Women’s health movements

Meredeth Turshen

Women’s Health

Movements

A Global Force for Change

Second Edition

Women’s Health Movements

Meredeth Turshen

Women’s Health

Movements

A Global Force for Change

Second Edition 2020

ISBN 978-981-13-9466-9 ISBN 978-981-13-9467-6 (eBook)

https://doi.org/10.1007/978-981-13-9467-6

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Singapore

Meredeth Turshen

Edward J. Bloustein School of Planning

and Public Policy

Rutgers University

New Brunswick, NJ, USA

In memory of Cecile and Jerry Shore

And for Vera, Juna, and Charlotte

vii

These headlines compel me to write: “Pro-Choice #StopTheBans rallies

take place nationwide,” “El Salvador’s women rise up against gender vio￾lence, femicide,” “Majority in Brazil’s top court to make homophobia

and transphobia crimes,” “5,000 women from around the world attend

Zapatista’s first ‘women in struggle’ summit,” and “Millions march to

demand climate action.” Behind each of these headlines is a story about

people mobilizing to protest assaults on their rights, or organizing to gain

recognition of their rights, or demonstrating to protect their livelihoods,

or meeting to strategize around human rights. I am compelled to write

about the movements that people form, motivated by anger at injustice,

in reaction to the tragic loss of life, and fed up with pervasive harassment

and assault.

Women’s health matters. The issues women unite around are impor￾tant: reproductive health and the right to abortion, domestic violence

and the right to protection, and disability and the right to services and

jobs. This book celebrates our work and warns about the new struggles

ahead and the old issues that never seem to go away.

My litmus test for change used to be structural reform. If the call for

correction did not lead to official commitment to adopt good new laws

or overturn bad old ones, then the initiative was not likely to last. Legal

changes do not necessarily mean that institutions, let alone attitudes, will

be transformed, but they are goals that determine whether a movement is

Preface

viii Preface

a trend with the power to endure. Now we see laws and regulations being

overturned, not just the bad old legislation women sought to repeal, but

also the good new policies we fought for with passionate determination.

I am writing from a place of struggle to preserve the access to abortion we

wrested from conservatives decades ago, access that is already severely

limited and may be denied for generations to come. Today, amidst evi￾dence of a global democratic recession, repeal increasingly means tight￾ened restrictions on women’s rights, rather than a relaxation of onerous

regulations.

“It is just that there be law, but law is not justice. The passing of a law

and the proof of its existence is not enough to assure effective resistance

to oppression,” says Gayatri Chakravorty Spivak (https://www.nytimes.

com/2016/07/13/opinion/when-law-is-not-justice.html, accessed 31

July 2018). Recent cases of sexual assault in India tell the story: in 2012,

Jyoti Singh Pandey was raped in Delhi and died of her injuries. The gov￾ernment responded to the huge public outcry by creating a fast-track

court for rape cases. Nonetheless, the attacks continue, only coming to

attention when they involve assaults on minors: a 17-year-old (Unnao,

2017), an 8-month-old (Rajasthan, 2018), an 8-year-old gang-raped and

killed (Kathua, Jammu and Kashmir, 2018), an 11-year-old repeatedly

gang-raped over seven months (Chennai, 2018), and a 5-year-old

abducted, raped, and murdered (Mumbai, 2019). The National Crime

Records Bureau recorded 19,765 cases of child rape in 2016, a rise of 82

percent from 2015 when 10,854 cases were registered. India’s Union

Cabinet (the nation’s supreme decision-making body) approved capital

punishment for the rape of girls under the age of 12 years in April 2018.

But 99 percent of rapes are not reported, in part because of police intimi￾dation and invasive vaginal exams, but also because the judicial, political,

and administrative systems are dysfunctional. Then, there are the atti￾tudes: Indian officials say people see rape “as less of a crime and more of

a social deviation or aberration against the family honor” (https://www.

nytimes.com/2018/07/28/world/asia/india-gang-rape-chennai.html,

accessed 31 July 2018).

At the same time, we see positive changes everywhere in attitudes (like

greater acceptance of same-sex marriage, which is now legally performed

and recognized in 27 countries) and in behavior (sexual harassment and

Preface ix

assault are less tolerated). Not all attitudinal changes translate into public

policy, let alone law. And women’s resistance does not always lead to

women’s emancipation. Still, movements matter: public protest does

pressure governments and politicians, even courts, in policy delibera￾tions. The mass mobilizations demonstrating changes in public percep￾tion are impressive, as is the speed with which rallies and marches

materialize. Undoubtedly, social media and new information and com￾munication technologies have provided organizers with faster and cheaper

means to attract crowds and disseminate their message. This book tries to

capture the current state of organizing for women’s health across a broad

range of concerns and to assess its impact.

When I wrote about women’s health movements more than a decade

ago, I was optimistic, perhaps overly so. I believed women had accom￾plished so much in the last century that the trend of expanded sexual and

reproductive rights and improved women’s health services was irrevers￾ible. The evidence was irrefutable, I thought, for progressive recognition

of women’s health rights in both the Global North and South. But, the

world’s political economy, impaired by the 2008 financial crisis and

freighted with higher orders of inequality, has shifted many policy agen￾das to a less liberal position on human rights. Witness the Polish govern￾ment’s targeting of women’s rights activists and organizations (https://

www.hrw.org/news/2019/02/06/poland-womens-rights-activists-tar￾geted, accessed 14 February 2019), the multifaceted discrimination

against Kurdish and other minority women in Turkey (http://jwf.org/

wp-content/uploads/2017/05/Womens-Rights-Under-Attack.pdf,

accessed 14 February 2019), and attacks on women human rights defend￾ers in El Salvador, Guatemala, Honduras, Mexico, and Nicaragua (http://

im-defensoras.org/wp-content/uploads/2016/04/286224690-Violence￾Against-WHRDs-in-Mesoamerica-2012-2014-Report.pdf). In revising

and rewriting this book, I realized that no gain is permanent, no win

secure. We must fight many of the same battles over and over again.

The backlash against women’s rights has served to awaken militant

feminism: in India, mass rallies condemned the gang rape of Jyoti Pandey

in 2012; in the United States, protests against sexual assault erupted on

college campuses in 2014; in Brazil, 30,000 black women descended on

Brasilia to demonstrate against sexual violence and racism in 2015; in

x Preface

Argentina, feminists came out against domestic violence in 2016; in

China, over 2 million people signed petitions in support of Young

Feminist Activism in 2016; and in Poland, women pushed back success￾fully against a total abortion ban. Worldwide marches against the newly

installed Trump administration filled the streets in January 2017. And in

October 2017, #MeToo campaigns began appearing in one country

after another.

This new edition of Women’s Health Movements avoids pessimism.

Although access to health services remains unequal, there are advances to

report—and no end of protest. Examples of progress are impressive: since

2000, women in 28 countries have fought for and won expanded legal

grounds for abortion (to protect a woman’s health, for socioeconomic

reasons, or without restriction as to reason), and 24 countries added at

least one of three additional grounds: in cases of rape, incest, or when the

fetus is diagnosed with a grave anomaly (https://www.guttmacher.org/

report/abortion-worldwide-2017, accessed 24 May 2019).

On the other hand, in reaction to liberalizing changes in abortion

laws, such as the remarkable vote to repeal the Eighth Amendment in

Ireland, the Holy See has become a more committed and effective oppo￾nent of abortion, and the Christian anti-abortion crusade has graduated

to a global stage. Access to reproductive health services in countries with

newly liberalized abortion laws is further complicated by the expanded

Mexico City Policy, also known as the “global gag rule,” which the

United States promulgated in January 2017: not only will nongovern￾mental organizations that provided abortion services or abortion counsel￾ing be ineligible for U.S. family planning funding, but all health services

offered by such facilities will be denied assistance. Responding almost

immediately to the $600 million anticipated funding gap, the Dutch

minister for foreign trade and development cooperation convened a fam￾ily planning conference in Brussels in March 2017, which was attended

by 60 nations, private funders, and philanthropists (https://www.

insidephilanthropy.com/home/2017/10/10/philanthropy-global-gag￾rule-grants, accessed 20 July 2018). By July 2018, She Decides had raised

$500 million for sexual and reproductive rights and health of girls and

women (https://diplomatie.belgium.be/en/newsroom/news/2018/one_

year_she_decides, accessed 24 May 2019).

Preface xi

Overall, the record of the past ten years is dispiriting: the acceleration

of global warming is relentless, and a hard turn to conservative politics in

many parts of the world manifests as rollbacks of women’s rights. Women’s

health movements everywhere are now making two urgent demands: we

need reproductive justice and we want environmental justice. These chal￾lenges are the principal themes of this book.

Demands for reproductive justice have fallen into the hands of author￾itarian politicians and religious leaders who, to further their own agen￾das, are distorting women’s causes under the banners of tradition,

nationalism, faith, and family. Emblematic of fascism (and widely copied

by autocratic and dictatorial regimes) is the restoration of patriarchal

authority, an archetype in which women and children are subordinate to

the male head of the household. Both twentieth-century fascist regimes—

those of Benito Mussolini in Italy and Adolf Hitler in Germany—prom￾ised to return women to the home and confine their activities to bearing

and raising children. The Italian and German dictatorships did not just

promulgate laws that relegated women to the homestead; they also built

a public cult of motherhood in the names of nationalism and state power.

The rightward turn today rides on political interpretations of religious

doctrine. Religious fundamentalisms use the latest technology and other

forms of access to governmental powers to naturalize their version of the

truth; their purpose is to take control of particular religious, ethnic, and

national communities as well as society as a whole. Religious leaders,

often in collusion with politicians, rally their fundamentalist adherents

with extreme views of gender. In their doctrine, not only has binarism,

which is predicated on the stable opposition of male and female, returned

to the discourse, but also the characterization of men and women has

hardened to biological basics and sociobiological caricatures. In these

perspectives, women are valued for their reproductive capacity, men for

their agency and performance. These characteristics are essentialized:

women are said to be instinctual mothers, warm and caring, whereas men

are assertive and leaders.

Religious fundamentalisms are closely related to gender, as notions of

“proper” masculinity and femininity and the relations between the sexes

are fundamental to the social and political order that these movements

try to construct as normative values.

xii Preface

A Personal/Political Statement

In the first edition of this book, I wrote that for nearly a decade, I had

wanted, with a growing sense of urgency, to write something that would

show what the women’s health movement has meant to the women of my

generation, the generation of girls who came of age in the 1950s and

1960s, became activists in the causes of others, and then turned to help

one another and, finally, to help ourselves. We grew up in New York, the

Casbah of Algiers, the Bantustans of South Africa, dusty Khartoum, pro￾vincial France, the North of England, and Old Delhi. Each of us carries,

on her body and in her mind, a site of humiliation, a scar of betrayed

trust, and a flashback to an indignity as vivid today as when inflicted. We

shared those humiliations, examined each other’s scars, and raged at the

indignities. I am still enraged.

This book is about sexuality, violence, reproduction, disability—wom￾en’s health issues and the movements that women created to confront

them. The issues are international and larger than medical care: women

oppose conflict and war, the debt crisis, and shortages of water, food, and

work. The most oppressed women urge action on the most basic issues:

eliminate poverty, unemployment, poor housing, deteriorating environ￾ments, and punishing welfare and policing programs. They entreat their

governments to provide any kind of medical care and public health ser￾vices for their neglected communities.

Women’s health movements deprecate the ways that society uses medi￾cal care to control women’s sexuality. We condemn the medical profes￾sion for so long ignoring the signs of domestic violence. We reject the

condescending, paternalistic, judgmental, uninformative, and infantiliz￾ing treatment that is routine in visits to gynecologists and obstetricians.

We abhor health workers’ participation in unnecessary, unwanted, and

punitive sterilizations; unethical clinical trials of contraceptive drugs and

devices; and denial of access to abortion. Women are appalled by doctors’

willingness to replace healthy breasts with health-damaging implants, to

mutilate girls’ genitals, and to condone torture.

Talking to one another and analyzing our experiences, women uncov￾ered the gender stereotypes that dictate the different medical care that

Preface xiii

women, lesbians, trans people, gay men, and people of color receive. By

paying attention to the ways advertising and the media manipulate

women, we exposed the malevolent and invidious practices of pharma￾ceutical companies—the substitution of pricey infant formula for free

breast milk; the marketing of carcinogenic hormones at menopause,

playing upon women’s fear of growing old; and the invention of new

conditions for which the industry also creates a profitable treatment—

vaginal odors, premenstrual syndrome, and generalized anxiety disorder.

In past decades, women’s health movements made dramatic changes in

health care in the United States. Women pressed for and won legal con￾traception and abortion. We pushed for more methods of birth control,

and we continue to insist that contraception and abortion reach more

women of all ages, married or not, whatever their race, income, and edu￾cation. We sued manufacturers of dangerous drugs and contraceptive

devices. By insisting on fully informed consent, we curbed abuse of ster￾ilization, widely performed on the mentally retarded and poor, black,

Latina, and Native American women. We tried to reform unethical

research procedures and clinical trials of new drugs both at home and

abroad (a work in progress). We changed obstetric care, demanding bet￾ter access and higher quality care for all women including the poor and

women of color. We won better control of birthing technology; we

insisted on the justification of Caesarian sections; and we questioned the

uncontrolled numbers of hysterectomies. We changed doctor-patient

relations in routine gynecological examinations, insisting on initial intro￾ductions when fully clothed and on explanations of each test and proce￾dure performed. We changed hospital practice to allow partners in the

delivery room and to let newborn babies sleep in mothers’ rooms to

encourage bonding and breastfeeding. We reinstated midwifery and

home birth alternatives, noting that midwifery is woman-centered

whereas obstetrics is baby centered. We forced attention to infertility

(now, alas, big business—these things turn on us sometimes). We forced

attention to menopause, breaking a taboo. We demanded an alternative

to radical mastectomy, the standard treatment of breast cancer for more

than 60 years. We pushed for attention to research on women’s health

and won it in the Women’s Health Initiative. We demanded equal medi￾cal education for women and got it: in 1965, only 7 percent of physicians

xiv Preface

were women; today women make up half of the entering class in medical

schools. We helped nurses unionize, improve their relations with doctors,

fight job discrimination, and get the pay and respect they deserve. We

urged recognition of the hidden, informal health care women provide at

home, especially to elderly parents. Women lawyers worked for legal

reforms and consumer protections; together with the battered women’s

movement, they reformed laws on domestic violence and treatment of

rape victims. We created shelters for battered women and rape-crisis hot￾lines. We are still working to change attitudes to gender—to lesbians,

transsexuals, women athletes, single mothers, obese women, and celibate

women (have I left someone out?).

Of all our contributions, I think the most enduring are new models of

health education based on the demystification of medicine and science.

We learned from the Berkeley Free Speech Movement to question author￾ity. We drew on the Self-Help Health movement to teach cervical self￾examination. From self-help and from traditions of adult education, we

turned ourselves into lay practitioners to provide women’s health care in

all-women clinics and to perform abortions before they were legal—skills

and networks we are now forced to revive. We used consciousness-raising

groups, study groups, and peer education techniques to learn about our

bodies, to raise our self-esteem, and to discover that yes, the personal is

political. We used our powers as consumers to influence the marketplace;

we learned to validate experiential knowledge and use it in documenting

our claims for change; and we became popular epidemiologists, studying

disease patterns in our communities and drawing attention to clusters of

unexplained cancer deaths and demanding investigations. We learned to

use new technologies like the internet, and we institutionalized our

achievements through web sites, publications, new laws, and transformed

facilities. And by paying attention to the need to put our ideas into the

mainstream of medical and public health practice, we tried to ensure that

the changes would endure.

There were also failures. We failed to take the profit motive out of

medical practice, despite our popular, oft-repeated slogan, “Health for

People, Not for Profit.” If anything, the situation has deteriorated, as the

U.S. model of private, for-profit medical care spreads throughout the

world. We won reforms of women’s health care but we lost the war for

Preface xv

universal access to health services. For every victory over the pharmaceu￾tical industry, there were reversals and new dangers. Most of our early

victories came after the damage was done—after doctors had prescribed

the sedative thalidomide to pregnant women, robbing thousands of

babies of their arms and legs, after the Robbins intrauterine contraceptive

device had left thousands of women sterile, and after silicone breast

implants had damaged the health of thousands of women. With evidence

of the dangers of marketing products that the industry had not tested

adequately, we won safeguards; but with the AIDS epidemic, demands

for early marketing of drugs to treat immune deficiency loosened many

of those restrictions.

Although we celebrate many successes in the U.S. women’s health

movement, the improvements are not distributed evenly. Women of

color are asking what it would take for them to get access to woman￾friendly and high-quality services. In the economic South—the poor

nations of Africa, Asia, and Latin America—women wonder what it

would take to replicate the successes of women’s health movements in the

North. They confront health issues and obstacles to better health care

that are the same and different, always with fewer resources than those

available in the North.

The same health issues—sexuality, violence, reproduction, and disabil￾ity—are intensified by legacies of conquest and colonialism, by ongoing

civil conflicts, new forms of global capitalism and religious fundamental￾ism, by the imperialism of one superpower, and the loss of an alternative

vision, as socialism is discredited everywhere and feminism cannot

even be named.

Progress in the South is uneven. For the 16th International Day of

Action for Women’s Health in May 2003, a coalition called the People’s

Health Movement made up of women’s groups from Cameroon, Chile,

India, the Philippines, Uganda, the United States, and Yugoslavia cam￾paigned under the banner, “Health for all—health for women!” The

coalition called on governments to take responsibility for women’s health,

to provide primary health care, and to respect women’s reproductive and

sexual rights. But in the years since the World Health Organization

declared “Health for All by the Year 2000,” personal income has dropped

dramatically in many poor countries. One statistic sums up the

xvi Preface

exploitation of Africans: according to the World Bank in 1993, the

median age at death in the United States and Europe was 75 years; in

Africa, it was under 5 years.

In the past 25 years, the G-7 wealthiest nations in the world have used

international financial institutions—the World Bank, the International

Monetary Fund, and the World Trade Organization—to impose condi￾tions on loans and aid. Nations no longer control national public policy:

to qualify for assistance, they must follow the neoliberal economic pro￾gram, cutting government services, eliminating subsidies on food and

fuel, devaluing their currency (which raises the prices of imported phar￾maceuticals even higher), and privatizing, well, just about everything in

sight. Of most concern to women are the privatization of water, health

services, and education.

These loan conditions masquerade as economic reforms. Called struc￾tural adjustment programs, the packages of privatization, deregulation,

and trade liberalization are really designed to ensure the repayment of

loans to Northern governments and commercial banks. The programs

have paved the way for religious fundamentalism, human trafficking,

new forms of slavery, child labor, child soldiers, child prostitutes, and the

AIDS pandemic. National governments are also to blame; they are pull￾ing out of health and education while inflating their defense budgets year

after year. But this is the story of the dog chasing its own tail: structural

adjustment undermines governments and opens a breach for rebels to

fight guerrilla wars, which governments must buy arms to put down.

Women have organized vigorously at community, national, and inter￾national levels over the past 25 years. We participated in a succession of

United Nations (UN) conferences, forging an agenda of women’s rights

in every area of concern. We achieved success with the adoption of the

Beijing Platform for Action at the Fourth World Women’s Conference

held in 1995, which called for women to control their own sexuality and

childbearing, to be free from all forms of violence, and to have access to

credit and inheritance. Since then, reality has run from the rhetoric.

Religious fundamentalists of every persuasion have challenged the

Beijing platform. Some groups like Development Alternatives with

Women for a New Era, Women’s Global Network for Reproductive

Rights), and Women’s Environment and Development Organization saw