Women Can’t Win: Ongoing Offensives against Maternal and Reproductive Health

By Miranda Waggoner, author of The Zero Trimester: Pre-Pregnancy Care and the Politics of Reproductive Risk

In late July of this year, the Republican-led Senate’s attempt to repeal Obamacare failed rather dramatically, punctuated by John McCain’s widely discussed—and widely viewed—thumbs-down vote. More recently, another Republican-led attempt at repeal, known as the Graham-Cassidy proposal, again disintegrated due to lack of support from several key GOP senators. For at least the foreseeable future, the spirit of President Obama’s Affordable Care Act seems here to stay, but this development does not mean that women and mothers in America are safeguarded from having key components of their health care—or dignity—stripped away.

For some time now, opponents of Obamacare have vehemently targeted family planning services, as witnessed by the Trump administration’s recent expansion of religious exemptions for contraceptive coverage. But, at the same time, GOP lawmakers have also argued that maternity care services are not “essential.” This two-pronged hostility—pointedly disregarding both maternity care and general reproductive health care—is somewhat curious because maternity care has characteristically been considered politically “safe,” while reproductive care—in its association with contraception and abortion—has been deemed politically “toxic.” I trace the trajectory of these two reproductive silos in my book, The Zero Trimester. I show how health-care professionals have sought to expand the time period of a healthy pregnancy from the typical nine months to twelve months, by creating a “zero trimester” period during which women are defined as “pre-pregnant.” In doing so, non-pregnant women’s health care is defined in terms of maternity care. The rise of the “zero trimester” was in part predicated on the assumption that policy makers care about mothers and babies—that they are in the “safe” zone. Yet, in a political environment that does not value maternity care or reproductive care, such an approach seems destined to fail.

This approach is also unfair to women. The thrust of “zero trimester” initiatives promoted by health professionals and government agencies has been public-service announcements and health campaigns aimed at alerting individual women who are of reproductive age that they inhabit a perpetual zero trimester, and must act “responsibly.” One of the most controversial of these messages was the 2016 announcement by the CDC that all women of reproductive age not using birth control should avoid alcohol.

How can we best navigate a political climate that is hostile to maternity care but that simultaneously tends to define women by their maternal capacity? Taking away women’s health care services is obviously not a step in the right direction, but neither are individual-level recommendations to women that make them feel guilty about their everyday behaviors. Comprehensive health care coverage for all potential reproducers—both women and men—across their life course is one important piece of the solution to improve health, especially maternal and child health, in America. Policies that enhance population health, such as paid parental leave or reducing toxic pollution, would also spur vast and positive change in maternal and child health in particular. The stakes are high: women in the U.S. continue to die of birth-related complications at a much higher rate than do women in other rich nations, and babies in the U.S. are more likely to die in their first year than in comparable countries.

If we cease working toward social policies that value the health of all citizens—of women and men, of mothers and fathers, and of babies and children—the most fitting image for the state of health care in this country will continue to be a thumbs-down.


Miranda R. Waggoner is Assistant Professor of Sociology at Florida State University. Her research has been supported by the National Institutes of Health and the National Science Foundation.


Banned Books Week 2017: What Feminism Means

As part of Banned Books Week, we share a list of recommended titles that promote the freedom to seek and express ideas. UC Press is proud to publish esteemed feminist scholars and activists who argue for inclusivity and social justice in all forms, who advocate for feminism and the movement towards an equal society for all people, without discrimination.

During Banned Books Week (ending September 30), get a 30% discount on these selected titles on Feminism.

Below, enjoy some highlights from our list:

How All Politics Became Reproductive Politics: From Welfare Reform to Foreclosure to Trump
by Laura Briggs

“This book is a tour de force that highlights the failures of neoliberalism for many American families. With intensity and verve, Laura Briggs reveals the crisscrossing binds that constrain women, particularly women of color, queer women, and poor women.”—Alexandra Minna Stern, author of Eugenic Nation and Telling Genes

“Move over Sheryl Sandberg and Anne-Marie Slaughter. Here comes Laura Briggs, who shows how questions of care stand at the center of all politics. Briggs unmasks the racialized, classed, and gendered politics of this neoliberal moment with verve, sophistication, and vision.”—Eileen Boris, coauthor, Caring for America: Home Health Workers in the Shadow of the Welfare State

 

The Big Push: Exposing and Challenging the Persistence of Patriarchy
by Cynthia Enloe

“With Cynthia’s accessible and engaging style, The Big Push shines an important new light on contemporary and historical events.”—Sandra Whitworth, author of Men, Militarism and UN Peacekeeping

“Women and men who care about democracy and social justice need to read this book. Cynthia Enloe’s astute and far-sighted interpretation of ‘sustainable patriarchy’ is just what we need for the feminist struggles unfolding in the twenty-first century.”—Kathryn Kish Sklar, author of Women’s Rights Emerges within the Anti-Slavery Movement, 1830-1870

 

 

Radical Eroticism: Women, Art, and Sex in the 1960s
by Rachel Middleman

“With detailed discussions of the bold ways that heterosexual women artists foregrounded their sexuality as confrontational, critical, and political, Radical Eroticism makes an important contribution to the literature on Sixties art and adds to the revisions of its history that locate sex and gender as defining characteristics of the decade.”—David J. Getsy, Goldabelle McComb Finn Distinguished Professor of Art History, School of the Art Institute of Chicago

“A crucial resource for future studies of contemporary women’s erotic art and the sexual politics of erotic representations.”—Susan Richmond, Associate Professor of Art History, Georgia State University

 

Provocations: A Transnational Reader in the History of Feminist Thought
by Susan Bordo

Provocations is an ambitious, pioneering, interdisciplinary anthology that promises to disrupt hegemonic narratives of the complex histories of feminisms that permeate women’s studies classrooms in the U.S. academy. From the ancient world to the recent Arab Spring, Provocations engages some of the most compelling and contentious debates in the centuries old ‘woman question.’”—Beverly Guy-Sheftall, Anna Julia Cooper Professor of Women’s Studies and Founding Director of the Women’s Research and Resource Center at Spelman College

 

 

Reproductive Justice: An Introduction
by Loretta Ross & Rickie Solinger

“Controlling reproduction and the bodies of women seems to be the first step in every hierarchy. That’s why reproductive justice—women having power over our own bodies—is the crucial first step toward any democracy, any human rights, and any justice.” —Gloria Steinem

“We need to know the history laid out in Reproductive Justice, because we need to not repeat the ugliness of the past. Our strategies need to be inclusive and intersectional.None of us are free until we’re all free.”—Cecile Richards, President, Planned Parenthood Federation of America

 

 

Ronnie Gilbert: A Radical Life in Song
by Ronnie Gilbert with a foreword by Holly Near 

“Activism is just one of the threads winding through this title, along with music, theater, performance, politics, and the challenges of building a life outside of the 20th-century mainstream. . . . Yet it’s the music that shines the brightest in this memoir; Gilbert’s time with the Weavers and her creative partnership with Holly Near bookend a life no less remarkable for being remarkably nonlinear.”—Library Journal

“Gilbert’s memoir brings to life the frightening political climate of the times. . . . We are fortunate that Gilbert took the time to document her singular experiences as a committed activist and singer whose soaring contralto and “dangerous songs” both accompanied and animated the progressive movements of her time.”—San Francisco Chronicle


Most Immigrants Are Women: Does the Trump Administration Want to Deport Them, or Just Keep Them Working for Low Wages?

By Laura Briggs, author of How All Politics Became Reproductive Politics: From Welfare Reform to Foreclosure to Trump

It’s always been unclear whether the goal of the Trump White House was to limit the number of undocumented immigrants in this country, or just to terrorize them and keep them as vulnerable, underpaid workforce, and the recent debate about DACA underscores that fact.

Our economy relies on immigrant labor, and needs it to be cheap—and not just for the reasons most people think. The majority of immigrants to the United States, and nearly half the undocumented population are women, and many of them are doing household labor—cleaning, caring for children, elders, and others who cannot care for themselves. They’re not doing it so the rest of us can have more down time—far from it. On average, everybody is working more. As real wages have declined, the middle class has hung on by throwing more adults into the labor force, mostly women. In 1960, 20 percent of mothers worked. Today, 70 percent of U.S. children live in households where all the adults are employed. So who’s doing the household work? Business certainly has not picked up the tab; workers in the U.S. aren’t even guaranteed sick days, never mind childcare. We haven’t raised taxes for government to pay for it, either. Indeed, the most revealing moments in the debate over the Affordable Care Act repeal were when Republicans admitted that to get Medicaid costs down, sick elders needed to get out of nursing homes and go back to living with their families (read: daughters—Paul Ryan sure wasn’t planning to go part-time to care for his mother.)

So for the whole economic calculus to work—in which women must work, but get paid less than men (to the benefit of their employers), and we don’t raise taxes to pay for government programs, something had to give. This was the brilliance of the 1990s crackdown on undocumented immigrants: it ensured that there a class of women who could be paid even less than women who were citizens, at exactly the moment when the economy most needed them. During the Clinton administration, three key things happened. Walmart became the largest single employer in the country, owing much of their “efficiency” to women’s low wages. The controversy over Zöe Baird’s nomination as attorney general—“Nannygate”—launched a nationwide enforcement crackdown on immigrants without papers, beginning with the couple that Baird was sponsoring for green cards, Lillian and Victor Cordero. And the number of middle class households hiring nannies and housekeepers began to grow exponentially.

Immigration enforcement of the sort the U.S. has been doing since then doesn’t necessarily mean all undocumented immigrants get deported. It may just make them vulnerable, trapping people in exploitative jobs. One mother of triplets told the New York Times why she wanted to hire someone who was undocumented: “I want someone who cannot leave the country… who doesn’t know anyone in New York, who basically does not have a life. I want someone who is completely dependent on me.” While some households just wanted to employ someone who was reliable and “affordable,” others were abusive and even violent. A 2012 study of household workers in fourteen cities found abysmal working conditions, with many reporting sexual harassment, abuse, and assault. Among live-in nannies, many did not even have their own bed; they were expected to sleep with the children in their care. There was also widespread wage theft, with 67% earning less than minimum wage. While race was also a factor, the single best predictor of how much people got paid was immigration status, with undocumented workers earning the least.

There’s a surprisingly clear case to be made that the Trump administration, for all its sound and fury, is not terribly interested in deporting large numbers of people. It’s not only Donald Trump’s personal history of hiring undocumented workers—the fact that Trump Tower was built by people without papers and that his modeling agency relied on them—it’s also what’s happened since he took office. For one thing, when his transition team discovered that his pick for Commerce Secretary, Wilbur Ross, had hired an undocumented household worker—the exact thing Zöe Baird went down for—they didn’t see it as disqualifying. Rather, they had Ross withhold the information until the last minute, in his tightly controlled confirmation hearing. Apparently, the administration was fine with having key positions held by people who were in favor of illegal immigration—at Commerce, at Labor (if they hadn’t been bested by Andrew Pudzer’s critics), and in the Oval Office itself.

Most significantly, the number of deportations under Trump has actually declined, and is on track to be lower than during any year of Obama’s presidency. Arrests and detentions have increased, to be sure. While Obama, the careful lawyer, restricted the actions of ICE to arrest and detain those most likely to be deported, the Trump administration has encouraged aggressive policing, creating terror, and a huge backlog of cases awaiting a hearing in immigration court. “When you go out and you arrest a whole bunch of people willy-nilly [an immigration judge] has got to fill his docket time hearing those arguments,” John Sandweg, acting director of ICE in 2013-14, told Politico. While it’s possible that more judges would mean more deportations, many of the people picked up are later released. In other words, it’s not yet clear whether this is a campaign to make immigrants afraid, or deport them.

This raises a question about all the back and forth about DACA: is the goal really to deport young people, or is it just to raise the flag that the administration is ambivalent about immigrants getting an education and a work permit, instead of remaining part of a permanent underclass of low-paid, illegal workers. One thing is clear: U.S. immigration policy has produced the largest exploitable, deterritorialized labor force since slavery times. Many of them are women, doing “women’s work.” Any effort at immigration reform—whether for the 1 million Dreamers or the estimated 10 million other undocumented immigrants—will have to take account of household and care work. Someone still has to watch the kids.


Laura Briggs is chair and professor of Women, Gender, Sexuality Studies at the University of Massachusetts Amherst and the author of How All Politics Became Reproductive Politics: From Welfare Reform to Foreclosure to TrumphereRead the first chapter .

Watch Laura discuss her book’s thesis, economics, race, and family on last Sunday’s episode of The Open Mind on PBS.

 


Why Jail Can Become a Safety Net for Pregnant Women

As discussions about reproductive justice and women’s rights as human rights continue, we mustn’t forget that these same rights should apply to pregnant women behind bars.

Carolyn Sufrin, author of Jailcare: Finding the Safety Net for Women behind Bars, recently discussed how the repeal of the Affordable Care Act could negatively affect pregnant women in prison—many of whom are women of color and come from low socioeconomic backgrounds. Despite a 1976 Supreme Court Case stating that prisons and jails are constitutionally mandated to provide health care to incarcerated persons, pregnant incarcerated women are still neglected and mistreated.

Many imprisoned women are in jail and prison for non-violent crimes, most times involving drugs. Most recently in an interview with Rewire, Sufrin states: “With the criminalization of drug use during pregnancy, although there was some recent encouraging news in Wisconsin, we have to be concerned that we’re going to see these laws and enforcement increase. Instead of investing in drug treatment and mental health treatment, women are going to be criminalized. The appointment of Jeff Sessions [Attorney General of the United States] and his commitment to roll back the progress of criminal justice system reform are deeply tied to the rollback on health-care reforms and reinvesting in safety net programs. It’s all tied together and only going to make things worse for women in the criminal justice system.”

In Jailcare, Sufrin writes:

Since the 1980s’ escalation of “the war on drugs,” the United States has seen an exponential rise in the number of people behind bars, from 501,886 in 1980 to 2,173,800 in 2015. The U. S. holds only 5 percent of the world’s population, but more than 20 percent of the world’s prisoners. We incarcerate more women than Russia, China, Thailand, and India combined. Blacks have been disproportionately targeted, imprisoned at a rate that is more than five times that of whites, a statistical fact which reflects the continuities between racist criminal justice system policies and plantation slavery and Jim Crow segregation. Amid this expansion, women are the fastest-growing segment of the prison population. And yet incarcerated women and their health needs remain consistently excluded from public discussions of mass incarceration.

Numerous scholars have chronicled the rise of mass imprisonment, arguing that the phenomenon reflects not a response to a rise in violent crime, but the “penal treatment of poverty.” Put simply, where the state once had a strong moral and financial investment in robust public services for the poor, it now invests in an increasingly large and punitive penal system to manage them. The public safety net has failed to help millions of people stabilize lives made precarious by inequality and trauma.

Sufrin believes that “it’s possible to advocate for improved health care inside jails at the same time we advocate for improved services and criminal justice reforms outside of jail. … We can advocate for those kinds of changes while also ensuring that the care [pregnant incarcerated women] receive while they’re in jail meets the community standard of care and is comprehensive. This does not mean that we should make jails less safe or less resourced to provide health care so that we can make communities more resourced. We need to work on both at the same time.”


Carolyn Sufrin is a medical anthropologist and an obstetrician-gynecologist at Johns Hopkins University School of Medicine. Learn more about Jailcare at www.jailcare.org/.