by Merle Hoffman
Ihave this fantasy. It’s a variation on that wonderful scene in the movie “Network,” when the eccentric, somewhat mad character played by Peter Finch attempts to wake the slumbering masses from their television caused stupor and into revolution. He opens his apartment window and screams: “I’m mad as hell and I’m not going to take it anymore.”
When he starts, he is just a lone voice crying out in the cavernous wilderness of Manhattan, but then, slowly, one window after another opens, until the screen is full of heads screaming: “I’m mad as hell and I’m not going to take it anymore.”
But in my fantasy, it is women who are screaming. They are screaming about the recent Supreme Court decision, commonly known as the Gag Rule, denying medical information on abortion to poor women treated at federally funded clinics.
It could start like a round -beginning with the 32 million women who have had legal abortions since 1973, then move on to all their lovers, friends, husbands, mothers, fathers, families and, finally, to all the thousands and thousands of women still living who risked their lives to have illegal abortions prior to the Supreme Court Roe v. Wade decision.
The whole country would be screaming -a massive constituency of conscience. But the reality is that it’s quiet -too quiet -and considering the entire state of women’s health in this country, it’s far too passive.
There is a disease festering in the body politic of American women and it has been growing for years. The disease is pandemic, touching all but the privileged few. Its mode of transmission is government edict, Supreme Court decisions, denial, ignorance, cynicism and lack of funds and attention from the highest to the lowest levels of government. It goes by many names: Racism, poverty, discrimination, but its real face is Medical Misogyny.
American women are sick, getting sicker all the time, and unless we do some radical social surgery, the prognosis is poor.
Women, the majority of health care consumers, visit physicians 25 percent more often than men and frequently control a family’s medical decisions.
Most American women are in continual contact with the health care system throughout their entire lives. The relationship of a woman to her doctor is a powerful, intimate dyad and one that is started early in life. Many young girls are taken to the doctor when they begin to menstruate, and, from that moment on, are engaged in a passive/receptive role with an institution that has input, if not control, of almost all of the reproductive, sexual and biological events in her life.
From menstruation, choice of birth control, childbirth, in treatment for cervical and ovarian cancer, hysterectomies and mastectomies, depression, addiction, menopause and, recently, AIDS, women and doctors are engaged in an ongoing, unequal and sometimes deadly partnership. This was, and still is, particularly true for poor and minority women who lack basic preventive health care and enter the system most frequently in crisis.
As a patient class, women are continually abused by a Medical Industrial Complex that systematically ignores their needs. Women are caught among insurance companies, providers, regulators and government bureaucracies, all moving on non parallel tracks. The end result is an arbitrary and discriminatory health care environment where women and children always lose. For example, the National Institutes of Health spends only 13 percent of its budget on women’s health and routinely excludes women from clinical studies. When the entire health care system is economically driven to reward high-tech procedures rather than ongoing preventive care, results are devastating. AIDS has become the leading cause of death among women aged 20 39. Syphilis, gonorrhea and other STDs are rising exponentially, and according to the CDC, the rate of ectopic pregnancies (a life threatening condition) nationally in 1987 was almost four times higher than in 1970.
Twice as many women as men are diagnosed with depression and far more are addicted to prescriptive and non-prescriptive drugs. The incidence of breast and cervical cancer is on the rise particularly among low income and minority women, many of whom are diagnosed in the later stages when survival rates are far lower. To make matters worse, women have become the fastest growing population of the uninsured.
The lack of attention to women’s health needs is nowhere more blatant than in the area of reproductive health. The issue of contraceptive use, misuse and development is critical, not only in terms of the millions of unplanned and unwanted pregnancies American women experience each year, but in terms of women’s health care in general. It is symbolic of the fact that women are the majority of health care consumers in this country yet have almost nothing to say about how funds or Research and Development monies are spent. It is interesting to note that since the introduction of the Pill and the IUD in the early 1960s only one fundamentally new contraceptive method, Norplant, has been approved for use in the United States. It is even more interesting to note that Norplant costs the consumer approximately $700 and is not reimbursed by Medicaid -insuring that once again poor women are discriminated against by the medical establishment. The fact that only one new contraceptive was developed in the last 20 years while, at the same time, millions of dollars were spent developing high tech devices like artificial hearts, which basically serve the interests of the research establishment, point out more clearly that the words “women’s health” are becoming an oxymoron. It also points to a political problem -that of women as a majority constituency -lacking the money, clout and political leverage to have their needs met. The new abortifacient RU 486, which, usually, safely and effectively induces abortion before the ninth week of pregnancy and has been called “The Moral Property of Women” by the French Minister of Health, has been blocked from being tested and distributed to American women by threats of antiabortion boycotts of the drug company that manufactures it. Called a “human pesticide” by fundamentalists, RU 486 remains on hold. Even more disturbing is the fact that this drug can also be used to treat breast cancer.
The pervasiveness of sexism in the medical establishment does not stop at withholding treatment and education from patients. Physicians themselves are often targets of harassment and discrimination. Dr. Frances Conley, one of the nation’s first female neurosurgeons, resigned from her tenured professorship at Stanford after 25 years, charging sexual harassment. Dr. Conley, 50 years old, said some male colleagues called her “honey” in the operating room and some fondled her legs under the table or made demeaning or sexual comments. “The most frustrating part of this whole thing is that most of the harassment is an attitude where male faculty members are in this time warp. They believe in male superiority and female subservience.” (New York Times, 6/4/91)
The Gag Rule, the latest salvo in the ongoing attempt to reinforce medical “female subservience,” is draconian in its formulation. Preventing physicians in federally funded clinics from even mentioning the word abortion as a possible alternative to an unwanted or unsafe pregnancy, it effectively succeeds in destroying the meaning of family planning for poor women.
Created by Congress in 1970, the purpose of the program known as Title X was to provide poor women with medical care as well as information about family planning. The populations that Title X serves have disproportionately high rates of teenage pregnancy, STDs and infant mortality. In many of these communities, the clinics receiving Title X funds are the only source of family planning services and information on general health care that these women have.
By dictatorially interfering with the doctor/patient relationship, the ruling allows the government to create ghettos of medical ignorance, places the lives of over five million poor and minority women at risk, and potentially succeeds in forcing poor women to have unwanted children. It also severely endangers free speech. More than any other recent restrictive ruling surrounding abortion, the Gag Rule cuts to the core of the meaning of Roe v. Wade by placing physicians in an even more powerful and potentially propagandistic role with their women patients than they have historically enjoyed.
As with other legislative initiatives regarding abortion that have sprung up since the Webster decision in 1989 allowing the states more leeway in regulation, the Gag Rule displays an alarmingly negative creativity. From the Utah legislators who were so hot to outlaw abortion that they forgot about a law on the books that could put women in front of firing squads for having them, to spousal consent, parental notification, 24 hour waiting pen ads, “right to know” bills that require women seeking abortions to be given information on fetal development, to Louisiana passing the most restrictive laws calling for 10 years hard labor for any doctor caught performing an abortion, the message is clear, direct and legible.
If abortion will not become totally illegal in every state in the union, the agenda and strategy is to make it almost impossible -even if that means interfering with other fundamental American liberties like free speech. In their strongly worded dissenting opinions on the Gag Rule decision, Justices Blackmun, Marshall, Stevens and, in part, O’Connor, wrote “We must wonder what force the First Amendment retains if it is read to countenance the deliberate manipulation by the Government of the dialogue between a woman and her physician.”
Walter Delinger, writing in the New York Times on May 25, said that “Thirty years ago, Justice William 0. Douglas voted that the “right of the doctor to advise his patients according to his best lights seems so obviously within First Amendment rights as to need no extended discussion.”
Thirty years later we are left to embark on a discussion whose possible ramifications are enormous.
Nat Hentoff, writing in the Village Voice 6/11/91, says that “Rhenquist was aware that some people, doctors for instance, were very concerned that preventing physicians from giving complete advice to the pregnant women in these clinics could greatly endanger the health of some of them.” But for Rhenquist this was not a great problem, “because, patients who go to these clinics ought not to expect comprehensive medical advice.’ Comprehensive advice like telling a woman that continuing a pregnancy with placenta previa, severe diabetes or high blood pressure is life threatening.
Many physicians practicing in federally funded clinics, concerned about the consequences of going against medical ethics and the possibilities of malpractice suits if they cannot adequately inform a woman of all available options surrounding a pregnancy, don’t have to worry. Government lawyers for the administration assure them that malpractice suits would be very unlikely because the physicians would be only “following orders” if they withheld information on abortion.
By their decision, the Rhenquist Court has reinforced the traditional gynecological view of women as disparate parts. To assume that pregnancy is not a condition that affects the entire physical system of a woman along with her psychological and spiritual health, is to reflect that most narrow of Cartesian dualistic universes. But this kind of thinking can be found in many anti-choice theories of fetal rights which elevate a fetus (no matter what the gestation) to a place deserving more consideration and legal protection than the woman carrying it.
Restricting a physician’s speech on abortion may be the first step in a domino effect of further restrictions. Ruth Marchs of the Washington Post writes, “In the President’s proposed school choice programs, for example, could the government support vouchers only for those schools that agree not to discuss abortion in their sex education classes?”
At least one other community is concerned that the Rust v. Sullivan decision could have a chilling effect on other areas of American life. “It’s a big issue,” according to Kathleen Sullivan, a Harvard Law School professor who helped prepare the brief on behalf of the clinics. “Rust has revived major concern in the arts community over whether content restriction is going to rise like a phoenix from the ashes. I think this will look to the right like a green light for more restrictions on funding.” The actual implication of the decision for the arts, Sullivan said, “depends on whether the court will follow the theory of this decision or the practice.” (New York Newsday, 5/31/91)
In the case of women’s right to have full and appropriate information regarding their medical condition and options, the issue of whether or not this is a case of theory or practice is moot. If physicians are forced to practice medicine according to government edict, women’s lives are directly at stake.
By attacking federally funded clinics, the Supreme Court has continued the political and legislative strategy of targeting the most vulnerable in society.
From the infamous Henry Hyde who, in 1977, sponsored the federal bill that cut off Medicaid funding for poor women’s abortions, stating that “lf we can’t save the babies of all the women, we can at least save the babies of the poor,” it has been poor women who have had to bear the brunt of conservative, fundamentalist attacks. Poor and minority women, who, more than any other, have a critical need for family planning and abortion services, who are so often left to bring up children alone in dire circumstances, are more victimized and endangered than ever before by this recent Supreme Court decision.
From the boardroom to the operating room to the halls of Congress to the chambers of the Supreme Court it’s all the same women’s health and women’s lives are not important. High rates of abortion, increased death rates from breast cancer, epidemics of STDs and the feminization of AIDS are merely the symptoms of the disease. The disease is the reality of women’s lives as second class citizens.
As long as the Medical Industrial Complex continues to reflect the agenda of male physicians and drug companies, women will remain an abused patient class.
And as long as women’s sexuality and reproductive capacities are controlled and defined by men either as lovers, husbands, doctors, legislators or judges, “women’s health” will remain an oxymoron.
Isn’t it enough to make you scream?
Merle Hoffman is publisher/editor-in-chief of On The Issues magazine and founder/president of both Choices Women’s Medical Center, Inc., and Choices Mental Health Center.