We continue our 30 Issues in 30 Days series with women’s health. It’s become one of the leading election topics this year. And the debate has changed from generation to generation.
The modern-day women’s health debate really begins in the 1960s and 70s, during the Women’s Liberation Movement. The advent of birth control, the fight over the Equal Rights Amendment and Title IX empowered women. But nothing has proven as divisive as abortion, legalized in 1973 and part of the political debate ever since. In the 1990s, debate turned to contraception coverage in health care plans.
“Women’s health, in this election season, like many in the recent past, has tended to focus on women as reproductive beings,” says Charlene Galarneau, a Women’s and Gender Studies professor at Wellesley College. “And so women’s health then has focused on reproductive health issues. It’s very important, I don’t want to underestimate the importance of talking about reproductive health to women’s lives. It’s ultimately important. But it is not all that women are. So I think it’s important that we have started to broaden the conversation to think about women’s health in other ways.”
So where is the conversation about women’s health today? One place is Mattapan Community Health Services, a sparkling new building bustling with families and other visitors. They offer primary care, pediatrics, dental and ob-gyn services. And now they’re providing mammograms.
“Health centers are very much concerned about the health of families. In a lot of families women drive the healthcare,” says Azzie Young, director of Mattapan Community Health Services. “So we of course advocate for self care for women so that they can be in a position to help their entire family to be healthy.”
The center is not politically affiliated. Young says they have already benefited from mandatory health insurance in Massachusetts, because nearly all their patients have health insurance.
“In terms of women coming to the health center, it’s increased access for preventive services, particularly for mammography services. We absolutely need it to stay in place, it will help the families that we serve tremendously,” Young says.
Today's conversation may center on women's overall health, but not far in the background is the ongoing political divide over abortion. Just a few miles from Mattapan is an unmarked clinic in Brookline that provides ob-gyn care and performs abortions.
“It’s important not just to look at this as pro-choice or anti-choice or anti abortion," says the clinic's director, Dr. Laurent Delli-Bovi. She says this year’s election conversation is surprising. “Health care” has become a loaded term, thanks in part to the Affordable Care Act. It’s making birth control largely free, but religious organizations are exempt from having to cover employees’ birth control if they choose not to. Opponents say the act is overly reliant on regulations, fees and taxes.
“It’s interesting because we’ve never really had economic concerns before. We were concerned about tax funding of abortion. But now we’re concerned about economics because it’s affecting care of people,” says Anne Fox, president of Massachusetts Citizens for Life, whose centerpiece is to end legalized abortion.
“In one sense politically you could say that right-to-life is our party because that’s what decides how we vote. If the government and the society is not able to protect life then really the other things that we talk about don’t have much meaning. So really we feel that the first thing that we have to do is protect life and that is getting broader and broader these days,” Fox says.
It's broader on issues beyond abortion, too, including the assisted-suicide ballot referendum in Massachusetts.
“People do tend to think of the pro-life movement as anti-abortion, which is true. But there’s so much just scientifically that’s happening now whether it’s embryonic stem cell research, even in vitro fertilization, cloning. So our focus has broadened," Fox says.
On the other side of the abortion debate is Planned Parenthood. They too see important women's health issues beyond abortion. But they're not ready to give up any ground that's already been won.
“I don’t think we could have more different candidates, when you’re looking at Obama and Mitt Romney," says Tricia Wajda, director of public affairs for the Planned Parenthood Advocacy Fund of Massachusetts. "Obama is clearly supportive of women’s health, he recognizes that Planned Parenthood is a point of entry into the health care system for millions of women, whereas Mitt Romney has said time and time again, he wants to get rid of Planned Parenthood. He clearly has overlooked the impact of what would happen if we were to go away, if he was to get rid of us.”
And again in today's debate, “economics” comes up when discussing women's health.
“These issues pertaining to women’s health are very much economic issues. When we’re talking about how much to invest in birth control and these other preventive things, it seems like it’s a far better investment than the money that we’re going to end up spending if we don’t make that investment in the preventative work,” Wajda says.
Gallup polls show that most voters — men and women — have made up their mind on the topic of abortion. The May poll showed 50 percent of Americans call themselves pro-life, which has remained stable for many years. But Americans who identify as “pro-choice” are at a record low: 41 percent, down from 47 percent in 2009.
Wellesley Women’s and Gender Studies professor Charlene Galarneau is also looking outside of Massachusetts. “I’m particularly watching the states and those that are talking about not buying into the Medicaid expansion, which is the expanding of health care to larger numbers of low income people. The federal government has offered a subsidy to states to do that and there are a number of states which are considering not being part of that program. And I think that’s going to have a huge effect on women’s and men’s health. But it’s an issue we haven’t talked about recently,” she says.
As the women’s health debate circles back to primary care and insurance, Galarneau points out that women do live longer than men and use more health care services in their lifetime.