Comprehensive Reproductive Healthcare for Women

It just so happens that Honey Alexander, wife of Senator Lamar Alexander, was the first name on my list. As I read her bio, I couldn’t help thinking that we would probably agree on many issues, especially those impacting children. This letter asks wives of senators to prevail upon their husbands to consider healthcare from a woman’s point-of-view. I decided to name this letter DEAR HONEY, underscoring the role wives play in the consciousness of their husbands.

A note from MadamaAmbi, author of this letter.

August 2009

As the wife of a powerful legislator, you also have power. You can be the ultimate persuader. If you have always had good health care, good luck and the kindness of strangers, you may not know how some women in the United States suffer. We put before you the voices of a doctor as well as a small sample of stories from women who belong to Feminist Advisory Board for Obama (FAB), and we ask that you advocate for these women merely by discussing these issues with your husband.

In American Forum’s nationally distributed op-ed., Dr. Ralph Riviello cautions us against separating comprehensive reproductive healthcare from a woman’s overall health and welfare. Dr. Riviello is a board member of Physicians for Reproductive Choice and Health, as well as an attending physician at Hahnemann University Hospital in Philadelphia.

"Recently I saw a pregnant woman I will call Lillian, a 22-year-old who brought her two children with her to the ER. Lillian has a full-time job whose health insurance doesn’t cover pregnancy. She can’t afford to cover herself and her family on the individual market, and she makes too much money to qualify for Medicaid. Lillian came to the ER because she wants to make sure her baby is okay. A friend with better insurance advised her that she should have an ultrasound.

I discharged Lillian with worry. I know that she will have a difficult time finding standard prenatal care. Without that help, she and her baby are at much higher risk for complications, like low birth weight, that can turn into tragedy. Or Lillian’s health might suffer. I am embarrassed by how many women die in childbirth in the U.S. — at 15.1 maternal deaths per 100,000 live births, our rate is higher than most developed nations.

Most women in America will spend roughly 35 years of her life preventing pregnancy, trying to become pregnant, having children, or recovering from pregnancy. She might also face a sexually transmitted disease — or a common condition of the reproductive system, like fibroids or polyps. Her health insurance will not help her with any of these basic needs, yet we still call it health insurance. Although women comprise more titan half of the U.S. population, many insurers treat their medical care as an exception to the rule, charging them more, to stay healthy than men and refusing to cover basic reproductive services.

When women do not receive gynecological care, they get sick when they could have easily and inexpensively been kept well. Just as she needs to be in good cardiovascular health, a woman must be in good reproductive health whether or not she is trying to got pregnant. An undetected problem in the reproductive system can have devastating consequences. Two of my colleagues have had patients who went without ob/gyn checkups because they could not afford health insurance. By the time they saw a doctor, their cervical cancer had already spread too far to save their lives. One of these women was in her 50′s. The other was 28. A woman’s reproductive health affects her throughout her life; it is inextricable from her overall well-being. Reproductive health care is a necessity that too many women have gone without for too long. And when women get sick and die, their children feel the impact, as do their spouses, employers, and everyone else who depends on them.

I was disappointed but not surprised by the following survey finding: 52 percent of women in our country did not visit a doctor when they had a medical problem or went without a needed prescription or follow-up care because they could not afford these services. I have worked in Philadelphia’s emergency rooms since 2002. where I have treated women of all ages who have nowhere else to go for fundamental care. Every day our department treats at least 10 women who come to the ER for pregnancy tests and ultrasounds. These women have to pretend that they have emergency stomach pain or bleeding so that they can get a little bit of obstetric attention.

In the rush to develop legislation for health care reform, our senators and representatives must not forget the health of half their constituents. Every private and public insurance plan must guarantee the same set of reproductive services to every woman. We can’t keep Lillian and the rest of the women in this country healthy and alive without taking care of their reproductive health."

Ralph Riviello, MD, quoted with permission from American Forum.

Lynn Morris, a mother and grandmother writes:

"My daughter was diagnosed with breast cancer when she was pregnant with my first grandson five years ago. Thank God both are healthy today. Cancer is something that is occurring in many young women. If this pregnancy had not been in the second trimester they couldn’t have saved my daughter’s life or the life of the baby. She had to undergo chemotherapy while my grandson was in the womb. At the time it was a nightmare.

We need think of abortion in this context. What if it was necessary to save the life of the mother? I think some of these young women need to go before Congress, No one has the right to make decisions for women like this. Can you imagine the health care bills these young women have already? My daughter’s bill is like a house payment that never ends. These young women would die because they can’t be treated."

Lisa Nicholson on the difference between a therapeutic abortion and an illegal one:

"Back in the late sixties, I worked at the University of Alabama in Birmingham Hospital as a candy striper. I was going to nursing school and wanted to get some experience. One of my assignments was the admitting office.

A diagnosis that, came in fairly often was TAB.  They were always white women, well-dressed, beautiful hair and nails, usually a fur coat if it was winter, and always a private doctor. I never could find out what that acronym stood for. No one wanted to share. Eventually, an intern on the ob-gyn floor told me it stood for therapeutic abortion. He also explained it didn’t necessarily mean something was wrong with the mother or the fetus (I asked, because the woman I had just admitted wasn’t sick looking).

I thought about all the poor women, white and black, that I had gone with to the ER to get admitted after a coat hanger back alley abortion. There are moments in a life that are never to be forgotten, and learning about class differences and health care differences in that way was one of those moments. My daughter has tried for years to have a child. She has had five unsuccessful IUI procedures. She has used fertility drugs. I have lost children to miscarriage and used fertility drugs to conceive. I understand the value of a pregnancy on many levels, both as a parent, a grandparent, and a labor and delivery nurse.

Abortion is not for me, BUT, I will defend to the death anyone’s right to have a safe and legal abortion and a doctor’s right to give someone that abortion and have it covered by insurance. The lies and scare tactics being used make me sick and angry. I just wish that everyone would remember that there were abortions before they were legal. There were also many, many tragedies—hemorrhaging to death, septicemia, ruptured uterus, etc., because they didn’t have insurance or a doctor to do a TAB."

Lisa Nicholson, mother, grandmother, labor and delivery nurse.

Thank you for listening to our stories.

MadamaAmbi, Activist Artist, Feminist Advisory Board for Obama
Joanne Bamberger, Founder, PunditMom
Gloria Feldt, Activist and Author
Stephanie Himel-Nelson, Lawyer Mama
Jen Nedeau, Women’s Rights Activist, Change.org
Amie Newman, Managing Editor, RH Reality Check

Also published on RH Reality Check and Change.org