Document 81: "Health," in Susanna Downie, Decade of Achievement: 1977-1987: A Report on a Survey Based on the National Plan of Action for Women (Washington, D.C.: National women's Conference Committee, 1988), pp. 41-43.
p. 41
HEALTH
NATIONAL PLAN GOALS:
•a national health security program, with coverage for women as individuals •benefits should include: preventive health service, family planning services, reproductive health care (and more) •license qualified midwives and nurse practitioners as independent health specialists, who can be directly reimbursed by health insurance providers • patient's bill of rights •expanded authority of Food and Drug Administration to: require testing of all drugs, devices and cosmetics by independent laboratories, extend test periods beyond one year or 18 months, enable immediate recall of hazardous or ineffective drugs, require the reporting of significant adverse reactions noted by physicians •increase research on safe, alternative forms of contraception, particularly male contraception •additional funds for alcohol and drug abuse research and treatment programs for women •fair representation of women on all Federal, State and private health policy and planning bodies •public funds for a network of community based, low cost reproductive health services •investigation of conditions in nursing homes and mental institutions plus federally mandated standards of care •health professions schools develop nonsexist curricula •investigation of increase in C-sections, hysterectomies, mastectomies, and forced sterilizations.
SOME BASIC FACTS:
•The U.S. and South Africa are now the only major industrialized nations which do not provide some form of universally available health insurance. An estimated 37 million Americans have little or no health insurance, and non-whites, women, the elderly and the poor are disproportionately represented among the uninsured. A 1984 ABC national poll found that 75% of those polled favored a national health insurance program.
•15 years ago Canada introduced a universal government-funded health insurance program. Since then, the proportion of Canada's GNP going to health care has dropped, while the equivalent figure has sharply increased in the U.S. Canada's program is sufficiently popular, with both the public and doctors, that conservative politicians have been unable to kill it. Age-adjusted mortality rates in Canada have also declined sharply relative to the U.S. in the the same time period.
•Though 12% of GNP in the U.S. is spent annually for health care, the U.S. has high rates for infant mortality, cancer deaths, and cardiovascular deaths relative to comparably industrialized nations, and we are 15the (from the top) in life expectancy.
•In 1986, Medicare paid for approximately 44% of health care expenditures for elderly married couples, but only 33% for elderly single women.
•In 1983, lung cancer began to surpass breast cancer as the leading cause of death among women. Women who smoke are five times more likely to develop lung cancer than non-smoking women.
PUBLIC HEALTH INSURANCE BREAKTHROUGH:
After years of organizing and lobbying by a coalition of hundreds of community groups, led by the Gray Panthers of Greater Boston, the state of Massachusetts has passed the first law in the country guaranteeing health insurance to all residents of the state. The program has been envisaged from the beginning as a model for the rest of the country, and was signed into law by Governor Dukakis in April 1988. Under the measure, no one would go uninsured, but individuals will be required to pay 25 to 30% of the cost of their insurance, depending on their income. People unable to obtain insurance through their employers will get it from a state-administered pool called the Health Security Trust Fund. The bill emphasizes preventive and community health programs, and is structured to work with existing services, facilities and reimbursement systems. Estimates put the cost to the state at $622 million over the first four years.
MIDWIFERY RESURGENCE:
90% of the world's babies are delivered by midwives. The suppression midwives by the medical establishment in the U.S. was a continuation of similar repression in Europe which stated in the late of 15th century. The battle in the U.S. was particularly fierce in the 1900's, and by 1932 the number of mid-wife-attended births nationwide was about 12%, down from 50% in 1900. By 1950, midwives were virtually eliminated, except for a few practicing in rural areas.
The resurgence of midwifery has been helped by the New Age movements in health practices (wholistic and preventive health), the women's movement, and the consumer advocacy movement. In 1971 a birth center was opened in Santa Cruz CA by Raven Lang and seven other midwives. Throughout the 70's, midwives and nurse practitioners all over the country who had begun to attend births were being arrested, harassed, and forced into legal battles. Nevertheless, state licensing for Certified Nurse-Midwives has gradually become available since the late 70's. 21 states have adopted licensure regulations, and 16 states have regulations in draft.
Free standing birth centers have been very successful.
In 1983, there were 80 of these operating nationwide; as of 1987, there are
150. In 1981, they formed the National Association of Childbearing
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CAESAREAN DELIVERY
The C-Sec (Caesarean Section) rate is still nationwide. The national rate is now 24.1% (1987), up from 22% in 1986, and 5.8% in 1971. In some hospitals (primarily teaching hospitals) the C-Sec rate is more than 33%, and for some doctors it is over 50%, Women under 20 and over 30 are more likely to undergo Caesareans.
Half of all women having C-Secs suffer complications, and the maternal mortality rate for C-Sec delivery is 4 times that for vaginal delivery. According to a study by Public Citizen Research Group (reported in NYT, 11/3/87) half of all Caesareans now performed in the U.S. are unnecessary. The same study predicted that the C-Sec rate could increase to 40% of all births by the year 2000 if nothing is done to stop the increase. The major factor in the increasing C-Sec rate is the prejudice among doctors for routine repeat Caesareans; the U.S. and Canada are the only countries in the world where this is common practice. VBAC (Vaginal Birth After Caesarean) is safer for both mother and child than repeat Caesarean, but in 1985, less than 7% of previously Caesarean deliveries were VBAC's.
Caesarean Prevention Movement International (CPM) has 62 chapters and 1500 members in the U.S., and is organized in 7 other countries. Most of the members are women who have had Caesareans. CPM was founded in 1982 to call attention to the problem of unnecessary C-Secs, to educate women about healthy birthing procedures, and to provide support for women who want VBACs. Esther Zorn, founder and president of CPM, feels that as long as women have no tradition of women-centered birthing practices, and doctors have a preference for keeping control in their own hands and using high-tech drugs and interventions in a routine way, the C-Sec rate will not drop. CMP's Childbirth Education program, Birthworks, teaches women to have confidence in their ability to give birth, to take responsibility for the process, and to make educated judgments about available methods and technologies for assisting birth. CPM also publishes judgments about available methods and technologies for assisting birth. CPM also publishes fact sheets, a newsletter (the Clarion), and is presently creating a consumer-oriented data-base on VBACs. The principal text for the C-Sec/VBAC issue is Silent Knife: Caesarean Prevention and Vaginal Birth After Caesarean, by Nancy Cohen and Lois Estner (1983).
HYSTERCTOMY:
62% of all adult women today will have had a hysterectomy or oophorectomy (removal of ovaries) by the time they are 70. Although most hysterectomies are elective, an estimated 30 to 50% of these operations are unnecessary. The U.S. has twice the hysterectomy rate of England and Sweden. Doctor's wives have proportionately more than any other group. The rate for younger women has been rising. In 1980, half of the 649,000 hysterectomies were done on women under 45. Hysterectomies occur far less frequently under prepaid insurance plans (such as HMO's) than under indemnity plans (such as Blue Shield). The death rate from this operation is high: 1.5 per 1000. Hysterectomy has ten times the complication rate of tubal ligation, and 40 to 50% of hysterectomies result in complications.
WOMEN AND ALCOHOL:
There are an estimated 30 million alcoholics today in the U.S., of which 10 to 15 million are women. Until very recently, nearly all studies of effects of alcohol or effectiveness of treatment programs have been done on men. But recent evidence suggests that alcohol is more harmful to women than to men, women are more likely to develop liver damaged, than men. Black women are six times more likely than white women to develop cirrhosis and for Native American women the rate is 36 times that of white women. Women who are heavy drinkers have more gynecological problems and even if they are only moderate drinkers they are at greater risk for cancer. Fetal Alcohol Syndrome is the third leading cause of birth defects and the only preventable one of the top three. Suicide attempts are more frequent among alcoholic women than among the female population as a whole or alcoholic men. The number of teenage girls who drink has been increasing faster than the number of teenage boys.
Alcohol is a factor in 50% of all rapes, 50% of spouse abuse cases, 70% of child sexual abuse cases, and 40% of family court actions.
Much of the above information is the result of research by women doctors and professionals in the alcohol rehabilitation field, who have seen first hand both the destructive effects of alcohol on women and the gross inadequacy of male-oriented treatment programs for dealing with women, particularly those with young children.
Feminist alcohol "rehab" counselors and others concerned with the issues have organized State Task Forces on Women and Alcohol, coordinated by the National Women's Congress on Alcohol and Drug Problems. Most of the public funding for rehabilitation comes through the states. Women for Sobriety is a national network of local self-help groups for recovering women alcoholics, which emerged in the late seventies, and has been growing steadily.
In 1987, the Women's Action Alliance established, the Women's Alcohol and Drug Education Project, to develop model programs and a Guide on Alcohol and Drug Problems to be used in women's centers nationwide.
THE TWO MAJOR ORGANIZATIONS CONCERNED WITH WOMEN'S HEALTH:
BWHBC & NWHN:
The Boston women's Health Book Collective got its start
in 1969 at a "Women's Liberation" meeting. In 1970 they published women
and Their Bodies, which went through several printings and was renamed
Our Bodies OurSelves in 1971. It spread like
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BWHBC has also produced a film — "Taking our Bodies Back" — and provides seed money and technical support to women's health groups in other parts of the country. Pamela Morgan, of BWHBC, observes that women's health issues get a lot more attention in popular media that they used to, and some of it is extremely good. But issues such as menopause, and osteoporosis, are still are not well understood, and there is much misinformation even in the women's publications. Everything that BWHBC produces is designed to empower women so that they can responsibility for their health and make better informed, more healthful choices.
The New OurBodies OurSelves (1984) is 647 pages long, with very comprehensive lists of publications and organizations at the end of each section. It is completely re-written, and stronger than ever, with major sections on: Taking Care of Ourselves, Relationships and Sexuality, Controlling Our Fertility, Childbearing, Women Growing Older, Common and Uncommon Health and Medical Problems, and Women and the Medical system.
THE NATIONAL WOMEN'S HEALTH NETWORK
NWHN got it is start in 1974, when Barbara Seaman and Belita Cowan created the "Women's Health Lobby" to influence health policy at the federal level. Their first public act was to stage a demonstration on the steps of the Food and Drug Administration in honor of women killed and injured by estrogen drugs, on the day the FDA held hearings on estrogen-replacement therapy. Later, as The National Women's Health Network, they waged many legal and bureaucratic battles: opposing cutoff of funds for Medicaid abortions, pressuring HEW to adopt new regs to prevent forced sterilization of Black, Chicana and Native American women, bringing a class-action suit against A.H. Robins to force worldwide recall of the Dalkon shield.
In 1983, they sponsored the first national conference on Black Women's Health (in Atlanta), and supported the formation of the National Black Women's Health Project. Currently they have 400 organizational members and about 10,000 individual members nationwide, many of whom are health care professionals. 21 Committees, each concentrating on an issue area, such as Midlife and Older Women, Health Law and Regulation, Sterilization abuse, Contraceptive technology etc., track research and report to the National office. They publish information packets on all the major issues, provide expert testimony to Congress and other federal agencies, answer 300 calls a month from women on a wide variety of health issues, and work with health activist groups around the country.
PREVENTIVE AND WHOLISTIC HEALTH:
The movement in health care away from doctor-centered "health care delivery" and specialization based on body parts toward preventive and wholistic health is relatively new but is almost as profound and broad as the women's movement itself and has similar motive forces behind it. One of them is empowerment of the individual to take responsibility of her/his own health, another is desire to restore wholeness to the individual, to define wellness in terms of the mind and emotions as well as the body.
But documentation of this movement is scarce. The American Holistic Medical Association estimates that at least 10,000 doctors (about 2% of the total) now practice some form of holistic medicine. The American Holistic Nurses Association started in 1980; it now has 1400 members and its membership is growing by about 20% per year. This transformation in our thinking about health has not been Documented, but it is clear that this is a long term trend, and that women are among the movers and shapers of it.
—with help from Anne Pride (midwifery), Esther Zorn (CPM), Pamela Morgan
(BWHBC), Pat Ryan (WAA),
RESOURCES:
American Holistic Nurses Association, 205 Saint Louis St. 506, Springfield MO 65806. (417) 864-5160.
Boston Women's Health Book Collective, 465 Mt. Auborn St., Watertown MA 02172. (617) 924-0304.
Caesarean Prevention Movement, P.O. Box 152, Syracuse NY, 13210. (315) 424-1942. Esther Zorn, Pres. and chapter organizer extraordinaire.
Childbirth at Home International, P. O. Box 39498, Los Angeles CA 90039. Started in 1972, trains childbirth educators and midwives, also publishes information pamphlets. (213) 667-0839.
Gray Panthers of Greater Boston, 11 Garden St., Cambridge MA 02138. For info, on "Health Care is a Right" campaign in Massachusetts.
Midwives Alliance of North America (MANA), c/o Concord Midwifery Service. 30 South Main St. concord NH 03301. Canadian and U.S. midwives.
National Women's Health Network, 1325 G St. NW, Lower level, Washington DC 20005. (202) 347-1140.
National Black Women's Health Project, 1237 Gordon St. SW, Atlanta GA 30310. (404) 753-0916.
National Women's Congress on Alcohol and Drug Problems 239 E. Manchester Blvd., Suite 203, Inglewood CA 90301.
Women's Action Alliance, 370 Lexington Ave., New York NY 10017. (215) 532-8330. Women's Alcohol and Drug Education Project, and Women's Centers and AIDS Project.
Women for Sobriety, P.O. Box 618, Quakertown PA 18951. Write for referral to local group.
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