Health care reform is the hurricane of U.S. public debate
this year. Within that debate, access to abortion has been smack dab in the eye
of the storm. Pro-choice advocates are outraged that legislators have sought to
strip us of our ability to retain private insurance coverage for abortion
services. But what of the women who never
had that coverage in the first place? What about the low- income women in our
country who, because of the Hyde Amendment (now considered to be “abortion
neutral” so to speak), never had equal access to abortion? Where do these women
go when they need or want an abortion in this country?
If you said Planned Parenthood, you’d only be partially
right. In some parts of the country, the majority of abortions and much of the
family planning services are actually provided by independent, non-profit,
feminist women’s health centers. Health centers that have been in continuous
existence for upwards of 30 to 35 years.
Health centers that provide the kind of woman-centered, non-judgmental,
empowering care so critical for abortion and other reproductive health related
Lower and middle-income women have relied upon these
independent, non-profit community health centers for years for abortion, birth
control and annual exams. Sure, we think about these clinics when a provider
like Dr. Carhart or Dr. Tiller is targeted, injured or killed by anti-choice
terrorists. We talk around them, discussing the lack of access to abortion
care, the problems with forcing women to view ultrasounds, how many providers
are left in this country and where they are located, how much it costs for a
woman to have an abortion, and how far she has to travel.
But how many of us actually think about our country’s
original basic reproductive health service providers, the architects of the
movement for informed, empowered, self-directed health care? These centers and
the women who staff them (many of whom have been there for 15, 20 and 25 years)
are pioneers quietly existing, on the periphery of our awareness; struggling
for the funding and resources necessary to continue providing optimal care to
mostly lower- and middle-income women in this nation. What many don’t realize
is that most, if not all, of these health centers are not solely abortion
providers. These community centers engage in extensive outreach, community
education, provider education and training, family planning services including
contraception, HIV/AIDS testing and more.
We can do all of the lobbying, grassroots advocacy and
activism in the world but in the end, if we don’t have providers and centers to
provide women with quality abortion care and related health services, what’s
Back in 2007, I wrote a two-part series entitled, “Life
Support for Feminist Health Care?”, during the closure of Aradia Women’s Health Center, the 34 year-old,
non-profit, women’s health center at which I worked for seven years. The
center, like all of the original feminist health centers in this country,
opened its doors in response to community need – i.e., responding to what
women, immediately before and after abortion was legalized, needed and wanted
but weren’t getting in terms of reproductive and sexual health services. You
could say feminist health centers were (and continue to be) both political and
health care related ventures, for sure.
At that time, with Aradia Women’s Health Center closing its doors due to rising
numbers of low-income women as clients with little or no insurance coverage,
decreasing Medicaid reimbursement, as well as the continued difficulty of
finding funding streams, and only fourteen independent, abortion-providing,
feminist health care centers in a similar boat remaining, I was feeling rather
hopeless that these centers would live on.
In 2007, I wrote, “…it is astonishing that so many still
don’t recognize the feminist women’s health movement’s many contributions to
the healthcare landscape in general and to women’s lives in particular. It’s a
shame, because it seems that we may be heading toward the end of an
identifiable era of great value to women in America.” After speaking with two
amazing women who have been doing this work for a combined total of 33 years,
both of whom have been integral to the creation of what’s now called the Feminist Abortion Network (FAN), a
network of these remaining independently operated, feminist health centers, I
am more convinced than ever that there is hope on the horizon for feminist
health care and the non-profit health centers that keep feminist care alive and
well, if we can address some key issues within health care reform, namely
Medicaid reimbursement and the importance of a public option to ensure that all
Americans receive coverage for care.
Kudra MacCaillech of Concord Feminist Health
Center in New Hampshire and Joan Schrammeck of Cedar River Clinics
in Washington, both agreed to speak with me about the formation of FAN, what
it’s like keeping independent, feminist women’s health centers alive and viable
and their hopes and dreams for the future of feminist care in general.
Kudra and Joan have coordinated their respective feminist
health center’s development, outreach and communications activities for more
than 15 years – one on the East Coast, the other on the West Coast. Both
organizations have been on the front lines providing abortion and many other
reproductive health services over 35-years.
Why did FAN form?
KUDRA: About five years ago, leaders in our
feminist women’s health centers (FWHCs) from various parts of country started
reaching out to each other, engaging one another in ideas and dreams for our
future. Though we weren’t
strangers (some of us were acquainted through regional or national initiatives)
we didn’t really consider ourselves “connected.”
I can’t say what inspired the “click” to connect, but that’s
exactly what it felt like. It was
exciting, but also very focused and coordinated. Initially, we were brainstorming ways to collaborate
on projects and funding; projects that had not only the potential to impact the
clinics in our own states and communities – but
every FWHC across the entire country.
Oddly, even we weren’t sure how many centers remained or
where we were located. So, the next logical step was a census of FWHCs in the
U.S. We sought out clinics that
were nonprofit, feminist in roots and philosophy, independent of a larger
corporate or institutional umbrella and were committed to providing abortion
It is worth mentioning how struck we were by the number of
FHWCs that over the last decade either closed or were left with no viable
alternative other than merger. In
this relatively short span of time, FWHC’s ceased operations in Burlington, VT,
Tallahassee, FL, Philadelphia, PA, and Eugene and Portland, OR. [Ed. Note: At FAN’s formation, Aradia
Women’s Health in Seattle, WA and A Woman’s Choice Clinic in Oakland, CA were
operating. Both centers have since
closed their doors.]
Through this exercise of identifying the FWHCs, we
discovered that despite our organizations operating totally independent of one
another, we were remarkably similar in structure, philosophy and not
surprisingly…challenges. As the group began to take shape, it became clear that
collectively, we possessed an enormous amount of experience, expertise and
resources – we were all on the forefront of social and reproductive justice
efforts in our states and regions.
Tell me about
feminist health centers and what you hope to accomplish with FAN.
JOAN: Each of our
FWHCs has long been committed to notion that independence is the best way to ensure responsiveness to our community’s needs. We also
firmly believe that ultimately, it will be our independence that ensures
abortion services remain affordable and accessible to women in communities
across the country.
Safe, compassionate and professional abortion services will
remain a top priority in our mission and services. In the years after Roe v.
Wade, in true grassroots feminist activism, without waiting for someone to give
them permission– each of our organizations was founded by local women who saw a
need and said, “Let’s start a clinic.” Our priority and promise today is the
same as it was nearly 40 years ago.
For all FAN clinics, women’s autonomy and
right to abortion is simply not up for negotiation.
Kudra: And, in
practical terms, FAN is our
conduit for connection. It
celebrates our independence at the same time it supports and encourages our interdependence. A major focus for this group is sharing resources and
information among members, whereby building stronger, more effective and
responsive FWHCs throughout the nation.
And of course, in working together we can be that much more effective in
our work informing public health policies, challenging legislative and
regulatory attacks on women’s rights, educating in our communities,
contributing to the national pro-choice conversations and agenda and perhaps
most importantly, raising the voices and experiences of the women who need and
deserve our care.
In current health
reform discussions, we hear about the fact that for many providers (not just
abortion providers), Medicaid reimbursement is too low to maintain providing
care for lower income Americans. How do you all do it and remain viable?
Kudra: In terms
of Medicaid and abortion coverage, it cannot be overstated how acutely
low-income women, struggling single mothers, women of color and young women and
feel the injustice of the Hyde Amendment’s ban on coverage for abortion care.
It is for this very reason that that FAN members uphold a
commitment to never denying a woman an abortion for lack of resources and
maintain internal women-in-need-funds.
For decades FAN clinics have been waiving and reducing fees,
collectively accounting for hundreds of thousands of dollars in subsidized
health care costs each year. We do
so with the support of outstanding organizations like the National Network of Abortion Funds, and of course,
generous individuals and foundations.
Even still, there is a significant unmet need and one that will only
become more problematic, should Congress restrict or deny coverage in the final
health care reform package.
Joan: Beyond abortion care, there
exists a huge challenge in making a
nonprofit successful when the majority of its clients are Medicaid
recipients. But with that said, I
believe that the nonprofit model of health care is the best option for the
whole nation. Primary care should be not-for-profit.
The whole country is looking at this question – where is
for-profit care taking us? It’s already brought about this chasm so that the
wealthy people have insurance and low income people, women needing reproductive
and sexual health care, don’t get it and need to reach into their pockets to
access care or go without. Our
nation and current health care reforms should be moving more towards the
feminist model of health care delivery.
This would look like:
information in a safe, supportive environment.
that every client has the opportunity to have all her/his questions answered so
they may give genuine informed consent.
empowered decision making (A.K.A. the client knows her/himself best and is
capable of making good decisions, if given accurate and unbiased information).
- And, something that is
all too rare in health care these days, taking as much time as each person
Is feminist health
care a wonderful health care model but not such a great business model? And if
so, is there something we can do to change that? Is there a way to provide
feminist care AND be more profitable?
Kudra: I have
thought about this question a lot, and as Joan points out, we believe that the
nonprofit and feminist model is a just and humanitarian approach. And I wonder if it were widely accepted
and adopted, if we would find that when people are engaged in the decisions
that affect them, and are trusted in the choices they make for themselves, and
are given real options, support and compassion, there would be enormous health
For now, I’m not sure that the business struggles of small
feminist health centers are much different than any small health care provider trying to remain independent in this
climate. In this way, we’re not
unique; there are hosts of challenges that private physician practices or
clinics must overcome in the face the corporatization of heath care. In my state for example, there are very
few independent OB/GYN or Family Practices physicians able to remain
competitive and similar to FWHCs, are often left with no option but to close or
merge with larger institutions.
It makes me think about the idea of diversity in health care
delivery; the value we place on people having more than one option for where
and how to receive care if they are consumers, or provide the care if they are
health professionals. Perhaps we
might think of this in the way that we think of biodiversity. Why is biodiversity to crucial? Because we know there are significant negative
consequences when a species is lost, and that once we lose it, there is high improbability that we will ever get it
I think there is a critical role to be played by the diverse
and distinct types of providers we still have in our “health care ecosystem”
and that we should consider what might be the consequences of their
disappearance and absorption into the corporate conglomerate.
Joan, if one out of
three women in this country have abortions, why do we continue to see such
vicious anti-choice legislation on the table? Why don’t women who have had
abortions speak up more?
Joan: The stigma
that the anti-choice people have put on abortion through years and years and
years of horrible, ugly picket signs, calling abortion doctors murderers and
then actually murdering doctors has really put a stigma on anything having to
do with abortion. And the pro-choice side continues to search for a unifying
message and theme to reclaim the moral position as well as to integrate
abortion into the full realm of women’s experiences. It’s important to repeat
the statistic that one out of three women will have an abortion in this
country. Eighty-five percent of
women will get pregnant and have a baby. Everything
about pregnancy belongs to woman. Abortion is one of the paths she might
choose but that it’s her decision.
Have you seen a
change in who is accessing the care you provide over the years?
Joan: Most of the
women who access abortion are young – in early adulthood, between twenty and
twenty-five years old. They don’t necessarily have insurance or a full time
career path type of job so they are more than likely reaching into their own
pockets to pay for care (including annual exams, STI testing and treatment,
birth control and family planning). The change, we’re seeing, is that it’s more
and more lower income women who are coming to our feminist community
All of our FAN clinics have the reputation as compassionate
safety net providers. As a result,
we are also seeing a new trend in large numbers of resettled refugee and
immigrant women referred to us. We
believe that language shouldn’t be a barrier to care, and so next year, Cedar
River Clinics budgeted $70,000 in interpreter fees alone. This is a concrete example of the
feminist model of care – – and it is this sort of responsive and responsible
approach that we hope to see in the health care reforms.
We hear often that
there are dwindling numbers of medical students or younger providers willing to
provide abortions. Is this true and what can we do about that?
Joan: In terms of
the mid-pregnancy, fetal anomaly services that Dr. Tiller provided and Dr.
Carhart continues to provide, yes, there is
a shortage of people willing to take on those responsibilities. As rare as
those abortions are, we need them in more than one place in country.
In addition, because public health clinics are closing due to state and county
budget cuts, we will see more women for both abortions and for preventive, routine well-woman care and birth control. In
fact, we are planning in Renton to start offering walk-in well woman care next
year to make it more easily accessible.
Is there anything
else you both would like to mention?
Joan: It’s a
value of our organizations to retain our independence from hospitals or
universities or other institutions, because that is how we retain our dedication
to our local community, to the needs of local women. We worry that if we chose
to merge with some other larger institution, abortion services would be the
first thing to get cut. We are here, first and foremost, to serve the women of
our communities. Through FAN we strengthen each of our organization’s abilities
Kudra: I totally
agree. We knew that in discovering each other again, were holding something
special and quite possibly, something irreplaceable
in our hands. Something that with
a little wit and will, has the capacity to ensure not only that our clinics
thrive, but that the feminist health agenda is advanced nationwide.
Rather than contracting in the face of our challenges, we’re
choosing to clasp hands and expand.
It’s just so exciting to be part of a renaissance happening within our
reproductive justice and feminist movements.
Mountain Clinic – Missoula, MT est. 1976
Boulder Valley Women’s Health Center
– Boulder, CO est. 1973
Cedar River Clinics
– Tacoma, Renton & Yakima, WA & est. Aug. 1979
Concord Feminist Health
Center – Concord, NH est. Oct. 1974
Emma Goldman Clinic – Iowa City, IA est.
Feminist Women’s Health Center – Atlanta,
GA est. 1977
Feminist Health Center of Portsmouth
– Portsmouth, NH est. 1980
Women’s Health Centers of California – Chico, Redding, Sacramento &
Santa Rosa est. Feb. 1974
Mabel Wadsworth Women’s Health Center
– Bangor, ME est. 1984
Memphis Center for Reproductive
Health – Memphis, TN est. 1974
Midwest Health Center for Women
– Minneapolis, MN est. Sept. 1975
Preterm – Cleveland OH
Women’s Health Center of West Virginia –
Charleston, WV est. 1976
Center PA – Duluth, MN est. April 1981
For more information on the Feminist Abortion Network or to
find a clinic near you, visit the FAN