Jane Special Feature

Visit this section of our website to learn more about the CWLU's Abortion Counseling Service, better known by its nickname "Jane". 

End Racism in the Healthcare System

(undated: probably 1970) A bold radical paper that exposed racism in America's health system. (undated: probably 1970)

(A bold critique of the pervasive racism present in America's medical-industrial complex of the 1970's. Undated and uncredited.)

1. The Racism of Professional Medicine:

The racism of the American Medical Association is blatant and undeniable. A scant examination of the organization reveals its lily white character, cloaked in the garb of professionalism and elitism. Under the guise of “quality medicine,” the AMA has become the spokesman for regressive policies which curtail medical manpower to its own professional and financial benefit. It jealously guards the pattern of guildism, endorsing allied medical training, rather than the expansion of its own ranks.

The character of the AMA is only a reflection of the whole of professional medicine and the barriers to entry into any of the health fields. Less than 2% of American physicians are black even though blacks constitute more than 11% of the nation’s population. No change is to be expected in the future, as most medical schools have less than 2% black enrollment. The AMA has consistently refused to take any position encouraging minority group entry into medicine nor has it done anything to censure those local and county societies which still refuse admission to members of minority groups. Much of the barrier can be attributed to the elitist admission standards to which most medical schools hold, but again, the AMA has refused to intervene to remove the white stereotypes from medicine.

The oppressive hierarchy of health workers is much more evident in the field of nursing. It is the common hospital where all RN’s are white, L.P.N.’s and nurses aides black and brown. The nurse is the victim of the doctor’s abuse and conveys it to those beneath her. Those subjected to the most oppression are those at the bottom; the sides, orderlies and maintenance workers. They have no protection under national or state labor relations boards, and as the many recent hospital strikes have shown,the right to unionize is one accepted eagerly by few hospital administrators. Earning pittance wages with no dignity or job security, hospital workers have been faulted at every turn in their attempts to organize themselves.

A major cause of worker dissatisfaction is the lack of upward mobility, in the health fields. LPNs cannot become RNs, RN’s cannot become MDs, orderlies see little hope of entering medical school. The current calls for paramedical personnel may be necessary to alleviate the manpower shortage in some specialized areas, but any such program is racist if it continues to perpetuate the dead-end nature of hospital jobs. What we need are more workers to take care of patients, with a leveling of the hierarchy and more equitable distribution of responsibility for patient care. We need a new definition of roles, whereby access to any field is available to all who want to enter, not designated by social class or racial background. No longer can we tolerate a system which capitalizes on the oppression of others for personal advancement.

In the past dissatisfactions about working conditions and subjugation of workers have been cited as causes of inferior patient care. But as the contradictions of the heath care system grow glaringly obvious, hospital workers are finding common cause with poor patients, often serving as their advocates for grievances. Workers know well the attitudes expressed by many professionals towards poor people and the low quality or inadequate care which results.

II. The Duality of the Health Care System:

The privatism of the fee-for-service system allows the doctor to treat whom he pleases. As a top administrator at one Chicago hospital admitted publicly, "Doctors are people. Who wants to spend their time in ‘Siberia’(away from a medical center) with people who stink, can’t speak your language and don’t care about their health, much less about the things a doctor is interested in?”

This attitude of contempt, characteristic of many private physicians results in the dearth of doctors to treat poor people, as in Chicago where less than 185 doctors practice south of Roosevelt Road, i.e., in the entire southern half of the city). This means that for many the emergency room may be the only available source of health care. Yet Illinois is the only state which requires hospitals to treat emergent patients seen in the Emergency Room. If the poor patient is seen upon presentation at the hospital, he most probably will only be given care necessary for life and then"dumped"on the large municipal hospitals. Such dumping of "undesirables" leads to situations where an average black in Chicago travels 16 miles to and from Cook County Hospital while living within one mile of the"white" hospital. Yet 50% of Chicago’s black people can find hospitalization only at Cook County Hospital, due to color bars and quotas which exist throughout the city.

The poor or minority group patient may have fortunate access to two other sources of health care: the outpatient clinic or welfare doctor. The outpatient clinic may be run by a government agency or medical center, but in either case, the result is the same — low quality medical service. They are treated by medical and nursing staff with undisguised condescension and punitive behavior, while they are expected to be “grateful”, for being “given” care. No personal responsibility for patients is assumed by the doctor, as patients see a new one each time. Patients are stripped of their rights to informed consent, confidentiality privacy and dignity; deprived of the “protection” of a private physician and in the case of the medical center, reduced to “teaching material” for the house staff. Feelings of dehumanization and experimentation pervade the clinic, as the patients are not educated about procedures to be performed nor warned of harmful effects. Revelations of practice such as the guinea pig testing contraceptives on Puerto Rican women prior to marketing further justify growing distrust of the professional.

The reasons for these attitudes on the part of physicians are apparent. They are taught on poor people, how to treat rich people. Little emphasis is placed on the special problems of poverty, the ecology of the ghetto. No respect is paid to the value of health as a community resource, although it not only affects demographic change and composition, but also affects the ability of individuals to function productively within the community. It is no coincidence that the high rates of deaths for blacks are in the area of communicable diseases and non—motor vehicle accidents. Blacks are more than twice as likely to die from pneumonia and influenza and four times so in the case of syphilis.

The welfare doctor is the alternative curse of the ghetto ill. No policing has been undertaken by the AMA against such bankrolling, despite loud proclamations of such intentions (for instance, last year by the Chicago Medical Society). $7.50 payments for patient visits and $3.00 per shot (Illinois figures). Thus every patient gets a shot on every visit, whether medically warranted, or not.

The outstanding role that medical institutions have played in the oppression of poor, black and brown people is exemplified in the mental health field. Psychiatrist-as-cop is encountered frequently in jails, police stations, and the army. The definition of mental health is of its nature, racist. Medical staff have little perception of the stresses imposed by the environment, as distinguished from true psychological disorders. It has been shown that blacks tend to be categorized most frequently as ”paranoid schizophrenic” regardless of their problems. This is of little consequence, for in most public mental health agencies: the psychiatrist serves only a cop-role of diagnosis for police purposes, with little thought of treatment. Frequently citizens arrested due to political motivation are quietly declared “unfit to stand trial” shipped off to serve indefinite sentences in mental institutions. Consider the state institution at Menard, Illinois, discovered to be holding hundreds of teenage boys, many former street leaders, due to their so-called “maladaptive” behavior .

Collaboration of medical institutions with police is infamous during riots and demonstrations. Records are perused without regard to rights of the patient to privacy and confidentiality. During the 1968 Democratic Convention, hospitals turned over lists of those seen for injuries in emergency rooms. In the recent murder of Black Panther leader Fred Hampton, the coroner’s office gladly cooperated with police in testifying that the body contained no drugs, whereas a private autopsy had previously showed over 2.5% Seconal present enough to have prevented his awakening. The hospital may also be the site of “informal” torture, as was done to Huey P. Newton when he was arrested in Oakland, California in 1967. Strapped by police to the table on both legs and arms, he lay in agony, as his wounded abdomen was brutally stretched and torn apart.

III. The Need for Racism:

Since the Kerner Commission’s official declaration in 1968 that American society is racist, the American people have anxiously sought to come to grips with this statement, to assimilate it, to pervert it and to find more socially amenable alternatives to fulfill their racist needs.

No longer is the myth of the inferiority of the black man acceptable. Long nurtured by the scientific and medical communities, researchers in many quarters labored to prove the necessary premise that the black was indeed subhuman. As late as 1954, Dr. A. Carothers, an expert from World Health Organizations, stated: “The African makes very little use of his frontal lobes. All the particularities of African psychiatry can be put down to frontal laziness.” His notion that the normal African was a “lobotomized European,” followed closely from those of previous workers, such as Dr. A. Porot, who in 1939 claimed that the life of the African native was dominated by diencephalic urges. The collaboration of behavioral experts in the perpetuation of this myth has its most recent expression in the “jensonist” proposition of the possible existence of genetic racial differences as a basis for differences in IQ scores. For the most part, however, research of this type is no longer as easily funded, as a new, more egalitarian theory is sought.

Hence the argument of cultural opportunities becomes the new mode of expressing society‘s racist needs. The black is not subhuman; he only lacks the proper cultural background. On the government scene enters the new wave of liberal thought of 1960 — and the host of government programs to repair the ladder of American success appear — OEO, Job Corps, Teacher Corps, Headstart. They have all since failed and disappeared; for the basic fallacy of the argument was not exposed: the notion of “opportunity’” implies from the beginning, an asymmetry of station — the benefactor “giving” the seeker an opportunity. Such a stance denies the basic right of all men and women to fulfillment of their selves, to life itself.

And so the argument given in medicine — anyone can enter medical school, regardless of color, provided HE IS “PROPERLY QUALIFIED" No thought is given to the right of all people to health, health care and knowledge of their own bodies.

Clearly the theory of opportunity allows and encourages the perpetuation of our racist system, through both the racism of contempt by the ruling class as they assume the role of benefactor, and the racism of fear among the black and brown bourgeoisie, by promoting divisive competition instead of cooperation among all oppressed peoples.

The emphasis is placed upon the individual black man. It is his problem if he cannot get ahead. Such denial of basic class nature of his oppression and the group effort necessary to break it leads to fulfillment of his individual expectation — failure. He must be satisfied with his low paying job, poor health care and dilapidated housing, for it is his own fault. It doesn’t matter that he is denied entry into many unions and training programs, that there are few doctors who will deign to treat him, or that there is no "better" housing available in the ghetto in which he must stay. It is only through recognition of the collective struggle involved that he and his brothers will be able to join forces to effect change.

IV. An Approach to the Present System:

It is evident that our present health care system demands that a small group (the physicians) retain its authority as extollers of opportunities, while allowing a few to join its ranks in the interest of the myth. Within this system general betterment of . People ’s lives can only proceed under their discretion to decide which doors will open and which will slam shut.

To reorder our health care system, the myth of opportunity must be smashed. In its place must come the recognition of the right of all people to adequate health care and health training. To this end we call for:

1. Solidarity of health and hospital workers with patients to assume control over those institutions with which they are associated.
2. Redefinition of roles of health workers, without regard to sex, race or socio-economic class, and end to the oppressive hierarchy which pervades the health system.
3. Equal access to health care facilities and services on the basis of need, rather than by race or, ability to pay.
4. Elimination of “white” stereotyped, elitist standards of admission to professional training programs, with the institution of vertical advancement available to all health workers.

Given all these expressions of racism in the health care system, what has been the response of the AMA and professional medicine? Opposition to all efforts towards change. They have refused to support those free community controlled clinics which do exist, while local. Health ”authorities” continue their harassment. In Chicago the clinics operated by the Black Panther Party and Young Lords Organization have been summoned to court by the Board of Health for non-licensure, while a survey revealed that over 60% of other clinics in Chicago have been running for years without Board of Health licenses. Only because these new clinics are operated for the people, without regard for the profit motive, they are being subjected to such harassment.

After great public relations from the Chicago Medical Society about its commitment to medicine for the poor communities, the Chicago Medical Society refused to grant any money to the People’s Health Coalition, the coalition of free clinics in Chicago. Despite endorsement by Comprehensive Health Planning, a federal agency, of the high quality medical service provided by these clinics, CMS chose to decide that those clinics do not serve the community.

It is increasingly obvious that the AMA and its local affiliates are less than willing to keep their promises to poor people. Many groups have accepted responsibility for the health care of their own people, both those on welfare and those poor who cannot qualify for aid. They are growing more and more aware that professional medicine is the enemy.

Free Abortion is Every Woman's Right

(circa 1970-71) A statement from the CWLU calling for an end to restrictive abortion laws, and the reform of our entire healthcare system. (circa 1970-71)

(Editor's Note: The Chicago Women's Liberation Union issued this statement on abortion as the movement to reform our nation's abortion laws intensified.)

We in Women’s Liberation refuse to remain silent any longer. We do not accept the will of the so called experts or the powerful in government who up until now have taken it upon themselves to define the rules, the time, and the place where women must bear their children. Abortion is every woman’s right, may she be rich or poor, married or unmarried; and it is a decision which she alone can make, especially in this society where the responsibility for childrearing in the vast majority of cases falls directly upon the individual mother. The laws that restrict abortion to emergencies and exceptional situations, along with the ridiculously rigid policies of hospital abortion approval committees which limit the number of legal abortions to a minute fraction of the actual need are among the most obvious and unjust examples of the way our society oppresses women. We must fight these laws and the medical profession, embodied in the male controlled American Medical Association, on the issue of free and safe abortion, keeping in mind that even this is only a small step toward satisfying our total medical needs, and is by no means a satisfactory alternative to free child care, safe and sure birth control and a guarantee that our lives and our children’s lives are healthy, happy, and fulfilling. Unless we fight the abortion laws in this broader context, we will find that even after the laws are repealed, our oppression will remain. Our victory will be as hollow as the victory of the suffragettes 50 years ago who staked their movement on winning the vote and then found that having the vote didn’t really change things.

Pressure is growing to repeal or change the abortion laws. Ministers, doctors, legislators, and population experts are all joining the repeal effort. We are likely to see the laws fall in just, a few years. But we as women must raise broader social questions, stressing our right to voluntary pregnancy and the need for collective responsibility for children. The blatant racism in the medical profession that forces sterilization on ADC mothers who seek hospital abortions yet approves four times as many abortions for private patients than for ward patients must end.

Our fight puts us in direct confrontation with the AMA, the singly most powerful institution in the health field. Its policies and its wealthy lobby has enormous influence over legislation, while it maintains tight control over the policies of every hospital, medical school, and clinic in the country. The AMA refused to come out in favor of repeal of all laws restricting abortion, a blatant contradiction to the AMA’s own policy statement which says that government must not interfere in the relationship between patient and physician. By making this exception for abortion legislation the AMA is revealing that it is not concerned with the welfare of the women patients of childbearing age, but is concerned instead with its own image in a society burdened by an irrational taboo on abortion, a legitimate and safe contraceptive method. By its choice the AMA is imposing upon women its own male oriented conception of what women are supposed to be: breeders first, total human beings second. Toward fulfilling their responsibility to the female half of the population of this country at the very least the AMA must officially favor repeal of all laws restricting abortion, as the obstetricians and gynecologist- have already voted upon as a group. All hospital abortion boards must be abolished and additional facilities provided for the present and ever growing demand for inexpensive, if not, free, medically safe abortions.

WHOSE DECISION

One of woman’s most basic freedoms is her right to control her own body and to determine if she bears a child. Only she can determine whether she has enough emotional, physical, and economic resources at a given time to bear and rear a child. An unwanted pregnancy is a lonely ordeal, and the consequences are immeasurable in terms of personal suffering. Only the pregnant woman can understand the guilt, fear, and anxiety of being caught between society’s morals and her own needs and desires. But far more painful, and destructive than an unwanted pregnancy is an unwanted child.

Yet at present the decision to bear a child or have an abortion is taken out of her hands by lawmakers and pressure groups that have only the slightest notion of the problems involved. Doctors, psychiatrists, social workers, and clergymen impose their advice on her, based on their sexist stereotypes of her psychological and biological makeup, adding to that their personal religious beliefs about the status of the fetus as a human being. The legislators in New York managed to overcome their stereotypes and religious biases in framing the recently passed law that makes abortion a decision between the woman and her doctor. Twenty-four weeks was named as the cut-off point for a legal abortion because only after this period an abortion becomes a premature delivery of an infant that with proper care can survive outside of the mother. But before 24 weeks the fetus is part of the mother and should not be considered as a separate human being with rights that contradict the desires of the mother.

Even in the case of the New York law, men decided what rights women can exercise. And the fact still remains that these institutions that retain the fight to determine the laws surrounding childrearing refuse to take responsibility for the well being of the children born under their laws. It is wrong that this society does not recognize children as the social wealth of everyone, instead of as the private property of their parents.

THE SAINT AND THE WHORE

Our society glorifies motherhood (if performed properly within the framework of middle class marriage, sanctified by the church and duly licensed by the county clerk). The married mother is a saint. She finds her ultimate fulfillment and achieves her biological destiny in motherhood. Childbirth is her most creative act. It is proof of her femininity. The married mother is a contented brooding factory and a devoted servant of her husband and children. She expresses her individuality through the things she buys for her home and family -— furnishings, food, clothes, and appliances. If a married woman does not want children, she is considered anywhere from cold and unfeminine to desperately in need of psychiatric help. If she indicates she wants an abortion, doctors and social workers will try to help her adjust to her pregnancy. They think of pregnant women as “expectant mothers.”

Yet statistics indicate that about one out of four married women terminates at least one pregnancy in abortion. In recent years approximately one of every five births in the U.S. was unwanted, and those births account for 35—45% of the population growth, according to Dr., Westoff of Princeton.

Just as the married woman is glorified as a wife and a mother, the unmarried women is glamorized as a sex object. She is taught that she achieves identity and fulfillment by pleasing and catching a man. To accomplish this, she is told to buy everything from Folger’s Coffee to strawberry flavored douche. But if she becomes pregnant then she is labeled a whore. Our society views pregnancy as a punishment for “immoral” or “careless” sexual activity of the unmarried woman. Society sets the trap and then condemns the pregnant woman for failing into it. It forces her to have the child, but refuses to take any responsibility for the child when it is born. Welfare laws are punitive, and child care facilities are nonexistent. The same society that condemns the unwed mother has virtually no concept of the unwed father. It glorifies motherhood within marriage, yet labels the unwed child “illegitimate.” There is no such thing as an illegitimate child. No child should be branded for life by a totally unnecessary stigma that implies that his or her existence as a human being is not fully recognized by society.

Abortion becomes the only realistic alternative for many women, married and unmarried, who are caught in society’s trap. Some of these women simply don’t want a child; others may want the child but are forced by economic need or threatened by social stigma to seek an abortion. In a humane society no woman would be forced either to have a child or to terminate a pregnancy against her will.

ABORTION: A MARKETABLE COMMODITY

Because abortions are illegal, they are exorbitantly expensive. Equal opportunity under our law means that well-connected middle class women can usually get hush-hush D&Cs in hospitals or can afford to fly to England, or to buy a safe abortions on the black market. Even therapeutic abortions can be bought, if the woman can stand the humiliation of pleading her own mental unfitness before a self-righteous board of doctors and psychiatrists. More than five times as many whites as non-whites are granted therapeutic abortions in New York City, a statistic which is inverse in relationship to the need.

Poor and black women, on the other hand, bear unwanted children or face unsafe backalley or self—induced abortions. In New York City, 80% of the women who die from illegal abortions are black or brown. There were almost 10,000 deaths from abortion, more than 4,000 of these from self-induced abortion. Those acts of desperation account for one—half of the deaths associated with pregnancy. In countries where abortion is legal the death rate is one in 80,000, or one-fourth the death rate from full-term pregnancy. Gynecologists who shake their heads when a desperate pregnant woman asks for help will shake their fists in righteous indignation at the “back alley butcher.”

A hospital D&C, even under the current profit-oriented health system, seldom costs more than $150. A black market D&C costs from $300 to $1,000, and the money often ends up in the hands of the syndicate or of corrupt politicians and law enforcement officials who get a kickback from the illegal trade.

REFORMERS SPEAK WITH FORKED TONGUES

We should be aware of reform laws which make abortions legal some of the time or under certain conditions, such as rape or danger to a woman’s health. Reform efforts avoid both the issue of woman’s freedom and the issue of social responsibility. Any reform law still holds that a woman’s childbearing is subject to legislative judgment or medical benevolence. Reform legislation will make it even harder to get all abortion laws wiped off the books.

Moreover, reform legislation does not significantly change things. In the eight states where reform laws have been passed, the inequities are increased rather than decreased. Authority relinquished by the legislature has been taken up by the medical societies, hospital boards, and private doctors. Safe abortions, once again, are for the rich but not the poor. In California, for example there are more therapeutic abortions being performed by private doctor in private hospitals, but the number of abortions performed in clinics has not changed under reform laws. The illegal abortion rate remains the same, and so does the number of casualties from illegal abortions.

ABORTION LAWS ARE UNCONSTITUTIONAL

California's s reform abortion law was struck down in September of 1969, as unconstitutional by the Municipal Court of Orange County, on the grounds that ‘The right to choose to bear or not to bear children is a fundamental right of the individual women to be exercised in any manner she chooses and (it) may not in any way be abridged by law.” One of the major faults of the law recognized by the court was that undefined and unlimited authority was given to the Joint Commission of Accreditation of Hospitals, which resulted in unfair and unequal application of the law. Two months after the California decision the U.S. District Court for Washington D.C. declared unconstitutional that part of the statute that defined abortion legal only when done “for the preservation of the mother’s life or health.” But as the civil rights laws showed, a legal provision of right does not guarantee that right in actuality. The hospitals in Washington will not increase their abortion rate although doctors would no longer be running the risk of prosecution for performing abortion. One reason is that the hospitals fear getting swamped with abortion cases from out of state. The answer to the dilemma is that the right to abortion must be made a federal constitutional right, like freedom of religion or freedom of speech. If women had written the constitution it probably would be a basic freedom today. A poll conducted in May of 1969 by Modern Medicine showed that 63% of the 27,000 doctors who responded favor of making abortion available upon request and 51% of them did not qualify this. Nevertheless at the 23rd Clinical Convention of the AMA the House of Delegated voted down as proposal endorsing repeal of all state abortion laws.

The exports, the AMA, the hospitals, the government are the real decision makers. Abortion decision making, like all other questions of life, must be taken out of the hands of these huge institutions and given to the people who are effected by theses decisions in the most intimate way.

Certain individuals and groups are lobbying for legalized abortion solely on the grounds of the population explosion. In reality, many of these groups want to control some populations, prevent some births, especially those of poor or black people. The population explosion has been used as an excuse for genocide by legislators and taxpayers who are sick of welfare and ADC payments. While it is true that the population explosion has freed women from the need to reproduce in order to preserve the species, it has also been used to institute now types of control and oppression over poor and third world women.

The same myths about the population explosion that are used to justify planned parenthood clinics in the ghetto and sterilization of ADC mothers are also used to justify U.S. -financed sterilization of 5.5 million men and boys in India in exchange for a transistor radio.

If there is a danger from the “population explosion” in this country, it comes from the middle-class suburbs where families with four to six children are the norm. A suburb an boy consumes and occupies 50 times as much as his environment as the Indian youth. Yet there are no planned parenthood clinics in the white suburbs urgently fighting the population explosion.

We are opposed to any form of genocide. We are for every woman having exactly as many children as she wants, when she wants, if she wants.

WHAT ARE THE ALTERNATIVES?

What we want sounds just like what everyone in high and in low places in this country are supposed to want: that every child be born healthy, happy and wanted by healthy, happy, and loving parents. This brings up social, economic, and political problems far bigger than abortion, or even the problem of general health care alone. We in Women’s Liberation recognize that the present medical care, contraceptive methods, and abortion legislation, as well as the commonly excepted role of woman as housewife and mother, the unavailability of day care, and the rotten living conditions and poor diet of 25 million Americans and a health system run for profit instead of for people pushes the rosy vision of healthy, happy people far into the future But we are not willing to wait. Things must improve for the people living now

As women we are concerned about women’s medical needs. free and available abortion being only one urgent problem, because women’s needs have been pushed aside and neglected too long. But we realize that, in order for all the health needs of women to be filled, not just those relating to childbearing, the priorities within the medical care system must be changed. Instead of being designed to suit the conveniences and pocketbooks of the, hospitals, the AMA, the government, the drug and insurance companies and the medical schools, the medical system must be greatly expanded, and oriented toward preventive medicine with private, personal attention for all people in the same facilities. The finest health care that our technology can provide must be available to everyone and not only to the rich.This means that the money will have to stop flowing into the hands of the drug companies and doctors , and start flowing from the war expenditures into medical facilities that are free or fully available at a nominal fee to all residents of the U.S. It is a revolting fact the the U.S. infant mortality rate is 17th for the nations of this world; that the infant mortality rate is highest in Chicago, the same city in which the average salary of obstetricians and gynecologist is the highest for the nation. Because the health care system is a profit system that makes its money over bad health , we do not foresee the present policymakers who have enriched themselves up until now, as the future leaders of a complete overhaul of the health system. The only real alternatives, then, appear to be the things that we can do ourselves, by our own initiative. In the area of women’s health these include community women’s clinics, an abortion referral service, day care centers, test cases en the constitutionality of abortion laws, and an ongoing effort to bring the problems of contraception, and social responsibility for children out into the open.

THE WOMEN’S CLINIC

One of the projects of the Chicago Women’s Liberation Union is a free community women’s health clinic which is new only in its preliminary stages. The clinic will concentrate on preventive care, as well as good human treatment of the sick. We emphasize community education in health, including pro-natal care, women’s and children’s nutrition, individualized counseling on birth control methods, sex education for teenagers, natural childbirth, and abortion counseling.

We chose the Southwest Side of Chicago for the clinic so that we could reach out to our sisters in working families from all the ethnic and racial backgrounds who live there.The women in the community will decide which services they want and will hopefully work in the center and play a major role in directing it.

We women need a free clinic of our own because we make 25% more doctors visits than men and more than twice as many with our children. Our clinic will give complete attention to the needs of each woman, unlike doctors new who often assume that women are incapable of understanding complex medical explanations, so often omit crucial warnings and the medical choice involved in prescribing a particular treatment. In the controversy ever the pill and the lack of sufficient information about what side effects and ether serious complications are being risked the medical profession has violated every woman’s option to control her body processes. The woman, not the doctor should decide what should or should not be risked. Not only have doctors been sloppy in providing information but they have been in some cases grossing irresponsible in prescribing the appropriate pill to a particular woman’s s chemical make-up. One planned parenthood clinic cut down the dosage for some women arbitrarily without warning them that they could get pregnant. When some women did get pregnant the clinic would not take responsibility for the unwanted pregnancies.

THE ABORTION COUNSELING SERVICE

The Women’s Liberation Movement in Chicago runs an abortion referral service that will help any woman who wants an abortion to got one as safely and cheaply as possible under existing conditions. More than a thousand women have passed through our service, and have been saved the dehumanizing and terribly frustrating experience of finding an abortionist through unreliable contacts, or of experiencing the humiliation of trying to prove to an abortion approval board that she is psychotic. But these women had to still pay $400-$500 on the average for an operation that should cost nothing or a few dollars as a government sponsored, alternative contraceptive method.

Although abortions are illegal in Illinois, the state has not brought charges against any woman who has had an abortion. Only those who perform abortions have been prosecuted.

Any information given to the counselor by the women seeking an abortion is confidential, and would be used for other purposes only with her explicit consent. But no matter how many women get safe abortions by sympathetic doctors they are only a minute fraction of the 1-1.5 million women who desperately seek this minor operation every year.

SUCCESS THROUGH COLLECTIVE ACTION

The health clinic and the counseling service are only two projects made possible by women working together to satisfy their needs. The Women’s Liberation Movement was formed when more and more women all across the country realized that they were helpless as individuals who, even if they were lucky, could sneak past the obstacles like job discrimination, unwanted pregnancies, the pressures of the mother-housewife role, and somehow make a compromise with the system, providing of course that they had money, determination, and talent.

The Chicago Women’s Liberation Union is one of many organizations in a decentralized movement with branches in large and small cities all across the country, The Chicago Union is itself made up of about 20 smaller chapters located all over the city, which come together in a city-wide meeting once a month. Each chapter has its own interests and projects, yet recognizes its solidarity with the larger group by the sense of the sisterhood,i.e., the feeling of support and kinship with other women. Perhaps what sisterhood means to us is best expressed by this anonymous poem.

Our history has been stolen from us.
Our heroes died in childbirth,
From peritonitis,
Of overwork,
Of oppression,
Of bottled-up anger.
Our geniuses were never taught to read and write,
We must invent a past adequate to our ambitions.
We must create a future adequate to our needs.

The Politics of Sterilization

(1971) A leaflet distributed by the CWLU to bring attention to the problem of sterilization abuse.

(Editor's Note: Sterilization abuse was a serious issue that the CWLU addressed in a number of ways. This leaflet is an example of an early CWLU attempt to bring forced sterilization to the attention of the women's movement.)

Waiting in the doctor’s office, I picked up the July ‘71 issue of McCalls. I was interested to see that McCalls now has a monthly newsletter for women which they call “Right Now.” I was even more interested to see what the first, feature article in July’s “Right Now” was all about — a new, better—than—ever method of sterilization for women.
According to Eleanor Clift, who wrote the article, this new method, with the imposing technical name of laparoscopy bilateral partial salpingectomy, can be done either overnight or on a one—day outpatient basis. It is considerably cheaper (at about $3OO) than the older method which required a fairly major operation to tie the Fallopian tubes (which carry the egg from ovary to uterus) . This older method, called a tubal ligation, costs from about $900 to $1,200 or so. With the new method, a very small incision is made in the navel and a laparoscope (a long slender tube) is inserted. A second, also small incision is made below the navel. A small, electrified forceps is put into this incision, and with the guidance of a light shone through the laparoscope, the forceps is used to cauterize the Fallopian tubes. This operation (like the tubal ligation) is almost always irreversible; that is,. it rarely can be undone to allow the woman to bear children.
All of this takes about twenty minutes under anesthesia, and is followed by what “Right Now” described as “minor discomfort for a few hours.” There are a few limitations as to which women can have this type of minor surgery (very obese women cannot be operated on this way: neither can women with adhesions — scars — from previous surgery) , but doctors generally feel that this is a very beneficial and widely applicable procedure. It turns out, according to the article, that this method of sterilization has been known since 1914. So why is it being pushed now?

Here I feel that the women’s movement has a few comments to make. It seems clear that this kind of surgery offers a welcome opportunity to those women who have decided definitely that they do not want to have children — or to have more children, as the case might be — and who do not want to take the risks of currently available methods of birth control. To the degree that women are developing lives centered around things other than the traditional wife—and—mother role, this operation offers another alternative to us, one which we can be glad to have around.

But we must recognize the other side of the coin as well. It seems important to note that Dr. Clifford R. Wheeless, a Baltimore gynecologist who is singled out in the article as a pioneer in working with this type of operation, is currently going to India, where he will train physicians to perform this operation in tents set up in the countryside. “Right Now” mentions “concern with overpopulation” as one reason for the current interest in this operation. Then I myself checked into possibilities of having my own tubes tied (I had a standard type of tubal ligation last January, at a cost of about $900 and five days in the hospital), I heard that this type of operation was being done experimentally at a local outpatient clinic. I was lead to believe that the clinic treated mainly women on welfare from the black community; I was told that I myself was not eligible to be enrolled in the clinic.

What all of this brings to my mind is the fact that more efficient means of sterilization can be used against poor and non—white women, both here in the U.S. and abroad (as in India) to make it easier to induce or coerce them, against their will, to give up their right to determine for themselves whether they will have children. For those of us who are white and middle-class, it might seem unreal to suggest that this could happen. But women on welfare, women in the delivery room at Cook County, women in India whose children are starving are in far more vulnerable positions than we can imagine. We must remember that the right to control our own bodies means exactly that: the right to choose to have children, as well as the right to choose not to.

Woman as Patient

by Laura Green (1971) Women faced deepseated and often outrageous discrimination both as patients and as healthcare providers. by Laura Green excerpted from Health Rights News September 1971 -- final paragraph by Womankind. 

(Editors Note: Prejudice against women both as patients and has healthcare providers was very strong in 1971.)

What really happens when we menstruate? Can't anything be done to end menstrual cramps? Why isn't there a safe and effective means of birth control?

Most of us don't know the answers to these questions, or to many other questions concerning our bodies and how they work. When we are ill, get pregnant, or want birth control, we have to rely on the doctor's advice without really knowing what it is that is happening to our bodies, why the doctor is saying what he (generally) is saying, or, in fact, whether what the doctor is saying is safe or effective. And this is true for virtually all women, even the rich. The American medical profession is based on keeping the patient ignorant -ignorant of her own body, ignorant of how normal, healthy bodies work, or what happens when we are sick, or of ways to know when an illness is serious or minor.

This built-in ignorance starts when doctors fail to explain how our bodies work when we are kids. It continues as our breasts develop and we begin to menstruate without ever having any sympathetic, clear explanation of what is going on, either from our mothers (who probably don't know themselves), our doctors (if we are rich enough to have a regular family doctor), or our schools (which don't begin to know how to deal with the subject of sex). It is reinforced if, as young women, we become pregnant, and deal (if we are lucky) with an obstretician who, though competent, plays the "father role" to us. He will try to "reassure" us about the fears which it is assumed that we have without ever giving us enough real knowledge about the exciting process of growth and birth to give us a clear understanding of what is going on.

This built-in ignorance results in two things. One is money for doctors whom we are forced to turn to and whose judgments we are forced to accept unquestioningly because we don't know enough to be able to challenge them. The second is our own sense of helplessness about our own bodies, which we ought, ideally, to know and understand very well. These two things work to reinforce each other; the more helpless we feel, the more we rely on doctors to tell us exactly what to do.

Good health care would be different. It would start with teaching us all, from infancy, what our bodies are like and how they work. We would each know enough to be able to care for our bodies wisely, and can care for ourselves, rather than making us into helpless, ignorant-feeling to be able to work with persons trained in medicine in finding out if our bodies are working as they ought to, and in deciding what to do if they are not. It would work to make each of us feel that we understand women, who must look to the doctor to make basic decisions affecting our lives.

woman as doctor

When Elizabeth Blackwell tried to become this country's first woman doctor over a century ago, children mocked her in the streets, landladies refused to rent her a room, and her teachers tried to prevent her from watching surgery. Woman doctors have come a long way since then, but the fight for equal admission and treatment in medical schools in hardly over.

Although the percentage of women in medical schools has risen from 9 to 11 percent in the last year, it hasn't changed significantly from the beginning of this century when four per cent of all medical students were women. The U.S. compares poorly with the rest of the world -three out of every four Russian doctors are women, and nearly one in three English doctors and one-quarter of the doctors in France are women. Only Spain, Madagascar and South Vietnam have a smaller proportion of woman physicians than the United States.

American medical schools don't seem troubled by this state of affairs. A seven-year study by Dr. Harold I. Kaplan, a psychiatrist at New York Medical College, revealed the deep-seated prejudices of medical school administrators toward female medical students. Dr. Kaplan's questionnaire provoked some responses he calls "too outrageous to publish." The answers he did print, in an article in The Woman Physician, dismally confirm the conservatism, indifference and callousness that American medical schools show women applicants and students - particularly those who try to complete their medical training while raising children.

One dean wrote: "I just don't like women -as people or doctors - they belong at home cooking and cleaning. Certainly not as medical colleagues who are at best dilettantes in our field." Another said: "We have not been overly impressed with the women that have been admitted to medicine even though academically they are entirely satisfactory. I think they ordinarily have so many emotional problems that we have not been particularly happy with their performance." A third dean complained: "I have enough trouble understanding my wife and daughters without attempting to explain the questions in this paragraph."

The study indicates that women who do get into medical schools are at least as well qualified, if not better, than their male counterparts. Marquette University wrote: "Those we admit must present excellent college records and Medical College Admission Tests scores, and must furnish evidence of emotional stability and of sincere motivation for medicine as a career."

Dr. Marvin Dunn, assistant dean at the Medical College of Pennsylvania in 1969, who interviewed admissions officers at 25 Northwestern medical schools, discovered that 19 schools admitted men in preference to women unless the women were demonstrably superior. He found women were not judged on an equal basis but required special justification for acceptance.

Most medical schools allow pregnant students to continue their studies so long as they do not miss too much time. However, most students resume their full school schedules within three days to two weeks after giving birth, hardly an adequate recovery period. Students return to class because they fear they will lose the year's credit if they stay out longer. In contrast, several schools in the Kaplan study said a student with hepatitis or mononucleosis might be given up to two months leave with full academic credit.

Most other countries provide a longer post-partum recovery period for both students and working women. Russian women are given 56 days paid leave before delivery and 56 days after. A woman is exempted from night duty until her child is one year old. In Sweden, a pregnant woman physician may take as much as six months leave around the time of her delivery. Polish women students are granted three months leave and lose no academic credit.

All of this is doubly interesting in view of the fact that the United States needs about 50,000 more doctors. All those who control admissions to medical schools - the American Medical Association, medical school administrators - are guilty both of blatant discrimination against women and of carrying out policies detrimental to the health of all Americans.

original editor's note: the Liberation School offers courses in natural childbirth nutrition, women and their bodies, and high school women and their bodies to help combat the type of ignorance discussed in this article. Call the Liberation School in care of the Chicago Women's Liberation Union, for information about these courses.

The Chicago Maternity Center: 77 Years of Home Deliveries

by Alice (1972) An article from Womankind which traces the history of the Chicago Maternity Center, a unique home birth clinic on Chicago's Westside threatened with closing by powerful financial interests. (1972)

(Editors Note: The Chicago Maternity Center was a unique clinic that allowed women to give birth in their homes. Long a landmark on Chicago's impoverished Westside, it had served generations of women. In 1972, it was threatened with closure by powerful financial interests. The CWLU organized a campaign that delayed, but could not halt the closing. This article was written as the campaign to save the Chicago Maternity Center was just beginning.)

In June of l688, the Queen of England was about to give birth. Her husband, King James II, wanting the child to be (naturally) male gave these directions to the midwife: “Midwife, since it depends on you, put the pieces of a boy into it”.

This story was recorded by the royal midwife who, fortunately for her, delivered a boy to the King. The ignorance of the King was probably not unusual. At that time, men knew almost nothing about childbirth. Until 100 years ago childbirth was in the hands of women, midwives who knew from practical experience how to help nature along. These woman were very capable of handling most deliveries. But some complications, such as a breech birth usually meant death for mother, child, or both.

Modern Medicine Begins

In the beginning of the 1800’s the science of medicine in Western Europe shared the fate of all science: it consisted of a few theories formulated by ancient Greeks and some practical knowledge gained by secretly (in violation of Church law) inspecting dead bodies. It was not until the Industrial Revolution, the growth of factories in Europe and America; that science became modern industrial science, and medicine along with the other sciences was applied and practiced on a widespread basis.

This historical development of medicine in the nineteenth century was a necessary step in the development of capitalist economies. As more and more wealth was being produced by the workers in expanding factories, the factory owners (capitalists) needed ways of preserving and replacing the population of workers. This meant they had to care about both the number of people available to work and the health of workers with special skills. Unlike the Catholic Church which used to forbid scientific experimentation, and unlike the kings and barons, who couldn’t care less about it, the capitalist rulers encouraged scientific development since it could be profitable to them.

Modern medicine is young in terms of human history. It wasn’t until after 1860 that Louis Pasteur established the connection between bacteria and disease. That discovery drastically changed the scope of medicine. The causes of such communicable diseases as malaria, typhoid fever, diphtheria, and gonorrhea were all discovered within a few years after Pasteur’s breakthrough.

From Midwives to OBs

Modern obstetrics (obstetrics: medicine concerned with the care of women during pregnancy and childbirth) began around the same time. But not without complications. When men first replaced women in the delivery room and began to use forceps and make frequent examinations during labour, there was a notable increase of a disease called “childbed fever”. Childbed fever began with a chill about the fourth day after the baby’s birth and nearly always resulted in the death of the mother. In 1846 a doctor named Semmelweiss began practicing in the First Obstetrical Clinic of Vienna —a clinic run by “professionals”, men who were doctors or medical students. Nearby was another clinic staffed by midwives. The men soon found that their clinic’s rate of childbed fever was much higher than that of the midwives. As a result, expectant mothers often demanded to be delivered by the midwives. This situation caused great embarrassment to the new profession of obstetrics. It was particularly upsetting to Dr. Semmelweiss who was very proud of his medical degree. He investigated the causes of childbed fever and discovered that the medical students often went directly from dissecting dead bodies, cadavers, into the delivery room without washing their hands. The midwives, who did not touch cadavers in the course of their work, did not spread infection. Semmelweiss began requiring his physicians to wash their hands after touching cadavers. One year later the rate of childbed fever in his clinic had dropped from 12% to 3%.

Semmelweiss’ colleagues demonstrated the traditional reluctance of the medical profession to accept new ideas, particularly when the new ideas meant admitting doctors had caused countless unnecessary deaths. Semmelweiss was fired from the clinic. Not until 30 years later were his ideas about the prevention of childbed fever put into widespread practice. It was during this period that the Chicago Maternity Center began its curiously unique existence. (It is curious that the CMC is unique. Although the need for such an institution is widespread, the CMC is one of a kind Its beginnings correspond roughly to the beginnings of obstetrical science.

Dr. DeLee, the doctor who founded the Chicago Maternity Center had gone all the way to Semmelweiss’ clinic to learn to deliver babies. In 1895 he established a center to provide safe home deliveries in Chicago. Most of his patients were poor, immigrant women. DeLee also founded the first maternity hospital in the midwest, Chicago Lying-In Hospital. It began in 1910 with the purpose of training obstetricians.

The First Crisis

By 1929 DeLee’s center was delivering about 2000 babies a year at home. The doctors and nurses staffing the center came from Chicago Lying—In. But when the Depression came, the Hospital which had been created to meet the staffing needs of the Maternity Center, decided to close the center down as an economy measure.

Fortunately DeLee understood the Maternity Center was more important than the Hospital and took it upon himself to run it without benefit of hospital support. Since no one could afford to pay for a delivery, DeLee also had to raise separate funds.

In 1931 Dr. Beatrice Tucker joined the staff as medical director of the Maternity Center. She has held that position ever since. Dr. Tucker put together a board of directors to manage the Center’s finances and fund raise since the Center could not be supported by the patients’ fees. Between 1929 and 1941, the Maternity Center home delivered am average of 360 babies a month.

Recognizing the need for a place to bring patients in case of complicated deliveries, Dr. Tucker sought the back—up support of several Chicago hospitals. An agreement was finally made with Wesley Memorial whereby the Hospital would require its residents (a resident is an M. D. who hasn’t finished training in a specialty) and fourth year medical students to spend time working for the Maternity Center.

The growth of the Chicago Maternity Center in those years paralleled a general shift from midwifery to obstetrics. As more and more babies were being delivered by doctors, in or out of hospitals, states around the country were passing laws about midwifery. In some states (Illinois) it became illegal for a midwife to practice. In others she was restricted to delivering in a hospital under a doctor’s supervision.

Medical practice was changing quickly during this period. Scientific discovery was still a major cause of change, but its role was becoming secondary to that of medical economics. Today it is this aspect of medical care which determines what happens or doesn’t happen when one sees a doctor. Modern medicine, first developed to serve the needs of capitalist enterprise, has become a major capitalist enterprise itself. Hospital construction, health insurance, and drugs — to name a few components — are all big businesses, with the goals of big business: to make profit.

The Present Crisis

Obstetrics is no exception. The Chicago Maternity Center has provided women with critical services for 77 years, but today its existence is being threatened. The overwhelming majority of the women who use the center are poor. Statistically, they are 140% Latin, 45% black, 5% white Appalachian and 5% white middle class. The Center charges $200 for a delivery, but the fee is adjusted according to ability to pay and almost no one pays the full $200. 30% of the Center’s cases are emergencies — women who have not seen a doctor before delivery or who have just delivered unattended. The Center is threatened not because it is less needed today — the need has increased — but because all the forces of medicine as big business operate against it: it is not profitable.

Recently the gold coast hospital complex, consisting of Wesley Memorial, Passavant, Northwestern Medical School and its clinics, announced a new hospital will be built in their area. This hospital, scheduled to open in about 2 years, will be called the Women’s Hospital is supposed to house the present Chicago Maternity Center among other things. Management of the new hospital appears to be planned in a peculiar way. Different services have been contracted out to the other two hospitals and to Northwestern’s clinics. The net effect is that so far no one group is taking public responsibility for the Hospital’s planning and policy. All advance public relations insist the new Hospital will not phase out the Chicago Maternity Center and will continue home deliveries. But recent decisions place these promises in doubt.

The Chicago Maternity Center is totally dependent upon its medical staff since that is all it has. Last year Northwestern Medical school stopped requiring its fourth year students to work for the Center. Wesley presently sends only one resident. This means the CMC operates with only two obstetricians (Dr. Tucker at age 75 is one of them) and one resident. Since one obstetrician must be on call at all times in case of complications, they are seriously overworked. Wesley and Northwestern have caused critical staff problems; the question is, why?What Is To Be Done?Increasing numbers of men and women are beginning to understand some things about health care in America: on the one hand quality health care is necessary to live; on the other hand the quality of the health care provided most people keeps them struggling to survive. This situation must end.

For example, the Chicago Maternity Center, which for some women is the only alternative to delivering at Cook County Hospital and for others is simply THE only alternative, must not be allowed to die. Likewise, the new women’s hospital must not be permitted to practice the kind of medicine, common to hospitals, which scorns or ignores the health needs of most women.

We must demand:

• Hospital provided day care for patients and health workers who are mothers.
• A program in midwifery.
• Seats for patients and health workers on all hospital committees deciding who will be hired and fired; setting policy about who will be granted abortions; and reviewing medical decisions in individual cases.

The new hospital must meet peoples’ real health needs. Any women interested in working toward this goal call Womankind.

Having a Baby My Way

by Pat (1972) A woman describes having her baby at home with the help of the Chicago Maternity Center, the legendary home birthing center formerly located on Chicago's Westside. by Pat (1972)

(Editor's Note: Pat describes having her baby at home assisted by the Chicago Maternity Center, the legendary Westside home birthing clinic. The clinic was closed after a long struggle with Chicago's male dominated health establishment. This story is from the February 1972 Womankind.)

I decided to have a child— my way. Ideally, I would have liked to have all my friends gathered together while my child’s father delivered it up into the world, and afterwards we could have all sat watching the afterbirth blazing merrily in the fireplace. However, I did not know a doctor or a nurse or a competent midwife who would assist at the at—home ceremony.

So I chose the next best thing: the Chicago Maternity Center. I was determined that nobody was going to direct my show but me. Nobody was going to get me into a hospital (hospitals are for the diseased, not the pregnant), and nobody was going to take my newborn screaming in the first trauma of life to some sterile nursery, deciding when I could see it and feed it— at the institution’s convenience.

Initially, I chose the Maternity Center only because it was the only place I knew of which would assist at a home delivery. I did not even know at first that the mother’s home environment is naturally the safest place to have a baby (for unlike in the so-called “sterile” hospital room, where the risk for catching a disease is shockingly higher, the baby will be born already as resistant as its mother to the particular elements of her bacterial environment) and that home babies have a significantly lower mortality rate than hospital babies. The Chicago Maternity Center has a much lower mortality rate than all of the hospitals belonging to the American Medical Association. I knew only that home was the only choice for me, regardless of, in spite of and perhaps because of modern obstetrics.

For nine months I went for regular adequate prenatal checkups taking a number each time, waiting my turn with 100 other women. During the long monthly sessions(toward parturition weekly) I met many women, including a ten year old mother, a mother of thirteen children on welfare, and a Radcliffe graduate— all coming to the Center in order to have their babies at home, either by choice or by poverty.

Throughout the nine months I gathered my stash of supplies for the grand ceremony: a two foot high stack of newspapers; one and one half yards of plastic sheeting; a dozen safety pins; a roll of toilet paper; a dime for calling the Maternity Center, a kettle with a lid for boiling water; a wash basin; a strong electric light; four dozen sanitary napkins; etc.

The day of the breaking of the bag of waters finally occurred. I thought, “Today is the day”, and had my dime ready. But nothing happened that day. On the night of the second day I thought, “Perhaps I’m having contractions and don’t know it!” So I called the Center to ask their opinion, they asked if I would please come in that night for a checkup. My man and I scrounged up carfare from neighbors and made our way to the Center. One drawback of the Center is that you cannot choose from month to month or even at the finale from whom you will get treatment. You get whomever is on duty. In this case the doctor I had was excellent. The young, Filipino woman doctor was beautiful and gentle. She said, “Your bag of waters has in fact broken, nor have contractions begun. We will induce labor. Do you wand to have your baby tonight or tomorrow?” I could not wait for the morrow. Two student nurses shaved my pubic hair and pumped me with enema water to flush out my midnight dinner. Then the two nurses, the doctor, a male resident, my man and I all drove back to our house with a few bags of equipment. Being a novice, I merely sat down on the couch wondering if we would all just sit around until the baby popped out.

The two student nurses laid plastic sheeting and newspapers on the bed, put the kettle of water on the stove to boil, cleared the table, set up the large electric hospital lights they had brought with and locked my nervous cat in the closet. The doctor set up an intravenous unit of oxytocin (the natural hormone which our female bodies usually produce to start labor) to run into my veins. I laid on the bed while the contractions gradually increased in time and my cervix dilated to six centimeters. Most of the two hours the Filipino woman sat on the bed beside me stroking my engorged uterus with a rhythmic lulling, while my man sat opposite her stroking my head. Mr. Resident, whose job was to watch the woman and learn from her, was conspicuously irritated and irritating in his role. He was offensively rough and insensitive, jabbing his fingers into me every few minutes and carrying on about how I should be given ether and be done with it. When the baby was ready to move down the birth canal I got out of bed, walked table and climbed up on it. The instruments on hand in case of necessity were boiled and waiting. After a few minutes, the small woman instructed the resident to call Dr. Beatrice Tucker, for she is often on hand at the Center to assist at complicated births. Dr. Tucker arrived within minutes to instruct in her specialty— breech deliveries. When her concern was no longer necessary; she left just as quickly.

The baby finally slurped from my womb still covered with the dark purple—veined placenta. First the infant was handed to me, then to his father who took him in the bedroom with one of the student nurses to be cleaned of mucous and given some water to unplug its air passages. The resident kept me on the kitchen table, sewing my slightly cut uterus. When he mumbled, “Whoops, I dropped a stitch,” he was politely informed that such things are not said in front of the inaccurately labeled “patient”. I was jealous that I was made to stay on the kitchen table for a half hour until the excessive bleeding stopped while everyone else was in the bedroom getting first crack at my baby. After a while I was able to walk back to the bedroom; where I could hold and fondle and feed my child to my heart’s content.

In very little time the two students nurses, the tired resident and the lovely Filipino woman I will always remember with joy, packed up their equipment, cleaned up the blood-covered newspapers and left (leaving behind them the services of a visiting nurse who came each morning for two weeks to check on the baby and me ). The people from the Chicago Maternity Center were the most important people in my decision to have my child my way —at home— and I never even got their names.

CHICAGO MATERNITY CENTER
1336 S. NEWBERRY
M06-3423

(Editor's Note: Although the Maternity Center no longer exists, we have included its old address and phone number as a tribute to its staff and the many women who had their babies with its assistance.)

Save the Chicago Maternity Center

by WATCH (1972) WATCH- Women Act To Control Healthcare, led a campaign to try to save the Chicago Maternity Center which offered safe home birth services to Chicago's impoverished west side. (November-1972)

(Editors Note: WATCH- Women Act To Control Healthcare, was organized by members of the Chicago Women's Liberation Union. WATCH led a campaign to try to save the Chicago Maternity Center which offered safe home birth services to Chicago's impoverished west side. The Center eventually was forced to close despite public protest. Below is the text of an organizing leaflet put out by WATCH.)

We, the Women of W.A.T.C.H. (Women Act To Control Healthcare) want you and your community group to join with us in our struggle to continue the services of the Chicago Maternity Center and to influence the building of Northwestern University ’s Women’s Hospital.

The Chicago Maternity Center is the only clinic in Chicago that sponsors home delivery. In addition, it provides complete pre- and post natal services and is the only agency providing 24-hour emergency services for the delivery of babies. Unlike other medical institutions, the center serves all people of the city according to an ability to pay.

Some years ago, Northwestern University agreed to provide back-up medical services and staff to the Maternity Center; the Maternity Center, itself, is financially supported by private donations recruited by a voluntary Board of Directors. Northwestern’s staff support included a full-time resident and 4th year medical students. Northwestern has reduced this staff support in recent years and this June the full-time resident was withdrawn. This left the center as the entire responsibility of medical director, Dr. Beatrice Tucker. Twenty-four hour emergency call is an inhuman burden which no single doctor should bear, let alone Dr. Tucker who now is in her 70's. She has devoted the last 40 years of her life to the Maternity Center, but feels that she must resign as full-time medical director, January 1, 1973.

At the same time, Northwestern has announced the construction of a new Women’s Hospital and Maternity Center adjacent to Wesley and Passavant Memorial Hospitals. Construction began this year and it is scheduled to be completed by 1974. The Board of the current West Side Maternity Center has been incorporated in the Board of the Women’s Hospital. HOWEVER, the fate of a similar program on an ability to pay basis, the fate of a home delivery service and the extent of Northwestern’s commitment to build community services are all in question at this time. While publicity for the new hospital insists that the Women’s Hospital will not phase out the Maternity Center, but will continue home delivery and expand community services, Northwestern’s actions toward the Chicago Maternity Center suggest otherwise. No public commitment has been made to finding a new director effective, January 1, 1973.

A hospital on the Gold Coast hardly serves the same neighborhood served by the Chicago Maternity Center at Maxwell and Newberry. 30% of the Center’s cases are emergencies—women who have not seen a doctor before delivery for any care or who have just delivered unattended by medical personnel.

WATCH is a women’s group of healthcare workers and consumers who are interested in community based services —financially and geographically accessible to women and their families. Northwestern University is a powerful and large institution; its policy will affect and control the quality and nature of women’s health care for a large portion of city women. Therefore WATCH is concerned. We find the only presently existing network of maternal infant and child care services in the city, run by the Board of Health, to be spotty, few and not comprehensive in serving many of our communities. Therefore we must demand of both the public and the private sectors responsible and adequate health care for our communities.

We see our concerns and the constituencies of our respective organizations to be the same. Only by gathering together to fight around these demands in a coalition (specific demands enclosed) can we begin to deal with the actions of institutions as Northwestern University in constructive and meaningful ways. We are announcing a meeting to discuss our demands, to organize a group of people who will reflect the large constituency of women who need quality, community ob/gyn services. We need a group of people who are willing to approach Northwestern on this issue.

Please come:

COMMUNITY MEETING
SUNDAY DECEMBER 10, 1972
2:00 p.m.
UNITED CHURCH OF THE MEDICAL CENTER
608 South Ashland
Chicago, Illinois
CHILDCARE PROVIDED

We have also requested a meeting between WATCH and the Executive Committee of the Board of Directors of the Chicago Maternity Center at their offices, 211 East Chicago Avenue

Tuesday, December 12th at 12 NOON.

We are hoping for a large turnout of patients and supporters to impress upon them the seriousness of our concerns.

In addition, please do any of the following with this insure attendance of people:

1) we are enclosing some leaflets to post around neighborhoods or your organization.

2) start several chain calls, if you can, informing your membership of our activity and the necessity of coming out to our meetings in full support.

3) call Laura Newman if you are having a organizational meeting or community meeting which we can attend to better explain our concerns.

4) at least, have a representative of your group attend our meeting on the 10th of December.

WATCH Demands

(1972) WATCH- Women Act To Control Healthcare, led a campaign to try to save the Chicago Maternity Center which offered safe home birth services to Chicago's impoverished west side. These were their demands. (November-1972)

(Editors Note: WATCH- Women Act To Control Healthcare, was organized by members of the Chicago Women's Liberation Union. WATCH led a campaign to try to save the Chicago Maternity Center which offered safe home birth services to Chicago's impoverished west side. The Center eventually was forced to close despite public protest. Below is the text of the demands put out by WATCH.)

For the past 77 years the Chicago Maternity Center has provided outstanding maternal, home delivery and childcare services to the people of the Chicago area according to their ability to pay. In no other city in America does such a community based clinic serve the needs of urban women wishing to have their babies at home. In addition, the CMC provides unique medical training in community medicine and provides 24 hour emergency obstetrical care and transport as no other agency in the city does.

The CMC points the direction in which all women’s medicine should be moving. Therefore, the only progressive action that the Board of Trustees of the Chicago Maternity Center and Northwestern University can take is to maintain and expand present services and certain not the opposite, to phase out the present services of the CMC or to relocate them our of the Maxwell Street neighborhood into the new Womens Hospital by Lake Shore Drive.

If the Board is truly responsible to the Center, all of the necessary money, influence and energies will immediately be directed toward fulfilling the following demands:

1. To maintain a 24 hour home delivery service the Board MUST provide:

a. One Medical Director paid by the Board of the Maternity Center with a tenured appointment to the faculty of Northwestern University Medical School, to work full time for the CMC with time devoted appropriately to the needs of the Clinic and Home Delivery Service.

b. At least two full time M. D.’s with training of Resident level or above to alternate call with the Director for Home Delivery Service.

c. An ambulance capable of safely transporting premature newborns and mothers to the hospital. (Such ambulance service could be partially financed by the Board of Health and Cook County

2. Improvements in the physical plant of the Maxwell Street Dispensary.

3. Improvements in the Clinic include:

a. Provisions for a Prepared Childbirth Clinic.

b. At least one 3 hour clinic during non—working hours (evenings or Saturdays) for working women.

4. We emphasize that responsibility for the Chicago Maternity Center services rests with the Board of the CMC. Leaving patients in the hands of representatives of other institutions without a specific contracted agreement is irresponsible and negligent. If the Chicago Maternity Center services are to be incorporated along with the name into the new Women’s Hospital & Maternity Center, then any money pledged to the building of that new institution by CMC and members of the CMC Board should be conditional upon the maintenance of adequate staff and provisions for a 24 hour home delivery and emergency service for the City of Chicago by that new institution.

5. To insure planning for comprehensive services, Board membership with voting privileges should incorporate representatives of staff and community organization which are served by and interested in the Chicago Maternity Center. WATCH demands voting representation in the Board of Directors of the CMC and the Planning Committee of the new Women’s Hospital and Chicago Maternity Center. We demand that the Board submit its plan to appropriate health planning groups such as the Citizen ’s Health Organization.

6. We want public disclosure of any and all information on plans for building, programs and services of the new Women’s Hospital & Maternity Center.

Rape

(1972) Rape became a major feminist issue and anti-rape programs sprang up across the country. from Womankind(1972)

(Editors Note: Rape was just becoming recognized as a feminist issue when this article was compiled from a pamphlet called Stop Rape and an article inRamparts Magazine.)

A look at the laws regarding rape along with the actual "justice" dealt out to rapists gives...us a good insight into society's view of women and the place it holds for her and expects her to keep.

Men can feel free and uninhibited to force sexual violence onto women as they receive full protection from the law, police and courts. Men know this and therefore understand that limitations are not placed on them in this area. The careful wording of the law with the broad latitude given the defense (rapist) make clear the state's intention to not prosecute rapists.

To reveal women's real status as sexual property, the law protects rapists by upholding that no man can be accused: of raping his wife. Who are the rapists? Strangers, friends, work or business associates, dates, boyfriends, and husbands.

In Michigan the prosecutor must prove that the rape was forcible and that there was penetration of the vagina. Forcible rape is determined primarily through trying to ascertain if the woman consented or not. Bruises, marks on the body, cuts or gashes all reveal assault but in the eye of the court they do not prove forcible rape and proof must be presented beyond a shadow of a doubt. Thousands of rapists have received acquittals by claiming that the victim had consented. Consent has been defined as everything from inviting the rapist to your apartment as a stall tactic, to not screaming loud enough. Anything a woman does issued against her in court. And therefore there can be no other conclusion than that the courts exist as one logical outgrowth of a male sexist social order that allows rape as one of the ways that men are permitted to oppress women.

Allowing a male friend into your home who turns violent and rapes you cannot be prosecuted in court. In the eyes of the court, allowing the male into your home implies consent for him to have sexual intercourse with you. The courts apparently see that opening your front door to a man means that the vagina is opened to his penis. As brash and boorish as these conclusions may sound, we must understand that they constitute the thinking of the society and the courts, not of women. It is no chance of fate that one man can visit another in his home, have an argument where the visitor beats up the other man and the beaten man can charge his former friend with assault. Yet a woman who has been raped in her home by a former male friend need not press charges because NO COURT will believe she didn't consent. But if rape was defined as anytime sexual intercourse took place with a woman against her will ill then husbands, boyfriends, and all men who are able to define their woman as their property would be subject to prosecution, women would be protected and have more freedom of movement and the chains of control would be dealt a heavy blow. It is exactly these things which the police and courts must prevent - not rape.

Here we come to the heart of sexism and its brutal mutilation of women. Now we must ask in all seriousness who is on trial. Women first of all may not do anything to try to prevent the rape such as trying to divert the attention of the man or direct him to a place where there is help for her nor may they do anything to prevent violence to try to save their lives, such as going limp instead of screaming, which may provoke more pain for themselves.

The requirement of the courts to prove penetration of the vagina is also established to protect the rapist and further victimize the women. The only possible way to prove penetration is through examination of the vagina and detection of sperm. There could not be a requirement in all the cannons of law with more loopholes in it than this one. What if the rapist didn't have an orgasm? There is no sperm but the vagina was penetrated. If we can't with any reliability determine penetration by examination for sperm, then what about the examination of the vagina. Although penetration may be revealed if the female is a young girl who has had no sexual experience, we know from the scientific data of Masters and Johnson that there is no way to prove penetration in a sexually mature woman unless it is done minutes after intercourse. But because the courts hold on to this requirement, women upon reporting a rape are rushed to the emergency room of the local hospital where they are initiated into the post-rape humiliation.

The treatment a woman receives after she has been raped indicates clearly that she has stepped out of her place in reporting a rape and asking for justice. The policemen responding to the call provide the first level of harassment. They apparently seek vicarious pleasure from having the women recount over and over again the details of the rape when their initial report usually doesn't require the information they are eliciting from the woman. Because the law requires proof of penetration of the vagina the raped women must be taken by the police to the hospital. Here doctors who also identify with the rapist hold attitudes toward the victimized woman from disinterest to sadism. A women reported recently that when she arrived at the hospital after being raped and visibly upset, the doctor shook her unmercifully yelling "Shut-up, you bitch!"

But the zealous interest the police frequently exhibit in the physical details of a rape case is only partially explained by the requirements of the court. A woman who was raped in Berkeley was asked to tell the story of her rape four different times "right out in the street," while her assailant was escaping. She was then required to submit a pelvic examination to prove that penetration had taken place. Later, she was taken to the police station where she was asked the same questions again: "Were you forced?" "Did he penetrate?" "Are you sure your life was in danger and you had no other choice?" This woman had been pulled off the street by a man who held a 10-inch knife at her throat and forcibly raped her. She was raped at midnight and was not able to return to her home until five in the morning. police contacted her twice again in the next week, once by telephone at two in the morning and once at four in the morning. In her words, "The rape was probably the least traumatic incident of the whole evening. If I'm ever raped again...I wouldn’t report it to the police because of all the degradation...”

If white women are subjected to unnecessary and often hostile questioning after having been raped, third world women are often not believed at all. According to the white male ethos (which is not only sexist but racist), third world women are defined from birth as "implore." Thus the white male is provided with a pool of women who are fair game for sexual imperialism. Third world women frequently do not report rape and for good reason. When blues singer Billie Holliday was 10 years old, she was taken off to a local house by a neighbor and raped. Her mother brought the police to rescue her, and she was taken to the local police station crying and bleeding:

"When we got there, instead of treating me and Mom like somebody who called the cops for help, they treated me like I'd killed somebody.. .I guess they had me figured for having enticed this old goat into the whorehouse.. All I know for sure is they threw me into a cell. A fat white matron... saw was still bleeding, she felt sorry for me and gave me a couple glasses of milk. But nobody else did anything for me except give me filthy looks and snicker to themselves. After a couple of days in a cell they dragged me into a court. The rapist got sentenced to five years. They sentenced me to a Catholic institution."

And so we come to the ultimate conclusion that this society protects rapists because of its insidious contempt for the female and all she represents but most particularly her sexuality.

This article combines articles from STOP RAPE, available from Women's Liberation of Michigan and Ramparts Magazine.

The Fear of Childbirth is a PAIN

(1972) An understanding of the politics of biology was essential to women's liberation. from Womankind (March 1972) 

(Editors Note: One of the goals of the women's liberation movement was to fight oppression with knowledge. Women were kept deliberately ignorant of their bodies and were often overwhelmed by the pain associated with childbirth.)

In thinking about health or health care, we do not usually think directly about pain. But pain is very definitely a part of our physical existence, and to a large extent the degree of pain in our lives depends upon our physical and mental health.

It seems to me that we often take pain for granted as a fundamental part of our lives, but we don't recognize, for instance, that our attitudes are very definitely shaped by our culture and that the ways we experience pain are therefore culturally shaped.

Our attitudes towards pain are also affected by our financial capabilities for buying drugs and by our knowledge of physiology. We are less afraid of sin if we know that we can simply get rid of it by rushing to the medicine cabinet for an aspirin or if we know that physiologically the pain does not signify anything serious. But there is a fly in the ointment here. Most of us are very ignorant of how our bodies work, and our ignorance is certainly not reversed by watching drug commercials on television. We end up being caught in a vicious circle: because of our ignorance, (and our fears of disease, death, and pain), we are especially gullible to TV's promises of comfort; and because the drug industry and medical profession have so successfully created a dependence on drugs, we tend to equate drugs with cures instead of seeing them as temporarily relieving our symptoms of illness; thus we tend to avoid thinking about the real causes of our distress.

In part, our attitudes towards pain seem to be determined by our attitudes towards death. A pain which seems to suggest something seriously wrong is quite frightening, mainly because it also suggests the possibility of death.

Death is something which we have great trouble dealing with for a variety of reasons (which I won't go into here). Culturally, we tend to fear death more than most societies; it is no coincidence that we also fear pain. A fairly common reaction for a person who experiences an alarming new pain is to avoid seeing a doctor because the doctor might confirm suspicions that he or she is going to die.

For women, our attitudes towards pain are especially relevant in terms of childbirth -- the event often considered to be the most painful in a woman's life. Here, particularly, social and cultural attitudes seem to play a large part in shaping our experience. For a pregnant woman, used to living in such a highly anesthetized society (where drugs are used to kill pain, induce sleep, quiet the nerves, and give people pep), having to bear the pain of labor which is unprepared for, inexplicable, and long-lasting, is a truly frightening experience. A trip through the labor room of any modern, "civilized" hospital will bear this out. Women literally sound like they are being tortured, as if they are undergoing an excruciating and barbarous experience. They scream and cry out not simply from the pain of labor, which is unprepared for, but from a deep-seated fear of that pain.

Women delivering their first child have never felt this kind of pain before; they can't take a pill and make it go away; they can't imagine how they can continue to bear a pain which seems to get worse and worse; and doctors and nurses seem oblivious to their cries for help. Of course they scream! They are largely unprepared by their doctors, by books, or by social conditioning to deal with pain in any other way.

Fear of pain is further reinforced by rumor and false consciousness. The dark foreboding surrounding childbirth are part of our social conditioning -- we learn to expect that this is a unique, awe-inspiring, but extremely painful event. We have heard that women are better able to bear pain than men; that women are "born to suffer," that pain is somehow an integral element in the definition of woman. These are part of the mythology which serves to keep us oppressed. Because we have absorbed these ideas so thoroughly, pain -- particularly that of childbirth -- becomes a mysterious kind of avenger which we are powerless to deal with.

When, in addition to this, we are told that it is strong to "bear" pain, weak to "give in to it," the trap of oppression is closed: women, frightened of pain and made to be passive in its grasp, are then expected to find strength in their suffering.

Finally, pain seems to be made worse for us by our not knowing or understanding what is happening to our bodies. In childbirth, especially, ignorance of anatomy and physiology works against us since it reduces contractions to mere feelings of pain. If we knew what was going on physiologically, that is, if we understood what a contraction was and what purpose it had in terms of the whole process of labor, we would feel less threatened by pain. In addition to this, without knowledge of what we can do to actively help the process along, we are left helpless, unable to exert control, absorbed solely by wave upon wave of pain.

Ignorance, tension, fear -- all these contribute to making pain worse, and especially where childbirth is concerned, it is clear that cultural conditioning increases rather than diminishes the pain of our experience. This is why it is so necessary to understand our cultural attitudes. It is possible to "decondition" ourselves -- that is, to "unlearn” attitudes, myths, and rumors that make childbirth a negative experience, once we understand how we got these attitudes in the first place. It is also possible to learn the techniques and exercises (such as those taught in the Lamaze method) which can help women maintain control over their bodies during childbirth.

These things are absolutely necessary if women are to really enjoy this event. It would certainly be liberating to be able to look forward to childbirth with expectations of joy rather than with helpless terrors about pain.

CWLU Expands Health Program

(1973) The Chicago Women's Liberation Union's health programs were some of its best known and successful projects. from Womankind (September-1973)

(Editors Note: The Chicago Women's Liberation Union's health programs were some of his best known and successful projects. This article discusses the work of the Pregnancy Testing Group, the Liberation School, and the Abortion Task Force.)

The Chicago Women's Liberation Union is expanding it's health care facilities. Health care has been a priority issue for women and the Union for a long time. Our services at present provide needed help for numerous women. It is assistance that is available and inexpensive but insufficient. Each workgroup now working on health or health related projects are increasing and improving their outreach and services.

Women controlling their own bodies -- there's a lot of talk about the subject and the reasons need to be repeated. We live in a society where our role is defined by our biology. We are not going to minimize our biological function. However, it is imperative that we understanding why we should control, completely, the where, when, why and how those functions.

We do have choices we can make about how we are going to live as women but our society makes it difficult and for most women impossible to exercise the right to choose.

Health care in this country is an industry that can be compared to automobile manufacturing or the food industry. Industries operate on the economic law of supply and demand, The number of beds provided in hospitals, the number of doctors graduating, the number of technicians passing registration is all controlled by the health Industry to insure there is a smaller supply of care than demand for it. That way the profession can demand higher prices and justify poor care by say mg it is understaffed and overworked.

The attitude of medical professionals are much easier to understand when it's realized that getting through an examination and getting the is more important than first reassuring the patient in the intimidating atmosphere of the office, clinic, or hospital. But understanding the medical profession as an industry does not excuse the continued insult against us.

It is the attitude that only the doctor knows what is best for women, as well as the idea that medical information is complicated and hard to understand that has kept women so dependent and at the mercy of the profession. Medical information is complicated but it is insulting to assume that therefore women cannot understand it and by understanding it able to care for ourselves.

The workgroups relate to the everyday medical problems of women and in doing so avoid the academic hang-ups of institutionalized medicine. We don’t need to pay or be patronized by a physician who studied for years about diseases we can't even pronounce. We need good, inexpensive health care that meets our needs.

Women should know immediately that they are pregnant so that if it is economically or personally impossible to have another child something can be done about it. If an abortion has to be arranged then it can be done without causing the endangering delay that make abortions more difficult the further along a pregnancy progresses.

There are many medical disorders that can cause serious problems and lead to very expensive operations. When women know enough about their bodies and the symptoms of the disorders, a self-diagnosis and treatment would avoid having to go through such an operation.

But its difficult to get that information alone either from books or a doctor. Women, together, organizing to face the problems of getting medical information and then learning to use it, are a powerful force providing opportunities otherwise denied us pregnancy testing costs $20 when done by a doctor. The Pregnancy Testing workgroup of CWLU does it for $2. That's all the chemicals cost and it takes only 20 minutes to get the results not three days.

Information now available to us is offered in a course by the Liberation School called “Our Bodies, Ourselves". The class is available with the new Liberation School session beginning October 15, 1973, call the CWLU office to enroll.

About controlling our bodies, here's another example. Individual women have for too long a time been the victims of profiteering, illegal abortionists. The fact is that for all of society's moralizing against abortion, it (society) refuses to deal seriously with the problem unwanted and unnecessary pregnancies give to women.

Even the legalization of abortion didn't end the problems. The Chicago Board of Health recently passed some regulations that would make abortions more difficult and expensive than necessary. The Abortion Task Force has filed suit against the Board and though the courts are not the best solution we might want for stopping the Board of Health, the suit will stop the regulations.

The lawsuit when won will improve abortion service and care for all women in Chicago. This direct action was possible because women united together had the strength to act where one woman would have found it impossible against the power of the Board of Health.

In addition, the Abortion Task Force is opening an information telephone line - HERS - #328-2736. The line will start October 1, 1973, and will provide abortion information at first, then in the future, additional assistance in finding medical aid.

Establishing the line is more than just providing needed help about abortions. It is a bid for power with the clinics giving the abortions. Presently, many abortion referrals are working with clinics giving preferential referrals for percentages of the profits of the business. By operating their own line, the Task Force will have bargaining power with the clinics giving the Task Force the Opportunity to insist on good care and changes in procedure within the clinics. Just as important, the Task Force will have direct contact with women requesting abortions and then will be in a position to give moral support.

This is certainly an exciting development for the Task Force and all of us in dealing with the Health Care industry. We’re now gaining the power so long denied us. Only with such power can we effectively demand and get the changes necessary.

There is another new group forming in the union that will also be dealing with health care issues with some power. A group of women including nurses and paramedics, are in consultation with a woman doctor to work through the details of opening a clinic.

In addition to providing inexpensive quality health care, there will be education on self-help and resources for gaining experience in diagnosis and with tests and treatment. We now can see in fact, what we have hoped for -- health care that is good, inexpensive, without profit as a motive. We can now see what can really be done when we do it ourselves.

Abortion Task Force: Who We Are

(1973) The Abortion Task Force was organized to ensure that abortions were safe and affordable in the wake of the Roe v. Wade decision.

(From Womankind July 1973)

(Editor's Note: The Abortion Task Force was organized as a workgroup of the CWLU after Roe v. Wade effectively legalized abortion.) 

The “problem” with abortion used to be that abortions were dangerous and illegal. Now the “problem” is that abortions are hard to get and expensive.

The Abortion Task Force has been challenging those institutions supposedly providing quality health care. In the process of our questioning, the Abortion Task Force has learned a lot about the health care system in Chicago and Illinois.

Health care is given for profit, not the patients, for the profit of the doctors, hospitals and related industries (drug companies, medical equipment suppliers, etc.). If one type of heath care is not profitable or “interesting” to the professionals, then the service is not provided.

The Abortion Task Force is one program of the Chicago Women’s Liberation Union we formed in order to collectively fight for the right of all women to easily obtain an abortion upon request. Abortions are becoming an extremely common operation, for doctors and medical institutions. Some say that abortions are “more common than tonsillectomies”. We are more concerned with the quality of the procedure than with the moral questions surrounding abortions. We understand that there are MORAL questions around the issue of abortion and we feel women should make the decision to have an abortion with her feelings on those questions in mind.

When women find themselves pregnant, we often must decide (1) if we can afford the child on our income, (2) if we would still have enough time for our lives, (3) whether we, our husbands and our family can handle the addition of another person, a time-consuming one at that (4) if the child will cause our lives to go in a direction that we don’t want.

Since the Supreme Court has upheld our right to make this decision, clinics and hospitals in Chicago are available to perform an abortion in the first three months. However, these places are overcrowded, often make us feel alone and awful and finally are too expensive.

But we have as much trouble getting good health care as we do abortions. Abortions could be avoided if safe and effective birth control were available for all women. Like all powerless groups of people, we must continuously force the health industry to understand and have concern for our medical needs. Who understands better our needs and share’s concern for our well being than other women? We need to insure that enough public health facilities are available to meet the demand for abortions adequately, that any regulations made are to protect or heath interests and that the cost, if any, is based on the cost of the operation (abortions are very inexpensive to do) and the they be flexible based on the individual woman’s income. Why should anyone be denied good heath care because they can’t pay? Good heath care is a human right that we all must fight for.

Many times we must handle all the consequences of an unwanted pregnancy for which she is obviously not the only one responsible. It is important that we give her the support that she needs and see that she gets the medical care that she needs.

Where To Go From Here

Hospitals are not now meeting the demands of their communities in providing adequate abortion services. We want to change that situation. We plan to work with women in communities who feel this lack of service and together demand that from their hospitals. We will be speaking to groups of women and to women in the neighborhoods. We will also distribute what information we have on abortion and on the hospitals.

We have continued our investigations into various abortion clinics around the city in order to determine their quality. We will be developing an effective referral service. Women are now working to set up this service and to find women who want to give some time. We also are continuing to investigate the medical power structure in Chicago and to plan the most effective strategy for winning our demands. Women interested in any of these projects can call us at the CWLU office, 348-4300.

What’s Happening With Legislation

State: Three pro-abortion bills introduced by the Public Health Department have been passed by the legislature and sent to the governor for signing. The bills weren’t passed until after July 1, which according to the state constitution would delay the effective date for a year. However, the governor will amend the bills so that they can take effect immediately.

Federal: Three constitutional amendments have been introduced in Congress which pose a threat to women’s rights to abortion.

One bill in the House of Representatives would establish that life begins at conception, therefore, making abortions illegal.

Another bill before the house would return jurisdiction on the abortion to the states and probably would result in a repeal of pro-abortion laws.

A Senate bill would make abortions legal only when performed to save the life of the women.

The Illinois legislature has passed a resolution supporting the three federal amendments but the resolution has no power of law. Since abortion became legal, pro-abortion forces have been working to facilitate access to abortions and encourage the creation of facilities to provide inexpensive, quality abortions. The more facilities operation, the quicker abortions become established medical practice, and the more public support for women for abortions, the more difficult it will be to reverse the Supreme Court decision with other legislation.

ATF Fights Board of Health Regulations

(1973) The Abortion Task Force challenged the City's new regulations in the wake of Roe v. Wade.

(From Womankind July 1973)

(Editor's Note: The Abortion Task Force was organized as a workgroup of the CWLU after Roe v. Wade effectively legalized abortion.)

It was a “stormy session” there at the June 20th meeting of the Chicago Board of Health, reported the Chicago Tribune. The ATF had come to present criticisms of the recent abortion clinic regulations. But, it became clear that Dr. Eric Oldberg, President of the Board and the Board had already made up their minds on everything.

Our crowd of 51 became frustrated and disruptive, finally walking out of the meeting. The ATF had met with Dr. Oldberg several weeks before, to discuss objections to the regulations, and he agreed that the ATF’s suggested changes were “reasonable” and said that he would work to bring the Board around. Though we had trusted him to be on our side, changes presented to the Board were minimal.

At the Board meeting, some of the arguments we presented for changing the regulations were the following:

1) The regulations required a 48-hour “think it over” wait for the woman between the physical exam and tests and the abortion itself. We objected to this as medically unnecessary and, from our experiences through ACS, psychologically unnecessary.

Most women have made up their minds firmly and carefully and do not need to be told to think it over again. This wait would also be a great handicap and expense to women for out of Chicago or with young children or working – all those who historically have had great difficulty getting safe, inexpensive abortions. The Board changed the 48 hours to 24 – we still objected but the Board was rigid.

During the discussion it became clear that they lay people on the board were just following the lead of the doctors, and certainly were not representing health consumers – and least of all, women – with any independent opinion. The Board members were able to treat our concerns casually because they are appointed by Mayor Daley for life, and have little to fear from us.

2) The regulations contained a requirement for a full pathological examination of the removed tissue. And our experiences and medical consultants felt this was medically unnecessary and expensive ($10-40). The Board seemed concerned about detecting obscure medical problems while there was no provision in the regulations for VD or cancer tests. The only woman on the Board came to support us on this point.

3) The regulations called for certain unspecified but extensive equipment be provided in each room where abortions are preformed. The Board agreed with us that one set of this equipment was sufficient for a whole clinic, but refused to change the wording. They insisted that the real meaning was understood and that inspectors wouldn’t be arbitrary about it. We continued to object because we know how city inspectors can hassle people around technicalities and vague rules.

We felt badly that we had been only partly successful in changing the abortion regulations. But we are determined to learn for this experience – to mobilize our allies such as doctors to support us openly and to plan other meetings to better focus on the most important points and really fight for them strongly.

Abortions are Legal, But...

(1973) Women in Chicago still faced problems even after Roe v. Wade effectively legalized abortion in 1973.

(From Womankind July 1973)

(Editor's Note: The Abortion Task Force was organized as a workgroup of the CWLU after Roe v. Wade effectively legalized abortion.)

It was a “stormy session” there at the June 20th meeting of the Chicago Board of Health, reported the Chicago Tribune. The ATF had come to present criticisms of the recent abortion clinic regulations. But, it became clear that Dr. Eric Oldberg, President of the Board and the Board had already made up their minds on everything.

Our crowd of 51 became frustrated and disruptive, finally walking out of the meeting. The ATF had met with Dr. Oldberg several weeks before, to discuss objections to the regulations, and he agreed that the ATF’s suggested changes were “reasonable” and said that he would work to bring the Board around. Though we had trusted him to be on our side, changes presented to the Board were minimal.

At the Board meeting, some of the arguments we presented for changing the regulations were the following:

1) The regulations required a 48-hour “think it over” wait for the woman between the physical exam and tests and the abortion itself. We objected to this as medically unnecessary and, from our experiences through ACS, psychologically unnecessary.

Most women have made up their minds firmly and carefully and do not need to be told to think it over again. This wait would also be a great handicap and expense to women for out of Chicago or with young children or working – all those who historically have had great difficulty getting safe, inexpensive abortions. The Board changed the 48 hours to 24 – we still objected but the Board was rigid.

During the discussion it became clear that they lay people on the board were just following the lead of the doctors, and certainly were not representing health consumers – and least of all, women – with any independent opinion. The Board members were able to treat our concerns casually because they are appointed by Mayor Daley for life, and have little to fear from us.

2) The regulations contained a requirement for a full pathological examination of the removed tissue. And our experiences and medical consultants felt this was medically unnecessary and expensive ($10-40). The Board seemed concerned about detecting obscure medical problems while there was no provision in the regulations for VD or cancer tests. The only woman on the Board came to support us on this point.

3) The regulations called for certain unspecified but extensive equipment be provided in each room where abortions are preformed. The Board agreed with us that one set of this equipment was sufficient for a whole clinic, but refused to change the wording. They insisted that the real meaning was understood and that inspectors wouldn’t be arbitrary about it. We continued to object because we know how city inspectors can hassle people around technicalities and vague rules.

We felt badly that we had been only partly successful in changing the abortion regulations. But we are determined to learn for this experience – to mobilize our allies such as doctors to support us openly and to plan other meetings to better focus on the most important points and really fight for them strongly.

A Young Woman's Death: Would Healthcare Rights Have Prevented It?

by Dr. Helen Rodriquez-Trias (1974) Dr. Rodriquez-Trias was a leader in the public health field and a founder of the movement against sterilization abuse. Her ideas helped to guide CWLU healthcare strategy.

by Dr. Helen Rodriquez-Trias M.D. Lincoln Hospital, Bronx, N.Y.

Prepared for presentation at the General Session on Women and Health APHA 102nd Annual Meeting, October 20-24, 1974 New Orleans

(Editors Note: This paper was originally delivered to the American Public Health Association. Dr. Rodriquez-Trias founded the movement against sterilization abuse internationally--and that effort led to stopping it in the first in Puerto Rico, then the US. Her ideas were internationally recognized. She came to Chicago in 1975 and spoke to a CWLU organized healthcare meeting. She was instrumental in establishing new healthcare standards for women.)

Six weeks ago the N.Y. papers carried a brief story on a 23-year old Puerto Rican woman who was seen twice at the Emergency Room of the Bronx Municipal Hospital for abdominal pain following the insertion of an intrauterine device. On the second occasion her husband insisted on admission which was denied. A few hours later, she died at home of a massive internal hemorrhage.

The event is certainly not an unusual one in our health care system, and the defenses of the individuals who are part of this system are well erected against attack. One doctor’s response dramatizes the unfeeling— ness that characterizes the professional who is generally much more concerned with his image than with what happens to the patient. He was quoted as saying, “Based on the information we have, I can’t see at this time what was done wrong with diagnosing Mrs. Castro. She was thoroughly evaluated twice by very good people who made their best diagnosis to the best of their ability”. “We stand on what was done at that time.”

Another response, much more insidious and dangerous in its content was observed on the second visit to the Emergency Room by the young woman’s husband who stated that the physician implied that she was faking and needed psychiatric intervention. Perhaps this should not surprise us. The same medical school that is responsible for care at that Municipal Hospital has on its staff two prominent pediatricians who edited a text of Pediatrics that indexes “Puerto Rican Syndrome” as a term for hysteria.

But it is not my purpose today to describe one after another instance of Institutionalized racism and sexism, but rather to explore with you and the other panelists, our growing awareness of the root causes of racism and sexism in the health care field. I shall attempt to discuss women’s health rights within the context of my experience as a pediatrician in a Black and Puerto Rican ghetto where I meet other workers and members of an embattled community. The struggle for health rights may then be seen in the social context, for these are as any other rights, real only when the society provides a concrete form for their exercise of the inadequacy of health services for all Americans is not idle rhetoric, it is a recognition of the seriousness of our social responsibility and belies the anger and frustration at a system that makes it impossible for us to function well.

As in our role as workers, a new consciousness of the socioeconomic determinants of the system is emerging. The contributions to the literature by feminist writers analyzing our social role and its relationship to the health care we get, are uniquely valuable. The historical approach used by Barbara Ehrenreich and Deidre English in their Witches, Midwives and Nurses, A History of Women Healers and their Complaints and Disorders, The Sexual Politics of Sickness, helps clarify our present state re: the medical system.

The Role of Women as Producer of Children

Our childbearing functions, once the province of the community based midwife, are now controlled and regulated by the medical establishment. This together with our visits to the doctor for our children, accounts for the fact that we make twice as many visits as men.

The availability of services to poor women, and particularly to third world women, makes for sharp class distinctions as to frequency of visits, be they prenatal, routine gynecological health maintenance or any other kind. The distrust that women rightly feel toward doctors undoubtedly contributes toward lower utilization As an example of the class distinction in utilization is the fact shown by Dr. Helen Chase and co-workers in their exciting study on Risks, Medical Care and Infant Mortality, that in New York City less than two percent of the Black and Puerto Rican mothers had “adequate” prenatal care. Though we may question the definition of “adequate” which included delivery on a private service, the fact is still outstanding.

Once more the socioeconomic realities bear unveiling. Neither time, nor presenter’s abilities, nor audience and fellow panelists’ patience allows for a complete analysis of the economic structure of the health care system. If most of us will agree that in the United States it is profit motivated, then I may go on with an example of how its control over us is a logical outcome of its profit seeking. However, we also know that relationships among phenomena in the social scene can be extremely complex and become understandable only if we look at the goals of those controlling the society as well as the compromise that they make in order to continue ruling. The official policies on population control, of which birth control is but one aspect, have changed as social goals have changed, in the zig-zag pattern of many social changes, this or that direction being taken because of pressure from groups, national expansionist imperatives, needs to control certain unruly population groups, wars, depressions and all such events.

A brief sketch of this evolution of policies on birth control may help discern the pattern in this one important aspect of our health care needs.

From the persecution of the Socialist nurse, Margaret Sanger, in the second decade of the century for her agitation in favor of birth control, to the pushy endorsement of birth control by an aggressive United States government and the big profits in the world wide sale of pills, intrauterine devices, foams, gels and what have you, has been fascinating change. The women who fought valiantly and effectively for birth control information could not have imagined the control that the medical and pharmaceutical concerns would establish over their daughters, granddaughters and above all, over women of other cultures that they in their respectable middle class worlds did not take cognizance of.

The pill tested by Searle in Puerto Rico from 1956-60 in doses considered too dangerous for the United States market, was rapidly pushed in the sixties into a big money making item.

As with women’s acceptance of sterilization in Puerto Rico, so that in the past two decades the percentage of women of childbearing age who are sterilized has reached thirty-five, the acceptance of the pill here and elsewhere, has been determined by availability, marketing, convenience and propaganda. The need and demand for birth control is obviously real and we take what there is and what we have been primed to accept.

The proliferation of programs in the United States and in the third world countries receiving aid from the United States make clear that the intention of population control is political.

That funds can be appropriated for population control in areas where even minimal health care is not available, is a clear contradiction. The failure to tackle the root causes of poverty is recognized by us. Laura Anderson speaking in testimony before the Commission on Population Growth and the American Future in a May 1971 hearing, declared the following:

The new governmental concern is based on the assumption that large family size, early, unwanted, out-of-wedlock pregnancies, broken homes, etc., bear the major responsibility for the poor’s state of poverty. In fact, the contrary is known to be true. Poverty and racism with the concomitant poor health care and resources are among the major causes of large families, broken homes, illegitimacy, as well as chronic ill health and the premature death of the poor and black.

We know that population control can be used to defuse discontented elements in the society. Mass migrations have often had this effect on the societies left behind, while on occasion an opposite one of creating ferment at point of arrival. A good example of this is the mass migration of Puerto Ricans to the United States which was manipulated by means of labor contracts, lowered air fares, government sponsored recruiting programs, etc., and which provided a source of cheap labor here as well as an escape valve for the potentially revolutionary situation on the island. Once here, of course, the source of cheap labor is often unemployed, the economic situation is precarious, reduction in welfare rolls becomes the official slogan and birth control becomes the program for the ghetto dweller.

So it is as third world women we are caught in the contradiction between a healthy desire to decide when and how to have children and social policy, not controlled by us, which seeks other ends. Feminists are highlighting this contradiction with increasing fervor. In a report by Lolly Hirsch on the World Population Conference held in Bucharest in August 1974 she states, “The United States government position is that population growth of OTHER parts of the world must be controlled.

The United States has tried to control specific populations by various means :

1. Hydrogen bombs over Hiroshima and Nagasaki.
2. Destruction of food sources by defoliation of hundreds of acres.
3. Vast projects of birth control; for instance: India and Thailand.

The Role of Women in the Struggle for Health Rights

Could Mrs. Castro’s death have been prevented by women’s health rights? Perhaps yes, if these rights had guaranteed presence, in that Emergency Room, of a woman’s health advocate, who understanding Mrs. Castro’s distress would have pressed for admission. Yes, if in addition, there had been sympathetic women staff members committed to following her closely and with the authority to take action when required.

There is no doubt in my mind that on the spot, knowledgeable and aggressive health advocates who represent a community point of view are deterrents to gross neglect of patients’ rights. An anecdote from my Lincoln Hospital experience is an amusing illustration of this. A few years ago, the Emergency Room inadequacies were under discussion at a Medical Board meeting. The Chief of Surgery of that time, in making a forceful presentation for additional staffing, said, “We need more surgical coverage, for if a “brother” dies on the table my ---- will be in the Young Lord’s sling.” My initial response of shock at his callousness toward peoples lives has changed with the New York experience to acceptance that there are some people who will move more readily from concern for some vulnerable part of their anatomy, than for love of sisters and brothers. If this is so, let it be so, but let us insure that there are caring sisters and brothers with power in the system.

This one element can save lives and its inclusion must be an immediate demand. But there are other health rights: to one high standard of care for all, healthy work and home environments, community based preventive services, chronic care and rehabilitation programs and many others that we demand for all Americans, women, children and men. These rights can become rallying points for those of us who see the need to force change.

We can demand an end to racism and sexism and in our patient advocate functions point out where these practices occur and militate against them. These are legitimate action points. However, our developing consciousness that the special oppressive forces that are marshaled against us as women and as members of third world communities are tools of a class society that fights to maintain its profitable stratification, must lead us to greater militancy and broader demands.

Within our feminist organizations, professional groups, labor unions, community organizations, health advocacy groups, political groups we must begin to expose the socioeconomic basis of the exploitation. We must forge coalitions that will demand the total integration of women in the decision making bodies of the health care system in numbers commensurate with our presences as health workers and as seekers of health care. We may then begin to develop the power base necessary for change in the institutions that oppress us.

Only in the process of a growing power of the people changing the society can health rights for all the people become a reality.

CESA Statement of Purpose

(1975) Outlines the program of the Committee to End Sterilization Abuse (CESA). (1975)

(Editors Note: The Committee to End Sterlization Abuse issued the document as part of their struggle against the use of sterilization to cure social ills. CWLU members were very active in CESA.)

The women and men of CESA: Committee to End Sterilization Abuse recognize the following:

1. In the United States today there is a massive drive to convince people that social evils such as poverty, overcrowding, increased crime, poor education, poor health care, etc. are all due to overpopulation. 
2. Population control programs have been pushed by the U.S. for people in the United States as well as in many countries abroad to do exactly that: control people and keep us from understanding the real causes of our suffering and thus keep us from dealing with the problems by eliminating oppression and exploitation. By pushing population control programs, the United States government and corporations hope to stave off the struggles of people for liberation from direct and indirect domination by the U.S.
3. Sterilization of women, and to a lesser extent of men, is on the increase in the United States. Sterilizations have tripled in the last five years. This is the result of an increase in sterilizations of women who are Black, Puerto Rican and Chicano and of all working women. 
4. Many sterilizations are done without women knowing that the result is permanent, that there are complications, or that there are other methods of birth control. Many are done on women who are coerced by threats of withdrawal of services such as welfare, the right to abortion, medical services and the like.
5. In Puerto Rico, under the guise of needed population control, the U.S. with the collaboration of the colonial government, has carried out programs for the past thirty years which have resulted in the sterilization of fully one third of Puerto Rican women of childbearing age. The Department of Health Education and Welfare in the U.S. has stated that "As U.S. professional attitudes change, it is possible that we may see sterilization become as important in family planning in the fifty states as it already is in Puerto Rico." For this reason CESA will focus particularly on the case of Puerto Rico.

Sterilization abuse will continue unchecked and victimize many more people unless we organize and struggle to stop it.

CESA is therefore working toward the following:

• to educate and publicize the issues raised by sterilization abuse, namely the purposes that population control programs serve, and to denounce the implementation of racism, sexism and the oppression of working people within the health care system.
• to demand that families and all women of childbearing age have free access to methods of birth control within high quality, comprehensive health care so that people may exercise choices.
• the establishment of guidelines on sterilization for New York City hospitals which insure that women give consent only after being truly informed and counseled, are not coerced into being sterilized and are permitted a waiting period of at least 30 days before the actual operation. Existing HEW guidelines provide only 72 hours. The New York City guidelines will set a precedent for all cities in the United States.
• Both New York City and Puerto Rico fall under Region 11 for health services of the Health Education and Welfare Department of the U.S. federal government. Clearly what is the rule in Puerto Rico today -rampant sterilization abuse -may well become the trend in New York City. Conversely the fight for guidelines in New York will have repercussions in Puerto Rico. The guidelines are the first to go beyond the federal guidelines and will mark a victory toward halting sterilization abuse.
• initiating legal actions against those who abuse patients' rights by whatever means.

CESA is unaffiliated and invites organizations and individuals to participate in our program to end sterilization abuse. There are a number of ways to participate, among them: sponsorship, inclusion of the issue in your organizational program, help with mailings and compiling mailing lists, donation of your time and/or your money, help with production and distribution of literature and publication of the issue within your communities and your workplaces.

Join us in the struggle to end sterilization abuse!

Medical Crimes Against Women

by Jenny Knauss, Janet M., Kathy M., Lauren C. & Sharon M.(circa 1976) A proposal to launch an ambitious CWLU healthcare organizing project. by Jenny Knauss, Janet M., Kathy Mallin, Lauren Crawford & Sharon M. (circa 1976)

(Editors Note: This document proposed that the CWLU adopt a comprehensive plan to organize around health issues.)

Health is an issue that affects everyone, one that cuts across class, race, and sex lines. Our health care organizing will have at least two goals; (1) building those kinds or struggles which more people to challenge the particular abuses of local institutions and providers, and (2) giving people a sense of the kind of quality of care they have a right to, and should demand, from this, or any other system.

The current national health policy debate about national health insurance makes it imperative that women demand that the abuses and inequities in the present system, in which patients suffer, and providers profit, not become embedded into whatever plan emerges from Congress. But in the long term, we must join other progressive forces in fighting for a national health system which incorporates bother worker/patient control over health institutions and the kind of quality of care stands which are at the core of the women’s health movement.

In the current economic crisis, health care services have increasingly come under assault; services have been cut back, especially in inner city areas, and lay-offs and speed-ups of healthcare workers, particularly minorities & women, have increased. The CWLU has been active in a city wide coalition fighting such cutbacks in public health services in Chicago (see CWLU news, Sept/Oct., “On Saving Cook County Hospital); but we have been slow to respond to two other issues of immediate concern to women -- aborting and sterilization. These are actually two sides of the same issue; women’s control over reproduction, for as access to abortion becomes limited, it becomes more likely that women may be forced into serializations they may not necessarily want.

Our rights to safe, inexpensive abortions have recently come under attack again with pressure to pass a constitutional amendment prohibiting abortion, a major issue in the Presidential campaign, and passage of the currently void Hyde Amendment, which would prohibit using Medicaid funds for abortion. Although the women’s movement was instrumental in forcing the 1973 Supreme Court decision legalizing abortion, poor women especially are still being victimized today by illegal butcher abortionists because access to decent services is limited, geographically as well as financially. By 1974, for example, only 15% of all public hospitals had performed a single abortion, and at least 400,000 women were unable to obtain legal abortions last year (Planned Parenthood Study). In Chicago, it was only in response to the Abortion Task Force of the CWLU that Cook County Hospital began performing second trimester abortions, albeit only two per week.

Even legal abortion clinics across the country continue to victimize women, financially as well as medically. In 1973, HERS. was instrumental in closing down a shoddy Michigan Avenue clinic, but we know that unscrupulous and shoddy practices are the norm, and not the exception on Chicago abortion clinics. Public hearings were held just last month on the atrocities committed by one such Chicago clinic which was being sued by three victims of botched abortions, one of whom died of complications due to her abortion.

Sterilization abuse is an issue around which groups across the country have recently begun to move. In New York, C.E.S.A. (Committee to End Sterilization Abuse) formed a coalition that forced the Health and Hospitals Governing Commission to institute more stringent guidelines for sterilization procedures in the municipal hospitals. There are now the subject of a court suit filed by a group of hospital gynecologists.

In Chicago, a small C.E.S.A. chapter has begun researching local institutional abuses and presenting community educational programs on sterilization. And we will soon have access to a study conducted by the Illinois Department of Public Health which gives hospital by hospital statistics on sterilizations, and which reveal the shocking fact that 30% of all Medicaid patients in Illinois receiving hysterectomies were under 30. Unnecessary hysterectomies are clearly becoming another issue which women’s groups across the country are just beginning to work on.

Abortion and sterilization are issues which together encompass a woman’s entire reproductive life, from puberty to menopause, and so can reach the young as well as old, poor and “middle-class”, and white and non-white. A programmatic strategy focusing on these two issues follows.

We would begin with an issue oriented forums. If we picked abortion and sterilization for our primary focus such as program might do the following:

Research

A Task Force would be set up which would be responsible both for collecting current data we have on abortions and sterilization and for delineating other research that needs to be done in the area and seeing that this research is done. In collecting current data on abortion the group would keep current files on all current birth control methods and abortion techniques (menstrual extraction through second trimester). This group would also organize the material we have on the Chicago area abortion clinics; gather statistics on how many women are using which clinics; which clinics accept green cards; which accept deferred payment; which do second trimester abortions; as well as how women are treated by staff and doctors at such clinics. Most of the above information is already available to us through the HERS files. The data collection function of HERS could be continued and perhaps expanded. Other groups such as Fritzi and Emma have already expressed interest in expanding their research and educational work. Further research would vary from collecting information on Medicaid payments, how they are made, who they are made, what restrictions govern them, new laws that threaten them (Hyde Amendment) to investigating vitamin C as a means to abortion (is it really safe? What are the possible side effects: Can you take medicine for the side effects without adversely effecting the process? How far into the pregnancy will this method work?) Early research in these areas could easily build a base from which we could expand our research into drug related issues--misuse of estrogen--the pill, DES and post-menopause estrogen therapy. While the abortion issues may just affect women of a certain age (“Child-bearing years”) it cuts across all class and race lines. At the same time expansion into the drugs areas cuts across all age lines as well. Equivalent research has to be done on sterilization. CESA has been strongest so far in educational and community work.

The proposed task force--which would probably divide into two closely connected have would guide and undertake research as a basis for developing strategy on sterilization, working closely with CESA. The hospital data on hysterectomies on Medicaid patients collected by the Illinois Department of Public Health will be released to us in a few weeks. The task force would access the need for further research and the implications for direct action strategy.Education and Outreach Work CESA has already begun educational work on sterilization. For this and for abortion--an educational group--perhaps part of the Liberation School but with close connections to the task force, would organize presentations, and audio-visual materials and set up classes co-sponsored with other groups and community organizations. This would also function as a Women’s Health Speakers Bureau. Classes and educationals should be offered in particular communities where they can be specifically applied to local institutions ( e.g. the issue of 2nd trimester abortions at Cook County or sterilizations at local hospitals.) Here again the Chicago Women’s Center and Emma’s are both interested in doing this kind of work--we should undertake it jointly.

We see the issue of the menopause of women through drugs as very important here. It’s a new mass issue, attracting women who may not be interested in sterilization or abortion, but who can easily make the connections and begin to work on those issues. The medically defined “sickness” of childbirth has been followed by the epidemic “disease” of menopause. Hundreds of thousands of women are beginning to understand the risks from the pill, DES, post-menopausal estrogen therapy, etc. We propose a series of classes and educationals offered jointly with CWHC, or Emma’s, or the Grey Panthers, or community groups--perhaps where CESA is active. We might begin with a class on menopause, follow it with one one Women’s Right’s in the Health System, which would include material on Medicaid, consent forms for sterilization, rights to records, etc. They have to provide good, reliable information. We have a number of resources--women who have worked on the Concerned Rush Students’ Project on the drug industry, nurses, physicians who can help. Probably we should ultimately have a Drug Abuse Research group (could also include appliances--like fetal heart monitors in childbirth.

Direct Action

Out of our educationals would emerge a organizing base. We could mount patients rights campaigns in specific communities directed at particular institutions or consider city wide campaigns centered around Medicaid payments or the closing of a specific abortion clinic which treats women around the city ineptly(i.e. Biogenetics)-or actions around hospitals or clinics with suspiciously high sterilization rates. From our own organization perhaps we could pull the skill and interest of such groups as PT and Secret Storm. Outside CWLU we would try to hook up with other health and community groups. Organizing campaigns would be directed both to win reforms (close down negligent clinics) and develop peoples sense of power over their health care institutions in order to make demands for expanded and improved services. Simultaneous or sequential campaigns on a number of these issues would make their essential connections clear.

The nature of the issues would make coalitions with a wide variety of groups possible. For abortion struggles these might include Illinois Abortion Rights Association, N.O.W. Health Task Force etc. For sterilization we would have a different grouping with stronger representation from third world and welfare groups.

Structure

The two task forces might initially be one group, though they probably should become separate but liked groups. If this proposal is to be successful at least 15 people should work on the two task forces, and at least 25 on the project as a whole. We are including in the long-term plans an Educational Group which could be part of the Liberation School, and a Drug Abuse Research group.

In time we would also include an occupational health group (safety hospital workers, for example, might be a focus--which would in turn provide contacts which we could use in further disentangling the sterilization situation in institution. If the schools group develops program around screening, there would also be connections.

This whole proposal looks grandiose at first sight. We stress that the overall chart is a blueprint for possible development in a year from now ?). We would start with one task force which subdivides into two halves, and go on from there.

As for leadership it’s really hard to develop this without a clear idea of what the structure of the CWLU will be over the next year. Probably we should ultimately have a steering committee consisting of representatives from task forces, educational groups, HERS, CESA Drug Abuse group and other groups who want to join--Emma’s, CWHC, community organizations. The connections to other CWLU program will become more clear at the conference. But there is room for most currently active groups to work on this program. At least 50% of the resources of the CWLU might be devoted to it.

Sterlization Abuse: A Task for the Women's Movement

by The Chicago Committee to End Sterilization Abuse (January 1977) A working paper written to mobilize the women's movement to demand an end to forced sterilization. by the Chicago Committee to End Sterilization Abuse (CESA). (January-1977)

(Editors Note: CESA- Committee to End Sterilization Abuse was organized to advance reproductive freedom at a time when forced sterilization was a common problem— especially for low income and minority women. CWLU members were among CESA's activists.)

Sterilization abuse is an issue that should be taken up by the women's movement as a whole, for it is not just an issue of reproductive choice and freedom, but one which encompasses a whole range of other issues as well, including the economic nature of the U.S. health care delivery system, the nature of medical education, patient rights and informed consent, as well as national and international questions of genocidal population control policies. But before analyzing the actual political context of sterilization abuse, I will first outline the nature and scope of the problem.

Within the last 20 years, there has been a dramatic rise in programs aimed at sterilizing women, both in and outside the U.S. It is the most risky and fastest growing method of contraception in the U.S. today.1 Female sterilization increased by 350% from 192,000 in 1970 to 674,000 in 1975. 2 Some estimated 8 million men and women in the U.S. today are sterilized,3 and approximately one million women undergo sterilization operations each year.4 In 1970, 16.3% of all couples using some form of 5 contraception were sterilized. In 1973, the percentage had increased to 23.5.

Sterilization is increasingly being touted as the 'perfect' method of contraception for those who desire no more children. However, it involves a decision which must be considered carefully, its risks and benefits weighed and compared with those of other methods of contraception- for it is basically a permanent and irreversible operation.

Medical indications for therapeutic sterilizations, which usually require hysterectomies should be considered even more carefully, as it is a more dangerous operation, and should not be performed solely for contraceptive reasons.

Sterilization procedures vary somewhat. In women, it is accomplished by tubal ligation, in which the fallopian tubes are tied, blocked, or removed to prevent the passage of eggs. Tubal ligation is either done during a 2 to 3 day hospital stay with traditional surgical procedures, reaching the tubes through the vagina or abdomen, or by a new out-patient procedure called laparascopy, in which a tiny incision is made in the abdomen and the tubes are burned or clipped. This procedure is often deceptively known as "band-aid" surgery, as the incision is covered by one after the operation. It implies that there is little risk or few complications inherent in the procedure, which is not necessarily the case. A new procedure called a mini-laporatomy is now being perfected, and does not require special laparascopic training and equipment, It permits direct visualization of the fallopian tubes, and can be performed in 10-30 minutes.6 This procedure, however, is not risk free either, and has not been adequately perfected to permit its indiscriminate use.

Tubal ligations, by whatever method, always involve some element of risk, more so than in other methods of contraception. It is considerably more dangerous than the I.U.D. or diaphragm, and is not any safer than the continued use of oral contraceptives. For every million tubal ligation operations, for example, 1000 run the risk of dying from the procedure, compared to 31 and 9 deaths for every million pill or I.U.D. users.7 Serious complications per million women are as high as 15,000 for tubals, 600 for the pill, and 400 for the I.U.D.8 Some of the common side effects from this operation include bleeding, uterine perforation, accidental burning or bowel trauma, and abdominal pain or pain during menstruation. It is obviously not the safest method of contraception available to women.

Hysterectomies, which involve removal of the uterus, are a much more dangerous operation than tubals. Despite this, many physicians are encouraging the use of hysterectomies solely for contraceptive purposes. It is the second most frequently performed operation in the U.S. today--second only to tonsillectomies. In 1975, 690,000 hysterectomies were performed.8 The complication rate for hysterectomies is 10 to 20 times higher than for tubal ligations, with between 3000 and 5000 deaths per 1 million operations.9 Recovery from a hysterectomy also usually requires at least six weeks.

Four different studies, have in fact, shown that approximately one-third of all hysterectomies performed in the U.S. have been unnecessary, that is, the medical indications did not require the procedure.10 And the number of 11 elective" hysterectomies performed has been increasing. At one major teaching hospital in L.A. for example, a 742% increase in "elective" hysterectomy has been documented between 1968 and 1970. A professor of gynecology there said that sterilization by hysterectomy had become a commonplace and widely accepted operation.11 Some gynecologists have even suggested that hysterectomies be performed as a preventive measure--as way of preventing uterine cancer for example.12 -They neglect to remind us however, that the risk of contracting uterine cancer is much less than the risk of dying from a hysterectomy.13 Would these physicians also suggest removal of the breasts to prevent breast cancer, or removal of the prostrate to ward off cancer of the prostrate gland? The analogies are obvious and endless.

If then, sterilizations, either tubal ligations or hysterectomies, involve many more risks and complications than other methods of contraception, why has there been such a tremendous increase in the numbers performed? Undoubtedly, some of the increase has been due to increase demand on the part of women who do want to permanently end their childbearing, and have made an informed decision to be sterilized with knowledge of the potential risks and benefits of the operation in comparison to other birth control methods. However, many women, in and outside the U.S., are often deceived or coerced into undergoing sterilization operations, often without even knowing that they had been sterilized. And most often, the subjects of such abuse are the poor, the Black, the Latino, the American Indian--those already abused by our health care system. But before going into more depth into the whys of sterilization abuse, I will first describe in more specific detail, the nature of sterilization abuse.

Sterilization abuse first gained national attention in 1973 with the revelation that two black sisters, the Relf sisters, aged 12 and 14, had been deemed mentally incompetent by an Alabama physician who subsequently sterilized them using Federal funds to pay for the procedures.14 Their mother, who could not read or write, had been deceived into signing her "x" on the consent forms. A federal lawsuit followed; one result being that a Federal judge ordered DHEW to stiffen its then newly formed guidelines in order to prevent such abuse from occurring again.

Sterilization abuse, however, can occur on many different levels, and it will take much more than a federal order to prevent it from occurring again. When a woman does not know she had been sterilized or is knocked out and sterilized against her will, this is sterilization abuse in its most blatant form. However, more subtle forms of coercion or deception are often used. Misinformation is one tool of abuse--women are not told that the operation is permanent and irreversible, or are not counseled about other methods of birth control. Or women are wrongly told that if they don't consent, their welfare benefits will be cut off. And illegal as well as legal immigrants are sometimes threatened with deportation if they refuse the sterilization. The lack of interpreters in health care institutions makes it especially problematic for non-English speaking women to be fully informed of their rights and the nature of the procedure itself. The issue of informed consent is particularly important when hysterectomies are encouraged for reasons not medically justifiable. One particular Chicago hospital15 for example, routinely suggests hysterectomies for women with Class III Pap smear results, which only indicate non-malignant abnormal cell growth of the cervix, and would not usually require removal of the uterus.

Sterilization abuse also occurs when the operation is suggested to women in stressful situations when they are not usually capable of making an informed decision and when they are not given an adequate period of time in which to consider their decision. At L.A. County Hospital, for example, some women were routinely asked during labor whether they wanted their tubes tied.16 Sterilization is increasingly being described as appealing and hassle-free, and is even suggested as a way of improving your sex life in a new pamphlet issued by DHEW.

A few examples should serve to illustrate the types of abuse I've been discussing. In L.A. in 1975, 10 Chicana women sued L.A. County Hospital and state officials. One of the women had refused to give her consent to a sterilization. She was punched in the stomach by a doctor and then sterilized. Some of the women signed consent forms after being in labor for many hours and under heavy medication immediately prior to undergoing childbirth by caesarian sections. Two were led to believe that the consent forms they signed were for temporary sterilizations. One of the women was not aware that a sterilization had been performed and wore an intrauterine device for 2 years afterwards.17

Then there is the case of the South Carolina physician who refused to deliver a black welfare mother's fourth child unless she agreed to be sterilized postpartum. He subsequently sterilized 28 women in three months, all of them Black.18

Norma Jean Serena, an American Indian, was also a victim of sterilization abuse. An excerpt from her "Statement of Need for Therapeutic Sterilization" reads "We find from observation and examination of Norma Serena that she is suffering from the following ailment of condition"...'socio-economic reasons'... and that another pregnancy in our opinion, would be inadvisable. Therefore, we are of the opinion that it is medically necessary to perform the sterilization."19Ms. Serena thought that she had been sterilized for medical reasons. It wasn't until later that she discovered that she had been sterilized because she was poor.

It is no accident that all of these victims of abuse were poor and nonwhite women. In fact, the prevalence of sterilization among non-whites is higher than that of whites, even though non-white women make up a smaller percentage of the U.S. population than white women. Twenty percent of all married Black women in the U.S. have been sterilized and 14% of all. Native American women, compared to 7% of all married white women. 20 A recent Government Accounting Office (GAO) study commissioned by Senator James Abourezk of South Dakota, discovered that more than 3400 Native American women of childbearing age had been sterilized over a three year period in four different Indian Health Service areas in the Southwest.21 This figure is particularly frightening given the declining population of Native Americans--today there are fewer than 800,000 in this country. It would be comparable to sterilizing 452,000 non-white women in the U.S. The study also found that many of the consent forms to be illegal and not in compliance with Indian Health Service regulations. It also found that 36 women under the age of 21 and been sterilized, despite the court ordered moratorium on such sterilizations.

In fact, the sterilization regulations issued by DHEW as a result of the Relf case have been ignored by many physicians and institutions. In part, 'these regulations specify a 72 hour waiting period between the time of consent and the actual operation, a full explanation of the operation as well as other methods of contraception in the patients own language; and, to be written prominently at the top of the consent form, a statement which says that refusal to undergo the sterilization would not result in the loss of any Federal or state benefits.22

Even these minimal regulations, however, have been ignored by many hospitals and physicians, for DHEW provided no means of enforcing them. A 1974 survey of 42 large teaching hospitals across the country found that 27, or 64% of them to be in gross violation of the regulations, including two Chicago hospitals who subsequently claimed to be in full compliance. Fourteen of the hospitals were not even aware that such regulations even existed.23

The response of the women's movement to these abuses has been varied, and not always successful. Women in several cities are demanding the implementation of these guidelines, and in some cases, are fighting for better and more comprehensive guidelines. In New York City, after a 9 month battle, the Committee to End Sterilization Abuse (C.E.S.A.) was successful in getting better guidelines adopted by municipal hospitals. The major improvements over the federal guidelines include a 30 day waiting period, a detailed consent form, and counseling in the women's own language.

Implementation, however, is always a key problem, and enormous resistance has come from the medical and population control establishments. Six M.D.'s in New York's major teaching hospitals have filed suit against the city, state, and federal sterilization regulations. They claim the rights of physicians are violated by the New York City guidelines, particularly their freedom of speech, since the regulations state that a doctor cannot be the first one to suggest sterilization to a woman.

In order to effectively fight against sterilization abuse, not only in this country, but throughout the non-Socialist Third World, we first have to put it in its proper political perspective. The following is such an attempt. I will briefly outline three major reasons which I see as contributing to such abuse: (1) the population control establishment--its policies and ideologies; (2) the economic nature of the U.S. health care delivery system; and (3) the nature of medical education in this country, especially intern and residency training requirements. I will deal with the last two issues first.

It should be fairly obvious that physicians and hospitals stand to gain more economically by pushing sterilizations as opposed to other methods of birth control, especially when welfare patients are involved. DHEW has been funding 90% of sterilization costs in Federally funded family planning clinics since 1974. When placed in such a conflict of interest position, it is not surprising that economic interests might obscure patients' best interests. We certainly do not lack for studies which show that surgery rates are highest when economic interests to perform surgery exist. Federal employees under pre-paid group health plans, for example, had a 16.8% probability of having a hysterectomy by age 70. The odds of getting this operation under largely unregulated Blue Cross plans is about 35%. 24

The nature of physician education and medical training in this country also contributes to abuse of the poor and non-white, who often make prime targets for the surgical knives of interns and residents, who need to perform a minimal number of operations in order to fulfill certification requirements. The use of public patients as teaching "material" is an issue that many of are aware of, and is particularly relevant to the issue of sterilization abuse. Back in 1957, a physician at a New York teaching hospital proclaimed that "Sterilization by hysterectomy is encouraged on the ward service in order to offer the resident staff experience in the operation puerpural hysterectomy." 25 Such practices were not confined to the pre-sixties era, however. Dr. Lester Hibbard of L.A. County Hospital admits in 1972 that vaginal tubal ligations were sometimes selected over abdominal tubal ligations because of their "instructional value," even though the vaginal procedure often led to serious complications.26 And in 1975, the acting director of a municipal hospital in New York City informs us that "In most major teaching hospitals in New York City, it is the unwritten policy to do elective hysterectomies on poor, Black, and Puerto Rican women with minimal indications, to train residents ... at least 10% of gynecological surgery in New York is done on this basis. And 99% of this is done on Blacks and Puerto Rican women."27

The most pervasive influence on the practice of sterilization abuse, however, is the population control ideology which lends academic and political credence to the "blame the victim" strategy which justifies such coercive practices. For "overpopulation" has been used to explain everything from poverty, unemployment, and starvation to revolutionary unrest. Population control has become an important part of the foreign policy of the U.S. It rests on the assumption that population growth may wipe out not only agricultural growth but all economic development. Beyond this, the population control programs rest on particular sets of priorities about the needs of the poor. With birth rate reduction as the highest priority, the policies assume that the prevailing class structure should not be altered, that only gradual, non-revolutionary political change is to be encouraged, that relations between the sexes should be allowed to shift only gradually and within the existing class structure. Thus population control becomes a force against revolutionary change.

This is not to say that real problems of overpopulation do not exist in some parts of the world--the point is, is that overpopulation is by and large a result of poverty, not a cause of poverty.28 Historically, birth rate decline has been a consequence, not a cause of, economic development. In every instance of industrialization, birth rates fell after changes in mode of production lowered infant mortality, made children less valuable and more expensive economically, and increased demands and opportunities for women's employment outside their homes. Even the most conservative of academic demographers would be hard pressed to deny that it is rising living standards which create the primary inducements for fewer children and so declining birth rates--not the other way around. In a rural economy governed by peasant agricultural production and social organization, children are often a family's most valuable asset.

However, it became increasingly clear to many formerly colonized peoples in the Third World, that capitalist exploitation of their resources, destruction of peasants livelihood, and creation of an economically helpless working class, could only be resolved through independence and economic development through nationalist and often socialist economic reorganization. Such revolutionary undertakings would have limited and even ended the continued economic exploitation of Third World countries by Western capitalists, such has already occurred in many places such as Vietnam, Cuba, and Mozambique, to name just a few. Population control provided a rationalization for the failure of capitalism to provide economic growth for the peoples of the Third World and a proposed solution to their poverty and underdevelopment. Born of the Cold War, the population controllers considered stopping communism not only their highest priority, but also, according to their propaganda, the main reason that economic progress in the Third World was desirable. For example, "The Population Bomb,'' a pamphlet of the Hugh Moore fund of the Dixie Cup fortune, first published in 1954, and reprinted frequently until the mid-sixties, featured such arguments as, "There will be 300 million more mouths to feed in the world 4 years from now--most of them hungry. Hunger brings turmoil, and turmoil, as we have learned, creates the atmosphere in which the communists seek to conquer the earth."29

Thus, in the 1960's, population control received first priority within U.S. nonmilitary foreign aid. In fact, receiving foreign aid usually obligated receiving nations to undertake population control programs in accordance with U.S. State Department specifications. So it was that Lyndon Johnson remarked that $5 spent on family planning was worth more than $100 spent on development. Today, approximately 67% of all U.S. outlays for health care are now earmarked for population planning.29 And the Agency for International Development (A.I.D.) has increased its population control budget 40% over the last three years to $144 million in 1976--at the expense of other health programs.30

However, the U.S. State Department is not the only financial backer of U.S. population control programs. Some of the top ruling financiers in the U.S. have been funding such programs since the early fifties and before. For example, the exclusively ruling class Population Council is one of the Rockefeller family's main legacies to the family planning field. The council, along with the Rockefeller and Ford foundations has been the most active in providing funds for research in bio-medicine, improved delivery systems, and more efficient means of disseminating current population control techniques. Most of the prominent population groups like the International Planned Parenthood Federation (IPPF) are headed by ruling financiers like the Carnegies and Mellons, and have barraged us with all sorts of racist publicity and mass advertising campaigns to check the so called population explosion.31

One particularly racist ad which appeared in 1969, that was put out by the Committee to Check the Population Explosion began by asking, "How many people do you want in your country? Already the streets are packed with youngsters. Thousands of idle victims of discontent and drug addiction. You go out after dark at your peril ... the answer? Birth control. The ever mounting tidal wave of humanity challenges us to control it, or be submerged along with all of our civilized values."32 The implication is clear. Civilized values belong to Western Europeans and white Americans, while the black, brown, red, and yellow people of the world account for the tidal wave of humanity.

Ads such as these were designed to generate popular and governmental support for population control programs both in and outside the U.S. And health workers are obviously not immune to this ideology, as evidenced in their own attitudes and practice. These attitudes are most prevalent among the top elite of the health professions--white, male physicians, many of whom believe that poor and non-white women should be sterilized for their own good, as well as the "good" of the country. And they are not hesitant about admitting it. At a conference of obstetricians and gynecologists in 1966, one physician panelist asserted that, "After working with these so called poor, especially with minority groups, the Negro and Spanish American, I have the impression that these people have the view that nothing in the past has ever worked and nothing is going to work now. They bring you a feeling of hopelessness unless 'if I have THE operation' as it is known among the Puerto Ricans."33 He further went on to suggest that sterilization of the poor would be a way of reducing the number of broken families and ADC recipients.

Planned Parenthood survey of 226 physicians in 1972 provides us with further evidence of the prevalence of such attitudes among U.S. physicians. Thirty-four percent of them favored the withholding of any public assistance for any subsequent pregnancies of welfare mothers with 3 'illegitimate' children, and 30, favored withholding public assistance to such women if they refused to be sterilized.34

Population control propaganda is promoted far beyond the borders of the U.S. however. It often reaches people in the Third World in the form of the pictures below:

Get the message? You too, can have a nice home, a car, and even a DOG, but only if you stop having so many kids! The working and peasant people of the Third World, however, are not so naive as the population experts would like to think. These women know that having their tubes tied is not going to bring them instant wealth complete with a color T.V. set. In fact, they know that their survival very often depends on having enough children survive to an age where they can provide economic support to the family.

It should come as no surprise then, that, by and large, most family planning programs in the Third World have been failures, at least in terms of reducing the birth rate. Population controllers have been increasingly suggesting that effective population control can never happen voluntarily. One of the chief architects of family planning programs in Latin America, for example, writes that there has been no evidence of any birth rate reductions there after a decade of such programs. Women who attend the family planning clinics there are primarily those who have used contraception without the clinics, and who have already had an average of 5 children.35

As a result of this kind of evidence, population controllers have increasingly advocated various kinds of coercion in their programs. In India, for example, the government first tried to bribe people into sterilizations by handing out transistor radios or cash payments. 36 As that didn't work, some states in India have passed legislation requiring sterilizations for government employees with two or three children. Last year, up to 150 people were shot in protests over the new sterilization laws. 37 Some reports tell of men being forced off buses and transported to vasectomy camps.38 Women are thus not the only victims of sterilization abuse.

Coercion has also increasingly become a part of family planning programs in Latin America. The Ford Foundation, for example, donated one million dollars for an experimental sterilization program there, in which individuals would be guaranteed $5, $6, or $7 a month for the rest of their lives if they agreed to be sterilized.39 Between 1963 and 1965, 40,000 women in Columbia were sterilized by Rockefeller funded programs. These women were coaxed by gifts of lipstick, artificial pearls, small payments of money, and promises of free medical care.40 And in Bolivia, a U.S. population control program administered by the Peace Corps sterilized native Quechua women without their knowledge or consent.41

An A.I.D. sponsored program in the U.S. has been training Third World physicians to perform laparascopic tubal ligations. At the end of the course, each physician is flown home with a $5000 laparascope. Since these foreign M.D.'s do not have a license to practice medicine in the U.S., they could only practice using the laparascope on rabbits, which obviously do not have the same kind of gynecological problems and pelvic structures as women.42

The International Association for Voluntary Sterilization (A.V.S.) is now providing mini-laparotomy instruments to government and medical institutions in the Third World. A quote from the A.V.S. newsletter is quite revealing of their practices; "Women living in rural areas deficient in physicians and electricity may be safely sterilized by minilaparotomy. Whether performed in a modern hospital or a converted one table shack, minilaparotomy is a simple, 10 minute procedure requiring inexpensive equipment and minimal training."43

No mention is made of its experimental nature; no mention of its surgical nature, or the problems involved in performing any type of surgery on women who are most likely already undernourished and in bad physical condition.

Instead of providing health workers to these underserved areas, the A.V.S. supplies laparotomy instruments. They have so far sent supplies to Guatemala, El Salvador, Peru, Brazil, Chile, Bolivia, Columbia, Costa Rica, Ecuador, Guyana, Haiti, Honduras, and Mexico. Among their programs in Latin America, the total number of minilaporotomy procedures performed in 1976 has exceeded the total performed in 1974 and 1975 combined.44 So much for progress.

Probably one of the most insidious U.S. population control programs in the Third World has been in Puerto Rico, which has the highest incidence of sterilization in the world. A government issued survey found that 35% of all women of childbearing age there had been sterilized--more than one out of every three such women.45 Thousands of women are sterilized each month in U.S. funded family planning clinics there, which provides them free of charge.46 many sterilizations are performed postpartum, which is standard procedure in some teaching hospitals for women with two or more children. Welfare women, people on food stamps, and people who want housing are all receiving special orientations about overpopulation and sterilization.

It is so common on the island that it is commonly referred to as "the operation."

The primary goal behind this U.S. population plan is to reduce the working class population on the island in order to make way for U.S. corporations. A report of a Puerto Rican economic policy making group proposes reducing the working sector of the population in order to reduce unemployment, which is by some estimates, as high as 30%.47 Heavy industries, mainly U.S. petroleum and petro chemical industries, have moved onto the island in recent years, displacing many rural and light industry workers. These heavy industries require a relatively small workforce--the excess working population must somehow be "disposed" of, either through sterilization or forced migration.

The fact that sterilization programs in Puerto Rico are being carried on in a colonial context in a nation where people do not have control over their own lives and their government makes the term "voluntary" sterilization totally inapplicable. It is our responsibility to put an end to these kinds of programs, just as it is our responsibility to put an end to the forced sterilizations in this country as well.

WHAT IS TO BE DONE?

There are a variety of ways in which the issue of sterilization abuse can be attacked. We can agitate for enforcement of the HEW guidelines as they now exist, or demand even more stringent Guidelines to be enforced, as was done by New York C.E.S.A. However, as the medical and population control establishments have such enormous power in this country, it becomes important to forge health worker, patient and community alliances in order to fight them. The New York experience has taught us that we can not solely rely on health care workers to fight against such abuses, but we certainly need their support in order to discover where abuse is occurring. Many of the cases of abuse we know about were first brought to light by concerned health workers in institutions where coercion and deception were commonplace. In fact, the M.D. at L.A. County Hospital who publicized and exposed many of the sterilization atrocities that had occurred there is now being threatened with revocation of his license by the state of California on the charge of "moral depravity."48

We cannot, then, simply wage a legal battle against sterilization abuse, for the forces of law can easily be turned against us. It is clear to me that we need to reach out to communities in the form of health care forums and educationals on such issues as patient rights, patient education, the nature of the health care system, as well as on issues of reproductive freedom. The work that the Chicago chapter of C.E.S.A. has done has taught us that we cannot simply wage a battle on the issue of sterilization abuse alone, but that we need to combine it with other issues of more pertinent concern to women. If the women's health movement combines its forces and resources with those of other community health organizations in order to provide innovative health education programs in targeted communities, we can begin to get feedback from people in those communities about the issues that might encourage active struggles around them. Sterilization abuse could become just one part of building active community struggles around broader issues of health and community control of the institutions that wield so much power over our lives.

FOOTNOTES

1. Rosenfeld, Wolfe, and McGarrah- 1973. "Health Research Group Study on Surgical Sterilization." Health Research Group (Jan.): Washington, D.C. 

2. Association for Voluntary Sterilization, Inc. 1975. "Estimate of Number of Voluntary Sterilizations Performed." (mimeo): New York, and AVS NEWS. 1976 (Sept.), New York. 

3. AVS NEWS, op. cit. 

4. Rosenfeld, Wolfe, and McGarrah, op. cit. 

5. AVS NEWS, op. cit. 

6. AVS NEWS. 1975. (Oct.): New York. 

7. Rosenfeld, Wolfe, and McGarrah, op. cit. 

8. Ibid. 

9. Rodgers, Joann. 1975. "The Change of Life Operation." Chicago Sun Times. 
Oct. 12, 
and Wolfe, Sydney. 1975. "Testimony Before the House Committee on
Oversight and
Investigations on Unnecessary Surgery." Health Research Group (July 19): 
Washington, D.C. 

10. Wolfe, Sydney, op. cit. 

11. Rosenfeld, Wolfe, and McGarrah, op. cit. 

12. Lieberman, Sharon. 1976. "What the 'Hysterectomy Mafia' Got From HEW." Majority Report (Nov. 13-26). 

13. Rodgers, Joann, op. cit. 

14. Relf et al. vs. Weinberger et. al. Civil Action No. 73-1557 U.S. District Court. Washington, D.C. March 15, 1974. 

15. Personal communication, July, 1976. 

16. Rosenfeld, Wolfe, and McGarrah, op. cit. 

17. Foner, Laura and Evelyn Machtinger. 1976. "Sterilization." New American
Movement (June) 

18. Chicago Sun Times. 1975. "Sterilization Suit Brings $5 Award." (July 26), and Dollars and Sense. 1977. "Congress Votes Against Women's Rights." (Jan.). 

19. Norma Jean Serena Support Committee. "Norma Jean Serena." (mimeo): 207 Oakland Ave., Pittsburgh, Pa. 

20. Westoff, Charles. 1972. "The Modernization of U.S. Contraceptive Practice." Family Planning Perspectives, IV (July): 9, and Committee to End Sterilization Abuse (C.E.S.A.). 1975. "Sterilization Abuse of Women: the Facts." (mimeo): Box 839, Coopers Station, New York. 

21. Comptroller General of the United States. 1976 (Letter and report to
Senator James

Abourezk): Nov. 4. (B-164031) (5). 

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22. U.S. Department of Health, Education, and Welfare. 1974. "Restrictions Applicable to Sterilization Procedures in Federally Assisted Family Planning Programs.,!! Federal Register 39: 13872 (April 18) 

23. McGarrah, Robert. 1975. "Sterilization Without Consent; Teaching Hospital Violations of HEW Regulations." Health Research Group Document 252. (Jan.): Washington, D.C. 

24. Wolfe, Sydney, op. cit. 

25. Guttmacher, Alan. 1957. "Puerperal Sterilization on the Private and Ward Services of a Large Metropolitan Hospital. Fertility and Sterility 8 (6):591-602. 

26. Hibbard, Lester T. 1972. "Sexual Sterilization by Elective Hysterectomy." American Journal of Obstetrics and Gynecology 112 (April):1076. 

27. C.E.S.A., op. cit. 

28. See especially, Commoner, Barry. 1975. "How Poverty Breeds Overpopulation." Ramparts (Aug./Sept.), and Folbre, Nancy. 1976. "Economics and Population Control." Science for the People Vol. 3, No. 6. (Nov./Dec.) 

29. Mass, Bonnie. 1975. "The Political Economy of Population Control in Latin America." (Pamphlet) Women's Press, Montreal. 

30. Mass, Bonnie. 1977. "Coercive Population Plans Continue." Guardian (Jan. 
19) 

31. Barclay, William, Joseph Enright, and Reid Reynolds. 1970. "Population Control in the Third World." NACLA Newsletter Vol. IV, No. 8 (Dec.) 

32. Ibid. 

33. White, Charles. 1965. "Tubal Sterilization: a 15 Year Survey." American Journal of Obstetrics and Gynecology 95: 31-39. 

34. Silver, M.S. 1972. "Birth Control and the Private Physician." Family Planning Perspectives." IV (2): 42. 

35. Stycos, J. Mayone. 1973. "Latin American Family Planning in the 1970's,"in Stycos, ed. Clinics, Contraception, and Communication. New York (Appleton, Century, Crofts) pp. 17-22. 

36. C.E.S.A., op. cit. 

37. Rosenhause, Sharon. 1976. "Tell India Deaths in Sterilization Row." Chicago Sun Times Oct. 28. 

38. Ibid. 

39. Barclay, William, et. al., op. cit. 

40. Mass, Bonnie. 1975, op. cit. 

41. C.E.S.A., op. cit. 

42. Foner, Laura, op. cit. 

43. AVS News. 1976. "Minilaporatomy Has Great Potential'' (Sept.) 

44. Ibid. 

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45. C.E.S.A., Opt cit. 

46. Ibid. 

47. C.E.S.A. 1975. "Government Network Sterilizes Workers." (mimeo): Box 839, Coopers Station, New York. 

48. "Sterilization: Report Lists Abuses." 1976, Guardian (Dec. 29).

35% of Puerto Rican Women Sterilized

by the Committee for Puerto Rican Decolonization (undated-but probably late 1970's) An expose of the reproductive policies pursued by the Puerto Rican authorities in collusion with the US government and US corporations. (undated probably, late 1970's)

(Editors Note: CWLU members were very active in in the movement to end sterilization abuse and formed alliances with Latina groups also working on the issue.)

A hitherto "secret" report from an economic policy group empowered by the Governor of Puerto Rico has recently surfaced in the United States. One can see immediately why the report, dated November, 1973, has been kept from the public: it talks openly and directly about alternatives available for reducing the ranks of the Puerto Rican working class.

As the report, entitled "Opportunities for Employment, Education and Training" would have it, Puerto Rico's key problem is, and has always been, unemployment.

The latest official figure given in the report is an unemployment rate of 12.3% in 1972 (although unofficial sources, such as the Puerto Rican Chamber of Commerce, hold it as high as 30%); what concerns this particular subcommittee of colonial administrators is that, at the rate things are going, unemployment could reach 18.5% by 1985.

" The Governor of Puerto Rico recently selected the figure of 5% unemployment by 1985", the report underlines. There is clearly a major discrepancy between the two figures, which presents a tough problem to the subcommittee. How to solve it?

The members of the subcommittee -Teodoro Moscoso, Administrator of Fornento, Secretary of Labor Silva Recio, Secretary of Education Ramon Cruz, and the then President of the University of Puerto Rico Amador Cobas, have come up with two solutions. One way is to foster new jobs --the same solution which has been advocated throughout Puerto Rico's twenty-five years of industrial development, and which has yet to reduce the high unemployment rate. The other, which they go on to discuss immediately, is to "reduce the growth of the working sector" of the population.

Their line of attack is two-pronged, involving the massive sterilization of Puerto Rican working-class women, and a forced migration of Puerto Rican workers to the United States. It is the former aspect of this plan which concerns us here.

The Sterilization Plan

Under the heading of "organization and focuses of family planning", the November report estimates the female population of child-bearing age outside of San Juan to be 485,948. Agreeing with other studies on the astounding figure of 33% for the number of Puerto Rican women of child-bearing age that have already been sterilized, the report goes on to say "in other words, of the 485,948 women of reproductive age living in Puerto Rico, excepting the area of San Juan, 160,363 are sterilized. This leaves a potential clientele of 325,585 women . . ."

The women of San Juan are to be handled through a "model project" controlled by the School of Public Health of the University of Puerto Rico.

The plan then, involves the entire population of Puerto Rican women of child-bearing age in its scope, and the primary method of birth control? What it has always been in Puerto Rico -sterilization.

One-Third of Puerto Rican Women Sterilized

Figures from different studies give a general picture of the rate of sterilization of Puerto Rican women over the past four decades.

In 1947-48, Paul K. Hatt, in a study of 5,257 ever-married women 15 years old or over, found that 6.6 per cent had been sterilized. A figure more or less equal (6.9 per cent) was put forward in 1948 by Emilio Cofresi from studies of women who were clients of various programs of the Department of Health in Puerto Rico.

In an island-wide survey carried out by Hill, Stycos and Back in 1953-54, the prevalence of female sterilization of ever-married women 20 years old or over was estimated at 16.5 per cent.

In 1965 the Puerto Rican Department of Health carried out an island-wide study on the relationship between cancer of the uterus and female sterilization. Although the Department of Health says no link between cancer and sterilization was substantiated, it did discover that 34% of Puerto Rican women between the ages of 20-49 years were sterilized.

The number of women sterilized in the same age group rose to 35.3% in 1968 according to a study by the Puerto Rican demographer Dr. lose Vasquez Calzada.

The incidence of sterilization in Puerto Rico is the highest in the world. India and Pakistan, for example, which have public sterilization programs, have an estimated sterilization of 5% and 3% respectively.

The Colonial Context

What is the context in which this massive sterilization was taking place? Since its invasion of Puerto Rico in 1898, the United States has maintained virtually complete control over the island's development. Until 1952, the Governor of Puerto Rico was appointed by the President of the United States, and had veto power over a local House of Representatives. Civil services, armed forces, police; mail, citizenship, trade agreements, schools, media, and economic programs were under U.S. supervision.

The establishment of the Commonwealth Government in 1952 in no way changed the fact of US control, since Congress still maintained ultimate veto power over any law passed by the Puerto Rican Government, and any law passed by Congress automatically applied to Puerto Rico. What the Commonwealth Government did do was supervise the influx of U.S. corporations in a rapid industrialization program during the fifties, which transformed Puerto Rico from a sugar economy to one of the most highly industrialized countries in the world.

Population Control -A U.S. Theory

In 1901 Governor of Puerto Rico William Hunt wrote in his report to the President of the United States: "Not only could it [the island] comfortably keep the one million inhabitants we have now, but five times that number."

By the thirties, however, J.M. Stycos reports in "Female Sterilization in Puerto Rico" that a good many doctors were already aware of the "problems of population". He cites the efforts of Dr. Jose Belavel, head of the Pre-Maternal Health program to interest many physicians in the "pressing need for sterilization and birth control".

During the thirties in the United States population control research was being carried on by the Rockefeller Foundation.

Theories were circulating expressing the general idea that economic problems in underdeveloped countries were really problems of too many people; if only the population growth could be controlled, the standard of living would rise.

The population theories, as the newsletter of the North American Congress on Latin America (NACLA) entitled "Population Control in the Third World" indicates, had, and still have, strongly racist roots, based on the concept of the safeguarding the superior white civilization from the crude and inferior "underdeveloped" world which threatens to overwhelm the globe with its "population explosions."

For the United States, there was the particular problem of keeping the colonial population of Puerto Rico under control. By 1933 U.S. sugar companies had monopolized 314,000 acres. Thousands of impoverished farmers, forced from their lands, migrated to the cities or became agricultural laborers on sugar plantations where wages averaged 37 cents per day. This had its political consequence: caneworkers began to organize militant unions, and nationalism was growing. What better way to obscure the real problem of U.S. control of the island than by blaming it on population growth? A quote from a Puerto Rican legislator during the time, (taken from Back, Hill and Stycos: "Population Control in Puerto Rico"), expresses this confusion:

" . . . those of us who have discussed maldistribution of Puerto Rican lands and its growing absentee ownership must realize that these problems are growing more and more serious through our existing surplus population and its constant growth, particularly in recent years. The inevitable consequence is increasing unemployment, growing poverty and mounting misery."

The Sterilization Campaign

According to Harriet Presser in "The Role of Sterilization in Controlling Puerto Rican Fertility", sterilization was introduced into Puerto Rico in the 1930's, along with contraception methods. In 1934, 67 birth control clinics were opened with federal funds channeled through the Puerto Rican Emergency Relief Fund. The funds lasted only two years; then in 1936 the private Maternal and Childcare Health Association opened 23 clinics.

The Family Planning Association of Puerto Rico, another private organization, was established in 1954, two years after the Population, Council was formed in the United States by John D. Rockefeller. During the next ten years, according to Presser, it subsidized sterilization in private facilities for 8,000 women. Between 1956 and 1966 it also subsidized sterilization of 3000 men. This organization still functions today, and has an important role to play in the future, according to the November, 1973 report. Presently it receives $750,000.00 of its $900,000.00 budget from the federal Department of Health, Education and Welfare.

Thousands of sterilizations also took place in public hospitals. In 1949 the Commissioner of Health in Puerto Rico was quoted in El Mundo as saying he would favor the use of district hospitals once or twice a week to perform fifty sterilizations a day.

Many doctors were pro-sterilization rather than other forms of birth control. "Many physicians thought, and still think," says J.M. Stycos, that contraception methods are too difficult for lower class Puerto Ricans and regarded post-partum sterilization as the most feasible solution to the [population] problems".

An experience of one pre-medical student in Puerto Rico in the 1950's, told to us by an informed source, indicates that this preference for sterilization was not only an obviously racist attitude, but a policy.

As part of her training, the student was told that any pregnant woman who came into the hospital for a delivery who had already had two or more children must have her tubes tied after giving birth. This was standard procedure, checked afterwards by another doctor to make sure that it was carried out.

Generally, it seems that most sterilizations were carried out post partum. In 1949, using J.M. Stycos' work again, 17.8 per cent of all hospital deliveries were followed by sterilization. Stycos notes that these figures may underestimate the actual incidence of sterilization because it did not count the women who had home deliveries and then hospital sterilization; also, not all sterilizations may be recorded as such in the hospital records, he adds.

Private hospitals also had an exceptionally high incidence of sterilization in proportion to deliveries, says Presser. She cites one hospital that had to reduce its sterilizations to 25% of all deliveries because of outside pressure.

Presser indicates that most sterilizations have been post-partum, and that "enabling an increasing incidence has been the continued rise in hospital deliveries", which went from 10 per cent in 1940 to 37.7 per cent in 1950, 77.5 per cent in 1960 and 90 per cent in 1965, according to the Puerto Rican Department of Health.

Hospitals in Puerto Rico are substantially financed by the United States government. The entire medical apparatus in Puerto Rico was developed by the United States; training was carried on by U.S. doctors. Many of the doctors working in Puerto Rico and performing sterilizations have been and are today from the United States.

The United States carries on population control programs throughout the third world, most of which, according to NACLA, are financed by the Agency for International Development. Some AID programs, such as the "Family Planning Insurance" in Costa Rica actually offer money in return for sterilization.

Puerto Rico's colonial status gives the United States the ability to carry on effective population control programs in the world.

The increased sterilization of Puerto Ricans becomes more and more necessary as the U.S. industrial plans for the island -plans which profit U.S. corporations, and do not build a future for the inhabitants of Puerto Rico -develop. This becomes clearer as we continue to explore the ramifications of the report "Opportunities for Employment, Education & Training."

Committee for Puerto Rican Decolonization, Box 1240 Peter Stuyvesant Station, Now York, N.Y. 10009, (212) 260-1290 / all labor donated