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.


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/.