5: Politics of Women's Health
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- 153103
The Sustainable Development Goals: Is It Time to Reexamine?
Sustainable Development Goals (SDGs)
by Sarah Baum
When we think of a desert, a dry, desolate place comes to mind. The same thing is true when it comes to food deserts. The US Department of Agriculture defines a food desert as an “area . . . with limited access to affordable and nutritious food, particularly such an area composed of predominantly lower income neighborhoods and communities.” For urban areas to qualify as a region of low access, they must have at least five hundred people and/or at least 33 percent of the census population residing more than one mile from a supermarket; in rural areas the distance is ten miles.We tend to think of food deserts as a US problem, but it’s a global one, affecting people across the globe in both developed and developing countries. Living in a food desert doesn’t just mean limited access to a grocery store, but also limited selection of affordable, healthy options, leaving residents to rely on junk foods, limited variety, and options with low nutritional value.
In Cape Town, South Africa, there is an 81 percent rate of food insecurity; because of the fractured transportation system, people spend so much time commuting that they rely on ready-to-eat foods, which are expensive and unhealthy. Australia also is dealing with the food desert issue. In Western Australia, access to fruits and vegetables is often limited by season, distance, and much higher prices. In some areas, families would need to spend nearly 60 percent of their income to buy healthy food. Food deserts are a growing global problem that is not easily solved, but one to which we must find a solution.
Globalization, Neoliberalism, and Health Inequities
by Cristina Rodriguez
Women are always at high risk of disease (e.g., HIV/AIDS, tuberculosis, and hepatitis) while incarcerated in crowded prisons. The COVID-19 pandemic is an extreme example. In many facilities, there is a shortage of PPE (personal protective equipment), such as masks, and air may be recirculated, spreading the virus. Some of these facilities have unclean/unsanitary conditions in general as well as inadequate medical care.
Women may be forced into rehabilitation programs to comply with probation requirements and are therefore put in difficult situations in order to better themselves and reunite with their families. For example, Elizabeth Lozano from California wrote Governor Gavin Newsom a letter expressing her concerns about being forced to attend a drug reentry program after being diagnosed with COVID-19 the week of July 15, 2020.
Women of color are disproportionately affected by such poor conditions. They already face higher rates of incarceration than white women, they may be economically and educationally disadvantaged, and they may have mental health issues, all of which make them more vulnerable to disease. As the COVID-19 crisis intensifies, women will continue to suffer the consequences from a flawed justice system that puts them in vulnerable positions.
by Christiana Huss
Inequities in health care are by no means limited to the Majority World. COVID-19 has highlighted the inequities inherent in the US health care system. In Michigan in particular, this divide has been underscored during the pandemic: the state is made up of 13 percent Black people, yet Black people accounted for more than 40 percent of COVID-19 deaths early on. In attempting to understand this pattern, the particularly tragic story of one woman is notable. Dr. Susan Moore studied medicine at the University of Michigan and graduated in 2002. In 2020, during the height of the pandemic, Dr. Moore reported to her hospital colleagues the symptoms and pain she was experiencing, advocating repeatedly for proper care. Nevertheless, her pleas were repeatedly dismissed. Less than a week before Christmas, Dr. Moore died of COVID-19 (Wixson 2021).
Realizing how tragically easy it was for a highly educated medical professional—who happened to be a Black woman—to be so easily disregarded stresses how profoundly ingrained systemic racism is in the US health care system. The University of Michigan is working to rectify this imbalance with the Antiracism Oversight Committee and university-wide plans to address diversity, yet Moore’s story exposes this devastating reality for people of color in the United States. How will the rest of the states and our society holistically address this inequity?
by Maysa Shakibnia
War and its repercussions are another way that systems of violence affect communities. In Iraq, unfortunately, babies and children bear the brunt of reproductive violence, as birth defects are a visible embodiment of the enduring toxic legacy of war for future generations and the environment (Rubaii 2020). It is not uncommon for babies in Fallujah, Iraq, to be born with hydrocephaly, cleft palates, tumors, elongated heads, overgrown limbs, short limbs, and malformed ears, noses, and spines. Case reports of babies who are “incompatible with life” or “stillborn” are also not unusual.
Dr. Samira Alaani, a pediatrician at Fallujah General Hospital, first began noticing the wide range of uncommon birth defects among infants just after the US occupation in 2003 (Rubaii 2020). The birth defects were strange in that they were numerous, with 144 babies being born with deformities for every 1,000 live births. These alarming rates exceed those of Hiroshima and emphasize the connections of militarism, public health, global inequities, and environmental racism (Rubaii 2020). The bodies of these children are a consequence of the toxic legacy of war in Iraq, as it has been suffering under decades of war, bombings, burn pits (military-based waste disposal), sanctions, and other military interventions that cause cascades of environmental degradation as well as destroy necessary health care and public systems (Rubaii 2020).
by Shannon Garvin
In rural communities across the globe, community health workers (CHWs) are the backbone of medical care. CHWs are defined as “any health worker carrying out functions related to health care delivery; trained in some way in the context of the intervention; and having no formal professional or paraprofessional certificated or degreed tertiary education.”
The United Nations (UN) estimates nearly a million people work as CHWs across sub-Saharan Africa. In communities without hospitals, clinics, or even a local nurse, CHWs help with childbirth, family planning, diagnosing malaria, bandaging wounds, immunizations, and other vital health services. CHWs go door to door in their local villages—they are generally lay members of the same communities they are seeking to serve.
The value of their services is evident: Muyingo Prossie, a community health worker in Uganda, says, “Ever since I became a community health worker in my community, no woman or child has died during delivery.” The COVID-19 pandemic has introduced additional challenges; shortages of personal protective equipment (PPE) like gloves, and the need to change between each patient, means services may be slower. Mariam Traoré of Mali says, “I typically visit up to 32 homes a day. However, when there are many children requiring my attention, I may not be able to visit as many homes.”
CHWs also offer the majority of health services across Southeast Asia, and in Russia, CHWs are being trained to administer first aid in remote villages where there are no medical professionals or clinics have been closed for lack of funding. The UN notes this can be a sustainable path for women to gain employment as they work in their communities.
For more information, check out the following report, which includes information about CHW programs from Afghanistan to Zimbabwe.
by Shannon Garvin
Period poverty and tampon tax have become international catchphrases as activists, government officials, corporations, and brave individuals have worked to break millennia-old taboos against speaking about menstruation and the need for girls and women to have safe access to supplies. In many parts of the world, women still use rags when they menstruate and because of local religious rules are not allowed to wash and dry their rags outdoors. Rags are hidden under beds and bacteria grow quickly, leading to illness.
Period poverty describes the economic reality that most women cannot afford basic hygiene supplies when they menstruate. As part of this, the tampon tax (which refers to the fact that in many places menstrual products are subject to sales taxes rather than being exempt, as are other essential supplies) has been recalled in several countries and thirteen states in the United States. Kenya ended its tax in 2004 and South Africa in 2019.
In addition to adding menstrual supplies to tax-exempt medical lists, period poverty has seen a number of groups partnering to bring free supplies to schools and communities. While rewashable supplies are more eco-friendly, in countries without water or with religious taboos, women need disposable supplies to menstruate safely. In Africa, one in ten girls still misses school on days she is having her period. In some countries, girls are simply withdrawn from school when they start menstruating. Indian inventor of a sanitary pad-making machine Arunachalam Muruganantham is featured in Pad Man, a film available on Netflix. Because this topic is so urgent and affects half of the world’s population, we invite you to further explore locations and topics of interest. Follow the links to learn more.
Why Do Women Still Die Giving Birth?
by Christiana Huss
In Afghanistan, 638 of every 100,000 live births result in the mother’s death—one of the highest maternal mortality rates worldwide. Several variables contribute to this statistic, including inaccessibility to health services, poverty, and a low rate of skilled health professionals overseeing births. In response to these deficiencies, Afghanistan’s community midwifery program is supported by the Canadian Government and the United Nations Fund for Population Activities (UNFPA); the trained midwives that graduate from this program establish family health houses to provide health care to rural and remote areas of the country (UNFPA 2020b).
The value and skill of these midwives cannot be understated. Shirin, a graduate who manages a family health house in Usho Golaka, has provided critical, life-saving medical care to hundreds of women in her village. When one of her patients became pregnant with her seventh child, Shirin advised the patient to seek medical care at the provincial hospital because of the baby’s breech position. Nevertheless, it was Shirin whom Fatima’s family called upon in the middle of the night as Fatima began labor. Though this delivery was beyond the scope of Shirin’s training and education, she had no other option but to carry it out; Fatima’s family could not afford to travel to the hospital. Shirin called a gynecologist at the provincial hospital and helped deliver the baby with no more than oral instructions. After less than two hours, Shirin successfully helped Fatima deliver a healthy baby boy (UNFPA 2020).
Although this experience was undoubtedly stressful, Shirin walked away from it with a sense of pride. The implications of this account are both hopeful and indicative of the reality that still disproportionately affects women worldwide; adequate medical training, services, and accessibility are essential to decrease the mortality rates facing pregnant mothers in certain countries.
The Global Gag Rule
by Sophie Brodish
Within the United States, more than 19 million women of reproductive age are living in contraceptive deserts. Despite the increased development of modern contraception methods, limitations in practice are still found. As of 2016, nearly half of the pregnancies within the United States were unintended, even with North America having the highest male sterilization rate in the world.
Contraceptive deserts are locations where the quantity of health centers is inadequate to meet the needs for the population of women eligible for publicly funded contraception. In order for a county to not be considered a contraceptive desert, there must be one available health center per 1,000 women of the population. Around 1.5 million women in these contraceptive deserts live in counties that lack any form of health center, requiring them to travel multiple hours while they must take off time from work or pay for childcare services in order to be able to receive the care they need.
There are numerous other barriers that can impede a person’s access even within existing clinics across the country. Unavailability of same-gender providers, cost, environment, transportation services, same-day service, and other factors can stand in the way. Environment pertains directly to the treatment of individuals when they seek care at a health clinic. Trans men, trans women, nonbinary folks, and others that the gender binary does not include face an increased difficulty in the number of health centers available to them owing to discrimination.
The primary populations affected by contraceptive deserts are low-income communities and the BIPOC (Black, Indigenous, People of Color) communities. The Title X Family Planning Program was introduced in 1970 as a mode of providing reproductive health services and family planning for low-income communities. In 2019, however, under the Trump administration, a Title X gag rule was implemented, putting affordable care even further out of reach for many, predominantly transgender people and Black women. In October 2021 the Biden administration repealed the rule, bringing hope to the hundreds of thousands across the United States who need affordable and accessible reproductive health services.
Women Should Be Able to Live without Fear of Breast Cancer
by Shannon Garvin
Despite all we know about the long-term effects of smoking, people still pick up cigarettes every day. In that process, they also expose others to secondhand smoke and its negative health effects.
While tobacco use is not banned outright, it is considered “wrong” by some religions such as Islam and Christianity. In the United States, tobacco is no longer allowed to advertise as an appealing product. All cigarettes carry warning labels, and the law sets minimum age requirements for purchase. Around the world, however, smoking is still common in most countries. In 2008, the World Health Organization (WHO) put forth a tobacco treaty. In it, countries have agreed to specific measures much like those in the United States, where taxes discourage purchase, age limits are set, and advertising is eliminated.
Tobacco companies that have lost market share in the United States have switched to aggressive marketing internationally. Asia in particular has long been a market for promoting smoking. The European Union is following the US lead in decreasing smoking, but areas such as Africa and Oceania offer opportunities to grow markets of new smokers. In Vanuatu, for example, more than 60 percent of men smoke, but less than 20 percent of women do. Slim cigarettes are marketed to women and children to increase revenue for companies. The death rates in places like the island nations of Oceania reflect the success of these efforts. One-third of men and a quarter of women die from noncommunicable diseases such as heart attacks, diabetes, and other diseases related to smoking and obesity. In homes where the men smoke, 22 percent of the monthly household income is spent on tobacco products instead of food and education.
by Charissa V. Jones
In August 2020, Dr. Asia Muhammad said, “there’s absolutely no reason why any Black person should trust the medical institution.” To understand this statement, we need to look at the historical lack of access to health care among Black, Indigenous, and other People of Color (BIPOC). Medical racism, also called medical apartheid, is the systemic use of racism against BIPOC within the medical system. It is the reason people say racism is a public health issue. Medical mistrust is justified by the centuries of abuse, mistreatment, and neglect that have killed communities of BIPOC.
It has been said that doctors are to Black women what police are to Black men. A case in point is the experience of well-known athlete Serena Williams during the birth of her daughter, Alexis. Even her wealth and fame didn’t afford her the luxury of being heard. The day after she underwent a cesarean section, she explained her history of pulmonary embolisms and shortness of breath, requesting a computed tomography (CT) scan and a heparin drip. Instead of listening and doing as she requested, her nurse assumed the medication she was receiving was the problem, and her doctor ordered an ultrasound instead. When the ultrasound didn’t reveal anything, she was finally granted a CT scan, revealing several small blood clots in her lungs. Williams’s birth experience highlights a recurring theme of Black women (and BIPOC in general) being devalued and disrespected by the medical field. It illustrates that bias shapes how medical professionals perceive and treat their patients.
A Transnational Feminist Approach to Reproductive Justice
by Kelsey Limnell
Senator Eduardo Girão, of Brazil’s “We Can” (Podemos) Party, introduced PL 5435/2020 in December 2020. This bill, known as the “Statute of the Pregnant Woman,” was said to protect women who become pregnant as the result of rape, while actually restricting their legal rights to abortion (already strictly limited), coercing them to continue with unwanted pregnancies, and giving the men who raped them the status of parents.
Girão claimed that the bill “would be an advance in the ‘humanitarian point of view’ by protecting pregnant women and holding men accountable.” But local feminists say it put on a facade of activism, and instead of working to aid in proper women’s rights and reproductive safety, it took the form of a “rape subsidy.”
The bill prompts the creation of a fund to financially support survivors of rape—but only if the woman proceeds with the pregnancy. Unfortunately, the bill doesn’t identify a source for the funding or specify how long it will last, and it excludes women who have financial resources.
In addition, the proposal includes a requirement that women in all contexts must “provide information to the father about the child,” even if that “father” was their abuser—forcing women to stay in contact with the men who raped them. Finally, the bill would prohibit harm to the fetus starting from conception, by “act or decision of any of its parents,” so that not only would abortion be illegal, but pregnant women might avoid other needed medical treatments, such as chemotherapy.
PL 5435/2020 would ignore the fundamentals of women’s rights and instead create a situation where women are not only at risk for lack of proper health care but also face further mental and physical dangers in keeping in contact with the men who abused them.
Feminist and anthropologist Debora Diniz summed it up by stating, “Criminal laws are not the best way to protect health needs, and abortion is a health need.”
Explore further: PL 5435/2020 had not yet been voted upon at this writing. Follow up and find out whether the bill was passed, modified, or coded into law.
Anti-Trans Violence and Trans Care
by Qamar Ahmed
Since 2018, coalitions of feminist organizations across Pakistan have been taking to the streets on International Working Women’s Day, under the banner “Aurat March” (which means “Women’s Freedom”) or “Aurat Azadi March.” They demonstrate for the liberation of Khwaja Siras (third-gender people), transgender people, nonbinary people, and women, and for the abolition of patriarchy and all forms of gender oppression and exploitation.
Ahead of its 2021 demonstration, Aurat March Lahore issued a comprehensive “Feminist Manifesto on Healthcare.” The manifesto calls for universal access to health care for all people “regardless of gender identity, financial/social class, religion, sexual orientation, race, ethnicity, dis/ability and citizenship.” Staunchly opposed to the privatization of health care in Pakistan, it specifically advocates transforming the health care system to fully and equitably meet the needs of Khwaja Sira communities, transgender people, disabled people, working-class women, people living with HIV, survivors of abuse, drug users, sex workers, and incarcerated women and children.
Specific demands include access to hormone therapies, drug recovery programs, HIV/AIDS medications, medical care for disabled people and for sex workers, and an end to forced sex-assignment procedures on intersex people.
Similarly, the Aurat Azadi March’s Charter of Demands, titled “Feminist Care in the Time of the Coronavirus” for 2021, addressed health care, disability justice, patriarchal violence, labor rights and protections, welfare, affordable housing and land redistribution, militarized state violence, students’ oppression, justice for religious and ethnic minorities, and environmental justice.
Select demands from this charter include free health care for people with mental and physical disabilities, taxation and environmental regulation of corporations, universal basic income, land redistribution, an end to enforced disappearances, demilitarization of educational institutions and reinstatement of student unions, legislation against forced conversions, and an end to police brutality, harassment, and murder.
Disability Justice
from Sins Invalid
- Intersectionality: Simply put, this principle says that we are many things, and they all affect our lived experience. We may be not only disabled, but we also each come from a specific experience of race, class, sexuality, age, religious background, geographical location, immigration status, and more. Depending on context, we all have areas where we experience privilege as well as oppression. The term intersectionality was first introduced by feminist theorist Kimberlé Crenshaw in 1989 to describe the experiences of Black women, who experience both racism and sexism in specific ways. We gratefully embrace the nuance that this principle brings to our lived experiences and the ways it shapes the perspectives we offer.
- Leadership of Those Most Impacted: When we talk about ableism, racism, sexism and transmisogyny, colonization, police violence, and the like, we are not looking to academics and experts to tell us what’s what—we are lifting up, listening to, reading, following, and highlighting the perspectives of those who are most impacted by the systems we fight against. By centering the leadership of those most affected, we keep ourselves grounded in real-world problems and find creative strategies for resistance.
- Anti-Capitalist Politics: Capitalism depends on wealth accumulation for some (the white ruling class) at the expense of others and encourages competition as a means of survival. The nature of our disabled body/minds means that we resist conforming to “normative” levels of productivity in a capitalist culture, and our labor is often invisible to a system that defines labor by able-bodied, white supremacist, gender-normative standards. Our worth is not dependent on what and how much we can produce.
- Cross-Movement Solidarity: Disability justice can only grow into its potential as a movement by aligning itself with racial justice, reproductive justice, queer and trans liberation, prison abolition, environmental justice, anti-police terror, Deaf activism, fat liberation, and other movements working for justice and liberation. This means challenging white disability communities around racism and challenging other movements to confront ableism. Through cross-movement solidarity, we create a united front.
- Recognizing Wholeness: Each person is full of history and life experience. Each person has an internal experience composed of our own thoughts, sensations, emotions, sexual fantasies, perceptions, and quirks. Disabled people are whole people.
- Sustainability: We learn to pace ourselves, individually and collectively, to be sustained over the long term. We value the teachings of our bodies and experiences and use them as a critical guide and reference point to help us move away from urgency and into a deep, slow, transformative, unstoppable wave of justice and liberation.
- Commitment to Cross-Disability Solidarity: We value and honor the insights and participation of all of our community members, even and especially those who are most often left out of political conversations. We are building a movement that breaks down isolation between people with physical impairments, people who are sick or chronically ill, psych survivors and people with mental health disabilities, neurodiverse people, people with intellectual or developmental disabilities, Deaf people, Blind people, people with environmental injuries and chemical sensitivities, and all others who experience ableism and isolation that undermines our collective liberation.
- Interdependence: Before the massive colonial project of Western European expansion, we understood the nature of interdependence within our communities. We see the liberation of all living systems and the land as integral to the liberation of our own communities, as we all share one planet. We work to meet each other’s needs as we build toward liberation, without always reaching for state solutions that inevitably extend state control further into our lives.
- Collective Access: As Black and brown and queer crips, we bring flexibility and creative nuance to our engagement with each other. We create and explore ways of doing things that go beyond able-bodied and neurotypical norms. Access needs aren’t shameful—we all function differently depending on context and environment. Access needs can be articulated and met privately, through a collective, or in community, depending upon an individual’s needs, desires, and the capacity of the group. We can share responsibility for our access needs, we can ask that our needs be met without compromising our integrity, we can balance autonomy while being in community, we can be unafraid of our vulnerabilities, knowing our strengths are respected.
- Collective Liberation: We move together as people with mixed abilities, multiracial, multi-gendered, mixed class, across the sexual spectrum, with a vision that leaves no body/mind behind. This is disability justice. We honor the long-standing legacies of resilience and resistance that are the inheritance of all of us whose bodies and minds will not conform. Disability justice is not yet a broad-based popular movement. Disability justice is a vision and practice of what is yet to be, a map that we create with our ancestors and our great-grandchildren onward, in the width and depth of our multiplicities and histories, a movement toward a world in which every body and mind is known as beautiful.
Transnational Engagements and Health Equity: A Way Forward
Learning Activities
References
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Further Reading
Benfer, Emily. 2015. “Health Justice: A Framework (and Call to Action) for the Elimination of Health Inequity and Social Injustice.” American University Law Review 65, no. 2, 275-351.
Flynn, Matthew B. 2021. “Global Capitalism as a Societal Determinant of Health: A Conceptual Framework.” Social Science and Medicine 268, no. 113530, 1-8. https://doi.org/10.1016/j.socscimed.2020.113530.
Jalan, Seema. 2018. “The Global Gag Rule: One Year Later, Still a Long Road Ahead.” United Nations Foundation (blog). January 23, 2018. https://unfoundation.org/blog/post/t...ne-year-later/.
Refugees International. 2017. “Coalition Statement on Opposing the Global Gag Rule.” January 24, 2017. https://www.refugeesinternational.or...lobal-gag-rule.
Reichard, Raquel. 2020. “In Puerto Rico, a History of Colonization Led to an Atrocious Lack of Reproductive Freedom.” Access for All. October 20, 2020. https://www.refinery29.com/en-us/202...rights-history.
UNHCR. United Nations High Commissioner for Refugees. 2000. “e) General Comment No. 14: The Right to the Highest Attainable Standard of Health (Article 12) (2000).” August 11, 2000. https://www.ohchr.org/EN/Issues/Educ...lation/Pages/e)GeneralCommentNo14Therighttothehighestattainablestandardofhealth(article12)(2000).aspx.
United Nations. 2020. The Sustainable Development Goals Report 2020. New York: United Nations. https://unstats.un.org/sdgs/report/2...eport-2020.pdf.
Venkatachalam, Deepa, Gargi Mishra, Adsa Fatima, and Sarojini Nadimpally. 2020. “‘Marginalizing’ Health: Employing an Equity and Intersectionality Frame.” Saúde Em Debate 44, no. 1, 109-19.
Image Attributions
5.1 Photo by Tim Mossholder on Unsplash
5.2 “June 2009: Protect Women’s Health!” by ProgressOhio is licensed under CC BY 2.0
5.3 Photo by Mulyadi on Unsplash
5.4 Photo by Claudio Schwarz on Unsplash
5.5 “Reproductive justice” by ConwayStrategic is available under CC PDM 1.0
5.6 Photo by Reproductive Health Supplies Coalition on Unsplash