PREVENTIVE MEDICINE7, 366- 371(1978)

Women’s

Occupational

Health and the Women’s Movement

Health

NAOMI FATT ‘Women’s Occupational Health Resource Center, Division of Occupational Health and Toxicology, American Health Foundation, 320 E. 43rd Street, New York, New York 30037 This article reviews the major role of women in the American health field over the last 150 years, linking the work of individual women to the larger social and health movements of which they were a part. In particular it examines women’s role in preventive medicine and occupational health efforts. The article goes on to explore the present-day Women’s Health Movement and its recent activities around women’s occupational health issues. In the light of past accomplishments, such activities may well be of great significance in the future.

HISTORICAL

CONTEXT

Women have always played major roles in the development of health and preventive medical policies and practices in America. Over the past 150years, the list of individual women whose names stand out as luminaries in these fields is long and includes Dorothea Dix, Lillian Wald, and Alice Hamilton. It would, however, be a mistake to perceive these women as individual pioneers, single stars on the health horizon, for the work of women in this area should be viewed within a larger social and historical context. If this is done, it becomes clear that most of these women were motivated and influenced by larger social movements of which they and many other women were a part (Table 1). Many social movements concerned with health issues have not been health movements per se. The abolitionist movement is an early example. As far back as 1839, Frances Anne (Fanny) Kemble, who later became an abolitionist and a feminist, wrote a “Journal of a Residence On a Georgian Plantation,” chronicling the deplorable health conditions faced by women slaves who worked as field hands in the American South (8). Likewise, the feminist movement of the early 18OOs,which in part grew out of the abolitionist movement, included many women who were active in the promotion of good health practices and disease prevention. The Popular Health Movement, which occurred at approximately the same time, included many of these feminists who saw no reason why women should not become trained health practitioners (13). During the heyday of the Popular Health Movement and continuing to the end of the century, there was a proliferation of numerous branches of medical thought. It should be remembered that modern medicine as we know it is substantially the outgrowth of one of these many medical philosophies, to wit, allopathic medicine which was responsible for curative procedures that depended upon surgical intervention, leeching, and large doses of medication (12). It generally excluded women from its schools, societies, and practice. The health sects included under the umbrella of the Popular Health Movement, such as the Thomsonians and the 366 0091-7435/78/0073-0366$02.00/O Copynghr All rights

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HEALTH

TABLE 1 EXAMPLES

OF WOMEN

HEALTH

ACTIVISTS

WITHIN

Social and health movements

WHICH

AND THE HISTORICAL

AND SOCIAL

CONTEXT

THEY WORKED”

Individuals and groups

Popular Health Movement (182Os- 1840s) Abolitionist Movement (183Os- 1860s) Early Feminist Movement (183Os-1920s)

Fanny Kemble The Grimke Sisters Ladies’ Physiological Societies

Public Health Movement (185Os- 1900s)

Elizabeth Blackwell Dorothea Dix Lillian Wald Florence Kelley Josephine Baker Alice Hamilton Women’s Trade Union League Women’s League for Equal Opportunity

Women’s Liberation Movement (1960s to present) “Jane” Women’s Health Movement (1960s to present) The Feminist Women’s Health Centers The Boston Women’s Health Book Collective HealthRight Women’s Health Network Coalition for the Medical Rights of Women Women’s Occupational Health Resource Center (I As movements have no clear-cut beginnings and ends, all dates are approximate.

Grahamians, as well as homeopathy, naturopathy, and others which flourished at the same time, were oriented more toward health maintenance and disease prevention (12). Their practitioners were more likely to rely on localized treatment with small, doses of herbal remedies and development of proper nutritional habits. Later, women also played leading parts in the Public Health Movement, which attempted to ensure not only adequate care for the sick, but prevention of the spread of illness as well. Starting with the Civil War and continuing through the early 19OOs,they helped develop public health institutions and regulations. Lillian Wald, who founded the Henry Street Settlement House in 1893, was also the mother of visiting nurse services in America (10). In the 1850sElizabeth Blackwell set up infirmaries (1). Josephine Baker, head of the newly created Division of Child Hygiene in the New York City Health Department in the first decade of the 20th century, perfected prevention-oriented models of maternal and child health care (10). A demonstration program she ran for immigrant mothers living on the Lower East Side of Manhattan resulted in the establishment of well-baby health stations where women could obtain pasteurized milk at low cost and learn how to care for their babies at the same time. A wide array of factors influenced women’s involvement, and sometimes their predominance, in prevention-oriented health care efforts. Of great importance was the fact that these activists shared with all women the role of family health caretaker and were influenced by the even older tradition in society of women as primary healers. Within the family, women have long provided disease prevention, health maintenance, and primary care services. Thus, concern with health and

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medical issues was part of the job of housewife and mother. Both in these positions and as community health workers, midwives, herbalists, and other practitioners, women gained little economic benefit from medicine. Rather, they received increased savings from prevention efforts, in time, energy, and money. THE WOMEN’S

HEALTH MOVEMENT

Since the late 1960s a new movement has evolved which continues this long tradition of women’s involvement in prevention-oriented health efforts. It is the Women’s Health Movement. Like a number of previous health activists, its supporters are almost without exception feminists, active supporters of the larger Women’s Liberation Movement in America. And, like their nineteenth century abolitionist predecessors, many of them were influenced by the Civil Rights Movement of the 196Os,as well as by the anti-war and community-control efforts of the same period. The Women’s Health Movement was sparked by prevention issues of a very particular type, those involved in reproductive control (15). In 1970, the movement made national news when a group of women forced Senator Gaylord Nelson to open to consumer testimony Senate committee hearings on the possible danger of the birth control pill. In the following year, numerous organizations formed coalitions which called mass demonstrations in favor of unabridged access to medical care for abortion to prevent the continuation of unwanted pregnancies. The Women’s Health Movement, however, has not been solely concerned with issues of reproduction. In 1968, women in New York conducted the first “Know Your Body” courses where lay women provided health education training to their peers. Much of this training was concerned with preventive health issues. A similar course taught in Boston at the same time resulted in the book, “Our Bodies, Ourselves” (2), which has been a best-seller since publication. These courses were probably analogous to the programs of the “Ladies Physiological Societies” during the Popular Health Movement of the 1830s and ’40s (3). In 1970 the Feminist Women’s Health Centers were founded in Los Angeles. These Centers originated the concept of self-help, now a household term among health experts, which is oriented toward holistic, well-woman care (4). During the 10 years since its inception, the over 1,000 primarily grassroots Women’s Health Movement organizations and thousands of individual women nationwide have pioneered a number of other concepts and practices which are cornerstones of modern-day prevention-oriented health care. These include the development of new paramedical professions and model services which encourage active consumer participation (15). While the Women’s Health Movement has encompassed issues of prevention, it has never been very active in the area of occupational health and safety, where prevention is a key element. In part, this is due to the fact that the Movement has focused on the treatment of women consumers by health professionals in health institutions. Many of the preventive medical activities initiated by the Movement were in reaction to medical problems resulting from that system. For example, the Movement has been actively concerned with iatrogenic problems related to surgery, medication, and malpractice such as side effects from synthetic hormones,

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unnecessary hysterectomies, and inappropriate use of drugs and devices during labor. As a result, the major distinctions made between different groups of women were in terms of class, and particularly in relation to the inability of the poor to get adequate or appropriate services. So, for example, in the early 1970s a welltrained but unlicensed group of Chicago women known as “Jane” provided abortions to over 11,000 indigent women. In recent years, a women’s health collective in Santa Cruz, California, has fought to ensure midwifery services for women who were otherwise unable to obtain this or other types of adequate care. A number of feminists have been active in CESA (the Committee to End Sterilization Abuse), which has developed model regulations to prevent coerced sterilization of primarily poor and Hispanic women. WOMEN’S

OCCUPATIONAL

HEALTH

Specific activities centered on the health needs of women as workers have been rare. This is not surprising in light of the low consciousness of the general population about occupational health problems, in addition to societal attitudes about the relative importance of women’s role in the paid workforce. Many assume that occupational health problems, especially those affecting female-dominated occupations, were solved by labor reformers and legislators sometime after the turn of the century. The widespread assumption is that most women do not work in hazardous jobs. In reality, unsafe working conditions are still only too plentiful, both in occupations primarily tilled by women, as well as those filled by men. Women laundry workers face hazards of heat stress, of burns caused by sterilizing and presser equipment, and of accidents on wet floors. Nurses run greater risks of infections such as viral hepatitis and, along with other health workers, risk exposure from radiation and anesthetic gases. Waitresses risk back injury and develop varicosities, and office workers are exposed to ozone from reproducing machinery and dangerous chemicals such as toluene. These are only a few examples. There has been no concerted effort on the part of worker organizations to refute these suppositions. In part this is due to the fact that, despite great increases in the number of women in the paid workforce, there has been no concurrent growth in the number of organized women. Even today, unions account for less than 13% of paid women workers (7). Another problem is that few worker organizations, union or other, have been very active in the area of occupational health, and fewer still about health and safety issues concerning women workers. They tended to concentrate primarily on bread and butter issues-wages, fringe benetits, etc. This situation may be changing. In 1970, the Occupational Safety and Health Act was passed by Congress. It represented an expression of national concern for occupational health issues concerning women and men. In response to the work of a growing number of persistent occupational health activists and reports of hazards in many workplaces, the general public is becoming more aware of these issues. A number of large and powerful unions have become actively involved in this area; the Oil, Chemical and Atomic Workers Union and the United Auto Workers are two examples. Organizations to aid the professionals and the public with information on scientific and policy issues in this area have also been formed.

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OLD PRECEDENTS

FATT

AND NEW EFFORTS

Within the Women’s Movement and the Women’s Health Movement, there are signs that a new trend toward greater concern with occupational health issues may be starting. In March, 1977, the Occupational Safety and Health Administration (OSHA) held hearings on a proposed new standard for lead exposure. If adopted, this particular standard could help pave the way for policies of exclusion of fertile women from many industries where workers are exposed to lead and other toxic substances (5). For the first time in recent history, Women’s Health Movement organizations joined with unions and other organizations in presenting testimony calling for standards strict enough to ensure the safety of all workers. One of the results of this joint effort was the establishment of The Women’s Occupational Health Resource Center, a project of the American Health Foundation, an organization which will be of great significance to women workers. One of the Center’s major goals is the development of a strong network of organizations and individuals which can facilitate broad dissemination of information and coordinated action toward making women’s occupational health issues a research and policy making priority. When it becomes fully operational this fall, it will have a broad range of programs including a library with the latest scientific and nonscientific materials and a research service to aid others in search of information. In addition the Center will publish a bimonthly newsletter and educational literature and hold roundtables, workshops, and forums. There have been other small but increasingly frequent indications of increased activity by feminists in this area. Over a year ago, Healthright, a nationally distributed Women’s Health Movement quarterly, ran a lead article on women’s occupational health (9). In March, 1978, a coalition of Philadelphia organizations, including Women’s Health Movement organizations, sponsored a well-attended conference on these issues. Other similar conferences are being planned. And numerous local organizations, such as the Coalition for the Medical Rights for Women in San Francisco, are starting or planning to start occupational health projects. In the same way that women’s work on issues of disease prevention and health maintenance has historical precedents, so does their particular involvement with occupational health issues. As has already been pointed out, people like Fanny Kemble spoke out in the mid-1800s against the horrors of working conditions of slaves. Later in the nineteenth century, women reformers included Florence Kelley who, in 1893, became the first Chief Inspector of Factories for Illinois (9). Alice Hamilton, head of the Women’s Bureau in the early 19OOs,was one of the most important occupational health physicians in America. At the turn of the century, many of the leaders of occupational health reform were women. Organizations such as the Women’s Trade Union League and the Women’s League for Equal Opportunity were active, albeit often on opposite sides, in the tight for improved occupational health conditions for women (12). Many union women went on strike in this century over occupational health grievances (8). In the past, the occupational health issues under consideration by these reformers dealt with a wide range of safety and health problems faced by women. In recent years, however, much of the occupational health research and regulation

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has neglected occupations dominated by women and the workplaces where the majority of women workers are employed. This has been true even when there have been clear indications of potential health hazards, e.g., back injuries from lifting among health workers and risks from possible cancer-causing substances among textile and laundry workers. When women have been considered, it was usually solely in terms of possible danger to the fetus if they should become pregnant (4). Extensive activity on the part of the Women’s Health Movement, particularly given its strong feminist tendencies, might well serve to broaden these considerations. Historically, it is clear that no one group or sex has a monopoly on positive change in health or, for that matter, in any area of human endeavor, just as neither the allopaths nor the homeopaths had a monopoly on medical efficacy. Likewise women’s ongoing role in preventive medicine has not been a solely progressive one. By and large, however, women’s leadership in this area has been positive, and their contributions to this area have been immense. For these reasons, any growing trend for greater involvement on their part in issues regarding women’s occupational health should be well worth watching. REFERENCES 1. Antler, J. Medical women and social reform-A history of the New York Infirmary for Women and Children, Women & Health 1, 11-15 (1976). 2. Boston Women’s Health Book Collective. “Our Bodies, Ourselves.” Simon and Schuster, New York, 1976. 3. Ehrenreich, B., and English, D. “Witches, Midwives and Nurses: A History of Women as Healers.” The Feminist Press, Old Westbury, New York, 1973. 4. Frankfort, E. Vaginal politics, in “Seizing Our Bodies: The Politics of Women’s Health” (C. Dreifus, ed.), pp. 263-271. Vintage, New York, 1977. 5. Hricko, A. Social policy considerations of occupational health standards: The examination of lead and reproductive effects. Prev. Med. 7, 394-406 (1978). 6. Hunt, V. R. Occupational Health Problems of Pregnant Women SA-53-4-75. U.S. DHEW, Washington, D.C., 1975. 7. Jacobson, C. J. Women workers: Profile of a growing force. Federalist 81, 14 (1974). 8. Kemble, F. A. “Journal of a Residence On a Georgian Plantation in 1838-1839.” Longman, London, 1863. 9. Lieberman, S. A. Labor pains: Occupational health in America. Healthright 2, 1, 4, and 6 (1976). 10. Nowicki, S. Rank and file organizing, in “America’s Working Women: A Documentary History-1600 to the Present” (R. Baxandall, L. Gordon, S. Reverby, Eds.), pp. 271-283. Vintage, New York, 1976. 11. Rosen, G. “A History of Public Health,” pp. 357-361 and 380. MD Publications, New York, 1958. 12. Rothstein, W. G. “American Physicians In The Nineteenth Century,” pp. 43 and 129. The Johns Hopkins University Press, Baltimore, 1972. 13. Shryock, R. H. “Medicine in America: Historical Essays,” p. 117. The Johns Hopkins University Press, Baltimore, 1966. 14. Stellman, J. M. “Women’s Work, Women’s Health,” p. 36. Pantheon, New York, 1977. 15. “Women’s Health Movement: Where are we now?” Healthright 1, I and 4 (1974).

Women's occupational health and the women's health movement.

PREVENTIVE MEDICINE7, 366- 371(1978) Women’s Occupational Health and the Women’s Movement Health NAOMI FATT ‘Women’s Occupational Health Resource...
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