Standing Up to Sterilization, Eugenics, and the Abuse of Women

“Keep your hands off my uterus!” That’s an often-repeated placard and plea at women’s marches I’ve attended over the past forty years. In the U.S. and abroad, it’s a common, continuing refrain because government sanctioning of abuse of women’s bodies has been occurring since well before the Second Wave women’s movement exposed it in the 1970s.

 

I worked in the women’s health movement then alongside Our Bodies, Ourselves and other national organizations. One of the myriad issues we dealt with was the sterilization of poor, black and brown women.  We helped raise awareness of the medical abuse of Puerto Rican women that resulted in a third of women of reproductive age being sterilized for decades at clinics often funded by the U.S. government. In the 1960s women in Puerto Rico were also the subjects of birth control pill trials, without their consent. Those who became pregnant on placebos were offered no help, financial or otherwise, and were forced to carry resulting pregnancies to term.  

 

Another frequent abuse women of color faced was the lack of real informed consent. It can hardly be considered consent when you are asked to sign a paper in English and your only language is Spanish, or you are asked by the nice doctor if you’d like to stop having babies after you’ve just endured a long, arduous labor.

 

There is a long, ugly history of abusing and using women’s bodies by way of coercion and for experimentation. Dr. J. Marion Sims, know as the father of gynecology, practiced medicine in Alabama from 1835 to 1849. During that time, he conducted hideous experiments, without any anesthesia, on enslaved women he had purchased in the 1840s. At an annual convention of the American Public Health Association in the late 1970s his portrait was still on display – until enraged women demanded that it be taken down and never shown again.

 

Affluent white women were often subjected to having their ovaries removed in the second half of the 19th century if they were deemed to be overly sexual. This practice coincided with the belief that if women used their minds too eagerly, their uteruses would atrophy, denying them the God-given role of child bearers.

 

Medical abuse was further embraced in the early 20th century when eugenics was popular, with the growth of programs that coerced women to be sterilized if they did not willingly consent. As Alexandra Stern, author of Eugenic Nation, points out, sterilization was viewed as part of a “necessary public health intervention aimed at protecting society from deleterious genes…” This mindset prevailed late into the century. My friend’s daughter, who was mentally impaired, was subjected to sterilization in the 1970s as part of her care plan.

 

Some states, like California, passed laws that resulted in thousands of residents being sterilized for decades (including some men). Even as late as 2010 the California Department of Corrections and Rehabilitation had sterilized 150 women in four years. Richard Nixon, a Californian, significantly increased Medicaid funding for sterilization of poor Americans with an emphasis on people of color.

 

Let us remember, medical historians remind us, that eugenics policies in the U.S. aimed at those considered too mentally defective to reproduce, are credited with becoming models for Nazi Germany.

 

One of the saddest stories of a black woman being sterilized during her childbearing years is that of civil rights activist, Fannie Lou Hamer. She had a hysterectomy without her consent in 1961 while undergoing minor surgery for removal of a benign tumor. She spoke about her experience as a Black woman who had been subjected to what was known as a “Mississippi appendectomy,” when women were taken to local clinics and sterilized.

 

Now comes Dawn Wooten, a courageous nurse, who revealed that women in an ICE detention center in Georgia, run by a private prison company, had an outside doctor perform hysterectomies on them when they complained about non-threatening reproductive health issues. Many of the women who experienced major surgery awoke to find that they had had their reproductive organs all or partially removed without their prior knowledge or consent. Most were still of childbearing age and most had no idea why they had undergone the procedure.

Pauline Binam, 30, was one of them. She was being quickly deported by ICE to Cameroon, which she left at age two. Binam, now 30, was on the tarmac when members of Congress including Rep. Shirley Jackson Lee intervened to keep her in the U.S.  Binam's lawyer has said her client thought she was getting a routine procedure last year, but "when she woke up from surgery, the doctor informed her that he had to remove one of her fallopian tubes."

Imagine how hard it will be to find records of the 17 surgeries that have now been reported.  Think about how many abused women will be rushed onto airplanes and deported so they can’t bear witness. Then try to understand what it feels like to have undergone surgery that renders you unable to have a child because you are young, poor, and unwanted.

 

It boggles the mind, and makes you want to weep.

 

                                                                        # # #

 

Elayne Clift writes about women’s health from Saxtons River, Vt.  www.elayne-clift.com

 

 

 

 

 

“Keep your hands off my uterus!” That’s an often-repeated placard and plea at women’s marches I’ve attended over the past forty years. In the U.S. and abroad, it’s a common, continuing refrain because government sanctioning of abuse of women’s bodies has been occurring since well before the Second Wave women’s movement exposed it in the 1970s.

 

I worked in the women’s health movement then alongside Our Bodies, Ourselves and other national organizations. One of the myriad issues we dealt with was the sterilization of poor, black and brown women.  We helped raise awareness of the medical abuse of Puerto Rican women that resulted in a third of women of reproductive age being sterilized for decades at clinics often funded by the U.S. government. In the 1960s women in Puerto Rico were also the subjects of birth control pill trials, without their consent. Those who became pregnant on placebos were offered no help, financial or otherwise, and were forced to carry resulting pregnancies to term.  

 

Another frequent abuse women of color faced was the lack of real informed consent. It can hardly be considered consent when you are asked to sign a paper in English and your only language is Spanish, or you are asked by the nice doctor if you’d like to stop having babies after you’ve just endured a long, arduous labor.

 

There is a long, ugly history of abusing and using women’s bodies by way of coercion and for experimentation. Dr. J. Marion Sims, know as the father of gynecology, practiced medicine in Alabama from 1835 to 1849. During that time, he conducted hideous experiments, without any anesthesia, on enslaved women he had purchased in the 1840s. At an annual convention of the American Public Health Association in the late 1970s his portrait was still on display – until enraged women demanded that it be taken down and never shown again.

 

Affluent white women were often subjected to having their ovaries removed in the second half of the 19th century if they were deemed to be overly sexual. This practice coincided with the belief that if women used their minds too eagerly, their uteruses would atrophy, denying them the God-given role of child bearers.

 

Medical abuse was further embraced in the early 20th century when eugenics was popular, with the growth of programs that coerced women to be sterilized if they did not willingly consent. As Alexandra Stern, author of Eugenic Nation, points out, sterilization was viewed as part of a “necessary public health intervention aimed at protecting society from deleterious genes…” This mindset prevailed late into the century. My friend’s daughter, who was mentally impaired, was subjected to sterilization in the 1970s as part of her care plan.

 

Some states, like California, passed laws that resulted in thousands of residents being sterilized for decades (including some men). Even as late as 2010 the California Department of Corrections and Rehabilitation had sterilized 150 women in four years. Richard Nixon, a Californian, significantly increased Medicaid funding for sterilization of poor Americans with an emphasis on people of color.

 

Let us remember, medical historians remind us, that eugenics policies in the U.S. aimed at those considered too mentally defective to reproduce, are credited with becoming models for Nazi Germany.

 

One of the saddest stories of a black woman being sterilized during her childbearing years is that of civil rights activist, Fannie Lou Hamer. She had a hysterectomy without her consent in 1961 while undergoing minor surgery for removal of a benign tumor. She spoke about her experience as a Black woman who had been subjected to what was known as a “Mississippi appendectomy,” when women were taken to local clinics and sterilized.

 

Now comes Dawn Wooten, a courageous nurse, who revealed that women in an ICE detention center in Georgia, run by a private prison company, had an outside doctor perform hysterectomies on them when they complained about non-threatening reproductive health issues. Many of the women who experienced major surgery awoke to find that they had had their reproductive organs all or partially removed without their prior knowledge or consent. Most were still of childbearing age and most had no idea why they had undergone the procedure.

Pauline Binam, 30, was one of them. She was being quickly deported by ICE to Cameroon, which she left at age two. Binam, now 30, was on the tarmac when members of Congress including Rep. Shirley Jackson Lee intervened to keep her in the U.S.  Binam's lawyer has said her client thought she was getting a routine procedure last year, but "when she woke up from surgery, the doctor informed her that he had to remove one of her fallopian tubes."

Imagine how hard it will be to find records of the 17 surgeries that have now been reported.  Think about how many abused women will be rushed onto airplanes and deported so they can’t bear witness. Then try to understand what it feels like to have undergone surgery that renders you unable to have a child because you are young, poor, and unwanted.

 

It boggles the mind, and makes you want to weep.

 

                                                                        # # #

 

Elayne Clift writes about women’s health from Saxtons River, Vt. 

 

 

 

 

 

Diminished, Dismissed, Misdiagnosed: When Doctors Don't Trust Women

Rana Mungin was 30-years old when she died of Covid-19 in March. A black teacher in Brooklyn with asthma and hypertension, she was twice diagnosed with having a panic attack in an ER, despite a fever and shortness of breath.

That reaction and lack of appropriate response by doctors was not a fluke. It happens frequently if you are female, especially if you’re a black woman, as several recent books about women’s health care reveal. That’s not news to women’s healthcare advocates, but perhaps now healthcare providers who may not have considered inherent problems involving diagnosing and treating women will be more enlightened.

Possibly the most important book on this issue is Doing Harm: The Truth About How Bad Medicine and Lazy Science Leave Women Dismissed, Misdiagnosed, and Sick by Maya Dusenbery. Adding to the impressive and important literature of women’s health, Dusenbery addresses two of the biggest impediments to women getting good care, the “knowledge gap” and the “trust gap.”

 The knowledge gap refers to the fact that many doctors don’t know enough about women’s bodies, their symptoms, or the diseases that affect them disproportionately. The trust gap speaks to the stereotyping of women as unreliable reporters at best, and hysterical at worst. These gaps are apt to occur more often with black women. Dusenbery’s central and necessarily repeated mantra is that women are either not trusted when they report symptoms or they are labeled crazy, malingering, or opioid- addicted.

“This book is not about a few sexist bad apples within the medical profession,” Dusenbery says in her introduction. “It is about how all health care providers, like all of us, have unconscious biases by virtue of living in a culture that holds certain stereotypes about women.”

These biases are revealed over and over again as women share their first-person horror stories of trivialization, misdiagnosis, not being believed and more, whether they suffer chronic pain, autoimmune diseases, reproductive problems, heart attacks or other life-threatening emergencies. 

Here’s one example. “I was asking for help. But my doctor said, ‘I don’t think you’re at the point where medication is an option, and it can be addictive. Keep exercising and doing yoga and maybe consider meditating. Try to get more sleep. If your symptoms persist, come back in a few months.”

Here’s another. A black woman I know was found to have multiple cysts in her body. She had gained weight and stopped menstruating. What did the doctor tell her? “You have a demanding job and a young child. I think it’s stress.” That opinion was rendered with no diagnostic workup, no referral to an endocrinologist, no curiosity or concern about what systemic problem might be causing the troubling symptoms.

Dusenbery backs up her conclusions with copious references to research studies, women’s personal stories, and other books in the women’s health canon, as she exposes “bad medicine and lazy science” in compelling and convincing ways.

“Doctors think that men have heart attacks and women have stress” speaks to the frequency with which women are told their symptoms are due to stress, a theme played over and over again in the stories women share. “It’s hard work behaving as a credible patient,” as one woman said, underscoring how often pain is deemed to be “all in your head.” 

A chapter in Dusenbery’s book called “This is Not Normal” reveals how often women must insist on having diagnostic workups. “Young women aren’t the only group of patients who frequently find their symptoms dismissed as ‘normal’ by healthcare providers. The tendency to normalize symptoms associated with women’s reproductive functions finds echoes in the way elderly patients, trans patients, and overweight patients are often treated.”

 “The Career Women’s Disease” points to the modern version of age-old myths suggesting that motherhood and work are incompatible. One 20th century “expert” on endometriosis notoriously stated that the painful condition was on the rise because of “delayed and infrequent childbearing.” The 19th century version of this myth was that if a woman exercised her brain her uterus would atrophy.

Autoimmune diseases are especially challenging for physicians who receive about five hours of lectures on this difficult topic during their entire medical education. Research has shown that women with these diseases, like with many others, see about five physicians over a period of seven years before receiving a correct diagnosis.

The frustration of not being believed or properly diagnosed is intense.  As Dusenbery puts it, “The long, frustrating search for a diagnosis is such a common theme running through the stories of women patients that many feel immense relief to finally get a diagnosis, any diagnosis. Being sick without knowing why is very stressful; being sick and told ‘nothing’s wrong,’ is more stressful still.” 

Delayed, downplayed, poorly diagnosed illnesses are not simply a medical issue. In this time of “intersectionality,” it’s important to realize that race, class, age, gender and more come into play. As one analyst put it, “if you’re not wealthy, not white, and not heterosexual, you may be receiving less than optimal care.”

That’s why Rana Mungin’s story is so sad, and why Dusenbery’s message, echoing that of other healthcare advocates, is so important. “Listen to women. Trust us when we say we’re sick. Start there, and you’ll find we have a a lot of knowledge to share.”  Books like Doing Harm go a long way in arming women for the task.

 

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Elayne Clift has been a women’s healthcare educator and advocate for over three decades. She lives in Saxtons River, Vt.  

 

 

The Challenging Failures of a Broken Health Care System

If there’s one issue on which there is consensus in this drawn out, drama-laden pre-election time it’s that our healthcare system is seriously broken.  Whether voters are for an incremental approach to reform, a course correction for the Affordable Care Act, or behind a magic bullet Medicare For All plan, they agree that the situation is a mess on many levels, often resulting in catastrophic outcomes or financial ruin.

We all have illuminating stories to tell. Mine is specific to the high cost of healthcare and a suspicion that Medicare is being seriously ripped off.

Not long ago I visited a specialist’s office to relieve a blocked ear that resulted from flying with a cold. A physician’s assistant looked in my ear, declared me free of fluid or infection, and bizarrely suggested I have an MRI to rule out a brain tumor. She then prescribed steroids.  I ignored her advice, tore up the prescription, and three days later my ear popped itself open. 

For that short visit I was billed $38. Medicare paid the remaining $305.

Astounded by a charge of $343 for a brief office visit with a PA, not the doctor I’d booked the appointment for, I called the billing office where I was seen to query the bill. I asked specifically who decided the billing codes, what the criteria were for coding, and why I was billed the same rate for a PA as for the MD I didn’t see. No one could answer my questions. I then called the physician’s office, which referred me back to the billing office.

I wrote to the billing office and soon received a troubling response from the Director of Customer Services, which I felt compelled to answer. My letter speaks for itself.

“Thank you for your response which attempted to explain your cost policies,” I wrote. “I do not wish to beat a dead horse, but I must reply for reasons which are obvious.

 

“You stated that ‘when it comes to pricing, rates are set by a board of directors annually.’ I fail to see how a hospital board can arbitrarily set prices, or codes, for services covered by Medicare, a federal program that establishes reimbursement standards for anyone whose primary insurer is Medicare.

 

“You also refer to ‘complexity levels based on the nature of your condition, paperwork, examination and counseling time.’ To be clear, my visit was hardly highly complex.  I had a blocked ear, not a perplexing condition. My visit required no paperwork beyond a chart note and a brief examination which simply involved looking in my ear. No sophisticated equipment or counseling was necessary. 

 

“You also stated that costs included “caregiver’s time, space where services were provided, equipment, supplies and medications used.” Let me be clear: No equipment, supplies or medications were used. My visit was a half-hour or less.  Am I to believe that my cost included a fee for using an examining room?  What’s next? An elevator fee? Restroom fee? Assessment for corridor or cafeteria space?

 

“You stated that yours is a ‘charitable healthcare organization’ that cares for people regardless of their ability to pay.  While that is admirable, I do not expect to be assessed a charitable giving fee.  I will decide, not your institution, how much and to whom my philanthropy goes!

 

“Equally, I do not expect to involuntarily subsidize ‘physician training’, ‘conduct of medical research,’ or ‘specialized services using the newest technology.’  If I wanted to support those goals, I would do so in the form of a dedicated donation. I am astounded that patients are unknowingly assessed fees for these things.

 

“How interesting that in listing your goals you state that you want to ‘have fair patient prices that enable [you] to advance health through research, education, clinical practice and community partnerships.’  Note the rank order of priorities in that list, and the absence of ‘quality patient care’ as the first priority.

 

“My experience doesn’t meet all the standards of Medicare fraud and/or abuse as articulated by the federal government and healthcare watchdog groups, but it comes very close to two of them: “Charging excessively for services or supplies” and “upcoding” or incorrect billing.

 

“I’m sad to say that I don’t expect this letter to change anything with respect to billing at your facility, but I do hope you and your colleagues will reflect seriously about the issues it raises -- and that you will be “fair and balanced” as well as transparent, when addressing costs incurred by Medicare and the seniors served by that program.  It is telling that I received a 10% cut in my Social Security this year due to the increased costs of providing Medicare.  No surprise there now that I’ve seen your billing criteria.”

 

According to www.CMS.gov ,  a government agency dealing with healthcare fraud and abuse, “No precise measure of healthcare fraud exists, but  those who exploit Federal healthcare programs can cost taxpayers billions of dollars.” CMS defines abuse as “practices that may directly or indirectly result in unnecessary costs to the Medicare program.” Examples of abuse include “charging excessively for services or supplies and misusing codes, or “upcoding.”

 

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Girls and Young Women Will Suffer Most from Anti-abortion Madness

Reading Facebook posts these days has become an exercise in masochism for many of us. Daily horrific posts reveal various forms of violence against the least powerful among us.

Among the victims of such violence are young women and “emerging adult” females. A recent post referenced an eleven-year old girl in Ohio pregnant by rape. Given Ohio’s newly proposed anti-abortion legislation, she could be forced to carry the fetus to term. That’s nothing short of state-sanctioned child abuse. State after state, the same kind of cruelty could be repeated.

We have heard little about the full impact of Draconian measures aimed at overturning Roe v. Wade on women’s mental and physical health, but of this you can be sure: The impact will be more drastic the younger the girl or woman subjected to such measures.

It should be noted that research reveals having a safe, legal abortion does not pose mental health problems for women. According to Lucy Leriche, Vice President of Public Policy, Planned Parenthood of Northern New England, “over 95 percent of women who have had an abortion report feeling relief that outweighs any negative emotion they might have, even years later.”

In contrast, a statement last month by the Activism Caucus of the Association for Women in Psychology (AWP) makes clear the psychological damage that will be inflicted on girls (and women) from restrictions on their reproductive rights, none more so than the hideous laws Alabama and other states want to impose.

“Growing girls learn that in crucial, life-altering ways, the government has more control over their bodies than they do. This is important for many reasons, one of which is that a sense of control has been shown repeatedly in psychological research to be important to mental health and well-being,” write psychologists Paula J. Caplan and Joan Chrisler on behalf of the AWP. “Rape and incest are examples of extreme loss of control, and at least in some cases, making the decision to have an abortion after rape and incest are important parts of healing, which the Alabama law prohibits.”

Like domestic abuse and sexual assault, current proposed and passed laws are about power and control, and men’s fear of losing that power and control. The laws aim to remove any sense of agency from women, over their bodies and their lives. In their worst form, they are a manifestation of terrorism in which a women’s body is owned by the state, as it was in the chilling novel, The Handmaids Tale. Laws that attempt to incarcerate a woman for crossing state lines to have an abortion, laws that can send her or her physician to jail for life, laws that in the extreme could result in executing a woman for having an abortion reveal the pure evil underpinning these laws.

Let’s remember that the same men (and yes, some women) who want to torture girls and women in these ways are the same men (and women) who legislate against ensuring the health, safety, education, and well-being of the babies born of this unspeakable coercion, and who rabidly support capital punishment.

Even if these reactionary attempts to challenge women reproductive and human rights were to fail, “the blaming and shaming of girls and women who choose to use birth control measures or who choose to have abortions causes fear, self-doubt, low self-confidence, feelings of being unsafe, and beliefs that others consider [women and girls] unable to make major, or ethical decisions,” the AWP points out.

The truly heartbreaking thing is that once shamed, fearful, self-doubting, and depressed, it is almost impossible to regain a sense of personhood or control over one’s life. That kind of despair, in which it seems impossible to envision a way out, especially prevalent in the young, can easily lead to self-destructive behavior, including suicide.

Some years ago, when I worked in Romania on reproductive rights, I saw the damage done to girls, women, and children during the time of the dictator Ceausescu. His regime required all girls graduating from high school to undergo a pelvic exam to determine if she was pregnant. Every working woman was also subjected to monthly pelvic exams in their workplaces. These cruel practices were enforced to ensure that all pregnancies were carried to term. I saw the results of that grotesque policy in the Casa Copii – orphanages where unwanted babies were dumped. Many of the children were visibly impaired, physically and mentally. Others suffered in ways that can only be imagined. Very few of them, I’m certain, had any vision of a happy future. It was worse than Dickensian and it broke my heart.

What is happening in this country now is not far removed from the tragedies that have occurred because of pronatalist policies elsewhere. The lack of humanity, morality, and ethics inherent in such policies is stunning. It leaves one speechless. Incredulous. Furious. Grieving.

But it must not leave us silent.

We must march in unity, speak out vociferously, resist mightily, vote, and support the #SexStrike movement together. Most of all, we must refuse to sacrifice our young and our females on the alters of misogyny and in the chambers of violence. Our survival as sentient beings depends upon it.

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Elayne Clift writes about women, health and social justice issues from Saxtons River, Vt. www.elayne-clift.com

Women Beware! Birth Control, Abortion, and Your Healthcare Are at Risk

 

You’re a middle-class mom with two kids, a mortgage, a fragile marriage, and an elderly parent to care for when you find yourself pregnant. You’re a sexually active college student and because of a condom failure you’re pregnant. You’re pregnant with a wanted child when you learn your fetus has a serious anomaly and probably can’t survive outside the womb. You are a rural woman with limited income who gets routine healthcare at a Planned Parenthood now threatened with closure.

Variations on stories like these abound. For all kinds of women, and their advocates, they are terrifying, as federal and state legislators continue gunning for Planned Parenthood and vehemently resisting female autonomy, privacy, and decision-making.    

As a recent New York Times piece by the editorial board stated, “In its continuing assault on reproductive rights, the Trump Administration has issued potentially devastating changes to the nation’s nearly 50-year-old family planning program, Title X, which allows millions of women each year to afford contraception, cancer screenings, and other critical health services.”

To be clear, health clinics like Planned Parenthood have been barred from using federal funds for abortions, but they have been able to to offer non-federally funded abortions and other family planning services under one roof. Now the Department of Health and Human Services wants to make clinics that provide abortions navigate ridiculous regulations if they want to receive Title X funds. I mean ridiculous regs, like having separate entrances for abortion patients, or establishing an electronic health records system separate from their regular system. Providers will also be prohibited from making abortion referrals, or providing information that adheres to standards for “informed consent.”

In addition to threats at the federal level, more and more states are attempting to pass ridiculous anti-abortion laws, like requiring wider hallways or revamping janitor’s closets.

More Draconian is the unethical “domestic gag rule” that allows so-called “pro-life” staffers in Title X facilities to say a particular procedure doesn’t exist or to lie to patients about false risks of abortion.

As Dr. Leana Wen, the new president of Planned Parenthood, told The New York Times, “There will be many providers that will face an impossible decision: to participate in Title X and be forced to compromise their medical ethics, or to stop participating in that program,” a step that would lead to overwhelming demand for reproductive health care but not much in the way of supply to respond.

Since Roe v. Wade was decided in 1973, states have been constructing a maze of abortion laws that codify, regulate and limit whether, when and under want circumstances a woman can have an abortion, as the Guttmacher Institute points out. Major provisions to states laws, some on the books, other in litigation or defeated, include requiring that abortions be performed in a hospital or set gestational limits on abortion.

One example is the attempt to ban abortions when a faint heartbeat is detected, which can occur as early as six weeks, before a woman may know she is pregnant. Another is state restrictions on coverage of abortion in private insurance plans, and states allowing individual health care providers to refuse to participate in abortions. Some states mandate that a woman have counseling, including information on purported links between abortion and breast cancer, the ability of a fetus to feel pain, or long-term mental health consequences for the woman.

The Trump administration clearly wants to evict Planned Parenthood from the federal family planning program. It also hopes to ban abortion referrals. At the state level, early abortion bans called “heartbeat bills” are being proposed in several states. So far, five of them have advanced this legislation but every “heartbeat bill” passed to date has been overturned in state or federal court. With Judges Gorsuch and Kavanaugh on the Supreme Court, who know what will happen?

Five states have already passed preemptive “trigger laws” which would immediately ban abortion outright if Roe v. Wade is overturned.

Several abortion cases are currently in federal appeals courts or pending litigation in various states. Lawsuits are challenging such issues as required waiting periods, required ultrasounds, 15-week bans, admitting privileges, abortions for minors, and Medicaid coverage.

The situation, not only for women seeking their constitutional right to abortion, but for women – and men - seeking appropriate, quality, accessible, affordable reproductive health care ranging from preventive screening and contraception to treatment of sexually transmitted diseases, grows ever more dire as the Trump administration, and state legislators attempt to control what should be women’s private, personal decisions.

The irony is that rules rooted in anti-abortion (and anti-sex education) feelings threaten access to contraception, which prevents unwanted or unintended pregnancy and consequently increases health care costs in a nation where the cost of care is already skyrocketing.  Can anyone explain why that makes sense? 

More importantly, perhaps, can anyone fathom what would happen without Planned Parenthood?

                                                            # # #

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

www.elayne-clift.com

 

 

America's Rural Health Care Crisis Grows

Not long ago I received a call from my doctor’s receptionist. My long-time primary care physician and partner in healthcare decision-making was retiring her practice, she said, along with two other doctors in our small town. Together they would be leaving 4,000 patients to find care in a community where most physicians are not taking new patients because they are already overwhelmed by their caseload.

I felt especially troubled by the news since I don’t go to just any doctor, even if one is available. As a proactive health consumer, I research providers carefully because I want to work with someone with proven competence, a compassionate heart, and a philosophy of primary health care that supports my own. Finding a doc like that is not easy. It’s especially challenging when there are too few physicians available.

I also realized that I had become part of the troubling landscape of rural health care. I was suddenly caught up in a picture represented by facts and statistics like these: Disparities in access to healthcare for people who live in rural areas of America continue to widen. Recruiting physicians willing to work in isolated areas has also become more difficult, and is not helped by Donald Trump’s plans with respect to work visas and travel bans. Rural hospitals are closing at an alarming rate. In the past six years, 80 of them have closed and if the rate of closures holds, 25 percent of rural hospitals are predicted to close in less than a decade.

The number of doctors per 100,000 residents is 40 in rural areas compared to 53 in urban environments. That’s not counting specialists, where the comparison is 30 to 263. More than half of our counties have no practicing psychiatrist, psychologist or social worker while opioid-related addictions and overdoses are disproportionately higher in rural areas.

In addition, America’s rural population is older, makes less money, smokes more, is generally less healthy, and uses Medicaid more frequently.  Diabetes and coronary heart disease are more prevalent in rural areas and the death rates for rural white women have increased as much as 30 percent in recent years, reversing previous trends.

Studies published in the British Medical Journal recently revealed a severe lack of resources at rural hospitals, sparse staffing and limited access to specialist consultations and diagnostic tools. An attempt to reduce emergency department admissions for cost-cutting is also putting patients at risk.

The situation is complex and challenging due to economic factors, social differences, educational shortcomings, lack of understanding and political will among legislators, and the isolation of living in remote areas, according to the National Rural Health Association.

Some health care analysts and managers advocate for increased use of technology to help solve the growing problems in rural health care delivery, arguing that while technology won’t solve all the problems, it can make a discernable difference. For example, the Institute of Medicine believes that telemedicine can allow rural hospitals to “cut down on the time it takes rural patients to receive care, particularly specialty care.”

That’s all well and good, perhaps, when it comes to hospitals reducing costs and meeting their other needs. But where does it leave me, and other rural patients, when we’re sitting in our johnnies waiting to (literally) see our doctors?  Where is the comforting face-to-face communication and the physical observation so vital to a clinician’s assessment of a patient’s condition and emotional state? Where is the Q&A necessary for shared decision-making? I once left a practice because my doctor, who had previously looked me in the eye when we talked, listened carefully to what I said, and talked to me like a peer, suddenly couldn’t get his face out of his computer screen long enough to greet me when I entered the room.

As I search for a new doctor – the right doctor – in the coming days, I recognize that like many others, I have a big challenge ahead. For me that challenge goes beyond numbers - something the profession includes in discussions of “accessibility.” It involves trust, proven skills, two-way communication - often around intimate issues or possible critical life decisions - and mutual respect.

Such a partnership for health is not easy to find no matter where one lives. In rural America, it is becoming even more difficult. Patience and perseverance in selecting, hopefully, from a crop of good new physicians, may be just what the doctor – and this community -need to order.