Taking Care of the Caretakers

In 2017, when I researched and published an anthology about women caregivers, I neglected to reach out to the Domestic Workers Alliance which advocates for the more than two million women who work as nannies, housecleaners, and home care workers. I focused on women who told their personal stories of caregiving for spouses, children, parents and friends. It was a bad oversight that has troubled me since.

I was reminded of that in June when the Federal Domestic Worker Bill of Rights was reintroduced by Rep. Pramila Jayapal (D-WA), Sen. Kirsten Gillibrand (D-NY) and Sen. Ben Ray Lujan (D-NM). Introduced initially in July 2019, before the pandemic hit by (then)Sen. Kamala Harris and Rep. Jayapal. It was groundbreaking legislation aimed at ensuring workplace protections for domestic workers in the U.S. and it is still sorely needed.

An article published in Mother Jones Magazine in April pointed out that “domestic workers perform grueling work with few protections,” often providing care in isolated settings that render their work invisible, as feminists have known for decades as they fought for women’s caretaking in the home to be seen as actual labor. As the Mother Jones article also noted, in the U.S., such work has also been done by Black women who were systematically excluded from the New Deal’s labor agenda. Ever since then, they have struggled to achieve standards that are in place for others covered by labor laws.

According to the Domestic Workers Alliance, 84 percent of domestic workers don’t have a written agreement with their employer. Twenty-three percent don’t feel safe at work, and 81 percent receive no pay if their employer cancels the job with less than three days’ notice. Over a third of domestic workers don’t get a meal or rest break and if they do they aren’t given compensation for that time. If they are full-time employees, they are extremely unlikely to get paid sick leave or vacation, or any kind of insurance. The work could involve childcare, cooking and cleaning houses, or providing physical care for family members who are aging or have disabilities.  Yet their work is among the most undervalued in our society and the workers are among the most vulnerable people in the country.

The Alliance also points out that in the early  20th century, southern lawmakers prevented domestic workers from being included in federal labor laws because the majority of them were Black. It states that “to this day, the legacy of slavery continues to shape domestic work and domestic workers have limited protections under civil rights laws.” That reality means that domestic workers are exploited and are often subject to long work hours with low pay, sudden job loss, sexual harassment and abuse.

The movement for ensuring all labor rights to domestic workers is global. The International Domestic Workers Federation is a global membership organization that operates in every part of the world. It began establishing its network in 2006 with the objective of building a strong, democratic and united domestic/household workers global organization to protect and advance domestic workers rights everywhere. 

Here is just one story (edited for length) shared on their website. “Like many indigenous domestic workers in Mexico, Maria is an internal migrant; she travels from a small village to Mexico City daily. In the beginning she worked long hours, with no rest time, little food, and extremely low pay (US$7) for ten or more hours of work a day…. She felt she had to endure the conditions as a single mother of two daughters…she desperately needed the income. Years later, Maria moved to a new job, just before the pandemic hit. Fearing that she would infect the household her new employer asked her to live-in but she couldn’t because she had two children, leaving her without income until she learned about an organization that was providing emergency Covid-19 benefits to domestic workers. In addition to emergency relief, she learned about her rights, negotiating techniques, and realized that her work had value. She was able to return to work and now has a contract that insures her rights.”

It's a common story among domestic workers all over the world, and I should have sought their stories too.

In the preface to my anthology, Take Care: Tales, Tips, and Love from Women Caregivers, I wrote “Today being the main caregiver may be more vital to understand than ever”. As women have children later and elders live longer, women especially are challenged by competing demands and shrinking resources. Many of us have elderly parents in a time of growing dementia or increasing frailty or growing children who have their own challenges. We may have ailing partners, family members or friends. And no matter our age, we are there for them in caregiving roles, well before we may have expect to be there.

My own experience with caregiving began when I was young. My parents had married late, and both suffered from chronic conditions as they aged. By the time I was in high school I had to take on many of the demanding tasks of keeping  a home going. I understood early what it means to be a caregiver, although I did not have the usual challenges expressed in this essay.

Now, when changing demographics challenge the world, we need to realize that caregivers are a special group of people, usually women, but also men, who deserve to be respected, protected by labor laws, and free from isolation and fear. We are so fortunate to have them in our lives when we need them. Surely we can be their caregivers financially, fairly, and emotionally. 

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Elayne Clift writes from Brattleboro, Vt. www.elayne-clift.com

Just How Broken is Our Healthcare System?

A young woman dies in childbirth for lack of proper perinatal care. An elderly man can’t afford meds to control his chronic conditions, so he rations them. A child is misdiagnosed in the emergency room. A patient waits months to see her doctor about a troublesome symptom.

Stories like these abound. They are shared by patients, parents, partners, good healthcare providers and others who’ve had enough of medical runarounds, cost issues, access problems, diagnostic and treatment errors, insufficient time with providers, and more, to contend with. Reports of major issues in healthcare by medical professionals as well as patients and politicians with a conscience are increasingly sounding alarms.

In a recent Instagram post, for example, Senator Tammy Baldwin (D-WI) was outraged to learn that drug companies charge as little as $7.00 for an inhaler outside the U.S. while here the price gouging rises to as much as $380 depending on what type of inhaler is needed. Senator Bernie Sanders (I-VT) is among several Democratic senators, and The Senate Health, Education, Labor and Pensions Committee, that have demanded information about asthma inhaler patents and prices from four major manufacturers accused of “manipulating the patent system.”

One of the four companies was cited for charging $645 for an inhaler it sells in the UK for $49. Another company was called out for charging $286 on the U.S. market for an inhaler that costs $9.00 in Germany. According to another Instagram post in February, “Pharmaceutical giant Eli Lilly reported over two billion dollars in profit in the last three months of last year alone. This massive number comes from hiking prices of vital drugs for American seniors and other patients”.

Dr. Ashish Jha, Dean of the School of Public Health at Brown University wrote in a Washington Post editorial in January expressing his concern that some doctors are selling their practices to private equity firms because running a medical practice has become a management nightmare. “The number of private equity firms in health care has exploded in recent years,” Dr Jha lamented. “It’s a trend that should have everyone’s attention, from politicians to patients, because it can significantly increase costs, reduce access, and threaten patient safety.”

In an article published in the New York Times in November last year, Dr. Amol Navathe, co-director of the Healthcare Transformation Institute at the University of Pennsylvania, worried that non-profit hospitals were focusing more on dollars than patients.  He wrote that nonprofit hospitals are “hounding poor patients for money, cutting nursing staffing too aggressively, and giving preferential treatment to the rich.” It’s gotten so bad, he says, that nurses and other healthcare workers are resorting to strikes to improve workplace safety at several hospitals during an “acquisition spree” that is making healthcare less affordable.

Nursing homes and assisted living facilities are taking a hit too. According to the New York Times these profitable facilities charge $5,000 per month or more topped up by fees for such things as a blood pressure check, $50 for an injection (more for insulin), almost $100 a month for medication orders from external pharmacies, and over $300 a month for daily help with an overpriced inhaler. There can be extra charges for help in toileting, dining room fees, or a daily check in by staff.

There are currently 31,000 assisted living facilities nationwide. Four out of five of them are for profit businesses. Most of them cater to affluent white elders, although minority groups are a quarter of the population older than 65 in the U.S. According to the New York Times piece, assisted living is “part of a broader affordability crisis in long term-care for the swelling population of older Americans.” Aside from cost issues, there are reports of serious care problems reported by watch groups, ranging from staffing shortages, growing infection rates, and lower vaccination rates in assisted living facilities.

Another area of healthcare feeling a looming crisis is mental health, including addiction.  Daniel Bergner, author of the book My Brother’s Story, the Science of Our Brains, and the Search for Our Psyches, points out that while housing, additional psych wards, and community-based treatment facilities are traditionally identified remedies, budgetary and logistical problems are ignored. “These fundamental changes often involve the involuntary nature of care,  and the flawed antipsychotic medications that are the mainstay of treatment for people dealing with the symptoms of  psychosis,” he says.

Bergner reveals that existing laws in almost all states allow for mandatory care that can rely on court-ordered treatment, including the use of antipsychotic drugs. “Imagine,” he asks us, “being hauled off to an emergency room, forcibly injected with a powerful drug…and held in a locked ward until being dispatched into a compulsory outpatient program.” He points out that is likely to add to a patient’s trauma, isolation, and lack of agency, rather than their recovery. “Compulsory care is deeply problematic…made more so by the medications at its core. … Drugs shouldn’t be the required linchpin of treatment.”

This is just a sampling of the issues confronting our failing healthcare systems. Our disgraceful maternal and infant mortality rates are often linked to racial discrimination. Shrinking Medicaid payments to clinics for the poor dramatically affects healthcare for the poor. And reproductive healthcare is on a rapid road to crises that smack of sexism -- all among the reasons our voices and votes need to be heard this year.

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It's Time to Confront Violence Against Women

“Do you know how it feels to get smacked around?”

“He abused me psychologically to the point that I wasn’t able to talk or think by myself.”

“I was told I was worthless. Abuse made me feel I’m nothing.”

“I asked my mom why indigenous women were being murdered. I wanted to be a boy. No one should be scared to be an Indigenous girl or woman. Please don’t let it happen to me.”

Those are some of the heart-wrenching testimonies on the walls of two collaborative museum exhibits that commemorate missing and murdered Native American women and victims of domestic violence. The exhibits, Portraits in Red by artist Nayana LaFond, and Voices by Cat Del Buono are powerful and important.

LaFond’s work is deeply personal. She is a citizen of the Metis Nation of Ontario and a descendant of the Anishinaabe and other indigenous groups and she is a survivor of domestic violence. “In indigenous cultures art is medicine,” she explains. “I see the work I do as sacred.”   

LaFond began painting the portraits when she painted an Indigenous woman from Saskatchewan who had survived violence. The woman appears strong and powerful, despite a red handprint over her mouth, which became iconic. “Red is believed to be the only color spirits can see in most indigenous cultures so I paint them the way a spirit would see them,” the artist explains.

 Subsequently she posted a call on the website of a Pow Wow held annually to commemorate the Day of Remembrance for Missing and Murdered Indigenous People. It changed her life and launched the Portraits in Red project. Offering to create similar portraits for other indigenous women at no cost, she had thousands of hits in no time from native women all over North America. Her portrait work grew exponentially with the women she paints having one thing in common; each of the women shares a symbolic red hand over their mouths, symbolizing violence and silencing. The women range in age; many wearing traditional dress. All of them offer a stunning wakeup call.

“When you’ve experienced something like these women have you want to claim yourself again,” LaFond says. “You want to speak up and be heard in a safe way. That’s why I do this work. I am claiming my own experience and turning it into something positive. I hope I’m creating change.”

“Voices,” an ongoing project by social change filmmaker Cat Del Buono, is a video collection based on more than a hundred interviews she has conducted with survivors of domestic abuse since 2013.  In the videos one sees only the mouths of women speaking and thus becomes part of an intimate, deeply sad conversation as women share their stories. Their voices serve to humanize and expose the travesty of domestic violence while encouraging others in need of help.

“The immersive nature of the exhibit reveals the enormity and the pain of domestic violence,” Del Buono says. “It’s powerful. It helps viewers understand that domestic violence doesn’t discriminate, it affects all ages and social classes. It isn’t just ‘their’ problem. It’s a society problem that urgently needs to be addressed.”

These two collaborative exhibits break the silence that surrounds violence and abuse that women suffer in larger numbers than we think. To see them together is to witness the enormity of the domestic violence crisis that goes far beyond North America and is pervasive in all cultures, classes, and communities. The statistics are staggering.

 About 4 out of 5 Native women have experienced violence. They are twice as likely than most other women to experience violence and they face murder rates 11 times the national average. The murder rate for Native women is about three times more than that of most other women. 98% of Indigenous people experience violence in their lifetime.

 There is only a six percent prosecution rate. In 2016, there were 5,712 incidents of missing and murdered Native American and Alaskan Native women but only 116 cases were logged into the DOJ data base. Sixty percent of the number of cases between 2005 and 2009 involving sexual abuse in Native communities were never prosecute by U.S. attorneys. On some reservations 96 percent of sexual violence cases against Native women were committed by non-Natives. non-Natives.

 According to Cat Del Buono, the data on domestic violence is equally staggering. On average, nearly 20 people per minute are physically abused by an intimate partner in the U.S. One in four women will be a victim of severe domestic violence in her lifetime; every nine seconds a woman is assaulted or beaten. Chillingly, one in five women in the U.S. has been raped in her lifetime, almost half of them by an acquaintance.

 Myths about domestic violence are untrue and pervasive, according to a YWCA “End the Silence” campaign in Spokane, Washington.  For example, “Domestic violence only happens to women.”  “Drugs alcohol, stress and mental illness cause DV.”  “Abusers are just out to control and need anger management.” “DV is always physical abuse.”  “If a victim doesn’t leave, it must not be that bad or they are ok with how they are being treated.”

 The fact is that all kinds of violence, against women especially, surrounds us and not enough attention is being paid to stopping it. We urgently need policy changes at every level of governance, serious and effective gun legislation, long overdue changes in the judicial system, educational programs that raise awareness of the epidemic of violence and abuse in all their forms, and sufficient resources at the community (and reservation) level aimed at prevention, identifying perpetrators, and sufficient resources to stop the scourge.

 As Cat Del Buono and Nayana LaFond know, “this is a societal problem that urgently needs to be addressed.” Their deeply important artistic work is a monument to those women who are alive and still waiting for an end to violence, and to their missing and murdered sisters. Let International Women’s Day remind us of that.

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From Designer Babies to Devalued Children

A recent press release I received got me thinking about how much we really care about kids?  The press alert came from the Coalition to Stop Designer Babies, which is organizing internationally to oppose efforts by some scientists and would-be parents who want to overturn legal bans and prohibitions on Human Genetic Modification (HGM).

A so-called designer baby is defined as “an infant whose genes or other cellular components have been altered by practitioners at the embryo or pre-embryo stage, ostensibly for the purpose of avoiding passing on genetic diseases, or making babies that are smarter, taller, or stronger,” according to the Humane Biotech organization.

Coalition spokesperson Dr. Daniel Papillon, a French scientist, notes that” There is no unmet medical need for this technology, but the risks are immense. … It would increase ableism and entrench social inequality.” Like other opponents of this technology, he notes that “HGM is the latest high-tech version of Eugenics,” the belief that the human race could be improved if reproduction was controlled and only those who were deemed worthy of being born or of reproducing should live or bear children. The movement advocated selective breeding and the elimination of those considered to be imperfect. Advocates ranged from Margaret Sanger to Adolf Hitler. Even Vermont practiced Eugenics.  Between 1931 and 1941, about 200 people, mostly women, were sterilized in the state.

The idea of designer babies and perfect progeny smacks not just of social control but of affluence and exclusion. It illuminates the deep chasm between privilege and poverty, both of which speak to the deprivation of lives that might have been lived. Let’s not forget that eugenics was at the core of slavery and is still a threat in a world of growing fascism.

The idea of designer babies versus impoverished, marginalized children made me think of all the ways children throughout history, and children now in this country, have been damaged, degraded, and devalued, despite the rightwing devotion to fetuses. There are deeply disturbing examples of the abuse children of all ages experience, physically, emotionally, sexually and via neglect and exploitation.

Take, for example, the revelation revealed by the Houston Chronicle that Texas state troopers were told to push immigrant kids, even babies, back into the Rio Grande as they tried to survive crossing the river alone or with others. Or the fact that thousands of children are at risk of separation, abuse and neglect at the Mexico-US border, and that documented major abuse takes place in retention centers on the US side. Kids trapped in Mexico are sleeping in the streets where they are exposed to violence and abuse, as Save the Children and other organizations have pointed out. And those who make it to U.S. Customs and Border Protection report physical and psychological abuse, unsanitary and inhuman living conditions, isolation from family, extended periods of detention, and denial of access to legal and medical services, reported in a University of Chicago Law School report five years ago.

Sadly, the National Children’s Alliance reports that more than 600,000 children are abused in the United States each year, with children in the first year of their lives being 15 percent of all victims; more than a quarter of child maltreatment victims are under two years old. Nationally, neglect is the most common form of abuse. What does that say about who we are as a country?

What does this say?  According to the Equal Justice Initiative eleven states have no minimum age for trying children as adults; some states allow children between ten and thirteen to be tried as adults, while children as young as eight have also been prosecuted as adults. Shockingly, the U.S. is the only country in the world where kids as young as thirteen have been sentenced to life in prison without parole, and until 2005 children were executed in the U.S.

Law enforcement and police brutality contribute to the abuse and criminalization of children ranging from kindergarteners to teenagers. Stories abound. In one state, an off-duty policeman placed his knee on a middle school child’s neck, while in another state, four

Black girls were arrested for not stopping young boys from fighting.

The stories are immensely disturbing. A child in kindergarten was arrested for picking a tulip at a bus stop. A12-year old was arrested for doodling at his desk.  A nine-year-old was arrested, pepper sprayed and handcuffed for “acting like a child” when police were called to her school. These and other stories like them have been exposed by the Legal Defense Fund.

Now comes the exploitation of kids in the workplace, courtesy of Republican legislators who are happy to ignore labor laws. Lawmakers in several states want to let children work in hazardous workplaces, and to work longer hours on school nights, including serving alcohol in bars and restaurants as young as fourteen. The Economic Policy Institute revealed that ten states in the last two years have tried loosening child labor laws, while the Department of Labor reported this year that child labor violations have increased by nearly 70 percent. It’s Dickensian!

These tragic tales are the tip of the iceberg. They speak volumes to the level of child neglect that is rapidly being normalized in America. The big question is what are we going to do about it? That’s a good question to ask anyone running for office next year. As for designer babies, that’s a question for the wealthy who are wedded to privilege and perfection.

Are We Ready for Another Pandemic?

Almost four decades ago, when I was deputy director of the first major global health communications program supported by the US Agency for International Development (USAID), my work involved child survival and family planning.  But our project, and its lessons learned about health promotion, went further than that, modeling a proven methodology related to behavior change for better health outcomes. 

It was during those years that the HIV/AIDS crisis erupted, which I learned about before most people took it seriously, through a journalist I knew who had written about what was coming at us around the world and here at home. When I alerted my boss to what would become a deadly epidemic, advising him that as a health communication organization we needed to be paying attention to the problem and thinking of ways to mount a strategic health communication response, was typical.  “If you’re not gay it’s not going to amount to much,” he said, which in itself was shocking in its prejudice. It was also irresponsible coming from someone working in public health. When HIV hit hard and several gay men in our organization began to die, the head of the organization publicly apologized to me in a staff meeting for not taking the crisis seriously.

 Later, when I worked in public health advocacy, promotion, and communication internationally, I followed news, challenges, and concerns shared with the public health community from the World Health Organization (WHO) and the Centers for Disease Prevention and Control (CDC). That’s how I knew that they were worried because, they said, we were long overdue for another huge epidemic, bigger than the early 20th century “Spanish flu,” and we weren’t prepared for it.

So when Covid-19 showed up, I wasn’t surprised that we still weren’t prepared, nor was I particularly shocked when the Trump administration was totally unprepared for an event that would take millions of lives here and globally. What was shocking was the disinformation, misinformation, and dangerous false information Republicans glibly spread in soundbites and press briefings as more and more people succumbed to the virus.

Those memories come back to me now because history seems to be repeating itself when it comes to public health preparedness related to epidemics and pandemics in light of myriad lessons learned by now.

It’s not for lack of scholarship on this issue. In researching this topic, I found no shortage of analysis about a rising concern about what’s going on as we recognize that we’re going to have to struggle all over again when another health crisis occurs.

The pressing issues include the need for more research as new and mutant viruses rise, scaling up production of newly developed and FDA approved vaccines, planning for broad and  rapid vaccine distribution, cost containment, and equal access to vaccines from various health facilities. It’s no longer only about Covid. Other infectious diseases are on the rise. According to WHO, “zoonosis”, infectious diseases that jump from animals to humans, now number over 200 identified bacterial, viral or parasitic agents. “They can be transmitted through direct contact, food, water, or the environment, constituting a major public health problem,” WHO says. “Many of these emerging infections have the potential to cause global  pandemics.”

The Covid pandemic revealed the challenges related to supply chains and their disruptions when it comes to vaccine distribution, in addition to vaccine shortages, which can occur when companies no long choose to make vaccines, often because of manufacturing and production problems. That leads to insufficient stock piles, and reduced competition so that prices for vaccines rise.

Another major failure in pandemic preparedness revealed itself during the Covid crisis. As health communication specialists like Kizzmekia Corbett, a researcher at the National Institutes of Health (NIH) point out, “Public health practitioners need to recognize that our research is only as strong as our communication. Even our strongest peer reviewed, evidence-driven findings won’t have full impact if we cannot clearly and effectively communicate them to the public.”

Practitioners also need to understand and respect the field of health communications as a multidisciplinary methodology aimed at behavior change for health promotion and disease prevention. Vicki Freimuth, former director of communications at the CDC, says that “the agency struggles to assure that experienced communication professionals are included in decision-making and developing scientifically sound public messages free of political influence.” (personal communication).  The exclusion of experts whose work has proven that behaviors can be changed (e.g., mask wearing) with research-based messaging is a troubling omission.

According to a poll taken in March and reported by  Politico, two-thirds of respondents believed the threat of future deadly pandemics is growing, while almost 90 percent wanted the federal government to be more prepared for another pandemic in its budget and planning. Still, the focus in Washington, DC seems to be on assessing what went wrong during Covd-19.

Mauricio Santillana, a professor at Northeastern University paints a daunting picture regarding future efforts. He says the influence of politics on government funding causes a “collective amnesia,” that leads to reactive responses to crises vs. proactive  prevention.

If the government prioritizes the prevention of deadly viruses, perhaps they will remember to include health communication strategies along with financing and other challenges that accompany pandemics that need to be stopped quickly. I’m not holding my breath.

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Elayne Clift has a master’s degree in health communications and has worked internationally with a focus on maternal and child health. 

The Horror of Healthcare Financing

It’s no secret that America’s healthcare system is broken. Most of us can cite a litany of problems we’ve personally experienced. But few would include the travesty surrounding how healthcare costs are billed and covered.  I ventured into that morass recently and what I learned provided another compelling reason for universal healthcare and a single payer system.

 It began with a pneumonia vaccination that I received at my doctor’s office instead of a Walgreens pharmacy. I expected a charge but assumed it would be minimal. Then I got the “patient statement” from the hospital where my doctor practices. On the statement a “pharmacy” line item appeared in the staggering amount of nearly $700. Other charges were for “preventive care services” and “physician fees.” I saw these charges as redundant since I saw my doctor for a “wellness check” that constituted preventive care with a physician.

 Although I was billed a small amount for these services because “contractual allowance adjustments” covered the bulk of the bill, I began trying to learn what it all meant. I started with two simple questions: Who sets healthcare costs and fees, and who regulates those fees, which included overhead costs and $243 the hospital is charged for “medicine” (serum). 

 Thus began an exhaustive search for answers that led me down a frustrating rabbit hole. Among the Vermont state offices called for information were the Governor’s office, the Healthcare Administration Financial Regulations office, the Division of Licensing Protection, the Department of Health Division of Rate Setting, and more.  Fifteen calls later I still had no answers. Instead, each call resulted in a circular handoff, often to agencies I’d already called. No one in these agencies, it seemed, had any idea how costs were established, who regulated them, and who paid for them.

 This led to a discussion with my local hospital’s CEO and financial officer who walked me through a bureaucratic maze of rules and regulations emanating from federal and state mandates, organizational finance relationships and more. It was so complex that even though I worked in public health as an educator, policy analyst, and advocate for over forty years and hold a master’s degree in health communication and promotion I could not understand everything they shared with me.

One of the things I learned is that no one actually pays the gross charges, which are based on what will be reimbursed by insurance companies, and the costs of various services and procedures as identified by Medicaid and Medicare, with fixed rates periodically negotiated based on current reimbursements. This is known as “cost shifting.” In Vermont, organizational relationships regarding financing of healthcare also play a part in this cost sharing.

 Christopher Dougherty, CEO of Brattleboro Hospital, agrees that the current system of healthcare financing is an odd system that “puts us at risk.” He is troubled by the fact that the financing system is modeled on covering the costs of services rather than measurable outcomes of patient care. That viewpoint aligns with equitable, accessible, quality healthcare for all and it is grounded in the holistic and cost-saving idea of health promotion and wellness, and the fact that healthcare is a human right.  

To explain the convoluted, crazy financing of American healthcare, which is fundamentally a national disaster, requires a full investigative report if not an entire book. My purpose here is two-fold: First, it’s to expose the problems in healthcare financing and to encourage healthcare consumers to self-advocate when those, or other healthcare dilemmas, affect them personally. That means asking key questions of politicians and healthcare professionals along with other measures that lead to accountability and transparency. It also means voting for leaders who understand and care about healthcare issues.

My second objective is to underscore the urgency of a universal healthcare system that eliminates the outrageous bureaucratic enigma and the power brokers that now drives health care and costs. To paraphrase the late Princess Diana, “there are three [organizations] in this marriage,” and one of them is not the patient. It is Big Pharma, the insurance industry, and the fact that healthcare delivery systems like hospitals are increasingly dedicated to business models rather than putting people above profits. This powerful triumvirate must be called into question, revised and re-invented in ways that will be difficult to achieve. But they are not impossible.

In 2020, T.R. Reid wrote a book called The Healing of America.  Reid researched five developed countries in which some form of universal healthcare was practiced. Drawing upon what he learned, he developed a model of universal healthcare that would be viable in the U.S. His recommendations went nowhere because Americans are loathe to pay higher taxes for social services (a chunk of which would be financed by corporate America paying its fair share of taxes), and very few in Congress, who are loathe to lose an election, understand what a social democracy looks like.

 Ironically, when I was mired in trying to get to the bottom of healthcare costs, not just in my state, but nationally, I was facilitating a seminar for hospital personnel, called “Humanity at the Heart of Healthcare.”  As great physician writers and profoundly humanistic caregivers still out there know, we need to return to that foundational idea in the delivery of health care. With enough people standing up for the principle that caring and curing can go hand in hand, we can focus on the Hippocratic idea to “do no harm,” (including financially).

As poet Amanda Gorman wrote in her poem Hymn for Humanity, “May we not just ache, but act.”  Now is the time.

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Maternal Mortality, Abortion, and Race: A Dangerous Trifecta

Much has been written in the literature of public health about America’s shocking maternal mortality rate. Occasionally media reports the alarming rate when there is a hook. Advocates concerned with women and health illuminate the problem in reports and at conferences. But in light of the SCOTUS Dobbs decision on abortion, new urgency arose in addressing U.S. maternal mortality and its causes because of the link between reproductive rights and the persistence of inherent racial issues in women’s healthcare.

It is disturbing and illuminating to note the World Health Organization's maternal mortality rate rankings.  The U.S. is 55th in the list of industrialized nations at nearly 24 deaths per 100,000 live births. A 2022 study found that women in this country face the highest rates of preventable problems and mortality when compared with women in 10 other wealthy nations, and that rate continues to go up. The race disparity in maternal mortality is additionally alarming. Black women die at a rate of 55.3 deaths per 100,000 live births, more than 50 percent higher than white women.

That’s one reason Rep. Alma Adams (D-NC) and several colleagues in the House introduced a bill earlier this year to specifically address the high rate of stillbirths, which Black women and other women of color are twice as likely to experience as white women. Targeted legislative like that is critical to changing the public health landscape when it comes to pregnancy outcomes and the health of women and children.

So are campaigns like the “Hear Her” initiative at the Centers for Disease Prevention and Control (CDC), designed to address the fact that women are often not heard, believed, or viewed as reliable when they present relevant histories or symptoms. That problem is worse for Black women too. Research shows that women of color are more likely to be described negatively in notes and reports and recent studies reveal that doctors are most likely to use “stigmatizing language” in their notes about patients of color, referring to them as “noncompliant, challenging or resisting,” as research at the University of  Chicago revealed.

That’s why the all-out attempt to end abortion nationally, ignoring 50 years of precedent regarding a woman’s right to privacy, reproductive healthcare and choice was such a travesty, exacerbating the already shameful maternal morbidity and mortality data which serves as an indicator of continuing racism in this country.   

Black women and their sisters of color are likely to suffer enormously from the consequences of state-ordered pregnancy in the states that cling to misogynistic, racist policies, and not only in terms of their health or possible survival. They will also be affected economically in dramatic ways. A Forbes report suggests they will be deprived of education that can lift them out of poverty, and they will be targets of aggressive invasions of privacy through data searches that enable the over-policing of their reproductive habits and practices. Depending on where they live, they may be subject to fertility and period-tracking apps used by police according to their zip code because they are deemed to reside in high .abortion areas.

In her monumental work resulting in the 1619 Project documenting the history of broad-reaching racism in this country, Nicole Hannah-Jones provides a historical perspective essential to understanding the confluence of maternal mortality, the abortion crisis we now face, and unrelenting racism. Her book provides vital context regarding the connection between those three issues.

The title of both the project and book derives from the origins of slavery in America, dating back to 1619 with much of the book’s relevance focusing on the period of Reconstruction following the Civil War, when a key question arose. What would white America do with black people post slavery? Where would formerly enslaved people fit in a paid workforce? How would former slaves be treated if they were free Americans? What would be done about their education or healthcare?

Southern Democrats resisted these considerations mightily, especially when reformers like Rebecca Lee Crumpler, the first black woman doctor in America, laid bare the burdens of being black in a country unwilling to facilitate freedom for former slaves.

Because of that resistance, the National Medical Association formed by black doctors in 1895 called for a national health care system - which went nowhere until the idea became a states’ rights issue during WWII when President Truman called for an expanded hospital system that predictably led to segregation and the denial of healthcare for black people. Later, insurance-based healthcare presented a further hurdle, while medical schools excluded black physicians and medicine became a for-profit, unregulated system. All of this has led to present-day lack of equitable, affordable, accessible healthcare if you are black or poor.

In the midterm election, five states had abortion on the ballot and in all five, voters supported the right to choose. Three of them guaranteed the right to abortion in their constitutions.   That is a huge relief to women in the five states, but it remains to be seen how women of color will fare. 

In Nicole Hannah-Jones’ words, “…arguments about socialized medicine, equity and human rights…echo down to the present day.”  Her book reveals the connections that make women of color exceptionally vulnerable even in this moment, and reminds us that there is still work to be done.

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Elayne Clift writes about women, health, and social issues from Brattelboro, Vt.

Actions Have Consequences: The Supreme Court Should Know That

It was like standing alone on a nuclear landscape. Like being in the center of a dystopian nightmare. Like being on a sinking ship without a life vest. At least that’s how it felt to me as the Supreme Court’s decisions were handed down, one after the other in their recent session.

Stunned and frightened like so many others were, I wondered whether the faux Christian, conservative justices on the Court had any idea what the consequences of their hideous decisions would be as they ended a term in which civil rights in America were systematically ended. Did they willfully ignore what would happen because of their Draconian decisions, did they not have a clue, or did they simply not care?

Was this the legacy they wanted to leave their children and grandchildren, let alone the rest of us? Did they have any sense of the consequences, intended or otherwise, for American citizens, and the planet? Do they grasp the context of our Constitution, or the concept of democracy? Do they really hate women and others unlike them this much?

As these questions roiled in my head, I thought about some of the consequences the justices’ rightwing agenda presented, beginning with what would befall women and girls who no longer have agency over their bodies and lives, or access to reproductive health care.

Among them is a ten-year old child pregnant by paternal rape being denied an abortion in Ohio,  women with pre-eclampsia – high blood pressure that can be fatal to mother and baby when not treated urgently, women with gestational diabetes, a condition that can be harmful to mother and baby, women with ectopic pregnancies in which a fertilized egg attaches to the Fallopian tube instead of the uterus, an emergency situation requiring immediate care to prevent a fatal rupture, women whose lives are at risk because of  drastic fetal anomalies.

 Now women with these urgent or other reproductive healthcare needs are too frightened to seek timely reproductive care while providers are increasingly unwilling to offer it, both for fear of being prosecuted. These examples offer a small glimpse into what will happen to women and girls because of the Court’s decision to end Roe v. Wade, but this much we know: Many of them will die. So will women who elect to have an illegal or self-induced abortion for any reason.

I also thought about the death knell being sounded for the fragile, struggling planet on which we live due to environmental degradation and the global warming crisis. Just these staggering statistics are enough to send chills down my spine: “Every hour, 1,692 acres of productive dry land become desert. We are using up 50 more natural resources than the Earth can provide.” What’s more, “We have a garbage island floating in our ocean, mostly comprised of plastics - the size of India, Europe and Mexico combined!” 

Further, “The effects of human-caused global warming are happening now, are irreversible on the timescale of people alive today, and will worsen in the decades to come,” according to NASA. “Glaciers have shrunk, ice on rivers and lakes is breaking up earlier, plant and animal ranges have shifted, and trees are flowering sooner,” while “effects that scientists had predicted in the past would result from global climate change are now occurring: loss of sea ice, accelerated sea level rise and longer, more intense heat waves.”

Against these chilling facts, six Supreme Court justices saw to it that the Environmental Protection Agency would now have limited ability to regulate carbon emissions from power plants “making it nearly impossible to cut greenhouse as emissions any time soon.” In their dissenting opinion three justices said the majority had stripped the E.P.A. of “the power to respond to the most pressing environmental challenge of our time.”

When it comes to separation of church and state the conservative majority outdid themselves. Recent decisions included a ruling in favor of a Christian group’s plea to allow a flag with a cross on it to fly over Boston’s city hall. Another decision allowed for taxpayer money to cover tuition for students attending religious high schools, while the six Supremes decided in favor of a high school football coach who led Christian prayers on the playing field  after games.

Then there’s states’ rights. Again, the Scotus-6 opined against New York State's concealed carry law requiring state residents to have a permit to carry a gun in public.  That law’s requirements for a permit were specific and in the public interest but when two guys who wanted to carry guns publicly were denied permits, they appealed to the Supreme Court, which ruled the state law violated the 14th and Second Amendments. The decision proffered that the Second Amendment protects the public carry of firearms and set up a new test for courts to determine whether a law violates the Second Amendment.  New York's law was struck down, and other laws like New York's are likely to be struck down now.

Is it any wonder these frightening, tip-of-the-iceberg rulings made me feel like we’re approaching nuclear winter?  Bundle up. The Supreme Court is just getting started.

Feminism Isn't Dead, It's Exhausted

Just days before the horrific Supreme Court decision that killed Roe v. Wade, a grievous act that rendered women and girls property of the state and subjected them to forced childbearing, a spate of opinion pieces appeared bemoaning the fact that feminism was all but gone in the face of massive backlash. Feminists I admire wrote disheartening columns that included expert opinion, research findings and personal analysis.

New York Times columnist Michelle Goldberg wrote that “As the backlash gains steam, a lot of feminism feels enervated. There had been a desperate hope, among reproductive rights activists and Democratic strategists alike, that the end of Roe v. Wade would lead to an explosive feminist mobilization, that people committed to women’s equality would take to the streets and recommit themselves to politics. But after the leak of the Supreme Court’s draft decision in Dobbs v. Jackson Women’s Health Organization, it’s far from clear whether a political groundswell will materialize.”

Susan Faludi’s New York Times piece argued that pop culture, celebrity, rampant consumerism along with fierce individualism has fueled not just a backlash but a subtle generational divide in which younger feminists can be said to fight against “practical impediments to equality,” while second wave feminists (like myself) were “old-fashioned shoe-leather organizers” who were “oblivious to race and class.” In making her argument against generational conflict she asks for “a reckoning with feminism” that “goes beyond generational indictments. It’s an admirable goal that has merit but her language seems to fuel the divide.”

What these two essays have in common is a focus on millennial feminism and their collective analysis should be taken seriously, But what troubles me is the notion that feminism, in all its variations and iterations, has spawned a powerful backlash and become divisive to the point of annihilation. As a second wave feminist I reject that idea having worked, marched, protested with and mentored millennial women. The feminism of my generation, flawed though it has been, is not dead; it is exhausted. In the words of the beloved civil rights leader Fanny Lou Hamer, we are simply “sick and tired of being sick and tired.”

Our fight has been long and arduous and unless you’ve been through it it’s impossible to grasp what it took to keep on keeping on, and how punishing it could be – which leads me to some thoughts on younger feminists.

First, with due respect to millennial women who never experienced a pregnancy scare in pre-Roe v. Wade times, times when women couldn’t get credit without a male guarantor, could be fired for being pregnant, couldn’t earn anything like what men doing the same work did, had no recourse to domestic violence, and more, there are lessons to be learned from those feminists – their mothers and grandmothers - who preceded and fought for them. Sadly, they are about to find out what it’s like and what it takes to begin again from the ground up. When they do find out their elders will be marching, protesting, voting, lobbying and more by their side. There will be no false dichotomy because we are all women who have been there or find ourselves there now. In that sense, context, as older feminists know, is everything; and “the personal [really] is political” because what happens to one of us can happen to all of us when male power presides over our lives.

In that context I urge young women to educate themselves fully about women’s history and courageous fights for equality, full personhood, social justice and human rights in this country. Our battles cross every sector of society and we have fought them well so that our daughters and granddaughters could lead better lives than many of my generation did.

As I tell my young friends, there is a qualitative difference between pussy hats and T-shirt slogans, and social media is not the same as showing up in big numbers, which takes organizing on a scale that can feel overwhelming. (Just ask Stacy Abrams.) Also, it’s deeply important to understand the politics of power, and the power of politics in order to think and act sufficiently strategically so that change becomes a new reality.

I’m not arguing against a new, different feminism; as the wise Greek philosopher Heraclitus knew, “The Only Constant in Life Is Change.” I’m making a case for a hybrid feminism that doesn’t fall prey to conflict among its constituents for lack of context, depth, and experience.

As for the disastrous decisions of a Supreme Court run amok, Rebecca Traister offered this call for hope: Noting that the situation is “wretched and plain” and will get worse,” she wrote in The Cut, “the task for those who are stunned by the baldness of the horror, paralyzed by the bleakness of the view, is to figure out how to move forward anyway. … because while it is incumbent on us to digest the scope and breadth of the badness, it is equally our responsibility not to despair.”

Sen. Elizabeth Warren and Tina Smith agree. Writing in a New York Times op ed., they noted that this is a “dark moment” that “will require a long, hard fight.” As second wave feminists, they know what they’re talking about. “The two of us lived in an America without Roe v. Wade, and we are not going back. Not now. Not ever.” I’m with them.

The Death of Stare Decisis and the Demise of the 4th Amendment

I was out of the country in May when news of the SCOTUS leak in which Justice Samuel Alito’s policy statement went viral.  I hadn’t watched TV for a week and barely signed onto social media but when I did, I read astute and deeply troubling reactions to the document designed to overturn Roe v. Wade, which has been considered established law for 50 years.

The document Justice Alito wrote was supported by four of his Court colleagues, revealing unsurprisingly that a majority of the Court concurred with ending women’s right to abortion. The timing of the leak was significant; it occurred when the Court was scheduled to rule on the constitutionality of a Mississippi abortion law which prohibits abortion after 15 weeks of pregnancy.

If the Court finds that the Mississippi law stands, it will have sanctioned ending Roe v. Wade, allowing states to make their own laws regarding abortion. Some states have already established Draconian laws that include charging women with murder if they miscarry or have an abortion. Some have ruled that physicians who perform abortions can be charged with a felony crime and some have set up vigilante laws that could affect anyone who helps a woman get an abortion.

Essentially the demise of the constitutional right to abortion up to 24 weeks of pregnancy will end women’s right to abortion in over half the states in this country. The implications are huge, not only for American women but for the future of the country, and they are abundantly clear.

Many analysts and pundits have written cogently and urgently about the legal, physical, economic and emotional consequences for women and others in this country, and for all of us with respect to our civil and human rights. As a women’s health educator and advocate I am all too familiar with those consequences. I have heard women’s testimonials, read their memoirs, listened to their stories.  I have helped them access abortion care and as a doula I have helped them give birth to much wanted babies.

After the Alito document was revealed (and during the last confirmation hearings) I thought about the great legal minds of the past who had served on the Supreme Court, Justices like Oliver Wendell Holmes, Jr., Thurgood Marshall, Ruth Bader Ginsburg among them. Now I mourn what has become of that institution, where several judges lied under oath to Congress regarding precedent, and where many are willing to ignore the Constitution’s 4th amendment right of Americans to be “secure in their persons” and to “not be violated or subjected to “unreasonable searches and seizures.”  

It pains and frightens me that faulty - some might say puerile logic - superficial, antiquated, cliched justifications, overt sexism, and religious ideology are blatantly on display. (It is worth noting that seven of the current justices are Catholic and no Protestants are on the bench).

Couple that with the less than stellar records and legal experience of several justices, the alleged sexual harassment conduct of two justices, the conflict of interest on the part of a justice whose wife actively supported the insurrection, along with the majority’s willing abrogation of civil and human rights and one can question where “liberty and justice for all” has gone.

How, I ask myself in these traumatic judgment days, has this largely trusted American institution so quickly deteriorated into depravity? How did its majority come to rely on bumper sticker taglines, social media tropes, and arguments so weak and sloppy that they wouldn’t pass muster in a law school? Where has compassionate consideration in difficult matters gone? Why have context, untoward consequences, and the reality of people’s lives disappeared?

The fact is the Supreme Court has become a political organization with its own dark agenda and its reputation will forever be tarnished, all because four men and one woman who should know better, appointed by a far right, self-serving autocrat, are now seated for life on the highest court in the land, along with several hundred inappropriate federal judges.

The price we’ll all pay for judicial travesties, individually and together, grows ever clearer and more threatening. If Roe v. Wade is overturned women’s lives will be destroyed. Precedent in other matters (gay and interracial marriage, LGBTG rights and more) will no longer be valid, and revision of laws that wreak havoc because of ignorance and a taste for punishment will return. 

It is no stretch to say that we will become an even more divided and dangerous nation, two-tiered and binary in ways that we can’t yet imagine. Violence is likely to flourish along with racism, anti-Semitism, sexism and increased marginalization. The elderly, young, disabled, and ill will suffer even more profoundly.  Murder charges, incarcerations and suicides will become commonplace. Poverty will prevail for those in the 99 percent, while corporations and billionaires flourish. Family structures will be deeply and sadly impacted. The earth will be at risk sooner than predicted. 

This is not solely about women’s rights, and it is not hyperbole. It’s a harbinger of what is to come because of laws we must live with, who makes and enforces those laws, who adjudicates disputes, what national priorities are established and by whom. It is about the future, which now is in the hands of the Supreme Court – a court plunged into decline that endangers us all. 

It’s a court that is beyond disappointing, a court with extraordinary power to shape our lives, and it grows ever more dangerous.

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Elayne Clift writes about women, health, politics and social issues. www.elayne-clift.com

Another Day, Another Newtown: The Obscenity of Gun Violence

When news of another school slaughter broke, this time again in Texas, the bile that rose in my throat was as bitter as the memory of Columbine, Newtown, Parkland – and the other grievous incidents of gun violence in schools – all 554 of them since Columbine, as NPR has reported.

From the Carolinas to California, 27 school shootings are among the 200 mass shootings this year alone in America, and it’s only May.   But this is not a time for numbers. It is a time for unprecedented action borne of rage about what is happening in our country. It is also time to answer burning questions: why is it happening, and what are we going to do about it? It is a time to shout our disgust and dismay, to demand gun legislation now, and to take action to end the slaughter of innocent children.

Here is what I believe must happen NOW. All living presidents (with the exception of Donald Trump) should stand together before Congress and declare that we are done with thoughts and prayers. We are done with the platitudes that surround grief and loss. We are done with inaction, and with turning the other way because political power is more important than loving our babies, especially among those who champion fetuses but ignore the needs of living children.

Go on strike because that is what it will take – teachers, clergy, workers, moms, women and men alike. Call for and participate in a national strike against violence and the insanity of mass murder. Bring down the economy as well as the evil that prevails on Capital Hill if that’s what it takes to stop the killing.

Call it what it is: a public health epidemic, not a gun violence or mental health issue.  We can and must learn the lessons of pioneering health communication campaigns, including, against all odds, the successful fight against the tobacco industry, which saved the lives of hundreds of thousands and demonstrated that people are capable of change.

It is vital for Americans to vote, this year and in 2024, with all the energy a soul can muster.  Stand in line for days if that’s what it takes to be counted among the family of humankind, and the families who must now endure unimaginable and unending sadness.

Most importantly, Americans who want the massacres of innocents to stop must demand an end to the filibuster and lobby for killing the Second Amendment -- the only way to halt the madness we’ve grown used to. Forget appeasing the irresponsible, vicious right wing with calls for limited legislation; go for the one thing that can stop gun violence faster and more conclusively than anything else -- an end to an irrelevant and antiquated amendment written before bullets and rifles that tear bodies apart in seconds were invented.

I believe that what lies at the heart of the tragic problem that is ours alone among developed countries is this: We are a nation wedded to violence and we always have been.

From the time white men first set foot on American soil guns have been used in genocides to eliminate non-white Native American peoples. During slavery guns were a way (along with physical punishment) to ensure forced labor and to instill terror among human beings who were bought and sold. Throughout our entire history guns have been part of our increasingly lethal war arsenals and today the sale of weapons in the U.S. is higher than it has ever been, while the people least likely to be killed by a bullet are made exceedingly rich.

Killing, it appears, is in our DNA. Mass murder has come to define us, whether through war, incarceration, racist law enforcement, the consequences of ignoring poverty while clamoring for personal and financial power, and random gun violence. All of it results in deep-seated human pain in a nation that is “exceptional” in all the wrong ways. We must end our killing fields if we are ever to have pride in a country that asks us to pledge our allegiance.

We have become a country in which the governor of Texas, Greg Abbott, appears at NRA’s convention, held in Texas, three days after 19 children were brutally shot to death there, a country where a former president who tried to overthrow an election, and a Senator from Texas who thinks we need more guns, join the governor. It is a country that exposes the personification of evil and reminds us how often scum rises to the top.

So I say this to Governor Abbott: Have you, at long last, no decency? And to Ted Cruz I say: You are not sorry. You are guilty. You have colluded with mass murderers. May the words spoken to me by a 4-year old child ring in your adult ears for all eternity: “Sometimes sorry is not good enough.”  As for Donald Trump, there are no words.

To all the others akin to these monsters, I say only this: We condemn your evil. We will inscribe your names and your deeds and your selfishness in the world’s history books, and we will celebrate the end of your cruelty for all our days.

Pathologizing Grief: How Long Can You Be Sad?

Here we go again. The so-called experts in psychiatry charged with updating the Diagnostic and Statistical Manual (DSM-5), the less than empirical “bible of psychiatry” that clinicians rely on for reimbursable diagnoses, have decided that six months, maybe a year if they’re generous, is sufficient time to recover from a life-shattering loss.

This pathologizing of “prolonged” grief is yet another example of the arbitrary labeling of human feelings that is present in every version of the DSM, and a reflection of the culture of pathology we have fallen prey to. Big Pharma couldn’t be more pleased as its chemists race to their labs in search of new psychotropic pills. I couldn’t be more concerned about the price women will pay.

Consider this comment by the psychiatrist who chaired the steering committee overseeing revisions to the DSM-5. While being interviewed for a story in the New York Times in  March he said, “They were the widows who wore black for the rest of their lives. They were the parents who never got over it, and that was how we talked about them. Colloquially, we would say they never got over the loss of that child.”

The absence of context in that statement is stunning.  The widows who wore black were likely not grieving forever; they were more likely observing a cultural norm. And can anyone who has not lost a child begin to understand the emotional agony of that experience? The insensitivity, judgmental language, assumptions, and lack of empathy and context among diagnosticians like that is nothing short of staggering. How can one practice psychiatry devoid of the emotional intelligence necessary to accompany someone on the long, sad journey of grief?

There are psychiatrists, psychologists and social workers who share this view. They are openly critical, arguing that pathologizing a fundamental aspect of the human experience is not only morally wrong, it’s dangerous, warning that being told you have a mental illness when you are emerging from a period of deep grief can add to despair and a debilitating sense of vulnerability.

The backlash against re-defining depression to include grief has been ongoing for at least a decade or more, along with longer term concerns about arbitrary labeling, lack of evidence-based diagnoses, overmedication of patients, and the lack of context in diagnosis, especially for women, who are all too often subjected to meaningless labels like “borderline personality disorder” and “premenstrual dysphoric disorder.”

Women are significantly more likely than men to be diagnosed with a range of psychiatric illnesses. They are also more likely than men to be prescribed psychotropic medication, given electroconvulsive therapy and hospitalized for psychiatric illness.

 One of the leading critics of the DSM was the late Dr. Paula Caplan, a pioneering feminist psychologist who resigned from the DSM-4 committee because she recognized that over-diagnosing and overmedication were occurring on the basis of unscientific labeling and diagnosing, especially for women. In a piece she wrote in 2012 in the Washington Post she said, “Since the1980s, I have heard from hundreds of people who have been arbitrarily slapped with a psychiatric label and are struggling because of it.”   She noted that “About half of all Americans get a psychiatric diagnosis in their lifetimes which can cost anyone their health insurance, job, custody of their children, or right to make their own medical and legal decisions.”

Others in relevant professions have similar, significant concerns about the DSM. Their concerns include oversimplification “of the vast continuum of human behavior,” misdiagnosis and over-diagnosis “simply because [the patient’s] behavior does not always not always line up with the current ideal,” labeling and stigmatization. The American Psychological Association, the American Counseling Association, and the society for Humanistic Psychology are among the professional organizations who have publicly shared their concerns about the DSM.

Psychiatric care and psychological counseling, of course, have their place in mental health. But practitioners, especially those charged with oversight of the troubling DSM, a reference book some professionals argue should be abandoned, as well as those who seek reimbursement for services, do clinical studies that require funding, and especially those who ignore context or lack sufficient empathy, must recognize their moral obligation to “do no harm.” That includes avoiding judgmental diagnoses, false assumptions, heavy reliance on medication, unhelpful labeling, and inherent sexism.

Paula Caplan had it right when she said “In our increasingly psychiatrized world, the first course is often to classify anything but routine happiness as a mental disorder, assume it is based on a broken brain or a chemical imbalance, and prescribe drugs or hospitalization…. These days you would think there is no such thing as normal.”

Perhaps the next DSM revision should include a new disorder: “Prolonged insensitivity to suffering.” It would be easily diagnosed by an absence of compassion and the overuse of meaningless labels upon meeting new people. Surely no one would argue with that.

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Elayne Clift is a health communications specialist and former Program Director for the National Women’s Health Network. She writes from Vermont. 

What the Supreme Court Has Done to Women

“My friend and I drew up to a drab brown brick building.  An older man, shrunken and slouched, opened the door furtively. We climbed a flight of stairs in a putrid green escape well and emerged into a hallway, then entered a dark apartment.  I imagined fleeing down the stairs but then considered the consequences.

“’Wait here,’ the man commanded.  After a few minutes he reemerged from another room and asked me some questions. I tried to stay calm.  I felt as if I were sinking into a huge hole from which I might never emerge. ‘Come with me,’ he said, leading me into what must have been a kitchen.  It had a table in the center of the room, at the foot of which, between stirrups, was a lamp on a stand, and a stool. The table was covered with a sheet of white paper with a thin pillow on it.  Next to it was a tray bearing silver instruments and a large jar. The man told me to take off everything from the waist down. There was no privacy screen. I asked him for something to cover myself. ‘You won’t need that,’ he said.  ‘Just get on the table.’

“He put my feet into the cold stirrups. I’d never been exposed like that. I felt dirty, naked into my soul. I shivered uncontrollably. He handed me a towel, but no blanket.  I wondered if he would wash his hands or put on gloves.  I stared at the ceiling, tears dripping from my eyes.  Why wasn’t there a nurse, I wondered?  He came toward me with a wad of gauze in his hand. ’Breathe,’ he said, forcing the gauze down on my mouth. I thought I would suffocate. 

“Then I woke up still on the table, legs straight, a sheet over me. Pain burned between my legs. I felt as if my stomach had been pulled out of me.  The man fiddled with instruments.  I heard a whimper and realized it came from me.  I passed out. When I woke the man said, ‘You need to get up and leave. Get dressed.’ He handed me a sanitary pad.  I rose slowly waiting for the dizziness to stop. The pad I had shoved between my legs felt saturated already. I hoped I wouldn’t die.”

That did not, in fact, happen to me. I imagined it for a novel I was writing.  My character was one of the lucky ones who did not die from a back-alley abortion, and I was lucky too because despite a few scares I never needed an abortion. But I knew lots of women who did. I covered for a friend who had to flee the U.S. to get one, and because I worked in women’s health I knew where to refer my friends, single and married, for safe abortions.

Now here we are again, having just passed the 49th anniversary of Roe v. Wade, which gave women agency over their bodies and their lives. It is inconceivable for those of us who remember life before legal abortion and who fought hard for reproductive control to find ourselves back in the trenches fighting for the sovereignty of self as the Supreme Court drags us backwards, starting with the Court’s support of Draconian laws launched in Texas, soon to be followed by as many as two dozen other states, according to the Guttmacher Institute.

The Court’s shocking position and lack of knowledge about, or regard for, women’s lives and the role that reproductive autonomy plays in those lives is staggering. It is a Court that views abortion as easy birth control instead of a deeply difficult choice, and adoption as an good way out of parental responsibility. It’s a court that has no concept of pregnancy confirmation, fetal viability or the lifelong trauma of rape and incest.

Neither does the Court have a clue or a care that without safe abortion there will still be unsafe abortion resulting in death, irreparable psychological harm, and possible suicides among women of childbearing age. Many other women will be deprived of economic security, quality of life aspirations, or the fulfillment of life goals.

“The erosion of reproductive rights is a result of raw, bare-knuckled politics, of a minority exercising their power over a majority,” Cecile Richards, past president of Planned Parenthood, wrote in a New York Times essay after the Court’s latest decision regarding SB8, the Texas law that limits abortion. “The millions of Americans who are watching, horrified, as the Supreme Court prepares to roll back a right they have had for nearly half a century need to be just as dogged and determined. But it’s going to take unprecedented levels of political activism to fight back.”

Perhaps it is Justice Sonia Sotomayor whose words ring out. "This case is a disaster for the rule of law," Sotomayor wrote in a dissenting opinion.  " It allows the State yet again to extend the deprivation of the federal constitutional rights of its citizens through procedural manipulation. The Court may look the other way,  but I cannot.”

Nor can women who will pay the price of a cruel procedural manipulation.

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Fanning the Flames of Poverty

A child plays with a lighter in a three-story apartment building in Philadelphia resulting in a fire that kills twelve people, mostly children. A malfunctioning hallway door in a Bronx high-rise apartment building leads to the death of seventeen people, including eight children – all within one week. Both tragedies housed low-income people. Both speak to the need for compliance with coded housing safety measures.

In the case of the Bronx high-rise building a self-closing door malfunctioned, filling a staircase with rapidly spreading suffocating smoke. The building had no fire escapes and residents reported that the building had door problems for years. They also reported persistent heat and fire safety issues, including fire alarms that no one actually paid attention to because “they rang at all hours of the day.”

In 2018 a fire in a residential building in the Bronx killed another dozen people. At the time, Rep. Richie Torres (D-NY) was a Bronx City Council member. He co-sponsored a bill that mandated all residential buildings in the Bronx have self-closing doors by the middle of last year. Now he has announced a federal, state, and local task force to examine residential building fire safety hazards. “We have to ensure that the housing stock is brought to the 21st century when it comes to fire safety, and the Bronx is no stranger to deadly fire,” he told the local press.

According to the press report, the Bronx building, built in 1972 under New York’s affordable housing program, only had sprinklers in the basement because, as a spokesperson for the owners of the building said, “its ceilings and floors are poured concrete and its fire doors are sufficient to make the building qualify as “non-combustible.” It’s worth noting that the current building owners include the son of a for-profit affordable housing developer.

Safe, affordable housing is a critical issue that gets little attention until there is a tragedy. Profit over people is usually the name of the game among developers and building owners, and politicians often look the other way or just don’t find time to address the urgent problems inherent in housing for low-income residents. Those problems often create health as well as safety issues, yet they remain ignored or skirted around because they are part of a complex, failing infrastructure too long denied, not only because of the expense of ensuring safety, but because building tenants at risk are not a high priority group for many building owners or politicians.

Sometimes it’s a matter of benign neglect on the part of landlords, but more often than not in large cities like New York, corruption fuels code breaking. And no landlords are more corrupt than so-called “slum landlords” whose neglect is criminal.

Take, for example, Jared Kushner, whose abuse of tenants was documented in a film by Alex Gibney called “Dirty Money,” in which one person interviewed called Kushner a “tier one predator.” According to the documentary, Kushner’s properties “have received hundreds of health code violations, including the presence of lead paint, lung carcinogens, and fire safety hazards.” In many documented cases, “the New York City Housing authority had issued violations but never followed up on collecting fine payments” nor had they checked to see if Kushner’s company actually fixed any dangerous living conditions.

Not all landlords rise to the level of Kushner’s abuse, but there are enough bad players that one guy’s mission in life is to keep landlords out of trouble. He calls himself “the real estate solutions guy” on his website which warns building owners about twelve common code enforcement violations. They include missing or inoperable smoke and carbon monoxide detectors, plumbing, heating, and electrical deficiencies, insufficient ventilation and rodents and infestations. Some cities, he adds, separate priority and non-priority violations. On his list of non-priorities? Missing or non-functioning smoke detectors.

Jessie Singer, in her forthcoming book There Are No Accidents: The Deadly Rise in Injury and Disaster – Who Profits and Who Pays the Price, points out that “the term ‘accident’ itself protects those in power and leaves the most vulnerable in harm’s way, preventing investigations, pushing off debts, blaming the victims, diluting anger, and even sparking empathy for the perpetrators,” her publisher, Simon and Schuster, says, adding “As the rate of [all] accidental death skyrockets in America, the poor and people of color end up bearing the brunt of the violence and blame, while the powerful use the excuse of the ‘accident’ to avoid consequences for their actions.”

That insight gets to the heart of the matter when it comes not only to building codes and fire safety but to the fundamental human right to safe, adequate shelter, as expressed in the United Nations Declaration of Human Rights, Article 25, which begins with these words: “Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing …”

As Jessie Singer said on an Instagram post following the Bronx tragedy, “Seventeen people in the Bronx died in a fire for the same reason that many Americans die in a house fire in 2022, because the only housing accessible to them is housing that is unsafe.”

In 2022, that is not only a human tragedy. It is a national disgrace.

The Supreme Court Takes Aim at Women

 In her memoir Recollections of My Nonexistence Rebecca Solnit writes, “To be a young woman is to face your own annihilation in innumerable ways.” Nothing proves her point more powerfully than the debacle of the Supreme Court as it debated the likely demise of legal abortion in this country.

With stunning ignorance of and disregard for women’s lives, five men and one woman in black robes pontificated and danced around the real issue before them -- women’s bodily integrity, agency, and personhood.  Instead, they reprised the overwhelming oppression of females that has existed for millennia in fear of women’s autonomy, thereby joining the generations of (mostly) men who view women as nothing more than state-owned semen vessels.

The argument before the Court aimed at gutting 50 years of precedent in the matter of abortion reminded many women of the medieval practice of disappearing women into convents and monasteries and later into asylums where they were diminished, demoralized, and drugged into passivity.  

Imagine this: You are a woman with three children living in poverty when you have a contraceptive failure and are forced to carry the pregnancy to term.  You are a woman 19 weeks pregnant with a much-wanted child when you learn that anomalies render the fetus unviable and continuing the pregnancy could endanger your own life, but you are denied an abortion. You are a college student who has been awarded a scholarship for advanced study when you realize you are pregnant.  Denied a safe abortion, you schedule a clandestine, illegal one. You are a 13-year-old child who has been raped by her stepfather and is now told she must bear her rapist’s child.

Try to imagine living with the crippling fear these scenarios engender.

And yet the Supreme Court is trying mightily to hold women hostage because macho-male powerbrokers are so threatened by the idea of female agency that they must control women at all costs and condemn them for believing they are entitled to fully lived lives grounded in equality and human rights.

There is, of course, one woman among the six justices chomping at the bit to effect the demise of legally sanctioned abortion. She should have been able to relate to issues relevant to pregnancy, for she too has borne children, felt them wiggle in her belly, done the hard labor of delivering them into the world and loving them when they arrived. Yet she argued that women don’t need abortions because they can easily dump their newborn babies into adoption or foster care like so much detritus, while her male colleagues grappled with numbers, the vagaries of viability, and the rights of fetuses over living women.

The reckless and dangerous disregard for women’s lives and lived reality during the justices’ discourse was nothing short of staggering as it showcased America’s Taliban.

It was also shocking to hear Scott Stewart, lawyer for the state of Mississippi which seeks to limit abortion to 15 weeks as a gateway to overturing of Roe v. Wade. His responses to questions from the justices were befuddled, obfuscating, superficial, and just plain ridiculous. This is the man Donald Trump put in charge of immigrant detention centers without any qualifications for the job.  Still, he was kept busy keeping monthly updated logs of females’ menstrual cycles during their incarceration to prevent legal abortions from happening.

How draconian can you get?

The foundation of entrenched, continuing misogyny women face yet again is what women like Emmeline Pankhurst and Alice Paul fought for when they risked their lives for women’s’ suffrage, what Margaret Sanger sacrificed in her fight for contraception and sex education, what Second Wave feminists fought for when they marched in every country in the world before, during and after the UN Decade for Women.  It is what women like Virginia Woolf, Tillie Olson, Betty Friedan, Carol Gilligan, Carolyn Heilbrunn, Audrey Lorde, and the multitudes who preceded or followed them wrote about: The trivialization, objectification, marginalization and silencing of over half the population in this country and elsewhere.

None of us who have been in the trenches for years fighting for equality, autonomy, economic justice, reproductive health care (which includes abortion), privacy, choices, and other basic human rights – all of which are at risk with this Supreme Court -- thought we’d find ourselves back to Square One in this moment, living in fear, facing limited opportunities and the denial of our chosen paths. Never did we imagine that in the 21st century we would again live with the oppression of patriarchal power, such that sexism, racism, and violence prevail.

When Justice Sonia Sotomayor asked this question during the SCOTUS debate, “Will this institution survive the stench that this creates in the public perception that the Constitution and its reading are just political acts?” she was asking a question so vital that it could have an impact on the outcome of the case being considered.

That question also invoked the patriarchy and misogyny that once again prevails as a dominating force in women’s lives. Sadly, especially for our daughters and granddaughters, the stench of annihilation is likely to be with us far into the future.

The Hands That Rock the Cradle Need Help

After MSNBC anchor Katy Tur gave birth to her first child in 2019 she devoted her come back show to the need for a Family Leave policy that matches that of other developed countries. Her plea was personal.  She had undergone an unplanned C-section to deliver her son and had struggled with breastfeeding her small baby who needed to nurse frequently. She also got a post-op infection which slowed down her surgical recovery. All of this made her feel exhausted to the point of hallucinations, and she feared being home alone with her newborn after her supportive husband returned to work. It’s not an atypical story, especially for first-time parents.

“Mothers and fathers need time with their babies and they need support,” she said then. “Lawmakers talk about family leave but nothing gets done. It’s shameful.” She might have made the exact same plea after the birth of her daughter earlier this year.

Tur was one of the lucky ones. Her employer had an excellent, supportive family leave policy. Most women – and men – are not so fortunate. Many women must return to work within a couple of weeks of giving birth because they can’t afford unpaid leave. Seventy percent of men must return to work within ten days or less after becoming a father.

An estimated 80 percent of U.S. employers do not have paid parental leave or have miserably inadequate plans, often following the federal government which gives most federal workers just twelve weeks of paid parental leave. That’s a pittance compared to other countries.

A 2019 study of 41 countries conducted by the Pew Research Center revealed the dismal U.S. situation. Countries like Estonia, which topped the list at 86 weeks of paid leave, Japan, Norway, Luxembourg, Malta, Korea and others had impressive leave policies. The U.S. ranked last.

Clearly, another Labor Day, a day on which we honor the country’s workers, has come and gone and still we fail to support women’s ongoing labor - in the workplace, at home, and essentially after childbirth.

While we have yet to enact a national mandate for paid family leave, some states do have paid leave policies in place. They report a measurable reduction in the number of women leaving their jobs in the first year after giving birth and up to a 50 percent reduction after five years, according to a 2019 study conducted by the Institute for Women’s Policy Research.

Paid leave is gaining more traction as an issue in need of legislation. In addition to an increasing number of national models that shame our own, more U.S. women are in the workforce and more families have two working parents. And paid leave isn’t needed just for new moms and dads. It may be necessary to recover from an illness or to care for a sick or disabled family member or elderly relative.

That’s why The Family and Medical Leave Insurance (FAMILY) Act was introduced by Sen. Kirsten Gillibrand (D-NY) and Rep. Rosa DeLauro (D – CT) yet again in 2019.  The Act, modeled after successful state programs, uses a social insurance system to provide workers with comprehensive paid family and medical leave. Comparable models have been passed in four states and the District of Columbia.

This year the two legislators have tried again to get Congress to pass a permanent paid leave policy nationally, arguing in language that male and conservative legislators like; The FAMILY Act, they said, would spur economic recovery and growth.

The Act would ensure that every worker, no matter the size of their employer, self-employed status, or part-time work would have access to twelve weeks of paid leave equal to up to 66 percent of wage replacement for every serious medical event every time it’s needed.

In defending the Act, Sen. Gillibrand noted that the Covid pandemic seriously impacted women in the workforce and hit middle class families hard. “Women have been forced to make the impossible decision between caring for their families or earning a paycheck.”

Rep. DeLauro added, “Long before this crisis there has been a desperate need for paid family and medical leave. This problem must be addressed in a permanent way.”

“It’s a national disgrace that our federal government doesn’t guarantee paid family and medical leave for the American people,” activist Melanie Campbell, CEO of The National Coalition on Black Civic Participation, says.

Activists like her and others aren’t mincing words. “They know what it means to go back to work three weeks after giving birth. They know the extraordinary cost of having to start from scratch because of lost income while caring for a loved one with a disability,” Sade Moonsammy of Family Values @ Work said in support of the FAMILY Act, which has been endorsed by more than 85 national organizations.

It’s an Act that is long overdue, as Katy Tur and other new moms and dads know. It’s time to join the list of countries that get it, and care enough to do something meaningful in support of American workers and their families. The hand that rocks the cradle has long needed a hug and a little help. Surely that’s not asking too much.

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Elayne Clift writes about women, health and social issues from Saxtons River, Vt.

Staring at America's Dystopian Future

In 1940, Alice Duer Miller wrote a beautiful epic poem called “The White Cliffs.” An American who had married a British man just prior to World War I, she soon lost her husband serving a country that wasn’t hers. As she penned the poem, she faced the possibility of losing her son to World War II, again for a country not her own.  Yet, her last poetic lines are these: “I am American bred. I have seen much to hate here – much to forgive. But in a world where England is finished and dead, I do not wish to live.”

Imagine loving a country that is not your own so much.  Then consider not loving your own country anymore because it has dragged you into a very dark place, a place of fear and disillusion, a place growing more dystopian by the day.

In the space of just a few days, we have watched a Congressperson promise to shut down media organizations if they complied with legal subpoenas, we saw a state pass draconian laws that inhibit voting rights in dramatic, disturbing and undemocratic ways, and then we watched as that same state ignored the constitutional right to abortion granted to women in 1973. On top of that, the state, Texas, granted vigilante rights with financial incentives to any citizen who didn’t want to grant women that right.   

Just let the idea of private bounty hunters sink in. They might be husbands or boyfriends, angry neighbors, relatives, friends, pastors, people who think pregnancy by rape or incest is not so bad, folks who hate the idea of abortion but especially like the thought of a $10,000 reward. Some may be devout, but they are all devious and despicable. Over what ideologies might other states consider employing them?

Then came the most stunning blow of all in the form of the unbelievable and terrifying silence of an overwhelmingly conservative and politicized Supreme Court in the face of Texas’s deeply dangerous, and replicable law; a law so hideously and overtly fascist, a law wreaking with the stench of secret police in autocracies and dictatorships like those of Italy’s Mussolini, Romania’s Ceausescu, and today’s Vickor Orban in Hungary. How can any American not be sickened by that level of betrayal?

Justice Sonia Sotomayor, one of four dissenting justices, unleashed her fury and spoke for many of us in her minority opinion: “The court’s order is stunning,” she wrote. “Presented with an application to enjoin a flagrantly unconstitutional law engineered to prohibit women from exercising their constitutional rights and evade judicial scrutiny, a majority of justices have opted to bury their heads in the sand. The court has rewarded the state’s effort to delay federal review of a plainly unconstitutional statute, enacted in disregard of the court’s precedents, through procedural entanglements of the state’s own creation. The court should not be so content to ignore its constitutional obligations to protect not only the rights of women, but also the sanctity of its precedents and of the rule  of law.”

How, one must ask, does the court overrule fifty years of precedent – a value deeply held by conservatives - in its race to allow the invasion of women’s lives, a question former Representative Claire McCaskill asked in rage when commenting on MSNBC. How quickly will states rush to replicate this precedent?

In a statement that could have been more strongly supportive of women’s right to privacy and agency, President Biden warned that the nearly complete ban on abortion in Texas will cause “unconstitutional chaos.” It also begs the question, how will the Supreme Court rule on other cases that seek to curb abortion rights nationally?

While civil rights advocates sound alarm bells about worrisome implications for future laws, social justice and human rights opinion leaders like Michael Moore and others suggest the situation has reached crisis proportions such that terms like “conservative” and “evangelical” in reference to right wing radicals are no longer appropriate because they normalize groups that have essentially become America’s Taliban.

That term may be offensive to some, but in the face of an ever-growing political climate of oppression, exclusion and violence, and a Congress or Supreme Court that increasingly embraces ideas antithetical to democracy and proceeds to exercise the power to curb it, surely the time has come to recognize the imminent and very real threat before us.  That threat is nothing short of an undemocratic and dystopian future in which we join in the despair of so many others around the globe.

It’s a world in which we may still have a choice: To deny what is happening with frightening speed, or to ignore what is bearing down upon us, only to find ourselves back in Plato’s allegorical cave, in which we all sit staring at a blank wall, our backs to the light, believing that is simply the way we must live.

As Alice Duer Miller might have said, in such a world, where freedom and hope are finished and dead, I do not wish to live.

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Elayne Clift writes from Saxtons River, Vt. 

Women Athletes Are Making Their Mark in Ways That Matter

I grew up never thinking about, observing, or participating in sports. I hated gym class, couldn’t play tennis, never imagined skiing, and didn’t learn to swim until I was an adult. Such activities were never fostered in my immigrant Jewish culture. Academics were the only thing that required excellence.

Consequently, I’ve never paid much attention to athletes or the Olympics. But this year, along came Naomi Osaka, Simone Biles, Suni Lee, Yusra Mardini, and the women who traded in their required G-strings for shorts or long leotards. That caught my feminist attention.

This year’s female athletes join tennis firsts Serena Williams and Billie Jean King, track and field Olympic champion Jackie Joyner-Kersee, and the great Babe Didrikson-Zaharias who excelled in golf, basketball, baseball, track and field, winning a gold in the 1932 Olympics. These women didn’t just demonstrate what women athletes could achieve. Each in their own way stood up to pressure, sexism, and misogyny just as today’s stellar female athletes are doing.

Naomi Osaka, who dropped out of the French Open tennis tournament earlier this year, explained why, in a recent TIME Magazine article. Anxious about press events she said, “It’s okay to not be okay, and it’s okay to talk about it. I wanted to skip press conferences to exercise self-care and preservation of my mental health. I stand by that. Athletes are human.”

For that decision, she was fined $15,000 for not doing media events, affecting the profit margins of companies that supported her.

Simone Biles, four-time gold medalist in the 2016 Olympics, caused a lot of sponsors and fans to become hysterical and verbally abusive over her decision to withdraw from several events this year. With 19 gold medals to her credit, the expectations had become unbearable for the 24-year old athlete, who along with other Olympic gymnasts, was sexually assaulted by Larry Nassar, the doctor for the American gymnastic team now serving a life sentence for sexual abuse.

As tensions mounted, Biles dramatically difficult routine became dangerous, so she decided to withdraw. She was then accused of being weak, unable to take the pressure, and more by would-be jocks who likely found it difficult to bend over to tie their shoes. Biles also ended her sponsorship with Nike this year to go with a smaller, less demanding and more supportive brand. “It wasn’t about my achievements, it’s what I stood for and how they would help me use my voice for females and kids,” she said.

Biles’s withdrawal opened the way for 18-year old Suni Lee, the first Hmong-American Olympian to win the gold and two other medals this year, a feat she accomplished after being out of action for two months last year due to injuries, the death of two relatives from Covid, and the accident that paralyzed her father in an accident. Stunned by her magnificent win, she said proudly, “I'm super proud of myself for sticking with it and believing in myself.”

Yusra Mardini is not as well known as Biles or Lee, but her story is equally compelling. She fled the Syrian war as a teenager, swam for three hours in the sea while steering her sinking boat to safety, and saved every passenger onboard. Then she walked from Greece to Germany. This year, she competed in the 100-meter Butterfly swim at the Olympics, revealing that even without winning a medal, women like these athletes are strong, self-respecting, and determined.

They were joined by Olympic women who refused to accept the sexualization in gymnastics by rejecting bikini cut underwear that likely induced the world’s worst wedgie with the required “close fit and cut on an upward angle toward the top of the leg.” Punishment time again: Team Germany earned their $1500 Euro fine from the International Handball Association for wearing shorts, which men’s teams wear.

The blogosphere went viral as women protested that kind of misogynistic nonsense. As one of them posted, “Biles set aside her dreams in order to do the right thing for her teammates and her country. I see a lot of dudes who look like they’d break a sweat opening a bag of Doritos mocking Biles for being ‘weak’. She could crack their spines with her calves and do a full floor routine afterwards [but] she’s too good a person to challenge them to a fight.”

Another said, “It’s hard to not feel feminist. It’s hard not to be angry and disgusted. Society refuses to acknowledge a woman’s worth. The system continues to fail women, even ones as outstanding as these. It’s time to get mad.”

Even if the women in this year’s Olympics never compete or win another medal again, they will remain gold star champions to every woman who has ever cleared her own hurdles and landed on her feet, hands in the air, the smile of achievement on her face. No longer will competent, strong women give their bodies to male titillation and sexual fantasy, or to corporations who view them as simply commodities, or to imposed pregnancies. Along with women who have aspired us anew, sisters in sport, we are reclaiming our power and our legitimacy in every arena. 

That makes every one of these astounding athletes, and all women, winners.

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Elayne Clift writes about women, politics and social issues from Saxtons River, Vt.

What is Title 42 and Why Should It Be Rescinded?

“A lot of girls cry. They have thoughts of cutting themselves,” a 14-year old Guatemalan girl told a Reuters reporter in June.  “I feel asphyxiated having so many people around me. There’s no one here I can talk to about my case, or when I’m feeling sad. I just talk to God and cry,” said another teenage girl from Honduras who was held in the Dallas convention center with 2600 other kids.

 It gets worse when you read press reports written over the summer. Kids in custody reported spoiled food, no clean clothes, sleeping on cots under glaring lights, drinking spoiled milk when there isn’t water. According to The New York Times a military base in El Paso detained youth who said they’d gone days without showering while in Erie, Pa, lice were rampant. In June roughly 4,000 unaccompanied children were being held by the Department of Health and Human Services (HHS), a step up from ICE detention, but still in facilities where press is not permitted.

 No one denies that growing numbers of immigrants seeking asylum in the U.S. present a difficult problem. The Biden administration understands and has worked to alleviate the suffering.  Still, the incarceration of children is inhumane. As Leecia Welch, a lawyer at the National Center for Youth Law, told The New York Times in June, “Thousands of traumatized children are lingering in massive detention sites on military bases or convention centers, many relegated to unsafe, unsanitary conditions.”

 That’s why there is growing outrage about the continuation of Title 42 as a deportation mechanism, used to keep immigrants out of the country by Donald Trump. President Biden promised to end it but is now allowing it to remain in place indefinitely.

  In a letter to the White House over 100 groups urged the president to rescind Title 42 expulsions charging that it violates U.S. refuge law and treaties and endangers people seeking protection at the U.S.- Mexican border  According to Border Report in Texas, the expulsions are not based on science and expose people being held to violence in Mexico.  

 Title 42 is one of 50 titles within the U.S. Code of Federal Regulations established in 1944 to move quarantine authority to the public health sector, but it was sometimes used to control immigration using public health as a rationale. Well before the Covid pandemic, Donald Trump’s advisor, Stephen Miller, suggested applying the Code to close the border to asylum seekers despite being told by lawyers they lacked the legal authority. Human Rights Watch (HRW) argues that “the expulsion policy is illegal and violates human rights,” and adds that “U.S. law gives asylum seekers the right to seek asylum upon arrival in the United States, even if seekers arrive without inspection prior authorization. U.S. Customs and Border Protection (CBP) is legally required to conduct screenings to ensure they do not expel people who need protection.”

 Yet since March 2020, CBP has carried out almost 643,000 expulsions using Title 42, without conducting required screenings, thus committing illegal “turnbacks”. In November a federal district court blocked use of Title 42 in the case of unaccompanied minors, but by the time the Biden administration vowed to end it over 13,000 kids had been expelled.

 Here’s the rub. These kids aren’t entering the U.S. with Covid.  They get it once they are held in detention because of overcrowding and unhygienic conditions in HHS and CBP facilities. Some children have died in detention.

 Along with children, pregnant women, some in labor, have been expelled along with LGBT people, who are particularly vulnerable to violence, even since President Biden took office, according to Human Rights Watch.

 HRW also states that “The Convention against Torture and the International Covenant on Civil and Political Rights (ICCPR), to which the U.S. is a party, prohibit expulsions or returns in circumstances where people would face a substantial risk of torture or exposure to other ill-treatment. Also, under U.S. law and the 1967 Protocol Relating to the Status of Refuges, to which the U.S. is party, the United States may not return asylum seekers to face threats to their lives or freedom without affording them an opportunity to apply for asylum and conducting a full and fair examination of that claim.” Nevertheless, by February this year CBP had carried out more than 520,000 expulsions, according to the American Immigration Council.

 Let’s be clear. No one risks their lives or suffers the unimaginable hardships of migration without compelling reasons that include crushing poverty, criminal gangs that kill people and abduct their children, devastating violence, hopelessness and more. (If you want to know what the journey is really like, read Disquiet by Zulfu Livaneli, or The Mediterranean Wall by Louis-Philippe Dalembert.)

 The United Nations holds that asylum-seeking children should never be detained. And still they come by the hundreds of thousands. That’s why the ACLU is moving forward with a lawsuit that seeks to lift the public health order for migrant families and unaccompanied children. As Lee Gelernt, ACLU’s lead lawyer says, “Time is up” for dealing with this human rights catastrophe.

 The kids cutting themselves as they weep couldn’t agree more.

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Elayne Clift writes about women, health, politics, and social justice from Saxtons River, Vt.

The Urgency of Saving Roe v. Wade

She is sixteen years old and pregnant. Still in school and devoid of job skills, she would not qualify to adopt a child, yet she could be forced to carry the fetus to term.

 She is a mother who wants another child, but in the third term of her pregnancy she learns her fetus has severe organ anomalies and will die soon after birth, but she is denied a late term abortion.

 She is a victim of rape who suffers post-traumatic stress that renders her unable to work, but she will be forced to give birth.

 She has been sexually abused by her uncle for years and is now pregnant by him, but she cannot have an abortion.

 Each of these women represent many others. They are the elephant in the room that no one wants to talk about as the United States moves ever closer to draconian restrictions on abortion, and ultimately the death of Roe v. Wade, the landmark 1973 decision in which the Supreme Court ruled that the Constitution protects a woman's liberty to choose to have an abortion without excessive government restriction. 

 Ever since the Supreme Court’s decision a growing number of states have worked hard to promulgate laws and regulations that limit whether and when a woman can obtain an abortion. Restrictions aimed at reducing abortions are designed to challenge to Roe v. Wade in the hope it will be reversed.  They include such measures as mandating unnecessary physician and hospital requirements, setting gestational limits, preventing so-called “partial birth” (late term) abortion, promulgating funding restrictions, and insisting on state-mandated counseling, waiting periods, and parental involvement.

 But never have we seen abortion restrictions like those that now exist in 45 states, making 2021 a “year that is well on its way to being defined as the worst one in abortion rights history,” as the Guttmacher Institute notes.

 Various state laws from Arizona to Arkansas are a Handmaid’s Tale nightmare, but none are as staggering as the laws in Texas. Beginning in January this year, patients are required to receive state-directed counseling including information designed to discourage abortion, coupled with mandated wait times. There are constraints on various insurance policies including those included in the Affordable Care Act. Parental consent is required, and patients must undergo an ultrasound at least 24 hours before obtaining an abortion while the provide shows and describes the fetal image to the patient.  

 Further, in May, Texas governor Greg Abbott signed a fetal heartbeat abortion bill that bans abortion as early as six weeks, well before most women know they’re pregnant. That bill is scheduled to go into effect in September, although it and many other proposed laws are being challenged in the courts.

 No wonder Texan Paxton Smith, graduating valedictorian of her high school class, found her graduation speech going viral.  With enormous courage, she ‘aborted’ her approved speech and spoke eloquently, noting at the start that the six-week “Heartbeat Act” had just been introduced.

 “I cannot give up this platform to promote complacency and peace when there is a war on my body and on my rights. A war on the rights of your mothers, a war on the rights of your sisters, a war on the rights of your daughters. We cannot stay silent,” she told the crowd, noting that medical authorities have said the fetal heartbeat argument is misleading.

 Shortly after Smith gave her speech, a Spokane, WA newspaper revealed that several months earlier a woman who suffered a miscarriage in a Spokane hotel had been investigated by police who found it suspicious that she did not meet them at the hospital as they had instructed. A search warrant followed because the cops thought she might be guilty of criminal mistreatment of a child. Ultimately the investigation was closed.  But women are actually in jail here and in other countries, charged with feticide following a miscarriage. 

 It doesn’t have to be this way.  There are many models we can look to in which women’s right to exercise control over their bodies is not in the hands of the state. The Netherlands is one such country. Abortion is free on demand there and yet they have the lowest abortion rate in the world, while complications and deaths from abortion are rare. Contraception is widely available and free, and abortion is covered by the national health insurance plan. Sex education starts early, and Dutch teenagers have less frequent sex starting at an older age than American teens; their pregnancy rate is six times lower than ours.

 Why, then, but for Paxton Smith, do we never hear media reports about the critical issue of abortion, which male powerbrokers embrace with the force of institutionalized misogyny? Why does the current administration remain silent on an issue of this import when three quarters of Americans want Roe v. Wade to remain in place, citing it as a key issue affecting who will get their vote? Why is the American public so ready to give up on a fundamental human right that can touch all of us?

 Why, Ms. Smith might well ask, do we stay silent?