However, after the warm glow subsides, the reality of working to regain traction on ground that was lost during the Bush administration will set in. With a president in the White House who understands and accepts a woman's right to reproductive justice, the focus will now entail a reexamination of the multitude of factors that are part of the larger picture.
As the economic crisis looms large, women need to be able to connect the dots from financial empowerment to their health care issues. In two recent events sponsored by the American Association of University Women, I was able to hear speakers define the picture.
At the first, Rep. Jan Schakowsky (D-Ill.) was the featured guest. The incoming Democratic chair of the Congressional Caucus on Women's Issues, she clarified that "We have to undo some things." She enumerated the "global gag rule, family planning money, and the conscience clause." The latter she compared to "hiring a fire fighter that won't go into a burning building."
With the goal of expanding paid and medical leave, childcare resources, and retirement issues...it all comes down to money. That conversation was taken up in a press call sponsored by AAUW featuring women's advocate, Rep. Rosa DeLauro (Dem-Ct.). While the Lily Ledbetter Act has received a lot of recognition, the Paycheck Fairness Act - which ensures women a second avenue to pursue discrimination claims - is not as visible to the general public. Both bills just passed in the House, but an outspoken advocacy push will be needed for passage in the Senate. Advocacy links have been set up to facilitate contacting Senators.
So how does this connect back to reproductive justice and women's health care? Do the math. Women account for 50 percent of the work force. One fifth of women are without health insurance, and half of women are in jobs without retirement plans. When you read the statistic that women are earning 77 cents on the dollar, there is another set of figures beneath the surface. Those tell the story about women of color. Black women earn 67 cents on the dollar; Hispanic women are at the low end of the scale at 58 cents.
As Schakowsky noted in a 09/23/08 op-ed in The Hill, "Women are disproportionately affected by higher medical costs that eat up more of their wages." Women require more health care, but have fewer financial resources to pay the bills. They pay 68 percent more than men for out-of-pocket expenses. As a result, one in four women is unable to pay her medical bills.
This can boil down to lethal consequences. Schakowsky gives the figures of almost one in five women in the nation as being uninsured, and therefore at risk of being one of the 22,000 Americans who will die annually due to lack of coverage. Women of color, those who hold the lowest paying jobs, and those who are living in poverty are most adversely affected.
When converted into women's medical realities the results are:
therefore are less likely to follow a course of prenatal care.
In tandem with the work of the 111th Congress to institute safety nets for women on the economic front and in the reform of healthcare, The Prevention First Act has been introduced to specifically deal with issues including Family Planning, Teen Pregnancy, Sex Ed programs, and Emergency Contraception for Rape Victims.
It should be noted that reproductive justice has different meanings across the board. To a young woman in college it can be access to low-cost birth control. To a mother-to-be it can translate as affordable pre-natal and follow-up infant care. To a woman living in poverty, it can be the resources to travel to a health care provider or clinic.
It is worth reflecting on the fact that in 1969, President Nixon stated in a message to Congress:
"It is my view that no American woman should be denied access to family planning assistance because of her economic condition. I believe, therefore, that we should establish as a national goal the provision of adequate family planning services within the next five years to all those who want them but cannot afford them. This we have the capacity to do."
On December 26, 1970, he signed Title X into law.
It's been a long eight years, but we have survived the badlands of the Bush administration. Good intentions on the part of the Obama administration towards women's concerns are a start, but not a guarantee. For that assurance, women need to look to their own resolve.
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In March of 2008, I interviewed a senior State Department Official who discussed efforts to highlight awareness of the link between sex trafficking and HIV/AIDS. He related statistics showing that as customers seek out increasingly younger girls, the rate of infection for HIV/AIDS for 15-year-olds and under has jumped to over 60%. The official supported a victim-centered approach, with the training of "forensic nurses" to be alert to the HIV/AIDS and sex trafficking connection. He believed there was "a false dichotomy" between the goals of the anti-trafficking activists and the health community.
Yet, several NGOs have been
accused of "turning a blind eye to trafficking in brothels."
Anti-trafficking supporters believe the public health perspective reflects
the given, "This is going to be happening anyway, so there should
be protection." They pose the rhetorical questions, "In
an effort to distribute condoms, is the result a form of "collusion"
between public health officials and brothel owners that sends mixed
messages? If a child is in a brothel, can the only concern be if this
child gets AIDS? Can you fight the spread of HIV/AIDS without
on some level contributing to the problem of forced sexual servitude?"
For health workers, the core matter is saving lives through the prevention of spreading AIDS. Anti-trafficking activists are goal-driven to free women and children from conditions where they may be forced to have sex 10 to 30 times per day. Katherine Chon, President and Co-Founder of Polaris Project, sees the "harm reduction" methodology as a narrow policy. She stresses the need for "finding a way to protect the health of women and girls that also address the systemic issues." She observed, "If you are not asking the right questions, you are not going to get the full picture."
Taina Ben-Aimé, Executive
Director of Equality
Now, believes that
many in the HIV/AIDS sector don't "have a gender perspective"
and are seeing circumstances strictly as "a medical situation."
She pointed out that distribution of condoms is not foolproof.
"Clients are willing to pay a higher price in order to avoid use,
and women can be beaten if they insist on use."
Professor of Women's Studies at the University of Rhode Island, Donna M. Hughes, PhD., told me, "The sex trade is a form of contemporary slavery. Legal reforms need to create solutions that assist victims and prosecute perpetrators, and are based on the premise that prostitution is a form of violence against women - an extreme form of gender discrimination." Hughes feels the burden is "on the policy makers of the NGOs and their funders." She is concerned with HIV/AIDS programs solely targeting disease prevention without pointing to sexual slavery and trafficking as a primary factor in the spread of HIV/AIDS, and sees short-term solutions for the AIDS epidemic as outstripping the examination of how to confront the human rights violations that characterize the slavery of women and children. Hughes suggested NGOs "take their budget, and split it between condom based programming and providing assistance to get out."
Doctors Without Borders/Médecins Sans Frontières (MSF), was pinpointed in a February 27, 2003 column by Hughes in the Wall Street Journal. "Aiding and Abetting The Slave Trade" questioned why the MSF goal was "not to get the women or girls out of slavery, (but) only to provide HIV/AIDS prevention education." Hughes asserted, "It's a sad reality that many seemingly well intentioned NGOs aren't really about helping victims of abuse."
Michael R. Goldfarb, Press Officer in the New York City office of MSF forwarded me a letter from the Asian Wall Street Journal (February 2003) in reply to Hughes's allegations. Written by the Head of Mission MSF, in Cambodia, Richard Veerman disputed the claim that MSF had turned "its back on the horrible plight of women and young girls forced into commercial sex work." "Nothing could be further from the truth," he said. Veerman wrote that MSF was cognizant of groups handling advocacy and rescue for those enslaved in brothels, but was also aware that the women and girls had no access to medical care. Based on that rationale, MSF opened a free clinic in an attempt to "alleviate some of the suffering of the sex workers." Veerman maintained, "MSF firmly condemns the trafficking of women and children."
Jerome Oberreit, Director of
Operations based in Belgium, explained the two primary concerns of MSF
are to provide emergency medical care and to use their medical activities
to "witness" the plight of the people it assists. Their foremost
responsibility, without judgment, is to the individual. The mandate
of "witnessing" is constructed to pass on information to local networks,
creating outreach through data. I received, via e-mail, the names
of the groups that MSF had passed their information on to.
Director of the Center For Battered Women's Legal Services at Sanctuary For Families, Dorchen Leiderholdt, believes "when health care workers encounter trafficking victims they have an obligation to take measures to protect those people from abuse." Holly J. Burkhalter, Vice-President of Governmental Relations for International Justice Mission, sees it differently. "It's asking health workers to also play the role of law enforcement," she said. Burkhalter believes those in the health movement do understand the importance of the anti-traffickers concerns, and that the two advocacy interests must work together.
Wenchi Yu Perkins, former Vice President of the Human Rights Program at Vital Voices Global Partnership, does not want to see "harm elimination" and "harm reduction" as mutually exclusive. "Everything comes down to reality...what works and what doesn't. People are finding the common ground is much bigger than we thought." Yu Perkins said unequivocally, "There is no such issue as consent for girls under eighteen in brothels. The priority is to get them out." Young girls, with immature immune systems who experience vaginal bleeding and forced abortions, are more vulnerable to higher rates of HIV.
Currently, the United States Government has taken a stand that they will not give funding or support to any NGO that says prostitution is a form of work. When the Obama team presents their approach to eradicating the crime of modern-day slavery while fighting HIV/AIDS, it will set the tone for the rest of the world. Hopefully, they will be at the forefront of building a global coalition to mobilize a comprehensive approach to the problem. ]]>