Feminist pioneers discuss women’s health policy

More than three decades after publication of the taboo-shattering book on female health, “Our Bodies, Ourselves,” activists are still struggling to bring attention to women’s health issues amid the national debate over medical insurance coverage, said one of the book’s authors and feminist pioneer Judy Norsigian.

“We think of access to quality health care as a human rights issue, and we want to frame it as a human rights issue,” said Norsigian, the executive director of the Massachusetts-based women’s health organization Our Bodies Ourselves, during a wide-ranging discussion on women’s health-care reform on Nov. 15, sponsored by the Radcliffe Institute for Advanced Study.

The discussion was moderated by Kip Tiernan, co-founder of Community Works in Boston, an organization supported through Harvard’s Community Gifts program (see box). (A scheduled participant, Byllye Avery, founder of the Black Women’s Health Imperative, was not able to attend due to a family health matter.)

Armed with extensive statistics and personal anecdotes, Norsigian argued that health care coverage is very much a women’s issue, noting that nationally women have greater annual health care expenses than men ($2,453 versus $2,316) and that in Massachusetts only 44 percent of women have job-based medical insurance compared with 59 percent of men.

“Many women are unable to work at jobs that provide health insurance because of the time they spend providing unpaid care to sick, disabled, very young, and very old family members,” Norsigian said.

Moreover, it is important to “de-link” a woman’s access to health care from whether “we may be married or not. [It] is not a good idea to have your health insurance access connected to … a partner, even if it is a domestic partner.”

Even under Massachusetts’ new, much-hyped mandatory health insurance program, many poor women will be penalized, not helped, because they can’t afford even minimum health insurance. “We have thousands of citizens who absolutely cannot pay for what is offered; the system isn’t working,” Norsigian insisted.

The health care crisis is not simply one of a lack of money; rather, Norsigian said, women are both underserved and overtreated: “We’re spending money in ways that are not good for us as individuals and also not for the system.”

Overtreatment includes a reliance on caesarean sections and unnecessary use of new prescription drugs, something impacted by extensive direct-to-consumer drug advertisements.

A plan to impose a two-year moratorium on direct-to-consumer advertising for new drugs (which would curtail use through its health impacts are as yet unclear) has won bipartisan support and could be an issue raised in the 2008 presidential campaign, Norsigian said.

Although many candidates are citing their determination to reform health care, Norsigian thinks that verbal assurances are not enough; that any national health care plan should directly address the question of access to contraception, sterilization, and abortion services.

“The larger question is: Are health care reform plans introducing a requirement that we look at the evidence basis for what we are doing? Maternity care is a great example of where it’s not [an issue of] spending the money; it’s not access to care. It’s the quality and the type of care that’s the problem,” Norsigian said.

For example, many hospitals have midwifery services — which have results as good as those in more traditional birth settings — but many young women are unaware of or afraid of those services. “A lot of women could be encouraged to have a more natural birth in a hospital setting,” Norsigian said.

Questioned about the recent statements by Catholic Cardinal Sean P. O’Malley that the Democratic Party is hostile to opponents of abortion rights, Norsigian waded into the difficult, murky issue of abortion. Choice, she indicated, can be a nuanced debate. Is abortion killing a fetus? Maybe, she acknowledged, noting that society permits other kinds of “killing,” such as in war. “We don’t live in a world where killing even of human beings is wrong,” she said.

In response, “It’s not the government’s role to debate whether it is right or wrong religiously,” said audience member Tanasia Barboza-White, a senior peer leader for Teen Voices, a magazine written by and for teen girls, which is a member of Community Works. Yet Barboza-White noted that she does not like the idea of women using abortion as a form of contraception.

In turn, Norsigian said she has deep misgivings about women — particularly in countries like India — who choose to abort female fetuses. But “you have to allow for choices which are more problematic for us,” she said.

Audience member Marilyn Dunn, executive director of the Schlesinger Library, said she was struck by Norsigian’s call for presidential contenders to provide written assurances on women’s health issues in their platforms, saying that politicians tend to “take the safest course, the neutral course.”

Neutrality was not an option for moderator Tiernan, a longtime activist and founder of Rosie’s Place, a women’s shelter in Boston. In comments after the formal discussion, Tiernan criticized O’Malley’s stance, saying, “I’m wondering why the Catholic Church doesn’t go after the fact that there is no housing and people are starving to death and there’s no medical access for poor people. I think all of this is a moral issue.”