Document 39: "Plank 12: Health," from National Commission on the Observance of International Women's Year, The Spirit of Houston: The First National Women's Conference, Conference (Washington, D.C.: U.S. Government Printing Office, 1978), pp. 53-56.



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PLANK 12
HEALTH

Federal legislation should establish a national health security program. Present Federal employees' health insurance policies and any future national health security program should cover women as individuals.

   Health insurance benefits should include:

   States should license and recognize qualified midwives and nurse practitioners as independent health specialists, and State and Federal laws should require health insurance providers to directly reimburse these health specialists.

   States should enact a patient's bill of rights which includes enforceable provisions for informed consent and access to and patient ownership of medical records.

   Federal legislation should be enacted to expand the authority of the Food and Drug Administration to:

   Congress should appropriate funds for increased research on safe, alternative forms of contraception, particularly male contraception. Research to identify the risks of present forms of contraception and estrogen-based drugs should be given higher priority. Outreach programs should be established by the Department of Health, Education and Welfare to identify and provide services for victims of hazardous drug therapy.

   The Department of Health, Education and Welfare should provide additional funds for alcohol and drug abuse research and treatment centers designed to meet the special needs of women.

   Federal and State governments should encourage fair representation of women on all Federal, State, and private health policy and planning bodies.

   Congress should appropriate funds to establish and support a network of community-based health facilities to offer low cost, reproductive health services.

   The President should appoint a special commission to conduct a national investigation of conditions in nursing homes and mental institutions and propose standards of care.

   Congress should appropriate funds to encourage more women to enter the health professions, and Congress should allocate funds only to those health professions schools whose curricula are clearly nonsexist.

   The Secretary of Health, Education and Welfare should undertake a special investigation of the increase in surgical procedures such as hysterectomy, Caesarean section, mastectomy, and forced sterilization.



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Background:

"Women have begun to rebel against male-dominated health care."

   Through most of human history, women have been the healers. They watch the health of their families, and paid or unpaid, they still do most of the work of caring for the sick, the disabled, and the elderly. But policy on professional medical care, drugs, research, hospitals, and environmental hazards is controlled by men who are frequently unsympathetic if not actually ignorant of the special health needs of women.

   One example of this unresponsiveness is the danger to women exposed to chemicals used in kitchens, offices, factories, and bathrooms, as well as in cosmetics and hair dyes. According to the Massachusetts Coalition for Safety and Health, substances that can harm reproductive organs or fetuses include trichloroethylene, used by typists in white-out correction fluid, and the radiation from microwave ovens used by homemakers and flight attendants.

   Mental health services are another area of neglect. According to Phyllis Chesler, author of Women and Madness, these are used twice as often by women as men but are still not available to many women who need help. Health education is needed to slow the rapid rise of smoking among teenage girls, as documented by the American Cancer Society. Family planning services are also needed, particularly for teenagers, among whom an "epidemic" of pregnancy is occurring. Research is needed to find safer contraceptives. And there are many other health needs of women that are not being met.

   Women require more health care than men. They bear the children. On average, they live longer than men and are more likely to acquire the age-connected chronic diseases that require many health care visits.

   In the past few years, women have begun to rebel against male-dominated health care. Health was the third most popular issue at IWY State meetings held prior to the Houston Conference. More than 400 resolutions were passed recommending changes in health care policy and priorities.

Health insurance   Many existing health insurance plans on which any future national health program might be based cover married women as dependents of men rather than as individuals in their own right. A woman who is divorced or widowed may lose her health coverage. A single woman may be denied pregnancy benefits. A man does not lose out on health insurance because he chooses to remain single, or because his marriage is disrupted by death or divorce. And family-based health insurance is expensive. According to the Committee on National Health insurance administration of the Canadian national health plan is cheaper in part because everyone is covered as an individual.

   Women often get shortchanged in health insurance policies coverage of their
unique health needs.

   In their 1977 report published by the Women's Equity Action League, "Sex Discrimination in Insurance," Naomi Naierman, Ruth Brannon, and Beverly Wall found that a majority of new health plans do not cover maternity, whereas those that do charge prohibitively expensive rates for the restricted benefits offered.

   They also reported that working women are seldom covered for loss of income due to disabilities or pregnancy. Many policies still exclude all conditions related to the female reproductive system. The general exclusion of preventive health care deprives women of insurance coverage for breast and uterine cancer screening and family planning services, while the general exclusion of mental health services bears more heavily on women than on men because women are more apt to use them.

   Finally, health insurance policies make little or no provision for the care of a chronically ill patient at home, where most of them are kept. Without any money for even occasional help, that care can become an intolerable human burden for the family, and that burden almost invariably falls on a wife or mother.

   Many national health programs intended to remedy these and other defects of the medical care system have been proposed in Congress, but the most comprehensive are the Kennedy-Corman Health Security Act (H.R. 22 and S. 3), which has been introduced for eight consecutive years, and the Health Services Act (H.R. 6894), introduced by Congressman Ron Dellums (D., Calif.).

Midwives and nurse practitioners   Few American babies are born naturally. Drugs, a dramatically rising proportion of Caesarean births—Medical World News says they doubled between 1970 and 1976—and the routine use of fetal monitoring of the infant during labor have made the normal event of childbirth into a medical procedure that often appears to be designed more for the convenience of hospitals and doctors than for the mother. "Is it beneficial for the woman and her newborn to have her lie flat on her back during labor and delivery," asks Dr. Hania W. Ris of the University of Wisconsin, "or does it only provide comfort for the obstetrician?"



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   Male medical control of childbirth has not necessarily made it safer. According to Doris Haire, president of the American Foundation for Maternal and Child Health, mothers and babies are more apt to live and babies are less apt to be damaged in countries such as Sweden and France where more parents choose to have their children born at home under the care of a trained midwife. Ann H. Sablosky, a social worker on the board of the National Women's Health Network, studied the record of midwifery in the United States and concluded that midwives could make the majority of uncomplicated births cheaper and more natural without sacrificing safety.

   Nurse practitioners, nurse and lay midwives, and physician assistants are new categories of health workers dominated by women. Nurse practitioners are registered nurses qualified by extra training to practice nursing independently of the supervision of a physician. Yet under Medicare rules requiring the approval of a doctor, these independent practitioners cannot be reimbursed for their fees.

Patient's Bill of Rights   The doctor's word is law, but women are beginning to question some of the heroic remedies practiced on their bodies, and consumer health advocates share their doubts. In 1977 Undersecretary Hale Champion of the Department of Health, Education and Welfare testified that American surgeons were making work for themselves by prescribing needless operations. Evidence is accumulating that many mutilating mastectomies might not have been necessary and, according to Peg Beals, past president, International Childbirth Association of Ann Arbor, and a nurse herself, some doctors prefer Caesareans because they save time and produce larger fees.

   In December 1977 HEW Secretary Joseph A. Califano, Jr. admitted that Federal officials had not been "nearly meticulous enough" in preventing over-zealous doctors, social workers, and prison officials from forcing women to be sterilized.

   In her article, "Forced Sterilization," in the February 1976 issue of Sister Courage, Dr. Judith Herman estimated that 20 percent of married black women have been sterilized, compared with seven percent of married white women. The Committee to End Sterilization Abuse, an organization based in New York City, contends that more than a third of women of childbearing age in Puerto Rico have been sterilized. According to The New York Times of May 24, 1977, Dr. Donnie Uri estimates that one of every four American Indian women has been sterilized, in many cases without realizing what was being done.

   In 1978 HEW was adopting new, stricter standards for sterilization operations funded by the Federal Government. The new rules require the written consent of the patient in her primary language, a 30-day waiting period, with certain exemptions, and a statement from the doctor that he/she has informed the patient of the risks and benefits of the operation and the fact that her welfare or Medicaid benefits will not be cut off should she refuse. The Federal Government will no longer fund hysterectomies performed solely for contraception.

   Experimentation on women without their consent has also been documented. According to an article in the June 15, 1973 issue of Medical World News, for instance, a San Antonio, Texas physician gave placebos instead of contraceptive pills to 75 Chicana women who had come to the clinic for help in preventing pregnancies. Eleven unplanned pregnancies resulted from this "experiment." A Senate Health and Scientific Research subcommittee heard testimony March 7, 1978 from Food and Drug Administration Commissioner Donald Kennedy that physicians hired by drug companies have made misrepresentations to women in labor to win their "informed consent" for use of experimental drugs on their newborn babies.

   Women are especially disadvantaged by the reluctance of doctors and hospitals to let patients see their own medical records. According to a compilation made for the Health Law Project of Philadelphia in 1976 by Carole F. Soskin, little more than a dozen States require doctors and hospitals to make any disclosure of their medical records to a patient. None gives the patient unconditional access, much less ownership.

   A Colorado statute, one of the most favorable, makes all records available for the patient to inspect except those referring to a psychological problem. Outright ownership is the only practical way for a woman to be able to take her medical records with her when she moves to a new community or travels.

Safety Women take two-thirds of all drugs prescribed by physicians, according to a study reported by Janet Holloway to the American Public Health Association Women's Caucus in 1976. Not only do millions of women take contraceptive pills every day, but women live longer and doctors are much more apt to prescribe "mood" drugs for them. According to Holloway, women take 72 percent of the antidepressants, 76 percent of the analgesics, and most of the tranquilizers. The cosmetics they use may be an additional risk to their health.

   Under existing food and drug laws, powerful new compounds whose long-term effects are unknown are test on the public at large. According to the Women's Health Concerns Committee, valium is the most frequently prescribed drug in the United States, yet it is only 10 years old. Its effects over a long period of time have not yet been determined. The Committee also points out that there is no serious testing of the vaginal douches many women use, and that regulation of the Intra-Uterine Device (IUD) for contraception leaves much to be desired. Federal control over the IUD was not established until 1976,

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and then only over new devices to be marketed in the future, leaving unregulated the IUD's that four to six million women were already using.

   The contraceptive pill has been shown to cause blood clots, stroke, heart attack, high blood pressure, urinary tract infections, gall bladder disease, and deaths in some of the presumably healthy 10 million women who take it every day. An article by Jerry Weaver in the March-April 1976 issue of Women and Health cites detailed evidence of the serious and sometimes fatal side effects of the pill for certain groups of women.

   The National Women's Health Network reports that estrogen hormone supplements, prescribed in hard-sell advertising campaigns to make women "forever feminine," have been proven neither safe nor effective in relieving menstrual and menopausal symptoms. The drugs have been linked with cancer of the breast and uterus. DES (diethylstilbestrol), widely prescribed to prevent miscarriages, has been shown to produce a number of cases of vaginal cancer in the young daughters of women who received this therapy. Only since 1978, after a sharply contested lawsuit by consumer advocates, have pharmaceutical manufacturers been required to provide labeling information on the risks and benefits of estrogen drugs.

   In March 1978 the Senate subcommittee mentioned earlier was hearing testimony on legislation supported by the Carter administration to strengthen Federal control over the testing of new drugs, to monitor adverse effects of drugs already on the market, and to make it easier to withdraw those which prove dangerous.

   In spite of the proven hazards of the contraceptive pill and the IUD, only two percent of the money spent on research by the National Institutes of Health has been earmarked for research on human reproduction in recent years.

Alcoholism and women   Alcohol is a problem for almost as many women as for men, according to the National Council on Alcoholism. Among heavy drinkers, females are twice as likely as males to develop cirrhosis of the liver, and gynecological problems and miscarriages may also be associated with alcoholism. Authorities disregard women alcoholics and shame keeps them from asking for help.

   Margaret Rudolph, director of the National Association of Halfway Houses, reports that only 30 percent of the 600 centers for helping alcoholics serve women exclusively. The Women's Health Network says that less than three percent of the treatment grants by the National Institute on Alcohol Abuse and Alcoholism are for women's programs.

Mental institutions   More women than men are subject to the inhuman conditions prevailing in many mental institutions and nursing homes for the elderly. In Women and Madness, Phyllis Chessler reported that many women are involuntarily committed to mental institutions where they are physically abused, medically neglected, and forced to work as cooks and cleaners. Because of their greater longevity, women are a majority of the occupants at nursing homes and homes for the elderly. The poor level of care in many of these institutions has been repeatedly exposed by congressional and other investigations.

Reproductive health   The rise in teenage pregnancies, documented in the background on the Reproductive Freedom plank, is due at least in part to the difficulty teenagers have in obtaining reliable, low-cost, confidential reproductive health services. When legal abortions are not available or are too expensive, women are forced to rely on dangerous, illegal methods of ending their pregnancies.

   In October 1977, a Mexican American woman died in a hospital in McAllen. Texas from complications caused by a cheap abortion in a nearby town, just after the U.S. Supreme Court ruled that States did not have to fund abortions under Medicaid. "The Government cannot stop abortions," The New York Times commented. "It can only stop paying for them."

Women's health centers   In many communities, women themselves have had to provide birth control and abortion information and services that doctors and hospitals have been reluctant to offer. Since the U.S. Supreme Court decision of 1973 upholding the right to abortion, the number of women's health centers has increased to more than 400, according to Carol Downer of the Los Angeles Feminist Women's Health Center. Where State law permits, at least 50 of these centers perform out-patient abortions at one third the cost of the procedure in hospitals. The low-cost, supportive educational services and nonjudgmental atmosphere of these women-run facilities make them especially helpful to teenage women.

Medical policy   Many observers agree with Dr. Vicente Navarro of Johns Hopkins University that the health care of women will not improve until more women are involved in making medical policies. According to an estimate made by the Women's Work Project, published in the May-June 1976 issue of Women and Health, 80 percent of the health workers in the United States are women, but 90 percent of the physicians and administrators who make health policy are men. The Association of American Medical Colleges reports that an alltime high of 25 percent of the entering medical school classes in the fall of 1977 were women. But, according to Mary Roth Walsh, author of Doctors Wanted: No Women Need Apply, the number of women in influential medical positions remains unchanged.

   

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