THE WOMEN’S HEALTH MOVEMENT Helen Marieskind This article provides a brief overview of the history, current status, and future directions of the Women’s Health Movement. The links between feminism and women’s health issues are drawn and reasons for their simultaneousoccurrence are suggested. It is shown that health issues are seen by the Movement as suspended in the larger social context from which they arise.
The Women’s Health Movement is basically a grass roots organization which has been in existence for the past five years. It has essentially been ignored by radical health analysts as being solely concerned with gynecologic problems and therefore fundamentally irrelevant (1). But it is important to note that while the history and strategy and subsequently the philosophy of the Women’s Health Movement is woman-oriented, the principles and problems addressed are pertinent to the health care of all consumers. Although the current Women’s Health Movement is a relatively recent phenomenon, it has its marked similarities to consumer health activities which arose in the United States during the 1830s and ’40s. Suffragism of the mid-19th century was accompanied by the Popular Health Movement (2). That movement demanded nothing less than a total redefinition of health care and health itself. Similarly, the Women’s Health Movement has evolved from the Women’s Liberation Movement of the late 1960s and ’70s and is directed toward a restructuring of the total health care system and a redefinition of health care. Both movements originated during periods of liberal and radical social thought. Both sought and seek to provide alternatives in areas where the medical profession is found wanting in interest and unresponsive in action. Both emphasize preventive health concepts, self-awareness, and comprehension through a basic knowledge of bodily processes, and both seek to demystify medicine. The goal of women’s social independence and autonomy is at the core of both movements. But an important difference exists between the two movements. The Popular Health Movement was only concerned with health issues-albeit of a far-reaching nature. The Women’s Health Movement, however, in addition to its obvious interest in health issues, is also strongly political in interest, and a new political focus is emerging from its collective health activities. This focus is maturing into an ideology known as Feminist-Socialism. It is this political thrust which assures the long-term viability of the Women’s Health Movement and which establishes the Movement as a potential revolutionary force. HISTORY OF THE WOMEN’S HEALTH MOVEMENT Women’s disenchantment with their relationships both personal and institutional heightened during the 1960s. Attested to in 1963 by Betty Friedan’s The Feminine InternationalJournal of Health Services, Volume 5, Number 2, 1975
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Mystique (3), this disenchantment later coalesced into the Women’s Liberation Movement and rapidly took up the wide-ranging cause of equal rights for women. Even more importantly, the Women’s Liberation Movement advocated that women form consciousness-raising groups. A consciousness-raising group is comprised of several women, preferably from varied socioeconomic backgrounds, who meet on a regular basis to share their life experiences, their dreams, self-images, and their personal and social problems. Criticism and self-criticism are part of the group dynamic and from this process strong supportive relationships develop among the group’s members. These relationships, generally referred to as a “sisterhood experience,” are at the core of the Women’s Liberation Movement. Understanding the collective nature of these group experiences is critical to understanding the development of the Women’s Health Movement and its evolution into Feminist-Socialism. Through their groups women are supported in their challenge of the traditional social roles assigned to males and females, and in their challenge of the social, political, and economic institutions (including medical) which maintain those roles. Irrespective of their socioeconomic class or their relationship to the corporate structure, women in the Women’s Health Movement have concluded that their reproductive potential is a central cause of their oppression. Women recognize that the means to control their reproductive potential is determined not only by the government, but by the preponderance of males in the top ranks of the health care industry (4). Medical knowledge and therefore “scientific” definitions of women are known to be made by men (5) and legislation concerning women’s health needs is created by men. Activities centered around abortion law reform provided the initial sense of cohesion from which a women’s health movement could emerge. Following the Supreme Court decision of January 1973 (6), it became readily apparent that while the law may have been reformed, the practice of, accessibility to, and control of that essential tool toward biologic freedom, and ultimately social equality, was still clearly in the hands of men, either as individual practitioners or as the heads of both the large and small health care institutions which performed abortion services. Recognizing their lack of control and remembering the medical experiences shared in their consciousness-raising groups, women heightened their concern and extended it to other areas of health care, particularly to general gynecology and obstetrics. As a result the Women’s Health Movement became a nationwide identifiable force. Indicators which were used to determine radical activists and their activities of past decades as belonging to a movement may be similarly applied to define the Women’s Health Movement. These are membership, self-conscious identification, a body of literature, social recognition, and a common goal. The Women’s Health Forum-HealthRight of New York City has conducted a nationwide survey on women’s health activities. They identified over 1200 groups providing diverse services, and tens of thousands of individual women who consider themselves t o be activists or participants in the Women’s Health Movement (7). In addition, groups are active in Canada, throughout Europe and South America, and in Australia and New Zealand. The self-conscious identification as a movement is expressed concretely in the form of conferences, both national and regional, and in several nationwide newsletters. A large body of literature has emerged in response to a sense of a movement. This literature is in the form of books, articles, or exposes on medical topics. These all contribute to developing additional foci of the Movement.
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In past years complaints by women users of the health care system were regarded as isolated incidents and easily dismissible. These are now recognized by society as testimony to women’s collective dissatisfaction: witness the public acknowledgments of this dissatisfaction by such disparate entities as women’s magazines (8), television talk shows (9), the Health Insurance Plan of Greater New York (HIP) (lo), medical journals (1 l), and the American Medical News (12) published by the AMA. Finally, although there is wide divergence in the long-term objectives of all participants in the Women’s Health Movement, one common goal serves to unite all: a demand for improved health care for all women and an end to sexism in the health system. If indeed the problems addressed are pertinent to the health care of all consumers, it is appropriate to ask: Why are women principally expressing their dissatisfaction? Why is it a women’s health movement? The answer to the fust question is very simple. Women have had the opportunity to discuss their dissatisfaction and recognize its collective nature. Women also have social vehicles through which to express this dissatisfaction, namely the Women’s Liberation and Women’s Health Movements. Undoubtedly men and children receive similarly inadequate health care, but as yet they have not organized to express their feelings or to challenge their treatment within the health system. The answer to the second question is more complex. The oppression of woman is derived from her “womanness”: her biologic differences and her ability to bear children. These differences have been used to build social structures and a supportive ideology of female submissiveness-an ideology so entrenched that woman herself came to believe it. Medical science in turn reinforced the ideology. For example, in 1905 the President of the Oregon State Medical Society stated that: “Educated women could not bear children with ease because study arrested the development of the pelvis at the same time it increased the size of the child’s brain, and therefore its head” (13). In 1971 James Robert Willson et al. assured us in Obstetrics and Cynecolou (14) that: “The traits which compose the core of the female personality are feminine narcissism, masochism and passivity.” Within the health‘ care system women are not only treated according to the doctor’s traditional concept of an authoritative doctor-patient relationship, but also according to the prevailing social norms of male-female relationships. Both frameworks permit condescension toward women. Women’s principal involvement with the medical system is through those organs uniquely female. Socialization patterns have taught women to regard their reproductive organs and their functions as unclean, a “curse,” and secret, yet nonetheless central to their identity as women (15). A woman’s gynecologic and obstetric experiences profoundly affect her entire lifestyle. When contraception or abortion is denied her, the result is likely to be motherhood-a status the woman may not desire, and at the very least for which she may be unprepared. When anesthesia is administered to her during labor both she and her child are affected, with frequently devastating results on the child (16). And when she is a victim of unnecessary surgery, her physical and mental well-being may dramatically alter (17, 18). Her essential femaleness-her uniquely female organs-are out of her control. Therefore there are particular issues of concern to women which are distinct from those which concern health consumers as a group. It is for this same reason-the need for women to control their own essential femaleness-that women’s health activities have arisen, and will undoubtedly continue to arise simultaneously with wider movements for female equality and liberation. The health care system has been an agent of social control as equally restrictive as any political or economic system. Women seek to dissolve the power it exercises over them (19).
220 / Marieskind CURRENT STATUS OF THE WOMEN’S HEALTH MOVEMENT Women of all classes (indeed, contrary to popular belief, working-class women predominate), of all ages, and little by little of varied ethnicities, identify as being part of the Women’s Health Movement. This grass roots composition is one of its greatest strengths and energy sources. For many women who would have defined themselves as neither feminists nor political, the undeniable commonality of putting one’s feet in stirrups has served as a rallying point. Work of the Women’s Health Movement can be categorized into three main areas: changing consciousness, providing health-related services, and struggling to change established health institutions(7). Whatever the specific focus of women within these categories, their work also serves to bring thousands of previously isolated women to control their own lives, to develop their skills, and to gain strength through shared experience, work, and political activity. In addition to direct consciousness-raising groups, the Women’s Health Movement offers know-your-body or self-help courses. A self-help course is comprised of several meetings held by a group of women who learn how to do cervical and breast self-examination, to identify simple vaginal conditions, and to share information concerning health needs (20). The idea was originated in 1971 by Carol Downer at the Feminist Women’s Health Center in Los Angeles. These courses differ from traditional health education in that they focus on a strong element of consciousness-raising, and because the health system’s perspectives on women and therefore the content of women’s medical care are seen as a problem as great as any infectious or degenerative disease. Colleges and universities have responded to the Movement by instituting women’s health courses which range from a personal health informational approach at the University of Oregon (21) to a medical care organizational approach at the State University of New YorklCollege at Old Westbury (22). The substantive content of the health-related services provided by the more than 1200 groups vanes widely. They may range from strictly educational and referral services such as the Women’s Health Forum-HealthRight of New York City to clinics providing direct obstetric, gynecologic, and abortion care as does the Feminist Women’s Health Center in Los Angeles. Sometimes the need for safe abortions has generated a clinic. This was the case with “Jane”-a group of about 50 women in Chicago who provided 11,000 abortions in the four years they worked together before legal abortion came to Illinois. Similarly, the Feminist Women’s Health Center of Salt Lake City originated because of the limited availability of abortion in that area. Other groups such as the Somerville Women’s Health Project in Massachusetts and the Fremont Women’s Clinic in Seattle have begun providing primary care in the underserved poor areas of their respective cities. Work to change established health care institutions takes various forms, ranging from picketing and leafletting to negotiating structural changes. For example, the San Francisco Women’s Health Center has negotiated space in San Francisco County General Hospital for a self-health clinic. The clinic will serve as a liaison between women patients, doctors, and hospital administrators. They use the name self-health to denote their own individual philosophy of total physiologic and psychologic well-being and to distinguish themselves from self-help groups (23). The strategies behind these services are as diverse as the groups themselves. Many activists in the Women’s Health Movement have chosen to clearly stand outside the organized health care system. They have established alternate clinics in which women
Women’s Health Movement / 22 1 participate actively in their health care delivery: for example, they learn breast and cervical self-examination, help to interpret their lab results, or conduct their own pregnancy tests. Several of these groups are considering establishing a women’s hospital and integrating the nurturing skills ascribed to women in a curing-caring continuum. Other activists engage in direct confrontation with health institutions. They demand female input into medical research-best exemplified by the disruption of Senator Nelson’s hearings on oral contraceptives (24), or by lobbying for legislative change as in the case of “Women vs. Connecticut,” where a class action suit was brought against the state in 1970 for reform of Connecticut’s abortion law. Still other activists who practice the supportive philosophy of feminism have become patient advocates. Workers in the Women’s Health and Abortion Project of New York accompanied women to institutions and worked to effect changes in structure, process, and the consequent outcome of women’s health care delivery. Through observing the delivery, many women’s health groups have developed evaluation skills and have compiled quality data on a wide range of health services, including a wide range of providers. Various foci are common to all women’s health groups, however, irrespective of their strategies or qualitative activism. All groups have questioned the hierarchical structure of our present health delivery system and stress the use of paramedics, lay health workers, the sharing of skills and information, and the active involvement of the patient in her health care process. The Movement as a whole rejects the power considerations which place the physician at the apex of the health care pyramid and recognizes all health workers as integral to the structure, process, and outcome of health care delivery. While the sex distribution among providers is obviously of concern, activists know that increased numbers of women physicians will not solve the problems of women’s health care, nor will the greater entry of men into the nursing profession. Rather, the Movement sees the solution coming from changes in the socialization and training of all health workers, in challenging the existing divisions of health tasks at all levels, and by eliminating the profit motive which appears to greatly influence the amount of specifically female surgery. m e collective experiences through which the vast majority of women entered the Women’s Health Movement are still at its core. Mutual support is therefore a top priority for all women engaged in health care activities. As a result of collectivism all women’s groups are attempting to create nonhierarchical structures within their own ranks and are working with varied degrees of success to find such alternatives to a traditional management model. All groups maintain the feminist perspective of self-realization as a universal goal for women and their varied activities are combined with consciousness-raising and educational components. It is important to note that all of these foci are derived from the collective origin of the Women’s Health Movement and potentially all lead to Feminist-Socialist thinking. Behind the work and activities of the Women’s Health Movement substantial contributions are being made to radical critiques of both the health system and its parent, societal structure. Briefly and specifically, the Movement extends the sociologists’ analyses of an affective neutrality in the doctor-patient relationship (25), it penetrates the substance of medical care, and it analyzes such examples of medical technology as the pill (26), DES (27), pelvic and breast surgery (28), and prenatal and childbirth care (29) for their potential benefits as opposed to their costs in terms of harmful effects on women’s health. Most significantly the Women’s Health Movement strives for patient
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autonomy through the direct participation of a woman in her health care process. It is pertinent to reiterate that while such principles and problems are discussed in a female context, they have very obvious implications to the health care of all consumers. FUTURE DIRECTIONS OF THE WOMEN’S HEALTH MOVEMENT The Women’s Health Movement is constantly evolving. The scope of function is increasing to include not only primary care but also nutritional, psychologic, pediatric, and gerontologic services. Specialty services such as menopause or mastectomy self-help groups are being established and outreach programs into grade and high schools have begun. A new concept in “participatory” clinics is being pioneered through the Feminist Women’s Health Centers. In these centers the patients experience care collectively, mutually sharing their histories, life, and health care experiences. They also learn to examine one another, with the physician’s function being merely consultative and to facilitate the participation. Thus a new concept is introduced. Providers and patients are all co-producers in health care and the significant healing relationships are shared equally among the co-producers (30). Such a concept again serves to question the control of the health system and leads to challenging not merely the hierarchy within the profession, but also the very content of medicine itself. Through these alternatives the Women’s Health Movement is attempting to redefine what falls logically within the field of medical expertise and what may be classified as “people’s medicine.” By confronting the social and scientific definitions of themselves as women and by building their own body of knowledge drawn from their own experiences, women in the Women’s Health Movement struggle agzinst the crippling mythology which has kept all women passive, subservient, and exploited. Thus the Women’s Health Movement contains the blueprint not simply of alternate clinics, nor of a new social class to replace an old elite and likely to become another bourgeoisie, but rather it is a pattern for social change in the fullest sense: a change in the consciousness of men and women freed from the binding roles of domination and submission. It is this potential for changing social consciousness which is the greatest contribution of the Women’s Health Movement and without which there can be no new order, no equality for all people, and no trust between women and men. REFERENCES1. Brodkey, A., Fruchter, R., Levine, M., Reverby, S., and Shape, J. Women and the health system. HealthfPAC Bulletin 40: 1-20,April 1972. 2. Shryock, R. H. Medicine and Society in America, 1660-1860. New York University Press, New York, 1960. 3. Friedan, B. J. The Feminine Mystique. W. W. Norton & Company, Inc., New York, 1963. 4. Navarro, V. Social Policy Issues: An Explanation of the Composition, Nature and Functions of the Resent Health Sector of the United States. Paper presented at the Annual Conference of the New York Academy of Medicine, April 25-26,1974. 5. Broverman, I. K., Broverman, D. M., Clarkson, F., Rosenkrantz, P., and Vogel,.S. R. Sex-role stereotypes and clinical judgements of mental health.J. Consult. Clin Psychol. 34: 1-7,1970. 6 . Supreme Court of the United States: Doe Bolton; Roe Wade. Decided January 22,1973. 7. Women’s Health Forum. Women’ Health Movement: Where are we now? HealthRight 1, 1,1974. 8 . Klemesrud, J. Why women are losing faith in their doctors. McCall’s, June 9,1973. 9. Walters, B. Not for Women Only W.N.B.C. 10. Health Insurance Plan of Greater New York. Women’sHealth Forum, November 23,1974.
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11. Kaiser, B. L.,and Kaiser, I. H. The challenge of the women’s movement to American gynecology. Am. J. Obstet. Gynecol. 120(5): 652-665,1974. 12. American M e d i d Association. And now the “liberated” woman patient. American Medical News, Oct. 7,1974. 13. Bullough, V., and Voght, M. Women, menstruation and nineteenth century medicine. Bull. Hist. Med. XLVII: 1,1973. 14. Willson, J. R., Beecham, C. T., and Carrington, E. R. Obstetrics and Gynecology. C.V. Mosby Co., St. Louis, 1971. 15. Levitt, E. E., and Lubin, B. Some personality factors associated with menstrual complaints and menstrual attitude. J. Psychosom Res. 11: 267-270,1967. 16., Haire, D. The culture warping of childbirth. J. Trop.Pediatr. (special issue) June 1973. 17. Hiibard, L. T. Despite higher risks, some doctors stdl prefer hysterectomy to tubal ligation. Fam’ly Planning Digest 2:1,1973. 18. Lembke, P. A. Medical auditing by scientific methods illustrated by major female pelvic surgery. JAMA 162(7): 162-167.1956 19. Ehrenreich; B., and Ehrenreich, J. Health Care and social control. Social Policy 5(1): 2 6 4 0 , 1974. 20. West Coast Sisters. How to Start Your Self-Help Clinic. Women’s Center, Los Angeles, 1971. 21. Davis, L. G., and William, N. The Development of a Women’s Health Class from a Feminist Perspective. Paper presented at American Public Health Association Conference, New Orleans, October 1974. 22. Marieskind, H. I. Women and the Health System. State University of New York, College at Old Westbury, 1975. 23. San Francisco Women’s Health Center. The Self-Health Movement. Unpublished paper, 1974. 24. United States Cangress. Senate Subcommittee on Monopoly. The Competitive Problems of the Drug Industry. Hearings, 90th Congress, 1 s t Session. U.S. Government printing Office, Washington, D.C., 1967. Present Status of Competition in the Pharmaceutical Industry, 2nd Session, Oral Contraceptives, Vol. 1, Part XV, Jan. 14, 15,21,22,23,1970. 25. Parson, T. The SocialSystem The Free Press, New York, 1951. 26. Seaman, B. The Doctors’ Gzse Against the Pill. Wyden, New York, 1969. 27. Mills, D. H. Prenatal diethylstilbestrol and vaginal cancer in offspring. JAMA 229: 4, 1974 28. Bunker, J. P. Surgicd manpower: A comparison of operations and surgeons in the United States and in England and Wales. New EngL J. Med. 282(3): 135-144,1970. 29. Boston Women’s Health Book Collective. Our Bodies, Ourselves. Simon and Schuster, New York, 1971. 30. Gartner, A., and Riessman, F. The Service Society and the Consumer bzguard. Harper & Row, New York, 1974.
Manuscript submitted for publication, January 16, 1975 Direct reprint requests to: Ms. Helen Marieskind Department of Health Sciences SUNY/Old Westbury P.O.Box 210 Old Westbury, New York 11568
The Women’s Health Movement is basically a grass roots organization which has been in existence for the past five years. It has essentially been ignored by radical health analysts as being solely concerned with gynecologic problems and therefore fundamentally irrelevant (1). But it is important to note that while the history and strategy and subsequently the philosophy of the Women’s Health Movement is woman-oriented, the principles and problems addressed are pertinent to the health care of all consumers. Although the current Women’s Health Movement is a relatively recent phenomenon, it has its marked similarities to consumer health activities which arose in the United States during the 1830s and ’40s. Suffragism of the mid-19th century was accompanied by the Popular Health Movement (2). That movement demanded nothing less than a total redefinition of health care and health itself. Similarly, the Women’s Health Movement has evolved from the Women’s Liberation Movement of the late 1960s and ’70s and is directed toward a restructuring of the total health care system and a redefinition of health care. Both movements originated during periods of liberal and radical social thought. Both sought and seek to provide alternatives in areas where the medical profession is found wanting in interest and unresponsive in action. Both emphasize preventive health concepts, self-awareness, and comprehension through a basic knowledge of bodily processes, and both seek to demystify medicine. The goal of women’s social independence and autonomy is at the core of both movements. But an important difference exists between the two movements. The Popular Health Movement was only concerned with health issues-albeit of a far-reaching nature. The Women’s Health Movement, however, in addition to its obvious interest in health issues, is also strongly political in interest, and a new political focus is emerging from its collective health activities. This focus is maturing into an ideology known as Feminist-Socialism. It is this political thrust which assures the long-term viability of the Women’s Health Movement and which establishes the Movement as a potential revolutionary force. HISTORY OF THE WOMEN’S HEALTH MOVEMENT Women’s disenchantment with their relationships both personal and institutional heightened during the 1960s. Attested to in 1963 by Betty Friedan’s The Feminine InternationalJournal of Health Services, Volume 5, Number 2, 1975
0 1975. Baywood Publishing Co.
217
doi: 10.2190/5XUN-VX3H-KMWM-F17M http://baywood.com
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/ Marieskind
Mystique (3), this disenchantment later coalesced into the Women’s Liberation Movement and rapidly took up the wide-ranging cause of equal rights for women. Even more importantly, the Women’s Liberation Movement advocated that women form consciousness-raising groups. A consciousness-raising group is comprised of several women, preferably from varied socioeconomic backgrounds, who meet on a regular basis to share their life experiences, their dreams, self-images, and their personal and social problems. Criticism and self-criticism are part of the group dynamic and from this process strong supportive relationships develop among the group’s members. These relationships, generally referred to as a “sisterhood experience,” are at the core of the Women’s Liberation Movement. Understanding the collective nature of these group experiences is critical to understanding the development of the Women’s Health Movement and its evolution into Feminist-Socialism. Through their groups women are supported in their challenge of the traditional social roles assigned to males and females, and in their challenge of the social, political, and economic institutions (including medical) which maintain those roles. Irrespective of their socioeconomic class or their relationship to the corporate structure, women in the Women’s Health Movement have concluded that their reproductive potential is a central cause of their oppression. Women recognize that the means to control their reproductive potential is determined not only by the government, but by the preponderance of males in the top ranks of the health care industry (4). Medical knowledge and therefore “scientific” definitions of women are known to be made by men (5) and legislation concerning women’s health needs is created by men. Activities centered around abortion law reform provided the initial sense of cohesion from which a women’s health movement could emerge. Following the Supreme Court decision of January 1973 (6), it became readily apparent that while the law may have been reformed, the practice of, accessibility to, and control of that essential tool toward biologic freedom, and ultimately social equality, was still clearly in the hands of men, either as individual practitioners or as the heads of both the large and small health care institutions which performed abortion services. Recognizing their lack of control and remembering the medical experiences shared in their consciousness-raising groups, women heightened their concern and extended it to other areas of health care, particularly to general gynecology and obstetrics. As a result the Women’s Health Movement became a nationwide identifiable force. Indicators which were used to determine radical activists and their activities of past decades as belonging to a movement may be similarly applied to define the Women’s Health Movement. These are membership, self-conscious identification, a body of literature, social recognition, and a common goal. The Women’s Health Forum-HealthRight of New York City has conducted a nationwide survey on women’s health activities. They identified over 1200 groups providing diverse services, and tens of thousands of individual women who consider themselves t o be activists or participants in the Women’s Health Movement (7). In addition, groups are active in Canada, throughout Europe and South America, and in Australia and New Zealand. The self-conscious identification as a movement is expressed concretely in the form of conferences, both national and regional, and in several nationwide newsletters. A large body of literature has emerged in response to a sense of a movement. This literature is in the form of books, articles, or exposes on medical topics. These all contribute to developing additional foci of the Movement.
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In past years complaints by women users of the health care system were regarded as isolated incidents and easily dismissible. These are now recognized by society as testimony to women’s collective dissatisfaction: witness the public acknowledgments of this dissatisfaction by such disparate entities as women’s magazines (8), television talk shows (9), the Health Insurance Plan of Greater New York (HIP) (lo), medical journals (1 l), and the American Medical News (12) published by the AMA. Finally, although there is wide divergence in the long-term objectives of all participants in the Women’s Health Movement, one common goal serves to unite all: a demand for improved health care for all women and an end to sexism in the health system. If indeed the problems addressed are pertinent to the health care of all consumers, it is appropriate to ask: Why are women principally expressing their dissatisfaction? Why is it a women’s health movement? The answer to the fust question is very simple. Women have had the opportunity to discuss their dissatisfaction and recognize its collective nature. Women also have social vehicles through which to express this dissatisfaction, namely the Women’s Liberation and Women’s Health Movements. Undoubtedly men and children receive similarly inadequate health care, but as yet they have not organized to express their feelings or to challenge their treatment within the health system. The answer to the second question is more complex. The oppression of woman is derived from her “womanness”: her biologic differences and her ability to bear children. These differences have been used to build social structures and a supportive ideology of female submissiveness-an ideology so entrenched that woman herself came to believe it. Medical science in turn reinforced the ideology. For example, in 1905 the President of the Oregon State Medical Society stated that: “Educated women could not bear children with ease because study arrested the development of the pelvis at the same time it increased the size of the child’s brain, and therefore its head” (13). In 1971 James Robert Willson et al. assured us in Obstetrics and Cynecolou (14) that: “The traits which compose the core of the female personality are feminine narcissism, masochism and passivity.” Within the health‘ care system women are not only treated according to the doctor’s traditional concept of an authoritative doctor-patient relationship, but also according to the prevailing social norms of male-female relationships. Both frameworks permit condescension toward women. Women’s principal involvement with the medical system is through those organs uniquely female. Socialization patterns have taught women to regard their reproductive organs and their functions as unclean, a “curse,” and secret, yet nonetheless central to their identity as women (15). A woman’s gynecologic and obstetric experiences profoundly affect her entire lifestyle. When contraception or abortion is denied her, the result is likely to be motherhood-a status the woman may not desire, and at the very least for which she may be unprepared. When anesthesia is administered to her during labor both she and her child are affected, with frequently devastating results on the child (16). And when she is a victim of unnecessary surgery, her physical and mental well-being may dramatically alter (17, 18). Her essential femaleness-her uniquely female organs-are out of her control. Therefore there are particular issues of concern to women which are distinct from those which concern health consumers as a group. It is for this same reason-the need for women to control their own essential femaleness-that women’s health activities have arisen, and will undoubtedly continue to arise simultaneously with wider movements for female equality and liberation. The health care system has been an agent of social control as equally restrictive as any political or economic system. Women seek to dissolve the power it exercises over them (19).
220 / Marieskind CURRENT STATUS OF THE WOMEN’S HEALTH MOVEMENT Women of all classes (indeed, contrary to popular belief, working-class women predominate), of all ages, and little by little of varied ethnicities, identify as being part of the Women’s Health Movement. This grass roots composition is one of its greatest strengths and energy sources. For many women who would have defined themselves as neither feminists nor political, the undeniable commonality of putting one’s feet in stirrups has served as a rallying point. Work of the Women’s Health Movement can be categorized into three main areas: changing consciousness, providing health-related services, and struggling to change established health institutions(7). Whatever the specific focus of women within these categories, their work also serves to bring thousands of previously isolated women to control their own lives, to develop their skills, and to gain strength through shared experience, work, and political activity. In addition to direct consciousness-raising groups, the Women’s Health Movement offers know-your-body or self-help courses. A self-help course is comprised of several meetings held by a group of women who learn how to do cervical and breast self-examination, to identify simple vaginal conditions, and to share information concerning health needs (20). The idea was originated in 1971 by Carol Downer at the Feminist Women’s Health Center in Los Angeles. These courses differ from traditional health education in that they focus on a strong element of consciousness-raising, and because the health system’s perspectives on women and therefore the content of women’s medical care are seen as a problem as great as any infectious or degenerative disease. Colleges and universities have responded to the Movement by instituting women’s health courses which range from a personal health informational approach at the University of Oregon (21) to a medical care organizational approach at the State University of New YorklCollege at Old Westbury (22). The substantive content of the health-related services provided by the more than 1200 groups vanes widely. They may range from strictly educational and referral services such as the Women’s Health Forum-HealthRight of New York City to clinics providing direct obstetric, gynecologic, and abortion care as does the Feminist Women’s Health Center in Los Angeles. Sometimes the need for safe abortions has generated a clinic. This was the case with “Jane”-a group of about 50 women in Chicago who provided 11,000 abortions in the four years they worked together before legal abortion came to Illinois. Similarly, the Feminist Women’s Health Center of Salt Lake City originated because of the limited availability of abortion in that area. Other groups such as the Somerville Women’s Health Project in Massachusetts and the Fremont Women’s Clinic in Seattle have begun providing primary care in the underserved poor areas of their respective cities. Work to change established health care institutions takes various forms, ranging from picketing and leafletting to negotiating structural changes. For example, the San Francisco Women’s Health Center has negotiated space in San Francisco County General Hospital for a self-health clinic. The clinic will serve as a liaison between women patients, doctors, and hospital administrators. They use the name self-health to denote their own individual philosophy of total physiologic and psychologic well-being and to distinguish themselves from self-help groups (23). The strategies behind these services are as diverse as the groups themselves. Many activists in the Women’s Health Movement have chosen to clearly stand outside the organized health care system. They have established alternate clinics in which women
Women’s Health Movement / 22 1 participate actively in their health care delivery: for example, they learn breast and cervical self-examination, help to interpret their lab results, or conduct their own pregnancy tests. Several of these groups are considering establishing a women’s hospital and integrating the nurturing skills ascribed to women in a curing-caring continuum. Other activists engage in direct confrontation with health institutions. They demand female input into medical research-best exemplified by the disruption of Senator Nelson’s hearings on oral contraceptives (24), or by lobbying for legislative change as in the case of “Women vs. Connecticut,” where a class action suit was brought against the state in 1970 for reform of Connecticut’s abortion law. Still other activists who practice the supportive philosophy of feminism have become patient advocates. Workers in the Women’s Health and Abortion Project of New York accompanied women to institutions and worked to effect changes in structure, process, and the consequent outcome of women’s health care delivery. Through observing the delivery, many women’s health groups have developed evaluation skills and have compiled quality data on a wide range of health services, including a wide range of providers. Various foci are common to all women’s health groups, however, irrespective of their strategies or qualitative activism. All groups have questioned the hierarchical structure of our present health delivery system and stress the use of paramedics, lay health workers, the sharing of skills and information, and the active involvement of the patient in her health care process. The Movement as a whole rejects the power considerations which place the physician at the apex of the health care pyramid and recognizes all health workers as integral to the structure, process, and outcome of health care delivery. While the sex distribution among providers is obviously of concern, activists know that increased numbers of women physicians will not solve the problems of women’s health care, nor will the greater entry of men into the nursing profession. Rather, the Movement sees the solution coming from changes in the socialization and training of all health workers, in challenging the existing divisions of health tasks at all levels, and by eliminating the profit motive which appears to greatly influence the amount of specifically female surgery. m e collective experiences through which the vast majority of women entered the Women’s Health Movement are still at its core. Mutual support is therefore a top priority for all women engaged in health care activities. As a result of collectivism all women’s groups are attempting to create nonhierarchical structures within their own ranks and are working with varied degrees of success to find such alternatives to a traditional management model. All groups maintain the feminist perspective of self-realization as a universal goal for women and their varied activities are combined with consciousness-raising and educational components. It is important to note that all of these foci are derived from the collective origin of the Women’s Health Movement and potentially all lead to Feminist-Socialist thinking. Behind the work and activities of the Women’s Health Movement substantial contributions are being made to radical critiques of both the health system and its parent, societal structure. Briefly and specifically, the Movement extends the sociologists’ analyses of an affective neutrality in the doctor-patient relationship (25), it penetrates the substance of medical care, and it analyzes such examples of medical technology as the pill (26), DES (27), pelvic and breast surgery (28), and prenatal and childbirth care (29) for their potential benefits as opposed to their costs in terms of harmful effects on women’s health. Most significantly the Women’s Health Movement strives for patient
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autonomy through the direct participation of a woman in her health care process. It is pertinent to reiterate that while such principles and problems are discussed in a female context, they have very obvious implications to the health care of all consumers. FUTURE DIRECTIONS OF THE WOMEN’S HEALTH MOVEMENT The Women’s Health Movement is constantly evolving. The scope of function is increasing to include not only primary care but also nutritional, psychologic, pediatric, and gerontologic services. Specialty services such as menopause or mastectomy self-help groups are being established and outreach programs into grade and high schools have begun. A new concept in “participatory” clinics is being pioneered through the Feminist Women’s Health Centers. In these centers the patients experience care collectively, mutually sharing their histories, life, and health care experiences. They also learn to examine one another, with the physician’s function being merely consultative and to facilitate the participation. Thus a new concept is introduced. Providers and patients are all co-producers in health care and the significant healing relationships are shared equally among the co-producers (30). Such a concept again serves to question the control of the health system and leads to challenging not merely the hierarchy within the profession, but also the very content of medicine itself. Through these alternatives the Women’s Health Movement is attempting to redefine what falls logically within the field of medical expertise and what may be classified as “people’s medicine.” By confronting the social and scientific definitions of themselves as women and by building their own body of knowledge drawn from their own experiences, women in the Women’s Health Movement struggle agzinst the crippling mythology which has kept all women passive, subservient, and exploited. Thus the Women’s Health Movement contains the blueprint not simply of alternate clinics, nor of a new social class to replace an old elite and likely to become another bourgeoisie, but rather it is a pattern for social change in the fullest sense: a change in the consciousness of men and women freed from the binding roles of domination and submission. It is this potential for changing social consciousness which is the greatest contribution of the Women’s Health Movement and without which there can be no new order, no equality for all people, and no trust between women and men. REFERENCES1. Brodkey, A., Fruchter, R., Levine, M., Reverby, S., and Shape, J. Women and the health system. HealthfPAC Bulletin 40: 1-20,April 1972. 2. Shryock, R. H. Medicine and Society in America, 1660-1860. New York University Press, New York, 1960. 3. Friedan, B. J. The Feminine Mystique. W. W. Norton & Company, Inc., New York, 1963. 4. Navarro, V. Social Policy Issues: An Explanation of the Composition, Nature and Functions of the Resent Health Sector of the United States. Paper presented at the Annual Conference of the New York Academy of Medicine, April 25-26,1974. 5. Broverman, I. K., Broverman, D. M., Clarkson, F., Rosenkrantz, P., and Vogel,.S. R. Sex-role stereotypes and clinical judgements of mental health.J. Consult. Clin Psychol. 34: 1-7,1970. 6 . Supreme Court of the United States: Doe Bolton; Roe Wade. Decided January 22,1973. 7. Women’s Health Forum. Women’ Health Movement: Where are we now? HealthRight 1, 1,1974. 8 . Klemesrud, J. Why women are losing faith in their doctors. McCall’s, June 9,1973. 9. Walters, B. Not for Women Only W.N.B.C. 10. Health Insurance Plan of Greater New York. Women’sHealth Forum, November 23,1974.
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11. Kaiser, B. L.,and Kaiser, I. H. The challenge of the women’s movement to American gynecology. Am. J. Obstet. Gynecol. 120(5): 652-665,1974. 12. American M e d i d Association. And now the “liberated” woman patient. American Medical News, Oct. 7,1974. 13. Bullough, V., and Voght, M. Women, menstruation and nineteenth century medicine. Bull. Hist. Med. XLVII: 1,1973. 14. Willson, J. R., Beecham, C. T., and Carrington, E. R. Obstetrics and Gynecology. C.V. Mosby Co., St. Louis, 1971. 15. Levitt, E. E., and Lubin, B. Some personality factors associated with menstrual complaints and menstrual attitude. J. Psychosom Res. 11: 267-270,1967. 16., Haire, D. The culture warping of childbirth. J. Trop.Pediatr. (special issue) June 1973. 17. Hiibard, L. T. Despite higher risks, some doctors stdl prefer hysterectomy to tubal ligation. Fam’ly Planning Digest 2:1,1973. 18. Lembke, P. A. Medical auditing by scientific methods illustrated by major female pelvic surgery. JAMA 162(7): 162-167.1956 19. Ehrenreich; B., and Ehrenreich, J. Health Care and social control. Social Policy 5(1): 2 6 4 0 , 1974. 20. West Coast Sisters. How to Start Your Self-Help Clinic. Women’s Center, Los Angeles, 1971. 21. Davis, L. G., and William, N. The Development of a Women’s Health Class from a Feminist Perspective. Paper presented at American Public Health Association Conference, New Orleans, October 1974. 22. Marieskind, H. I. Women and the Health System. State University of New York, College at Old Westbury, 1975. 23. San Francisco Women’s Health Center. The Self-Health Movement. Unpublished paper, 1974. 24. United States Cangress. Senate Subcommittee on Monopoly. The Competitive Problems of the Drug Industry. Hearings, 90th Congress, 1 s t Session. U.S. Government printing Office, Washington, D.C., 1967. Present Status of Competition in the Pharmaceutical Industry, 2nd Session, Oral Contraceptives, Vol. 1, Part XV, Jan. 14, 15,21,22,23,1970. 25. Parson, T. The SocialSystem The Free Press, New York, 1951. 26. Seaman, B. The Doctors’ Gzse Against the Pill. Wyden, New York, 1969. 27. Mills, D. H. Prenatal diethylstilbestrol and vaginal cancer in offspring. JAMA 229: 4, 1974 28. Bunker, J. P. Surgicd manpower: A comparison of operations and surgeons in the United States and in England and Wales. New EngL J. Med. 282(3): 135-144,1970. 29. Boston Women’s Health Book Collective. Our Bodies, Ourselves. Simon and Schuster, New York, 1971. 30. Gartner, A., and Riessman, F. The Service Society and the Consumer bzguard. Harper & Row, New York, 1974.
Manuscript submitted for publication, January 16, 1975 Direct reprint requests to: Ms. Helen Marieskind Department of Health Sciences SUNY/Old Westbury P.O.Box 210 Old Westbury, New York 11568
