The Boston Women's Health Book Collective and Our Bodies, Ourselves: A Brief History and Reflection
Women usually find it difficult to obtain the good health and medical information necessary to ensure informed decision making, especially for alternatives to conventional forms of treatment. This problem is intensified for poor women and for those who do not speak English, in part because their class, race, and culture increasingly differ markedly from those of their health care providers.9
Many women are subjected to inappropriate medical interventions, such as overmedication with psychotropic drugs (especially tranquilizers and antidepressants), questionable hormone therapy, and unnecessary cesarean sections and hysterectomies, although managed care has reduced the rates of unnecessary surgery in some places. The medical care system has been slow to recognize the importance of preventive and routine care, as well as the need for more rigorous study of alternative (nonallopathic) approaches to women’s health problems that have not responded well to conventional forms of treatment.10
Despite enormous advances for women over the past two decades, ongoing gender bias in public and private settings continues to relegate women to a separate and unequal place in society. We must have a strong community of women’s organizations to assist women individually, to articulate women’s needs, to advocate for policy reform, and to resist the more destructive aspects of corporate medicine. Organizations such as the National Women’s Health Network, the National Black Women’s Health Project, the National Latino Health Organization, the National Asian Women’s Health Organization, and the Native American Women’s Health Education Resource Center, to name just a few, could play a key role in insuring that lay and consumer voices are part of any larger women’s health debate. The inclusion of such groups by the office of Women’s Health Research at the National Institutes of Health already has enriched discussions concerning research affecting women.
Ironically, except in a handful of states, poor women on Medicaid can obtain a federally funded sterilization but not a federally funded abortion. This limitation has led some women to "choose" sterilization because they have so few options. As the women’s health movement continues to emphasize, without access to all reproductive health services, there can be no real choice in matters of childbearing.
Over the years, the BWHBC has collaborated with physicians who have shared the feminist perspective represented in OBOS. One such colleague, Mary Howell, MD, (more recently known as Mary Raugust), died from breast cancer in February 1998. The author of a popular 1972 book entitled Why Would a Girl Go into Medicine? and the first woman dean at Harvard Medical School, Mary contributed to the research that resulted in a legal ruling forcing medical schools to eliminate female quotas. These informal quotas had kept the female presence in medical schools well below 20 percent of the total number of students since the turn of the century. She remains for us one of the finest role models for women in medicine, and we hope that her speeches and writings will be published to inspire the younger generations of female physicians. Another physician, Alice Rothchild, MD, has written and spoken eloquently about her experience as a feminist obstetrician-gynecologist, and we have made her 1997 AMWA speech available at our website.11
Members of the media often ask us if we think that progress has been made in addressing the concerns women have had about medicine. We believe that physician awareness of condescending and paternalistic behaviors that are now generally regarded as disrespectful elsewhere in society has been heightened. It also appears that more women feel that their physicians take their concerns seriously, rather than dismissing their complaints with "it’s all in your head." But other problems have been exacerbated, and although not unique to women, women’s more frequent contact with the medical care system means that women confront these issues much more regularly than men do.
Many managed care plans have contributed to reductions in access to care, especially good quality care, for some women. They have, for example, not allowed some physicians to provide needed treatments. Sometimes, physicians have not had the time to adequately assess the plethora of new drugs and medical technologies that they regularly recommend to patients. Cutbacks in local community services and public health programs make it harder to sustain an emphasis on preventive health care.
The BWHBC has a special interest in such problems as the increasing influence of right-wing organizations over public policies affecting women’s health, the explosion of health and medical technologies marketed primarily to women, the objectification of women’s bodies in the media, the exclusion of consumers from policy setting and oversight functions in many managed care plans, and the relatively few sources of noncommercial information about women and health, especially with a well-informed consumer perspective. We recognize institutional racism as a continuing problem exacerbated by the fact that most caregivers and health care administrators come from economic, social, racial and ethnic backgrounds quite different from those of the people they are serving. Finally, we believe it is critical to challenge the tendency to over-"medicalize"12 women’s lives and turn normal events such as childbearing and menopause into disabling conditions requiring medical intervention.
As the women’s health movement moves into the next century, the ability to build broad coalitions will largely determine the political effectiveness of women’s health care advocates. We can learn much, for example, from the passage of the Americans with Disabilities Act, which succeeded in large part because the disability rights community reached out to form broad alliances with other groups not initially aware of the universal impact of this legislation. Finding common ground and ways to bridge racial, ethnic, and class difference in particular, will be among the great challenges we face.
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