reproductive health equity

The Oregon Legislature has passed the Reproductive Health Equity Act, which will ensure that Oregonians, regardless of income, citizenship status, gender identity, or (with a few exceptions) type of insurance, will have access to the full range of preventive reproductive health services, including contraception, abortion, and postpartum care. This victory offers important lessons about how to continue making gains for equity and empowerment in the face of the national government's push to the right, and the law offers important ground for building toward further health equity, including single-payer.

Although the Reproductive Health Equity Act, like the Affordable Care Act, includes an exemption for "religious employers," it largely moves counter to the trend in many other states and at the federal level to restrict access to reproductive health care.

With this bill, Oregon will become only the second US state, after California, to require private insurers to cover all abortions. In contrast, 25 states restrict abortion coverage allowed in plans offered through their state insurance exchanges.

And funding is only one method of restriction. Just this year (according to the Guttmacher institute), legislators in 28 states have introduced 88 measures that would ban abortions completely or under certain circumstances, while another five states have already adopted 10 major new abortion restrictions.

The federal government, since the 1976 Hyde Amendment, has prohibited using federal funds to cover termination of pregnancy, except in cases of rape, incest, or endangerment to the life of the mother.  The common exception for rape, of course, helps reveal that a driving concern in controlling access to abortion is less the purported life of the fetus, than the right of women to choose to be sexually active.

Anyway, federal funds have been supporting other forms of reproductive health care. Medicaid is indispensable for ensuring that low-income people have coverage for family planning, pregnancy-related care, STI testing and treatment, and other reproductive health services. But right-wing policymakers are seeking to undermine or even dismantle Medicaid, the source of health coverage for 74 million U.S. residents, including 13 million U.S. women of reproductive age.

A contributor to Forbes calculated that the republican health bill will provide about 3 million dollars in tax cuts to the wealthy for each person who dies because of loss of access to health care.

Even if the Republican bill passes, the Reproductive Health Equity Act will make safe, legal abortion more affordable and more accessible for about 43,000 Oregonians whose insurance plans have prohibitively high deductibles.

But the Reproductive Health Equity Act concerns more than just abortion; and it includes access provisions for non-documented women and anti-discrimination protections for transgender Oregonians.

It will remove barriers that hinder access to essential reproductive health care services, including prenatal care and lifesaving cancer screenings, for transgender and gender-nonconforming Oregonians.

It will expand postpartum care to about 48,000 Oregonians who have coverage for labor and delivery that drops immediately after birth.

It will help almost 19 thousand Oregon residents who are forced to pay out-of-pocket costs for preventive health services, including contraception, and it will continue to ensure that all Oregonians receive the full range of preventive reproductive health services at zero out-of- pocket cost, even if the Affordable Care Act is overturned.

And it will safeguard the right to abortion even if Roe v. Wade is overturned.

This legislation is not just a response to the Trump administration. The bill was developed, written, and supported, over the last three years, through the work of people directly affected by these obstacles to health care, and through the work of organizations that have been building the knowledge, capacity, and community to develop legislation, educate voters, petition the state, lobby legislators, and get out the vote.

Like the Cover All Kids bill--which also passed the Oregon House this past week, making Oregon the seventh state in the nation to provide healthcare for all children, regardless of residency status, and up to 300 percent of the federal poverty level—the Reproductive Health Equity Act is the product of long years of work on the part of many, many groups and individuals.

The success and value of such legislation requires the thoughtful and long-term work of a wide and diverse coalition of activists. The steering committee of the Pro-Choice Coalition included not just reproductive healthcare organizations – the state groups for NARAL and Planned Parenthood—but also legal and community organizations, and racial and gender justice groups, including the Oregon Latino Health Coalition; the Asian Pacific American Network of Oregon (APANO); the ACLU of Oregon, Family Forward Oregon, which works at the intersection of family and labor issues for family friendly workplace policy; and the Western States Center, which works to connect and build the power of community organizations . . . to achieve racial, gender and economic justice.
The list of supporting groups is even longer and more diverse, but special mention should go to We Are BRAVE, a project of the Western States Center led by women on color and focusing, as the acronym indicates, on Building Reproductive Autonomy and Voices for Equity.

The Director of Programs and Strategies at APANO, Kara Carmosino, describes the work that began three years ago to make the bill a success. In those three years,

APANO members and staff have supported a truly coalitional effort that collected nearly 10,000 petition signatures, gave dozens of workshops on strong families and reproductive justice, created art and collected stories to include transgender and gender-nonconforming people, as well as immigrants and refugees, in the narratives around who needs reproductive health care. 

[They] launched a Mend the Gap report that directly challenged the myth that everyone in Oregon already has access to the reproductive health care they need. And [they] built a policy and a campaign that centered the stories of those who need this win the most.

APANO also has a handy link for thanking the legislators who passed the bill. But, as Carmosino notes, the "victory belongs to ... many people, from those who canvassed events two summers ago, to those who bravely shared their stories, to those who signed petitions and lobbied in the capitol."

The importance of that wide and diverse coalition goes back to the origins of the bill and its design. Collaboratively developed to address the needs of marginalized communities, it was written by and for those who have been most impacted by the gaps existing in reproductive healthcare, to address the things that those communities themselves said they needed.

Although some of the arguments brought to bear in support of the bill pointed to economic questions—highlighting the fact that birth control is cheaper than maternity care, for instance. But saving money is just part of a strategy, never the goal; the goal is better healthcare—and thus better health and lives.

By lifting up the voices and supporting the advocacy of the least advantaged, these organizers have helped improve the lives of tens of thousands of Oregonians, and have demonstrated that the intersectional approach is not just ethical but effective. Their work has provided examples of how to expand access to healthcare, and have taken further steps toward getting health care for all.

If you're interested in working for a state single payer system in Oregon, you might want to check out the work of Health Care for All Oregon. They're offering a free screening Wednesday at noon at the Multnomah County Health Department 426 SW Stark, in the tenth floor conference room, of the video "Sick Around the World: Other Rich Countries Have Universal Health Care. Why Don't We?" HCAO's calendar on their website, lists other events and meetings around the state.

Why the Handmaids were White (supremacy)

Among the literary portraits of American fascism garnering renewed interest since last November, Margaret Atwood's 1985 novel The Handmaid's Tale is probably the best known.  Indeed, its nightmare of reproductive injustice is so familiar that signs at the Women's March earlier this year could simply allude to it, with slogans like "Make Margaret Atwood fiction again" or "Nolite te bastardes carborundorum" (also a popular tattoo).  Activists in Texas recently protested proposed further restrictions on abortion access by dressing as Handmaids.

The novel has been variously banned, translated, and adapted, including multiple dramatic adaptations for radio and stage, a ballet, an opera, a 1990 feature film, and most recently, a ten-episode series on Hulu.

The Handmaid's Tale  describes a near-future American theocracy in which environmental pollution has led to widespread infertility. The patriarchal regime that takes over portions of the United States and renames it Gilead imposes a totalizing system that dictates clothing, ritual, and family structure: the few women who are still fertile are assigned as 'Handmaids'  to the families of powerful Commanders.

Publicity for the series has stressed its timeliness while acknowledging its updating.  But while many of the inevitable changes from the book work well, displacing and condensing elements for clarity and visual impact, dramatizing  moments unrepresented in the novel, and elaborating on the experiences of secondary characters, one problematic change has been evident since the previews revealed the protagonist's friend Moira is played by Samira Wiley, best known from Orange is the New Black.  The attempt to make the setting post-racial runs counter to the political history of the United States, the details of the novel, and the ostensible goals of the change.

Among the small number of writers to critique this choice, I'm drawing here on points from Susan Rensing on Nursing Clio, Soraya McDonald on The Undefeated, Priya Nair in Bitch Magazine, Jane Hu in the Los Angeles Review of Books, and blog posts on Fangs for the Fantasy and by Ambereen Dadabhoy.

In the novel, the Gilead theocracy is racist as well as sexist and homophobic.   The excuse for the imposition of martial law that leads to the Gilead takeover is a supposed threat of Islamic terrorism.  African Americans are relocated to the Midwest, to homelands imagined as resembling those of apartheid era south Africa.  Dissidents of various sorts are either executed—their hanged bodies often displayed for days as a warning to others—or are sent to clean up the toxic wastelands known as the Colonies, apparently a slightly slower sort of death sentence. 

But only white women become handmaids. 

Some critics have faulted the novel for this.  The book gets some of its frisson from imposing on white women some of the oppressions imposed on enslaved Black women in the antebellum South and the tropes and imagery of US chattel slavery:  Women in Gilead are forbidden to read, write, or congregate. They are treated as property, valued for their reproductive capacity, and named for their owners—the central character is called Offred because her commander is named Fred.  Those escaping to Canada are helped by a secret network known as the Underground Femaleroad, and many of their allies are Quakers.  Offred's narrative, like many 19^th century slave narratives, originates in oral form. 

But while Atwood's novel thus arguably obscures the intricate relation of racism and sexism by silently transposing races, centering a white woman's experience by taking what happened to African American women under slavery and imagining a near future where white women experience forced breeding,  the book does acknowledge the racism of Gilead. In the far-future epilogue, an historian looking back at Gilead notes that the regime's “racist policies … were firmly rooted in the pre-Gilead period, and racist fears provided some of the emotional fuel that allowed the Gilead takeover to succeed as well as it did."

For the Hulu series, however, executive producer Bruce Miller decided to cut out the white supremacist ideology of the Republic of Gilead, saying that he "made the decision that fertility trumped everything." 

But of course concerns over the birthrate and population have always been about whose fertility and the fear of being overrun by someone else’s babies. The religious right first got traction as a political movement not in trying to stop abortions but in trying to stop racial integration. White supremacist groups worry that interracial marriage constitutes "white genocide" because it taints Aryan purity. Stormfront and similar sites fret about whites being outbred  by non-whites, and the "Quiverfull" movement encourages Christian white women to breed incessantly. 

The reaction of an oppressive, White Straight Male, religious patriarchal society to a fertility crisis is most certainly not going to be “let’s breed more Black/Latino/Asian babies!”. The womb wars are a very real thing among this movement - outbreeding the “other” is a campaign for them. These people are not going to see a declining birth rate and think “all of humanity is in peril, come people of all races unite in joint purpose to produce multi-racial babies by the score!”. They’re going to see a decline in White babies and panic. 

So the change is implausible  in relation to real history. 

It also works badly in relation to Gilead rituals, as Soraya McDonald points out.

When a pregnancy results in a birth, there’s a special chair devised for Wives and handmaids once a handmaid goes into labor, one that positions the handmaid (rather uncomfortably) below the wife and between her legs. Wives are encouraged to experience birth days as if it is they who are going through labor to deliver a child.

All of this serves to reinforce the idea that the handmaids are merely ambulatory wombs. They serve one purpose, which is to pop out babies, then give them up as soon as they’re weaned. And so introducing the idea of nonwhite handmaids prompts a question: What happens when a black woman gives birth to an interracial baby who serves as a daily reminder to a Wife that she’s not the child’s biological mother when so many rules and ceremonies have been created to obscure that very reality?

Moreover, the producer's attempt to suggest that this is a post-racial world is implausible. 

As Jane Hu asks in the LA Review of Books,

 where are all the Asian handmaids? Given the show’s rhetoric of concubines and its reflection on outsourced female labor and reproductive carework, postracial America is strangely devoid of any Asian women.

As Ambereen Dadabhoy points out,

 If this were truly a world devoid of white supremacy, would all of the wives of the commanders be icy blondes or pale gingers? We have only to look at the ruling elites to know that this is a mere fiction or palliative for those of us who demand some form of diversity from the entertainment we consume.

Compounding this is the fact that other than Moira, the other black and brown bodies are both scarce and light-skinned.

....In fact, if “fertility [did] trump everything,” then I suspect that we would see a lot more brown people than we do. It’s not as though there is evidence that white women are more fertile than others. At the very least we would see equal distribution of races within the ranks of the handmaids. Finally, the lingering and loving gaze of the camera lets us know how much the narrative is invested in white suffering and white pain. We are treated to long close-ups of delicate white faces forced to wince and blink at unspeakable atrocities. It is their pain we are asked to witness and with which we should identify.

We are asked to identify with the suffering of these women on a fundamental level, on a universal level, and on a human level.

In trying to rationalize the series'  casting choices, producer Miller asks,

What’s the difference between making a TV show about racists and making a racist TV show? Why would we be covering  [the story of handmaid Offred...], rather than telling the story of the people of color who got sent off to [the Midwest]?

But surely there is potentially a great deal of difference between making a TV show about racists and making a racist TV show, and the possibility that Miller presents this as a rhetorical question should cause concern.   In the terms Miller tries to set up, there is indeed no good reason that Offred herself need be played by a white woman.  Moreover, since we've begun to see the series develop scenes and characters not followed in the novel, there is no good reason we would not follow those who were exiled to some homeland. 

In short, the series effects a denial of the continuing significance of white supremacy. 

It Can't Happen Where?

image via wikipedia

It's the #1 bestselling work in the "classic American literature" category on Amazon dot com—though it's also available for free through Project Gutenberg Australia or the Multnomah County Library.  Salon dot com called it "the novel that foreshadowed Donald Trump's authoritarian appeal."

It Can't Happen Here was written in 1935 by Sinclair Lewis, who in 1930 had become the first U.S. author to win the Nobel Prize for literature. Lewis was  known for his 1920s novels like Babbitt and Main Street, which lovingly excoriated the vacuity of middle-class, middle-American, small-town Rotarians.

Although it's not considered his best book, It Can't Happen Here became Lewis's best-selling novel, and when he turned it into a play the next year it was widely performed in multiple languages.  More recently, the novel has gained renewed attention, becoming an online bestseller, and the topic of frequent commentaries. 

The satirical narrative features a demagogic presidential candidate who wins support among economically distressed voters with mesmerizing speeches full of anti-elitist populism; racist, sexist, anti-Semitic nationalism; inconsistent proposals; and authoritarian promises to "make America a proud, rich land again." He's published a ghostwritten book combining boastful autobiography and contradictory policy, and he slams the press as a bunch of liars. 

So, you can see why it might be of interest.

But the crass and charismatic Berzelius Windrip—known as Buzz—is of course not the result of any clairvoyance on Lewis's part, but a riff on the dictators of his day.  Lewis was married to the journalist Dorothy Thompson, who interviewed both Hitler and Huey Long in the early 1930s, and whose work may have provided both impetus and material for Lewis's novel. 

Huey Long, in particular, provided a model for Buzz.  The Louisiana Democrat had been compared to Hitler, Mussolini, and Franco, and intended to challenge Franklin Roosevelt for the 1936 nomination.  Instead, Long was shot to death a month before Lewis's novel appeared, and its explicit references to him were quickly revised into the past tense.  

Pundits on the political right have snarked about the comparisons of Buzz Windrip to Donald Trump,  because not only is Windrip a Democrat, but also his platform, among its various and often conflicting items, proposes economic redistribution, limits to the size of individual fortunes, caps on dividends, and five thousand dollars per year to be given to every family.  But it's worth noticing that in fact, this is not what he does once he's elected.  Instead, Windrip's capitalist supporters were well aware of the loopholes and qualifiers in his platform, and generally find themselves much more satisfied than his working-class supporters. Buzz promotes and protects big business, bans strikes and labor unions, and, aside from thus heightening exploitation and adding new layers of graft and corruption, he mostly enables economic business as usual. 

Windrip does follow through on the one item in his fifteen-point plan that he has presented from the start as most important: the consolidation of power in the executive branch.  When Congress refuses to approve his demand for complete control of legislation and suspension of any interference from the judiciary, Windrip declares martial law, and has troublesome congressmen arrested for "inciting to riot."  His edicts are enforced by an informal citizen militia he has regularized, known as the Minute Men, or the MMs.  Within the first year, he has terminated all the older political parties and replaced them with just one, the American Corporate State and Patriotic Party, whose members are widely known as the Corpos.  Soon there are concentration camps, filling with a lengthening list of dissidents, including "such congenital traitors and bellyachers as Jewish doctors, Jewish musicians, Negro journalists, socialistic college professors" and so on. The racist and anti-Semitic planks in Windrip's platform are, like his insistence on centralized executive power, also "vigorously respected," in their case because "Every man is a king so long as he has someone to look down on." 

"Every Man a King" was a motto of Huey Long's, the title of his autobiography and his theme song.  Unlike Buzz Windrip, Long seems to have followed through on some of his populist promises, taking on the Standard oil trust, and expanding hospitals, schools, roads, and bridges in public works programs across Louisiana.  Though his methods were autocratic and his power exercised through patronage, his campaigns helped pushed FDR's New Deal further to the left.

But the mainstream in the 1930s was already further left than it is today.  Windrip's redistributive platform reflects a widespread consensus, and explicitly references Huey Long's Share the Wealth program, FDR's New Deal, Upton Sinclair's End Poverty in California, and Townsend's social security plans, among others.

When opposition to the Corpo state gets organized under the leadership of the Republican former candidate, he declines contributions to the cause from an oil tycoon and tells him that,  whatever happens,

you and your kind of clever pirates are finished. Whatever happens, whatever details of a new system of government may be decided on, whether we call it a 'Cooperative Commonwealth' or 'State Socialism' or 'Communism' or 'Revived Traditional Democracy,' there's got to be a new feeling—that government is not a game for a few smart, resolute athletes like you . . .  but a universal partnership, in which the State must own all resources so large that they affect all members of the State....

It does take a while for that opposition to get organized, because, as the title suggests, so many people believe the US immune to fascist tyranny.

The main center of consciousness in It Can't Happen Here is the newspaper editor Doremus Jessup,  who recognizes himself as a "small-town bourgeois Intellectual,"  a  "rather indolent and somewhat sentimental Liberal."  He prides himself on his broadminded detachment, right up until he's taken to jail for his own protection, after he publishes an editorial critical of President Windrip.  Then he thinks the "tyranny of this dictatorship" is the fault of "all the conscientious, respectable, lazy-minded Doremus Jessups who have let the demagogues wriggle in, without fierce enough protest."  Thus the novel criticizes Jessup's indolent complacency, and the narrative trajectory requires his rebellion.

But despite acknowledging Jessup's flaws, the book aligns us sympathetically with his perspective, and seems to share his resolute anti-Communism, despite its critiques of the capitalist inequality that can generate support for fascism.  To some extent it also shares some of his other limits of vision. African-American and Jewish characters are few and relatively minor, and the only apparently queer character is Windrip's behind-the-scenes policy-and-propaganda chief, his Steve Bannon figure, if you will. 

More useful, perhaps, are the observations of the Communist character Karl Pascal, who points out that grinding poverty existed in the U.S. in the supposedly prosperous times before the Depression, and that "Buzz isn't important—it's the sickness that made us throw him up that we've got to attend to." 

Of course the novel is neither a prophecy nor a blueprint, but a satire and a warning, and it remains worth reading for the provocations offered by its funhouse-looking-glass reflections of American history, economy, and culture.