Health Care, Self Care

Alison, one of the founding members of the Pomegranate Health Collective, lists possible workshop topics for a health conference scheduled for the fall: pain management, nutrition, tattoo care, safer sex, herbalism, gardening, abortion rights, and prisoners’ health. But the list doesn’t stop there; Alison continues naming topics, so many topics that she has to stop and catch her breath. From intersex workshops to veteran’s health, this conference will cover everything imaginable having to do with health. At the end, Alison exclaims, “I love this list!”
    The Pomegranate Health Collective started as a women’s health collective, but soon broadened its scope. “When we first started meeting we were interested in women’s health, but from our official beginning it’s been broader than that. Among our founding members there was a trans person, and well, how does that fit in to women’s health care as all these other sources define it? How can we limit ourselves in these ways?” Alison explains. “It expanded to the point where now we include pretty much anything you can justify as being healthy. We do work a lot in women’s health care and sexual health, but we’re trying to expand and keep it open.”
    With ten active members and an extended network of about thirty, Pomegranate is guided by radical feminist ideals such as nonhierarchy, consensus, and peer-based learning. Alison names ACT UP (AIDS Coalition to Unleash Power) and the ‘90s queer health movement, as well as activist groups from the ‘60s and ‘70s such as Jane, as Pomegranate’s influences. Pomegranate’s primary focus is education; the collective organizes workshops and film screenings about health issues. Alison says, “We try to emphasize a much more broad and pervasive definition of health that goes beyond just treating illness. Not only prevention, but empowering people and engaging people with their own bodies, instead of treating them as patients and objects of an industry.”
    Pomegranate members call themselves “do-it-yourself (DIY) health activists.” “A large part of DIY health care is education and de-mystifying the body,” Alison explains. “No doctor can understand your body better than you can, because you live in it and experience it. You have to take your health into your own hands and know that mainstream healthcare is incomplete if the individual is not actively involved, learning about and understanding how their body works.” Taking responsibility for your own health is a principle Pomegranate shares with organizations that were part of the women’s health movement.

educating women about their bodies

In the late ‘60s, Chicago was the center of the women’s health movement—a natural outgrowth of the social justice and women’s liberation movements happening at the same time. The women’s health movement focused on getting women information about their bodies and empowering them to make their own decisions independently from “male experts.” Chicago was home to organizations such as Jane, the Chicago Women’s Liberation Union, the Women’s Graphics Collective, the Emma Goldman Clinic, the headquarters for the Reproductive Rights National Network, and the Chicago Women’s Health Center.
    One of the catalysts for the movement in Chicago was the feminist underground abortion service called Jane, which operated in Chicago from 1969 to 1973 and focused on public education and providing safe abortions. Jane members counseled each woman before she had an abortion. According to Laura Kaplan in her book The Story of Jane: The Legendary Underground Feminist Abortion Service, “most women [Jane members] counseled lacked basic knowledge of reproduction, or even their own physiology …as the group had discovered while researching abortion, there was almost nothing written for women on women’s health. The general public was insulated from medical knowledge. It was as if there was something inappropriate, if not indecent, about a woman wanting to understand her body.”
    Jane members also counseled the woman through every stage of the abortion, letting her know what to expect, what was happening, so that she could be an active participant rather than passively having the procedure “done to her.” This was radical stuff; only doctors were considered experts, and they were predominantly male.
    A milestone for the movement was the publication of Our Bodies, Our Selves by the Boston Women’s Health Collective in 1970. (It was a stapled newsprint booklet then, not the huge best-selling book it is now.) Jane distributed the book, as well as the Birth Control Handbook; and both were considered daring publications.
    Education has always been a vital part of the women’s health and liberation movements in this country; Emma Goldman lectured about birth control in 1916 (and was subsequently arrested for doing so). The Comstock Act tightly controlled women’s reproduction; from 1873 to 1936, it outlawed distribution of information about contraception and contraception itself.
    Most doctors don’t spend a lot of time explaining things to their patients, as medical knowledge is considered to be a physician’s exclusive territory. This is a somewhat recent phenomenon; traditionally women’s health was the domain of laywomen (including midwives) until healthcare became professionalized. (In the 1800s, the American Medical Association made a big push away from self-care when it outlawed abortion and jockeyed for dominance over medical care.)

before roe vs. wade

In pro-choice circles, Jane is legendary, but their story is not widely known— many activists refer to the group as “Chicago’s best-kept secret.” Paula Kamen interviewed former Jane members for a play she wrote called Jane: Abortion and the Underground. I sat down with Kamen to talk about Jane’s significance within the women’s health movement. Kamen says, “A reason why I was fascinated with Jane is because this is something that everybody knew about, from police officers who sent their own daughters there to university administrators, social workers, nurses, doctors. So the fact that it was the best kept secret shows that even when abortion is illegal the need for it doesn’t go away.” She adds, “I know that seems like a basic point, but often you don’t see that anywhere in the media—like, what will happen if it goes away?”
    A few women started Jane in Chicago as a referral service to provide safe abortions for women in the pre-Roe v.Wade days (the 1973 U.S. Supreme Court decision that made abortion legal in the United States). Jane wasn’t the only one; there were other feminist referral services and even huge networks of clergy that referred women to places where abortions were legal (like England or Japan, and New York State after 1970).
    But Jane was unique, because eventually the women started to perform the abortions on their own. They learned the procedure from one of their male abortion providers, and then taught each other. The turning point came when the Jane members found out he wasn’t a physician; they concluded “if he can do it, why can’t we?’”
    Kamen cites a lesson learned from Jane’s time: “When abortion is illegal, very bad people step forward to do it.” She continues, “A lot of people don’t realize that the mafia ran a lot of abortion services. It made it all the more harrowing when you’re dealing with organized crime for your health procedure. So Jane was actually very rare, to have women who care about other women doing it.”
    Not only did they provide relatively safe abortions (they performed over 10,000 abortions with an almost perfect safety record), they also provided them on a sliding scale. Cutting out the expensive illegal abortion providers was a motivating factor for Jane members to learn how to perform abortions themselves, in addition to providing a situation in which they had total control.
    Even after the passing of Roe v. Wade, many women still do not have access and/or cannot afford an abortion. Partly, this is due to the Hyde Amendment, passed in 1976, which bars Medicaid from paying for abortions. In a recent interview on Chicago Public Radio’s “Eight Forty-Eight”, former Illinois Congressman Henry Hyde (the man for whom the amendment is named) said that before the issue was presented to him as a legislator, he had never thought about abortion. This is a luxury for Mr. Hyde as a man because, as Laura Kaplan says in her book, “for every woman, abortion as a decision is not a theoretical abstraction, but is rooted in the concrete conditions of her life.”

chicago women’s health center

Thirty years later, women still face losing the right to control their own bodies. Alison from Pomegranate says, “I feel like we’re backsliding on the abortion rights front. People are becoming more and more apologetic, using euphemisms and not even using the word ‘abortion’ …I mean, you have Hilary Clinton saying that it’s a ‘sad, even tragic, choice.’ What we do with our pro-choice work is to try to take the offensive instead of being so defensive, because we’re sick of that rhetoric; it’s moving us backwards. We shouldn’t be apologizing.” Despite backsliding in political realms, the reproductive justice movement is alive and well, as witnessed by the thousands who attended the SisterSong Women of Color Reproductive Health Collective’s Second National Conference, held in Chicago in June 2007. SisterSong is based in Atlanta and was formed in 1997 “to educate women of color and policy makers on reproductive and sexual health and rights, and to work towards the access of health services, information and resources that are culturally and linguistically appropriate.” (taken from www.sistersong.net) Also, the March for Women’s Lives, an abortion and women’s rights demonstration in 2004, attracted a whopping one million people, making it one of the biggest protests to march on the National Mall in Washington D.C.
    Conservative legislators may soon have to face that they are out of touch with young women who feel entitled to have access to birth control, abortion services, and Plan B (the emergency contraception pill). A majority of young women may insist on reproductive rights, but Kamen points out, “the problem is they are not taking the next leap to politics and organizing or anything beyond themselves. They’re not looking at poor women and access.”
    In 1973, there was litigation pending against the members of Jane for practicing medicine without a license. When Roe v. Wade was enacted and the suit was dropped, the Jane collective decided that the best use of the money from their defense fund would be to start a women’s health center—and  the Chicago Women’s Health Center was born.
    I visited the health center on a warm June afternoon. I mention where I’m going to my co-workers and to my surprise, all five women regularly go to the Chicago Women’s Health Center, even though our employer provides us with a health care benefits. My boss exclaims, “They showed me how to look at my cervix!”
    Even though the health center is far from our neighborhood, my co-workers insist it’s worth the trip. The Center is nestled in the middle of Dudeville, aka Wrigleyville. A bright purple flag outside the nondescript building is the only indication that a women-friendly space awaits inside. When I arrive, a few women are seated in the homey waiting room, a myriad of informational pamphlets are on the coffee table, and colorful women’s liberation posters adorn the walls.
    Louise Champlin, director of the Center’s gynecological services program, warmly greets me and we sit down to talk. Champlin has been working at the health center for twenty-one of its thirty-two years. One obvious reason women are excited to come here is that Champlin immediately makes you feel at ease. She also spends an hour with each patient. Champlin says, “We schedule a full hour for a routine gyne [gynecological exam], which is very different, and becoming more and more disparate from the way health care is provided in this country. With many providers you see the doctor for five or six minutes.”
    The hour Champlin spends with patients is mostly filled with education, both for the provider and the patient. “One of the problems a lot of people have with health care in this country is that they feel they’re not being listened to. And that’s an important part of providing care, because as a provider you learn a tremendous amount about the individual’s health. I’m talking about health in a holistic way: everything from what her personal habits are, to personal attitudes, to mental health problems. Just a full gamut of things, and primarily what her concerns are.”
    It is clear that women are flocking to the Center because a sensitive approach to gynecological care can be hard to find. It is common for women to dread having a pap smear because of uncomfortable gynecological exams they may have had in the past. It can also be difficult to find a woman ob/gyn who is accepting patients, especially within an HMO system. This makes the center a valuable resource for women.
    Champlin says, “I remember hearing stories about women’s first gyne exams, women from my generation, and I remember my own. I went and saw this guy—he was devastatingly handsome, which made it worse—and I was draped from here to here, and he was down there doing god-knows-what. Nothing was explained. I had no idea what a pap smear was. I had heard that I was supposed to get one. So I did.”
    In addition to longer appointment times, the Center is unique in a number of ways: a sliding-scale fee, therapy services, affordable emergency contraception, an artificial insemination service, an all-women staff, and an emphasis on preventive and self-care, including breast and cervical self-exams.
    Champlin believes that the women’s health movement made many gains from the ‘60s through the ‘80s, but recently there has been a shift backwards. She cites the power that the legal profession and insurance companies wield over how health care is provided and says drug companies, HMOs, and people’s attitudes are the culprits. She says “there were tremendous gains in the ‘80s in attitudes about pregnancy and child birth. Hospitals were opening alternative birthing centers, hiring midwives to deliver babies. Now we’re reading about women electing to have C-sections, and intervention in childbirth being the norm, rather than being used in specific cases when there’s a problem.”
    While the Center offers specifically women-oriented services, it has recognized a need to open up its services due to the dire need for affordable health care in Chicago. Cuts in health care services initiated by Todd Stroger, the Cook County Board President, are making a bad situation worse. Even before the cuts, a woman referred to the Cook County Hospital for a mammogram experienced an 18-month wait, according to Champlin. She says, “It’s grim; there’s a tremendous need. While we’ve maintained our women-centered and feminist ideals, we’re very much more interested in accessibility to health care. Because that’s the problem now.” To meet this need, the Center’s outreach program focuses on educating adolescents in the Cook County Juvenile Detention Center and in Chicago schools. The center has also beefed up its bilingual staff as part of its Latina Health Initiative, in conjunction with Centro Romero.

the acudetox healing collective

Access to health care is something Liz Appel also tries to remedy. Appel is a member of the Acudetox Healing Collective; they define themselves as a group of community health workers, activists, and organizers who believe that accessible health care is social justice. Appel is absorbed by questions like, “How does something as broad as general oppression and gentrification affect you on a daily basis in terms of your health?”
    Appel attends Chinese medicine school in Chicago, and in her spare time organizes fellow students to provide community healthcare. “I like to think of it as a clinic without walls, right now.” She works weekly at the American Indian Center, organizes large open healthcare events, and does acupuncture and massage for social justice organizations, all on a sliding scale. Appel says, “I think there’s a lot of ways to be really creative, it doesn’t have to be this inaccessible, unaffordable boutique medicine.”
    Appel says, “ I feel like [Chinese] medicine itself is radical; it forces you to pay attention to what’s going on in your body. We have people that come in, and we ask them questions about what they’re eating, what their stools look like, what their energy level’s like, and people say, ‘I don’t know.’” Appel continues, “then weeks go by, and people say ‘hey! I started noticing this!’ People start to recognize patterns.”
    In addition to massage, Appel offers the National Acupuncture Detoxification Association (NADA) protocol. It is a simplified five-point ear needling technique originally designed for people recovering from addiction, but can also be used to alleviate stress. The NADA treatments can be performed by lay people under supervision of a licensed acupuncturist in most states. The treatment is simple enough that it can be performed on multiple people at the same time making it viable for treating a community together, Appel says, “I like NADA because you can work on 30 people at once.”
    Appel has an inclusive vision for offering community healthcare. She cites Working Class Acupuncture in Portland, Oregon and Acupuncture Without Borders as examples. “What is possible is building these larger clinics where you don’t have to have insurance, you don’t have to present a social security card, and people can come in and pay what they can.”
    Appel doesn’t name the women’s health movement as a direct inspiration, but she shares certain values with feminist health advocates such as challenging the way medical care is delivered, and working towards affordable healthcare access for everyone. And the fact that most people in her medical school are women is a testament that times have changed.

The increasing need for health collectives proves there is still a long way to go in attaining adequate, affordable and respectful healthcare. For women’s health advocates, the struggle has grown beyond the confines of women’s health concerns, as the overall need for health care for everyone has reached frightening proportions.
    The women’s health movement provided effective models of healthcare delivery, such as Jane and the Chicago Women’s Health Center. And perhaps because such collectives are rooted in feminist ideals, they are more able and willing to offer respectful health care to everyone: transgendered people, men, women, and youth.