly the same battle that she fought the battle for reproductive rights women, there is a tendency, I think, to be that somehow abortion is what's issue here. And that all of this discussion that goes on about women's bodies today is about, you know, the moral status of the fetus. And a legitimate moral position is different than when you're talking about family planning. But the kinds of assault I just described to you on family planning budget suggests otherwise, they suggested something else is going on here, that we're not really talking about the moral status of the fetus, but you could debate that's going on is really about social and economic, and political status of women. And I guess I would leave, and I would perhaps credit, a legitimate, more moral position on abortion, if the same people who took the very severe positions, limiting abortion, and the availability of abortion services were generous in their support for family planning and reproductive health care, particularly not. I guess I have to sense that the same debate, the same conditions that Margaret Sanger confronted with the conditions we're trying to get cracking appear in the debate today, that reasonable people could agree to disagree over, we're when life begins better even here, some like in aging sperm, whether this is some house buying an important moment at conception, whether somewhere along the development of the fetus path, we should intervene and limit abortion, that those kinds of discussions don't seem to be what really is happening here. But what is happening is in salt, Lake income, women's rights to control their own body and it gets worse. In fact, ironically, Unknown Speaker 14:20 as we move rights in other arenas as our access to education, jobs, political equality becomes greater. That conservative reaction against women's empowerment becomes louder and greater. Also, you clearly this is a country where the great majority of people support autonomy for women in terms of the production, but the variance of the minority gets greater and is becoming a greater political force. Really, as we take that majority takes its rights for granted as women move more into the mainstream, as childbirth is very much a A limited for poor women as well as as wealthy women. And so what we need to confront is how you're going to deal with that very nearly minority and impacted now had on our politics. Perhaps we can learn something as to how to deal with that minority how to deal with that kind of organized resistance by listening back to see someone like Mark was saying or bathroom Ira four years ago. Just for those of you who don't know anything about the history of birth control, Annabeth Canary about four paragraphs I'm going to summarize the 600 page book. She was paid as a practical nurse engineers and architects and painter with whom she had three children. She emerged on the American team in those halcyon days with the turn of the century, when it was easy to believe in the potential individual and social renewal inevitability to progress. She was alive with the Socialist Labor Movement in New York in the early decades of this century, oriented political activism through her efforts on behalf of labor rights, and then called the birth control caused by the tragedies of unwanted pregnancy and abortion. The two witnesses the nurse beginning is working with Lillian Wald among the immigrants for a New York's Lower East Side, went to jail in 1917, for distributing contraceptives, immigrant women from a makeshift clinic and attendant insurify. Much like the when's my colleague here, Ron Margaret's is in Brooklyn on picking avenue to conviction when appealed when an interpretation of New York law that allowed doctors to prescribe contraceptives for medical purposes under medical conditions because of medical event. And under that definition, Sandra built the Modern Family Planning using actually she had gone to jail and then on appeal argued for the rights of nurses as well as doctors to shoot yourself a nurse. She won the doctors exception and under that condition built Planned Parenthood as a doctor. Following World War One, she broke from the radical labor movement on Socialist Party. With the Great Depression of the western country, there wasn't much hope. I think, in her view of achieving political consensus on the issue, the tough issues of women's reproductive rights issues remained alive with the left because she just decided to mainstream her movements vigorously. And mostly, she decided to invest in what she considered to be the collective potential of women. The victory for women's suffrage, as you all know has been achieved the efforts of coalition's and women of all classes oriented activism and looking for a new cause after 1920. Birth control Sanger argued would enhance the opportunities of women beyond the promise of economic reformers on the one hand and a separate just from the other, it would be a tool for redistributing power fundamentally in the bedrooms instead, often in the home and the larger community. Women would achieve personal freedom by experiencing their sexuality to be of consequence, just as men had always done. But in taking control of the forces of the production, they would also lower birth rates alter the balance of supply and demand for labor and beer and accomplish the revolutionary goals of workers without what she sees as the social upheaval of class warfare. She took these ideas from Emma Goldman, there was a whole debate going on in the socialist movement in that time, about whether we needed to produce more and more children and workers to the color period or whether controlling the forces of reproduction is every bit as important controlling the forces of production was more talked about in male circles on the left, that Goldman came back from conferences. Now museum conferences in which Marx's participation was extreme in in London, and on the continent in the early years of the century, and she in Sanger developed an alternative theory for how women might advance the goals of the labor movement. She'd lied also with many leaders on the left Unknown Speaker 19:18 when she tried to leave this message for more than half a century, Sandra's dedicated herself to deceptively simple proposition that access to occasionally reliable means of preventing pregnancy was a condition of women's rights and in turn of human progress. She gave the same speech and 50 years he was passed 70 When the world finally began to eat her concern for population growth that was unchecked Pat at when the team of doctors and scientists have long encouraged first marketed the oral inoculant birth control show which was found the money to develop she needed in 1969 and six, and therefore, just before she died, he saw the valuation utilization and for repeated efforts with the litigation as a lobbyist in Washington, when the Supreme Court in its landmark 1965 ruling use was versus Connecticut, finding guaranteed constitutional protection to the private use of contraception by married Americans. And you may not know that it took seven more years for unmarried Americans to get their privacy rights in a second decision in 1972, called Eisenstadt v. Bear. Sandra died just as Lyndon Johnson incorporated family planning into America's public health and social welfare programs and community at least a fraction of our foreign policy sources. It wasn't until the 1960s Excuse me, not now that we ever had any public funding for contraception in this country versus domestically through the work to our welfare programs. To OEO, and then, you know, our foreign assistance programs as well. Birth control has fundamentally altered private life and public policy and essentially no other issue was for so long cascaded our attention, or polarized political thinking. Psychologists, late psychologist Erik Erikson of Harvard, once provocative, suggested that no idea of modern time states perhaps for arms control, more directly challenges human destiny. And I think this may account for the kind of profound psychic given into social conflict that you see around these issues. Why there's so pronounced for why you can have even as the century turns the kinds of punitive measures against women in their bodies, the right to control their own bodies, that I described to you at the top of my remarks. For why the power, the organized power of the minority is so great around the issue, because the majority even if it joins, in supporting elections, the right of me still has some kind of psychic conflict about it. I think it comes from the real challenge to atavistic, you know, human reproductive desires from the controlling reproduction controlling human sexuality. Engaged. I have a long lecture, which I think I'm not going to be about what we can learn from Margaret Sanger. I can summarize it in part by saying that I think their fourth nificant areas were first, she was recognized the profound importance of talking about the skeptics in public to engage decision versus a free speech issue. The Comstock Laws in the ninth and 10th We did not only the provision of practice, but also the discussion of sexuality and and and contraception in public and it was by forcing the issue in public that I think she became a true change maker and social Liberator she was no act too outrageous to be too daring for saying or she went to jail as I said she staged hunger strikes to publicize this card when denied the. What's up robot Unknown Speaker 25:00 hey buy your Kleenex and we have here in our audience somebody who works for training here in New York City which is the direct outgrowth of Margaret Sanders birth control organization she founded the American Brewing Company in 1921 in the first clinic uniting 23 later all its name was changed to Planned Parenthood again she was willing to make compromises and how she spoke to that physicians but she was not interested in just law right now that's it evening the middle class and look for something I bought that she contacts for IRA Unknown Speaker 28:11 at Genesis and a great political opposition progressively Genesis leads to individual applications against principles that lead in public health Unknown Speaker 28:36 athletes appeal services and harm done to fetuses in the womb because when they didn't have any prenatal care either Unknown Speaker 29:02 get by today All right undermines the motives of family planning and abortion providers by simply saying that what we're interested in is not the liberation of the poor or helping have access to private medical services but but our desire to control the fertility report this is the only argument on day five right aren't they were immune we have public national family right Unknown Speaker 31:39 to be forgotten, I've been many abuses and we need to speak against abuses, that there is now I think, since Cairo engaging a center that is holding with respect. Unknown Speaker 32:17 Finding the tools that will impact the fundamental basis for mainstream women in the developing world in ways that needs to do in the next millennium, if we hope to have assistance programs, foreign assistance programs to seek meaningful people who need I'm going to stop there. And again, stress how important I think the message about service delivery is and public support of bottom up provision of health care and family planning is also to say one thing which I missed in this summary of a longer lecture, which is big in almost all social democracies in the 1930s, with the exception in the Western world, with the exception of the United States, part of the social welfare package for this design, was public provision of health care, particularly preventive health care in this country did you happen in part because of the tremendous rising up of the Catholic Church's political power and its opposition family planning, in another part because of the peculiar idiosyncratic nature of our provision of medicine generally, in the power of the American Medical Association. It was a great loss. I think when the New Deal passed, the welfare assistance Bill didn't include health care for poor women or women and their children. We paid a tremendous price for that, as we've seen in the debate over guaranteed universal health care. It's gone on in the last four years. But again, it's the history that we have to understand if you really understand how we're going to work our way out of this public policy predicament today. And so I posed and not only the gods are with us and you're suggesting that perhaps we we really ought to be prepared I guess I feel like the roar of the of the crash of the cloud we really need to understand what it is. By the absence of these kinds of guaranteed rights, is providing people services, I think, in a way that's what you want to hear about in You all ought to go and work a report. Unknown Speaker 35:02 When Listen, one of the things that we have to close at about 430 right now. So I would like I mean, it either one of us, any one of us in the previous panel or on this panel could be here and speak for four hours, all of the interrelated issues. So, I'm going to try to finish at about four or five hours before so we could have a discussion and have some sort of change. I, because the areas are so related and so difficult, I brought the information about my agency and what we do, and I will close that you will look at it, it is colorful, so you will not be too bored. And I promise you that is a little bit more interesting that the debates that we have been trying to avoid on television, the presidential debates. Let me when I was thinking about how to approach these, and I had all of these ideas, and my staff was talking to me about what are you going to do on Saturday and on these, and I talked to Helen yesterday, I said we're heading I don't know, I mean, I'd be guided by this portion of this and that. And then this morning, I thought about how we're going to approach it while I was swimming. And the reason why I thought about it, what I was swimming, I usually have a lot of ideas when I'm swimming, because you know, there is no people, no telephone, no cellular telephone, no interruptions when you're swimming. But it's also because the swimming pool in the place where I leave is open on weekends only from 10 o'clock in the morning to five o'clock in the afternoon. And during that, though, all of those hours, and that is even when he's close as a tenant, I have a right to use the swimming pool. But on Saturdays and Sundays, my access to a swimming pool is very, very limited. And in fact, this happens a lot of time when the women that we serve, whenever they have very strong competing interests of my wildlife photography comes into my swimming. wildlife photography requires that I'm out there at the Jamaica Wildlife Refuge, at about five o'clock in the morning, before the sun is up, and right stay there until sunset, because those are the two extremes will be ours that is better to take pictures. So when I read the swimming pool is close, and when I come back the swimming pool close. So I don't have access to the swimming pool during the weekend. So it is irrelevant, whether I have the right to use the swimming pool if I don't have access to it. And I submit to you that it may your issue that we are not discussing, you know, is a question of access. That at the same time that the right to abortion, and the right to reproductive health care is being discussed. And it's been eroded. In a more poignant way, women are being denied access to reproductive health even when they have the right to have them. So that is a very important thing that I want to leave with you. That is not enough to fight for the right to have something one has to look how that is going to be translated in Access. And I will give you a couple of examples. They are for example 28 states that require parental notification and parental consent for another lesson to have an abortion. And we know that usually what happens we start because many of us will think oh, why should adolescents that reality that we are talking around your young adolescent we're talking about women of 17 1819, who have been sexually active for a long time, and who in the absence of the right to have an abortion and the need to consult with his parents. We made a decision and quite often have to have even illegal dangerous abortions or fly to other states and have very horrendous circumstances and they have been kids who have died because they'd rather go to an illegal abortion abortionist, rather than cost the herd to the parents to let them know that they are sexually active. So that is the major issue. There are 11 states that require a woman to have the consultation with a physician and 24 hours wait, Unknown Speaker 39:42 walk home 24 hours and then come back for an abortion. All of these are kind of again, they should have access. One of the major problems in terms of access in general is the disappearance of recessions. well qualified physicians or other practitioners in good safe environments to provide an abortion, because many of them has been carried away by different vendors tactics that have even killed physicians. And we have a situation for example, in New York State 55%, according to the labor market Institute, 55% of the counties do not have abortion services. So one of the problems is that those of us who live here in New York City, and by the way, let me tell you, we don't provide abortions. So I don't have any vested interest foundation where we don't my sense is don't provide abortion. No, your city is one of the few privileged areas where there is no scarcity of abortion, legal, safe abortion for every range of women from the poor women to the to the rich women. But 55 of one of the counties where women leave in New York state do not have abortion services. There is a state which is in the North Dakota or South Dakota, where there is no abortion physician in that state, there is a physician who flies in to that estate once a month for a week to provide abortion services. Now a woman who is reached or household means can just get on a plane and fly and come to New York for a weekend and have an abortion. The people who don't have that luxury, not just the welfare mothers, but working women who are really struggling hard to make ends meet, to not have access. And for them, they having a child that is because usually when they don't have abortion, access to abortion, they don't have access to family planning either. So what happens is that then a birth of a child to those women is even more critical, because it may prevent them from continuing to be in the workforce. So the issue of access is essential. When we talk about the issues of welfare rights, one of the major questions that is going to come up is the issue of access to all kinds of health services to illegal immigrants. And let's talk for a minute about who illegal immigrants are not illegal immigrants. Because it doesn't deny to illegal immigrants. It denies too many legal immigrants. But then it denies who people who are here who are not legal immigrants. And there is a broad level of people who are not illegal, but who are not legal either. Let me give you an example. The first HIV woman who came to us for services when we started to do primary medical care to women, in 1991. was a woman from the Caribbean poor the time was illegal. Since then, we have been able through certain legal services to review her her case, she has two children are American citizens. Now she's working. And she now has a legal status, not an illegal what he said was called voluntary departure. So she doesn't have a green card, which is not here illegally chicken work. And in fact, she's now working for us. But she can lose all of her benefits. And at any minute be deported. Because of the anti immigration even though that woman has been working is supporting herself and her two kids and is paying taxes. But she is doesn't have the green card. Or the women that we are serving who really have what I call diverse immigration status, because I'm not sure what it is they have, for example, women that we are seeing in our South Bronx center in the South Bronx, you know, what women are we seeing for prenatal care, people from women from Bosnian Unknown Speaker 44:14 people who did not come here, because they came here to take opportunity of this big fish country and exploit us. They came here because they were escaping a horrendous massacre in Bosnia. And they came here because they were scared. And because this is still a country where they felt they could find a safe haven. If they had their preference. They would have to stay in Bosnia, but they have to go we are seeing women from Bosnia, political refugees from Bosnia in our South Brooklyn, South Bronx clinic in the Lower East Side. We are seeing women for prenatal care. And I'm not talking about abortions here. I'm talking about basic health care Chinese women from certain province in China, people who have come here, who had to pay $65,000 per person, or $70,000 per family to come to the United States, and who had not come here, because they don't want to work, who have not come here, because they want to be on welfare, they want to come here because they don't have to have to be in a position where they have more than one child, they may have to kill that face, particularly if it is a girl. So they have come here for the right to have a family for the right not to have to kill a second born. Because that is, I don't know, you have to know that in certain countries in India, and in China. Kids are being killed when the parents have not had the access to contraceptive and get pregnant, because the policy says that they cannot have more faith, especially to their girls. So this women who come here with their with their horsemen, with their kids who have babies 35,000 precursor 70,000. I know working, their husbands are working, they're working in the sweatshops. They're working in the clandestine economy, they are being paid below minimum wage, raise wages, out of that little money, they have to pay their city 5000 or $70,000. And now we're going to deprive them of health service services, were going to deprive them of clinical care, and that is going to cost us by the nose. Because every child that is born in this country, to a woman that doesn't have proper nutrition, to a woman who doesn't have proper prenatal care to a woman that is living in a little hole the size of God will be costless and minimum, a minimum of $60,000 a month for anywhere between one to four months. And that is only during the first two or three months of the life of that baby, then the developmental disabilities to pressure disabilities and the others in terms of what the cost is horrendous. So we are not talking here about saving any money. We are talking here about punishing a group of people who are different, a group of people who are primarily women, a group of people who are here, no, because they want to employ those people, but because we are leaving for rendus lack of freedom and closure of their safety. So that is lack of access. And then when we have been able to against all odds to maintain a network of women health services, like the ones that we have, we have eight centers and two mobile units, as you can see there, in the areas where the infant mortality is high this where the HIV amongst women is highest. And by the way, if you don't know it wake up to the reality that HIV is primarily a sexually transmissible disease, and that the major target of that epidemic is women. The major killer of women between 20 and 39 or 40 years of age, in this country at this particular time, is HIV AIDS. So when, when you have these centers and the family planning, we have our 250 family planning providers in the state of New York. When you hear about reform of the Medicaid services, and when you hear the President and everybody else talk about how it is for the first time that the women on Medicaid and the people on Medicaid are going to have better services because now they're going to be enrolling managed here. Unknown Speaker 49:14 I have no sway you there is great hope that managed care could be very good. But the bad news is that the way in which has been developed and the reason for which has been developed in the state of New York and in many states at this particular time is not to improve the services even though the relative is there. It is really to cut costs. And before blue sigh there, Seidel is spoke about a redistribution of pawns from the taxpayers back into and from the lower incomes to the to the higher income. The major redistribution of public dollars due to taxes and my taxes in history is happening to the man Wash care program, particularly in the state of New York, where we are taking public public dollars, given them to manage care companies and accomplishing two things at the same time, one, reducing services and risking the disappearance of the majority of the centers that are now the only access for women. Because what is happening is that the way in which the managed care programs are organized, managed care, you know, is somebody that instead of paying you when you come to visit me that anybody knows what managed care is. Let me tell you very quickly, managed care is a euphemism. For the originally it was called his maintenance organizations. But now, for us, the UN, I am a member of a managed care organization, but it for me, it's not called managed care for me is called his maintenance organization. But the concept is the same. The concept is that instead of my physician being paid, every time that I visit my physician, my physician is paid a particular amount of money every month, whether I go to see him or not. In our case, it would be that instead of my charging, the Medicaid program, every time that a patient comes in, I would be receiving the same $19 a month per patient. If they don't come, I make them money. If they come, I lose money. So what is happening is that the tendency of the majority of the providers is not to want to see the patient because they receive the money, whether the patient comes or doesn't come. The other thing in the case of the women that we are serving that the managed care program does, is that because of the amount of money that it pays, the only way that the family planning clinics could survive, will be by providing most produced serve services. Our population are women who are subjects of substance abuse of violence, have been subjected to sexual abuse when they were children. I have a pregnant woman right now in my system, who is 16 years old, who when the social worker had problems knowing who it is that she was talking to, to refer the 16 year old pregnant woman to our psychiatrist, consultant, who found that she had five personalities. And that the in the mentality that she has is the result of very intense on continued sexual abuse when she was very, very young. So we are treating people whose health we cannot maintain, because their state of health is very, very low. So the concept of the health maintenance organization doesn't apply, because we're starting with a population that requires services because they are sick, physically, emotionally, mentally, and because of the violence that they saw. So this is one of the issues of access, that the majority of the providers, including the family planning providers in the state of New York, that have been providing that are providing services, all of those services that you see on that annual report to the most vulnerable populations, which are the poor women in the city of New York, and implemented the threat of disappearing. So access to services for that population is very, very threatening. So that is what I wanted to leave with you that when we talk about rights, we must look about the issue of access, and have to focus on all of the barriers to access, whether it is that the physicians have been intimidated by the bombings and the killings, or whether it is that they have been Unknown Speaker 54:10 really terminated by an older, something that led I had a couple of points that I was going on. And I was talking I kept checking on things that I was going to say that led me but there was one that you didn't mention. So I'm glad for that. And it is that up to now, by law. They have been a requirement in the OBGYN The authentic organic Korean curriculum of medical schools, a requirement that they must train their physicians in providing abortions. Part of the legislation that was passed in that omnibus broaden legislation is a data requirement is eliminated. So medical schools departments of OBGYN no longer have to think decisions in providing abortion services. And that if they do, those medical schools that decide to continue to have it, the internal the resident has the right to opt out of that particular part of the curriculum. So we're going to be seeing is that even though Roe against Wade may not be as taken out by the Supreme Court, we are going to be seen, in fact, the axis shrunk and shrunk and shrunk and shrunk? And what are we going to do about it? I don't have an answer. Only that I will continue to fight and talk about this. You have each one of us have to look at these very carefully and decide at this particular stage in our lives. Where we are at this particular time, whether as a student or as a professional, what is the best role and the best vehicle that I can use to try to be active in the political arena. And one more thing that I forgot to mention that in addition to the tremendous assault on the human rights of women and the rights of women to reproductive health services, on the access issue, there is a growing and I think that we saw that discussion a little bit in the previous panel, he was touch upon a little bit, but a tremendous emphasis on creating a wish drama pie, dramatizing a false wedge between the woman as a mother and the baby. And that is the most insidious attack on the rise of women and men, the character of women. And the thing is that those issues are very, very complex. They are presented, they are not good for 32nd sound bites or less you are a demagogue, which most of us on this side have usually had not. And that is a problem. So it cannot be and let me give you just one example. So drastic and so difficult, that even many people that I have spoken with are usually very clear. And all these are confused about decision, we don't have to talk to them. They in the state of New York, there is something called the newborn screening. And you may have read at different times about the screening for HIV. And you have seen editorials because every single editorial board in the state of New York controlled by men have decided on the side that we should have mandatory screening of HIV of pregnant women when when their babies are HIV positive. What is underneath that is, again, the argument that the child is more important than the woman. That is one of the arguments. The other is that was false arguments to try to create an impression that if you do not take certain action, to do mandatory testing of pregnant women without informed consent, somehow you're going to be condemning 1000s of kids to be HIV positive. So with a lot of false arguments, which are really very difficult, we cannot discuss them here. They Impressionists created, that on behalf of trying to prevent the transmission of HIV, we must sacrifice the rights of women. And what is going to happen is that first, we start with a screening, when you start to erode it right? Either right, on the right of a group of people, you know, where you start. You can no longer control where it's going to end. I tell you, I know that I meant to be from Cuba and I was in the revolution. Okay, you know what it starts, you don't know where it's going to finish. Unknown Speaker 59:09 But I want to tell you what is going to happen. We are going to see at least when I were talking about it before, but we have been predicting this in the next legislature, there is going to be legislation introduced that not only goes to a screening the newborn, there's going to be mandatory HIV testing to all pregnant women more of course, to the poor women because women who go to primary physicians will not be poached. What is the purpose of that legislation? The purpose is to save lives to prevent the perinatal transmission from infected more than two babies. Will the test affect the outcome? Can be with the test affect the outcome? What would affect the output treatment, the treatment was AC t. So, the logical thing is that once we have mandatory testing of pregnant women, then we will have to go to the next consequence, which is mandatory treatment with ACP of pregnant women, for a very small percentage that is going to be affected. And that is not only going to take the bright away of women, but is going to have all known devastating consequences for both the woman and the baby, including the 80 or 85% of the babies born to HIV positive women who are never going to HIV to be HIV positive to begin with. So we are going to expose the fetus at already 5% of which are not going to be HIV positive, to a drug that gets into the genetic pool that never gets are under we don't know what the consequences are going to be. So the reason why I mentioned this to you is please do not respond to short sound bites, look at what is behind there. And less don't accept the false wedge between the mother and the child, there is nobody that is more interested on a baby than a pregnant woman. So that's what I want to leave with you abscess. And do not allow this way. I'm getting very, very informed totally scooper. Go to me. And we'll give you all the arguments and all the data and all the scientific evidence, thank you very much for being so patient here with us Unknown Speaker 1:01:43 in family because we talk in a general way about what we're going to save enough. Both presentations, I think really did emphasize anything about the critical issue of service delivery and access to services. And secondly, the way in which our politics is demonizing women, which being built between women and their babies, but also the wigs between women of poverty and well funded women. And I think, one, perhaps hope we can have teachers to look at the past, and the ways in which coalition's among women have different classes were built to bring you back social change in the progressive movement, one of which was the family planning movement should give us some optimism. I mean, I think women as interest groups become more powerful in ways that that is scalable, is talked about with respect to welfare rights, or did it theories and models in the best part of Planned Parenthood? Unknown Speaker 1:02:49 Can I say something, you say how awful I want to do guys say something to God. Powerful. Let's don't lose track. That there are several bases of power. Sources, we need to get power groups of people, there is one source of power that no one could prevent us from having and is known as. Knowledge is one of the sociologists tell us one of the most important basis of power is knowledge. And I always think I would never forget Shirley Shirley season that she's the first black elected to Congress, when she told a group of kids at the Academy of Medicine, Joe need to develop power. And the power that I'm talking about, he said, is not the power of the guns or the power of the of the knife, but the power of the nose. So we have to be hopeful that we can find a way out of all of these difficult situations that we have it within our power, because nobody can take away the power of knowledge. And we would find a way of framing the argument of organizing of electing whomever we have to lead with this man or woman because not all women are created equal. So women are our worst enemies. You know, so man's best friend. So Unknown Speaker 1:04:29 the women, men as well. Unknown Speaker 1:04:31 Yeah, we have to see, for example, and Republicans are not all bad. And Republicans are not all bad all the time. They may be bad most of the time. But for example, Ruth Seidel mentioned the California lawsuit against the welfare reform. I think that may you Giuliani has to be applauded, because he really was the first one who took the issue of the immigrants, and who has already brought a lawsuit in federal court against for an injunction. And I think that that is very important. So we have to really support this kind of thing. I want to open it up for discussion. Unknown Speaker 1:05:11 Are there any questions or three? Just totally? Unknown Speaker 1:05:17 Yes. 28th? Well, because it's a very, it's not now it's been for a long, long time. For sure, absolutely. That has been a long standing argument, and it's very appealing, is very appealing because every family that has another lesson, leaves under this great illusion that that adolescents are really not sexually active. And that the other the other illusion is that the that they're sexually active, every parent believes that they really have a very good communication with adolescents. They believe that every other lesson should trust their parents, and that every parent is to be trusted. Okay, so there is a lot of fallacy in the argument, but it's very appealing. So for years, one may your target because you see, a major reason I'm going to divert a minute, a major reason why I believe the health care reform of President Clinton and Hillary's was defeated was because they took with no into motion about the healthcare field. They took the whole ball of wax, and wanted to change it so completely, that they antagonize everybody, including me, who could have been supporting them because they were at the delimiters. The right, the everybody. The people who are against abortions and family planning are smarter than that. They know that they cannot take on the full ball of wax. So they target either populations, estates issues, and they go incrementally, incrementally. Adolescence is something that usually is really very difficult amongst whites, our blacks are most Latinos, most liberals are most conservative, it is a very easy issue for them. So there is a very way of targeting, and they have been doing that for years. And now they have 28 in the state of New York every year, in the state of New York, every year, legislation is introduced for a parental consent for adolescents. And every year, we have to argue that very, very carefully and very intensively. Unknown Speaker 1:08:09 Again, just as we said power, power, knowledge is power. I think with respect to sexuality goes on the right. The less you know, the better you are. I mean, that's was true. In all 50 Your battle against birth control was really a battle that controlling the morality of us. Birth control was out there prove acknowledged Britain Coker, sex education, people will be immoral. And when in fact all the data shows quite the opposite. And the data I lead off with today, but the last four or five years, the more we've gotten programs out there, the more they're working. But Unknown Speaker 1:08:44 no, but there's another issue and that also Ellen parallel to that is the issue of employment. I mentioned the question of the unemployment policies and how it affects everything. So the services, what we know and there have been stories. Some of you were asking before of references, and I don't remember the name, but I think it's Wilson, an economist from Harvard, who was in Chicago, when major corporations, right, when May your corporation move out of Chicago, I mean, demonstrated that, and also you look at teen pregnancy, and you look that up to 1968 1970 think pregnancy have been going down. And after the 1970s as we started to, on the one hand erode the programs. And on the other hand to continue to have this trickle trickle down economics and all of these older theories, where we have this hybrid and as we have increased the own employment of young people, particularly of reproductive age, hey, when men come with reproductive age, and they had need to have sex to have sex, whether they have a job or not, as you have tremendous increase in the unemployment among young men do have a tremendous increase at the same time of the pregnancy, where the where the male was not taking responsibility for that. I don't think that is an accident that in the last four years, when we had both more programs, but where our economy, creating more jobs is creating more jobs, and we have the lowest unemployment rate in four years that we ever had, is not an accident, that thing pregnancy is going down, because they see a reason for postponing gratification, because they have some hope for the future. So all of these things are very, very related. The services and the employment, very related, I think the. Same Unknown Speaker 1:10:55 time, you don't have to be Unknown Speaker 1:10:57 coercive. Unknown Speaker 1:11:00 That your plan, your plan is given to teenagers in the inner city of Chicago. I mean, basically, how testing that's been done on like injectable forms of birth control, specifically, women of color and for women. How do you find the balance? Is the answer just to have for places like the CFTC? Or what what prevented Unknown Speaker 1:11:28 me from what we should talk Unknown Speaker 1:11:30 about technology? Because there may be some differences of opinion here, because I think you'd have to see, I think that it's dangerous. And it's one of the things I talked about in terms of saying director, technology was also one controversial aspect of her his personal leadership as a group. And she was pro experimenting with technology, because she always was mindful of the fact that the alternative to better technology was not no sex, or no babies, but often more babies that were unwanted babies, or were worse, more technology that was truly terrible technology like sterilization. So I think that one, I mean, I may have a very different point of view here. But I think even on I would join me, thank you, we shouldn't be resistant as feminists to technology, per se, we should be. What we should strive for is the provision of technology and in circumstances where the individual served the women particularly but men as well are affected. Who are the recipients of the technology are wisely informed and understand the menu of choices. But that if if the alternative is sterilized, and then perhaps Norplant is a better idea, Unknown Speaker 1:12:47 with a secrecy? I don't think it is directed. Well, there's some cases have been in and I think it's not if it's Unknown Speaker 1:12:55 coercion, but if it's voluntary compliance, and I think Unknown Speaker 1:13:01 it's directed Unknown Speaker 1:13:02 at certain groups of people. And it's not I mean, women who are in live in the Unknown Speaker 1:13:09 suburbs to go to school, there are more women that are white in the suburbs, it's not Unknown Speaker 1:13:15 offered to them, but Unknown Speaker 1:13:17 it does have to be offered to women. Unknown Speaker 1:13:25 I, I think that Helen is correct. Elon is correct. I mean, technology by itself, is not a problem. The problem is how it is used. And you are correct. They have been in Philadelphia, it has been targeted for for welfare, mothers and for adolescents. We don't use the word plan. By the way. We don't use the plan, not because we are against technology. But because we are not sure that the that we have heard the last thing about no parent, but particularly the reason it doesn't mean that we don't inform our patient that is available. We tell them we educate them because we don't believe that we have the right to deny information to the patient. We don't have the right to denied information, but we tell them that it's available and we made this vague one and many of our patients want it we make arrangements so that they would go and get it. Well, the reason why we don't use a addition that we we don't believe that the last word is out is because we have to realize that our population with the population most are high risk for the HIV infection and for sexually transmissible diseases, and we cannot afford to give is criminal to give any of our populations, any of our patients if misguided sense falls of safety. Yes, they're not going to get pregnant. They going to be HIV AIDS positive HIV and being able to have AIDS. So what happens is that that is a technology imposes in those organizations like ours, who have a commitment to the individual, right to make their own decision, and to be non compromising in taking freedom away from people. It imposes on us tremendous burden, because it imposes on us the need to have more over our own bias. Education, has education so that people could really understand what are the pros and cons of a new technology and could make a real informed consent. If real, for Unknown Speaker 1:15:46 example, Planned Parenthood clinics are found, after indications that there are individuals who prefer injectable contraceptives, or your plan of dermal contraception to having to take a pill every day or two, using a condom. And there's sort of arrangements have been made with the provision of those services with informed consent. I mean, I that's that my only point, I mean, I think there is some tragedy, for example, the fact that you can't get an ID and this kind of thing, because IUDs, while they were committed to abuses of them, and they were terrible for certain populations, that ship in junk be in other countries reasonably, okay. And maybe I'm saying something very controversial for women who were postpartum had children, and who prefer that method to, to having to take an oral contraceptive or chemical contraceptive or to sterilization, the highest rate among married women in America. Now. The number one, contraceptive is sterilization. And that's because of the absence of other technologies, which I guess I think responsible was say, there should be a menu. I mean, so that so many people appear to kind of quiet coercion to sterilization, because there's nothing else out there anymore, except to take the birth control pill or to use a condom. Unknown Speaker 1:17:05 That somebody in the back I mean, you know, it's working on NASA, we should, we should because our force, yeah. What do we do with the machine? I just leave it here. Yes, you have a question or a comment? Unknown Speaker 1:17:30 That struck me that was Unknown Speaker 1:17:40 advocated for birth control Unknown Speaker 1:17:44 board. That was one. Unknown Speaker 1:17:48 And, and what we're experiencing now is a really fun research. Right. Now the sterilization old which has significant negative results, you know, how we can encourage Unknown Speaker 1:18:15 research Unknown Speaker 1:18:18 that will make things more? Unknown Speaker 1:18:21 Well, I think one that we didn't talk about are important systems have been one of the positive things that's happening today, in my view, but again, it's very controversial and I and I think needs to be very carefully watched, are you 46 may be a very good idea in certain populations and a very bad idea of not controlled and carefully used in other populations. It is a very potent chemical, but it is a one time chemical administration, as opposed to, for example, taking the birth control pill 100 Every day forever. And are you 46 may also be developed into a sort of a morning after pill which might be healthier than taking 30 days a month of some sort of chemical. But I frankly think that there has been too much extremism on both sides of the of the technology issue because if we are so now frightened by technology, that we're almost going backwards, backwards and forwards and that was all I meant to say I mean, obviously these things in terms of access and in terms of coercion are are very serious Unknown Speaker 1:19:24 issues I think they do first and then Unknown Speaker 1:19:34 the opposite adults start when they start. Unknown Speaker 1:19:54 I wanted to ask those of us choice find Unknown Speaker 1:19:59 out I personally feel horrible about the fact that I think last night a lot of Unknown Speaker 1:20:08 people asked me to Unknown Speaker 1:20:09 go over the ocean. And where do you think you went wrong? Obviously, gross misinformation. Obviously, Christian coalition, Unknown Speaker 1:20:21 and all the others just never gave up on, continue to plug away on every level. Those things. Unknown Speaker 1:20:30 I think that we lost in in several instances, and I'd give it to Ellen in a minute you have as a historian for she has a better perspective. But I think that we lost it on the use of the language. Right now, you use the same language, late term abortion. And I think that as long as we don't look at the impact of language, we are going to be in a pickle here is not like term abortion, it is catastrophic pregnancy. What we're talking about is a very, very small percentage, a very small number of catastrophic pregnancies is really very horrendous circumstances, what these kids are going to be hydrocephalic no BS, not the other. I mean, and it's very small number. So I think that we have to have a procedure and we have to re educate ourselves. And I think that the first thing that we want to do with that to make it flesh, among all the pro choice people, never again to use my late term abortion, abortion Unknown Speaker 1:21:29 itself is a problematic term. When I talked about Sanders, I usually talked about this I talked about protected Sanger, Sweden invented the term birth control, because nobody had an easy way of talking about the subject in public. In 1912. They talked about family limitation, or they didn't know what says she came up with the term birth control. And then in the 30s, when there was a tremendous backlash against women during the New Deal and became a tremendous desire for the family that she came up with family planning, because it was more user friendly. Essentially, even though she hated the term and always regretted that you've given up the idea of women controlling your own bodies, simply to try to have some of legislation in Congress that would allow public funding of contraception. But on the abortion thing, too, I argue not only late term abortion is a terrible idea. But we ought not to use the term abortion for early term abortion. One of the reasons that are you 46 I think is very interesting is because it gives us the possibility of talk a different procedure and a different different naming. I mean, the worst thing that ever happened was that are you 46 marks on the board page. It's not any different than an IUD. It's a contra Jester. It doesn't allow a pregnancy to move forward. It doesn't allow the the fetus to develop or to have a food supply. So in a sense, you could argue no likes creative I mean, I don't believe in the present moment of conception as having some sort of inviolable moral status that's an invention of theologians it's not necessarily true that somehow you need a vegan sperm in allows or attaches more moral status to the egg and the sperm than before it this United word then it may however, be along the line of gestation that there's a change in moral status and the most important thing It seems to me is that as in many kinds of things we caught we early term abortion also have a different name and most Americans think that all abortion is chopping up fetuses and it you know 95% of the abortions performed are very simple procedures on you know, on I'm on Unknown Speaker 1:23:39 all differentiates Unknown Speaker 1:23:42 an embryo Unknown Speaker 1:23:51 every day, Unknown Speaker 1:23:52 because that was more dramatic for them and they go to what he's going to sell more papers on he's going to Unknown Speaker 1:23:57 pension and what have you had a question, are you going to list Unknown Speaker 1:24:10 because you were touching on please now acts this Unknown Speaker 1:24:18 way, even though we made Unknown Speaker 1:24:24 this deletion training, the larger the number, the larger the number of doctors can prescribe. This is not limited, Unknown Speaker 1:24:32 but it's very important to make certain that you're willing to do it because so far they're not in fact, and I mean that in terms of an Agenda for Action. That's practical, which I think is what this conference is intended to produce. That's a very important agenda item, which is the training and education of physicians in the use of are up to six or I can never pronounce it never met the methotrexate be Because the truth is that there is a chemical out there that is already out there doesn't even need FDA approval. And yet, we don't have a lot of physicians willing to use it in or it's been trained. Unknown Speaker 1:25:15 For six teenagers instead, consent is a 24 hour waiting period. All of these things are techniques on the right. So it's kind of fallen off a little bit this morning, that they're techniques for light to just sort of peel away the weight between the mother and the baby, but you've also got the wages that people are trying to create, within the issue itself. To meet to meet my trigger test is always respected. Does this policy perspective economy of women make decisions on their own about their bodies? And if the answer is no, or only sometimes the chances are, it's not a pretty good policy. And you have to start to call it for what it is in that context, because they will try to get away and they do something successful giveaway on this. And the teenage Bill attaches to Senator for a year and thank God and stuff you simply. But the however, we're going to call it play term with it, whatever catastrophic Assembly this year, I mean, we're gonna have to deal with it. Unknown Speaker 1:26:19 That's what I was gonna say after November, you can expect that to be in the assembly class, people start arming the speaker. So for the key backfill. Unknown Speaker 1:26:36 And you know, what happened to children's silhouette on the issue of a screening, or newborn screening, they name it something else, and he changed it. Because he has a very conservative constituency, he's on the Lower East Side, but he's from the most conservative piece in the Lower East Side. So the minute he has the opportunity to show how non liberal he is, he does. Unknown Speaker 1:27:02 But I hope you take away from this though. And the reason I when I was asked to recommend somebody from the service delivery, part of this area that I recommended, Anna is at all odds against all odds, there are extraordinary men and women providing extraordinary services, particularly in New York and take a look at the photographs for annual report or read the stories of the recipients of these services, you recognize that you don't have to go away without any hope at all because we do have a resilient community. And somehow, even in the face of great adversity, we've managed to come up with services and even under the worst circumstances and I just got a terrific several $100,000 grant through the through the environment the Harlem impairments and so there's ways in which that's another thing about being strategic and you can't get the money caught don't call it reproductive rights call it economic development Thank you Alan. Unknown Speaker 1:28:08 I don't know you want me to talk about Unknown Speaker 1:28:12 you when you started? You talked about CFTC exactly the right way by doing it friends no relation but we can't actually it's very funny because two women writing about women with an eight was very odd me yeah, we're often confused but we just never let me know gonna use a figure and I don't know what the new legislation provides a bonus for every step down to see but at the Unknown Speaker 1:28:53 same account, County Washington that's abortion Unknown Speaker 1:28:58 you chose not legal yet and it's not available. That's very interesting question. It's going to be an enforcement issue. I mean, the truth is, I think that many people really shouldn't be addressed Are you worried Unknown Speaker 1:29:27 but the important thing is to try to do it and also to reverse them under health care. You may have seen universal health insurance and that quite easily but phone and it will make those nobody can stand in front of Unknown Speaker 1:29:57 you