Comprehensive health care reform should give all Americans affordable access to care and prevention. But will health reform give women access to the services we need, including reproductive health care? Only if we're on the front lines helping shape health reform policy.

This summer, women's health and reproductive justice advocates are working hard to ensure that health reform is a top issue in this election year. From grassroots efforts and rallies in state capitals to big-budget national media campaigns, women are making our voices heard. "If we want health reform to meet our needs, we've got to speak up, get involved and make sure we have a place at the table," says Byllye Avery, co-founder of Raising Women's Voices and founder of the Black Women's Health Imperative and the Avery Institute for Social Change.

Avery's Raising Women's Voices for the Health Care We Need has launched a national action campaign aimed at mobilizing grassroots women to speak out at Congressional town hall meetings and candidate forums about problems in the current health system and the need for health reform. The campaign emphasizes women's roles as health decision-makers and coordinators of care for entire families, positioning women as sources of "kitchen table wisdom" about what's wrong with the health system and how it might be fixed.

Meanwhile, in Washington, a number of women's health organizations have become actively involved in broad-based progressive health reform coalitions, even though these coalitions have not explicitly endorsed access to comprehensive reproductive health services. The National Women's Law Center and the Planned Parenthood Federation of America have joined the steering committee of Health Care for America Now, a coalition of progressive organizations and unions that is mounting a $40 million media campaign to promote what it calls an "American solution that provides quality, affordable health care for everyone." That American solution? To allow Americans to keep the health insurance they have, pick a new insurance plan or join a public health insurance plan.

A $500,000 commitment per steering committee member, along with a $10 million grant from The Atlantic Philanthropies, kicked off HCAN, which represents the mainstream progressive push for health care reform heading into a new national administration in 2009. Other steering committee members include ACORN, Americans United for Change, Campaign for America's Future, Center for American Progress Action Fund, Center for Community Change, MoveOn.org, USAction and several big unions.

Not represented in HCAN are the major organizations advocating a "single-payer" national health insurance system administered by the government, such as the 15,000-member Physicians for a National Health Program (though some smaller single-payer groups have joined). Also absent from the HCAN coalition is the high-profile Washington, D.C- based consumer health organization Families USA, which recently announced "a brand new action project called Stand Up for Health Care -- with the goal of persuading our elected leaders to provide quality and affordable health care for all." And yet another organization -- the Universal Health Care Action Network -- is concentrating its efforts on "building active unity" among the various health reform campaigns, so that leaders of the progressive community don't squander an historic opportunity to make change by fighting each other.

Will Reproductive Health Care Services Be Included in Health Reform?

There are no guarantees. But the presence of PPFA and NWLC on the steering committee of HCAN ensures that women's concerns and reproductive health issues will be raised in the inner circles of the high-visibility health reform campaign. NWLC Co-President Marcia Greenberger and PPFA President Cecile Richards spoke at the Washington, D.C., HCAN launch event, and women representing affiliates of PPFA had speaking roles at some of the rallies HCAN sponsored in 38 state capitols.

While HCAN's "Statement of Common Purpose" does not explicitly advocate for comprehensive reproductive health services, it does call for "a standard for health benefits that covers what people need to keep healthy and to be treated when they are ill" and explains that health benefits "should cover all necessary care including preventive services..." While those benefits have not been defined, women's health leaders are expecting that their presence at the table will make a difference in whether reproductive health services are explicitly included.

It's equally important to note which organizations are not in the HCAN coalition: the powerful anti-choice faith-based organizations like the U.S. Conference of Catholic Bishops and the major Catholic health systems. In recent years, some progressive health reform groups have sought "common ground" with these religious organizations by deciding to stay silent on reproductive rights and instead emphasizing such noncontroversial issues as children's health care.

That strategy has alarmed reproductive justice advocates because religious conservatives' view of health reform does not include abortion or contraception (or even referrals for these services), but does include explicit protections for doctors and hospitals who refuse to provide reproductive health services.

The Raising Women's Voices Vision

Raising Women's Voices, while participating in HCAN as a member, has issued its own vision of health reform that explicitly calls for "provision of the full range of women's health and reproductive health services," including, at a minimum, maternity care, pre and post-natal care, contraception, abortion, treatment and prevention of sexually transmitted diseases and infertility treatment. RWV also calls for the provision of comprehensive sex education as part of health care, not just in schools.

"Reproductive health care is not the only issue we address, but it is an important feature of our vision of quality, affordable health care for all," says Eesha Pandit of The MergerWatch Project, one of the three organizations that co-founded RWV. "We are placing reproductive health just where it should be - as an integral part of primary and preventive health care for women."

Choosing Issues and Strategies

"Americans know that the last people we can trust to fix the health care mess are insurance companies," HCAN National Campaign Manager Richard Kirsch says. HCAN's website declares war on the insurance companies: "Taking on a multi-billion dollar industry means TV advertising and massive organizing. We'll need serious money to take these guys on." The group is also using Internet outreach (such as by HCAN member MoveOn.org and through an on-line petition drive on the HCAN website) and old-fashioned community organizing through HCAN members' chapters and affiliates around the country. And HCAN is employing organizers in 45 states to ensure lots of activity as the election nears.

Where HCAN is guided by a high-profile steering committee and has the resources to make large media buys, RWV's emphasis is on building support for health reform from the grassroots up and ensuring that individual women's voices are heard. The Raising Women's Voices campaign held listening sessions with small groups of grassroots women and girls of all ages and from diverse racial, ethnic and income groups. Participants have voiced concerns about such issues as the high price of birth control, the refusal by some health insurers to cover midwifery services, the pressure on pregnant women to have cesarean sections, the desperate need for support services for family caregivers (often women) and the impact of the Hyde amendment ban on access to abortion services for Medicaid recipients. The RWV vision statement, as a result, encompasses the health needs of women and their families across the lifespan.

Like HCAN, the RWV 2008 Action Campaign is also focusing, in part, on insurance company practices - but specifically from a woman's perspective. One of the campaign's three key focuses is the fact that women are being denied individual insurance policies (or charged more for them) because of pre-existing conditions that can include breast cancer, pregnancy and even having had a cesarean section.

"When women find out they can be denied health coverage because they are pregnant, or because they had breast cancer, they are just outraged," says pollster Celinda Lake, who helped brief RWV advocates on the issue of pre-existing conditions.

RWV's campaign also addresses two other issues:

• Making health coverage affordable for women and families. "Women are being hurt badly by the high cost of health insurance -- many can't afford to buy health insurance any longer. And even women who have insurance are going without the health care they need because insurance companies are finding more and more ways to shift costs to consumers," says RWV's Cindy Pearson, Director of the National Women's Health Network, the third RWV founding organization.

• Insisting that health reform plans must actively work to end health disparities. "Getting health coverage for underserved women is definitely the first step toward eliminating disparities, but it can't be the only step," RWV's Byllye Avery says. "We know that even when people have the exact same health coverage, such as Medicare, some of the people still get second-class health care."

The group has prepared fact sheets and talking points on all the campaign issues and is recruiting regional coordinators in locations across the country. RWV's 26 advisory board members, ranging from the Black Women's Health Imperative, the National Latina Institute for Reproductive Health and the National Asian Pacific American Women's Forum to Our Bodies, Ourselves and the National Coalition for LGBT Health, are leading outreach to women of color, lesbians and other groups of women often left out of health policy debates.

Both Raising Women's Voices and the National Women's Law Center have been working to inform women about health reform plans and to prepare them to actively participate in debates and legislative struggles over expanding access to health care. In 2009, when health reform hits state legislatures and, let's hope, Capitol Hill in Washington, women's health advocates will know whether their efforts to work with consumer health groups this election year will pave the way for health reform that meets all of women's health needs.