Women, Capitalism, and the Ongoing Attacks On Bodily Autonomy and Reproductive Rights

By Karina Garcia

This article was originally published in the Autumn 2019 issue of Breaking the Chains magazine, titled “Not a Moral Issue.”

Thirteen years ago, a speaker at a meeting, addressing the right-wing attacks on women’s rights in the context of the Affordable Care Act, also known as Obamacare, emphasized how important it was to elect pro-choice Democrats. The speaker gave no further explanation to the attacks.

At the time, the right-wing was attacking the ACA because it would expand abortion and contraception access. A couple years after it became law, the Supreme Court had already restricted access to birth control to “respect the religious beliefs” of corporations vis-a-vis reactionary owners. And to pass the ACA, the Democrats gladly compromised on reproductive rights. Obamacare ultimately continued to deny federal funds for abortion coverage and required that every state offer at least one insurance plan that did not cover abortions.

At the meeting, a young socialist woman spoke from the floor and criticized the speaker for not raising the “systematic” explanation. She said that capitalism was behind these patriarchal policies. She said that the bosses—the capitalists—want to restrict birth control and abortion because they want the working class to produce more workers and thereby drive down wages. On top of that, they want to pay less in healthcare costs to cover their employees. I remember nodding in the moment that indeed there must be a deeper cause. I knew capitalism as a system was implicated. What she was saying had a logic to it. But when I went home it started to make a lot less sense.

Do the capitalists really need more workers? Millions of people are unemployed as it is and they are incarcerating the “surplus” population. Is it really possible that the capitalists would conspire in this way to restrict abortion rights, but none of them would ever slip up and admit it? Why is it that some Democrats support abortion rights then? They too represent the capitalist class’s interests. It can’t just be about forcing women to produce more workers.

And as for costs and profits, the Affordable Care Act was going to make insurance companies, the healthcare sector, and the banks mega-profits with or without abortion coverage, so why try to tank the bill on that basis? It wasn’t really only about profit either.

She was right that the attack was “systematic” and that these sexist policies are linked to capitalism, but there seemed to be more to the answer than she’d presented. I dove into the Marxist and historical writing about the anti-abortion movement because I wanted to understand this and be able to explain it—for myself and others.

The Marxist approach to women’s oppression and liberation is often misunderstood or mischaracterized. In university settings it is portrayed as “economic determinism” or “reductionism” — asserting that Marxists reduce every issue to economics. In a way, that’s what the socialist speaking from the floor was doing in that meeting. But that’s not an accurate description of the Marxist method.

It is true that Marxists emphasize the importance of the economic system, in that the mode of production plays a critical role in shaping the economic system and the structures of society. Marxists start by looking at how a society produces and reproduces itself and the norms, laws and relationships under which production and reproduction take place. That is what “economics” really means anyway. At its base, every society is engaged in producing and reproducing.

The ideas, laws, formal institutions, religions that justify, strengthen, and stabilize those underlying processes and relations at the base of production and reproduction is what Marx called the superstructure.

The capitalist mode of production and the family

So for instance, under capitalism, there are some people who own the means of production (land, factories, technology, etc.), while others go to work every day and work on those means of production. They generate profits that go back to the owners. That exploitation is at the base of society. But that arrangement would not last a single day if it was not backed up by the laws, the courts and the police—which protect the owners and landlords—and by the schools, media, politicians, and religious institutions that have taught us since day one that this is the normal and perfectly natural way of things.

The capitalist mode of production developed historically out of previous modes of production, including slavery and feudalism. Capitalism represented a major change in the dominant form of property and labor and many other things changed as a result of that. Racism and white supremacy are part and parcel of the foundation of modern capitalism. In the case of the United States, colonial dispossession and racialized chattel slavery are the foundations for the accumulation of wealth within the capitalist mode of production.

Capitalism did not simply erase the pre-existing world and start with a blank slate. Patriarchy has existed since the dawn of class society and is part of the fabric of the capitalist system. In pre-class society, before private ownership of property there was a much more diverse set of family arrangements and women generally played a leadership role for the community as a whole.

After those pre-class modes of production were overthrown, and eventually the forms of social and family organization alongside them, women were held in a subordinate position and male supremacy became the law. For thousands of years, women’s basic conditions and status were confined to the home. Law, custom, and ideology held women to a dependent status and entirely subject to the whims of the leading male in the family. Housework and child rearing, in addition to ongoing work in the fields (in the case of agricultural societies), were delineated as “women’s work.” This was a central element to modes of production based on private property.

In the United States, today, the capitalist mode of production has changed in many ways, as has the shape and detail of the superstructure. Yet core historic features persist. While women can enter the wage workforce and women can legally own property and have independent political and civil rights, the basic unit of what has been called social reproduction is the nuclear family. In that family, women carry out the vast majority of the labor in the household, in child rearing, and in elder care. Because this family form has been carried over in its essential characteristics, all the values, traditions, and cultural norms that developed to explain and justify male supremacy have been largely carried over, too.

While capitalism has broken down many of the economic relationships that were at the heart of a nuclear family, the family has not been abolished or collapsed entirely. The family unit has changed, but the precarious existence of workers under capitalism makes it necessary for most workers to have a family to survive. One income is not enough. Take, for example, the conditions of so many LGBTQ youth who have been rejected by their families. To not have a family is, in these instances, to be subjected to the worst forms of deprivation, homelessness, and brutality that capitalism has to offer.

For the purposes of the capitalist system, the family unit is highly valuable—especially as it relates to the reproduction and caring for the next generation of workers. Lisa Vogel highlights this in her social reproduction theory [1]. Others have taken it in different directions, highlighting the other forms of labor that are often unpaid or underpaid, but are nonetheless essential for reproducing a workforce that is healthy and stable enough to continue to come into work.

Reactionary worldview explains economic shifts

How does this relate to the attacks on women’s rights and attacks on women’s growing assertiveness in challenging sexual violence and sexist rhetoric? These don’t present themselves as issues of the basic functioning of the mode of production. They can appear distinct and separate, so people fighting for women’s rights on these fronts might not see the linkage to capitalism. And yet more and more activists are talking about systemic patriarchy. The Party for Socialism and Liberation banners, “The whole system is sexist! Fight for socialism!” have been very popular in these movements.

Here we are talking about struggles in the world of politics and culture, the superstructure [2]. They appear as fights within capitalism—in the sense that you should be able to fight for and achieve full abortion rights and other reproductive services under capitalism. In some countries that already exists. You should be able to reduce sexual harassment or violence or eliminate it altogether under capitalism. At least, in theory, it is not pivotal to the mode of production.

But if that is the case, why are those gains so hard to win? Why do socialists insist a revolution would be necessary to really achieve them? It’s because the domination of women remains a pillar of the U.S. capitalist class’s form of rule.

Abortion access became a major political issue starting in the late 1970s as a cornerstone of an emerging reactionary trend. A reactionary is someone who says that things were better in society before they changed. “Make America Great Again” is a true reactionary slogan. It implies we should return to the past. Big sections of the ruling class turn to a reactionary agenda when they feel that their social control is slipping in the face of a powerful social movement, or when capitalism itself has destabilized the economy and when life seems more uncertain for big sections of the population.

In the late 1970s, both were happening in the United States. The mass uprisings of the 1960s and early 70s with the struggles for women’s liberation, Black liberation, LGBTQ liberation, and the anti-war movement were powerful challenges to the U.S. capitalist status quo. The Vietnamese anti-colonial resistance defeated U.S. imperialism, dealing it a major blow while imperialism was engaged in constant heated confrontation with the socialist bloc.

The U.S. economy also went into a period of recession during which layoffs and unemployment increased, consumer spending decreased. Capitalist recessions are cyclical and occur regularly because of overproduction. From 1979 to 1984, approximately 11.5 million workers either lost their jobs or shifted to lower-paying service jobs. Most of the jobs that were lost were in manufacturing industries such as steel, auto, mining, electronics, and more.

The reactionaries have a very powerful appeal and socialists should understand how it works. They say essentially, “Your life used to be better, right? You’re feeling less sure about your future right? Well, that’s understandable because look at how much has changed. We’ve lost our way. And now we’re going to hell in a hand-basket unless we turn back.” Then they link that to whatever issue, whether it be abortion, sex education, gay rights, and so on. The reactionaries sometimes blame the “weak” government, which has bent to pressure and refused to defend “our values, while at other times attacking the government for being “too big.”

Another example is how the economic ravaging of whole Black communities is laid at the feet of Black women for “having too many children out of wedlock,” or at the feet of “absent” Black males. This reactionary worldview builds upon the extreme racist character of the U.S. capitalist system along with thousands of years of ingrained cultural indoctrination that with a “strong” family—that is with men and women in their “proper place”—everything will be fine.

This sort of reactionary worldview offers an all-purpose explanation for general problems or unsettling changes. Politicians then conveniently avoid discussion of the actual causes of social and economic distress, i.e., capitalist instability. It furthermore coincides with and makes use of the explanations being cultivated in conservative religious institutions, which tend to focus on going back to a more moral time, and theorize the problems of modern society as a reflection of an absence of godliness and values. So these ideas and theories are already circulating and can easily be picked up on by a politician who wants to present himself as a champion of “family values” while not actually doing anything to change families’ material conditions.

And so the “New Right,” ascending in the Republican Party in the late 1970s, started to really focus on abortion in the 1980s and 1990s. Abortion rights were identified as a weak spot for the women’s movement because it had been secured in the Supreme Court in Roe v Wade, not via legislation. There was existing opposition on religious grounds that they could mobilize, and there were big parts of the country where abortion rights had become law but the movement was weak.

Evangelical mega-churches and televangelists were entering politics in a big way—most famously in the “Moral Majority”—and eventually became significant power-brokers that handpicked and groomed elected representatives. They delivered considerable resources and a captive audience to enterprising politicians, as long as they took on their issues and their framing. The whole Moral Majority movement became a target base of support for hard-right capitalists who personally did not care much about abortion or other moral issues, but who wanted to turn back government regulations, social spending, and the power of labor unions. Over time, this relationship produced a major pipeline of campaign funds and airtime.

In short, abortion became a preferred electoral issue, quickly moving from local and state to federal politics. Right-wing politicians could portray pro-choice Democrats as ‘baby killers’ and link them to the “decline of the family.” It is not so much that these issues in and of themselves threaten capitalists profits, but that they offered a way for one sector of the capitalist class—leaning on the powerful institutions of the superstructure in their areas to consolidate political legitimacy—to distract constituents from social and economic concerns that the politicians have no desire to address.

It became a central political strategy for the conservative right. The Republican Party used to be considered just the “pro-business” and “law-and-order” party. Some were actually liberal on “social issues.” But as the party moved further to the right, that has changed.

In the United States, where money controls so much of politics, the agenda is set by the highest bidder. With the near obliteration of campaign finance laws, this has become more overt. A few billionaires could say, “These are my political interests, these are my priorities and I’m gonna throw my money around only to those who take on my agenda and my interests.” When Karl Marx and Friedrich Engels wrote that “the ideas of the ruling class are in every epoch the ruling ideas, they meant that ruling-class ideas were dominant because the ruling class “has the means of material production at its disposal” and therefore “has control at the same time over the means of mental production” [3]. Today ruling-class ideas become dominant because of the direct and explicit intervention of the most powerful capitalists and their politicians. In the absence of a fight-back movement, the reactionary obsessions of some really rich men can set the tone of politics, and actually can determine major issues for hundreds of millions of working-class women in the United States and worldwide.

The anti-abortion billionaires are not spending their money because it will help their immediate profits. If anything, they are spending significant parts of their fortunes on these right-wing causes. That is where capitalism comes back in at the systematic level. It is not as a conspiracy for profits, but as a form of political rule based on disciplining and intimidating one section of poor and working people, distracting and confusing others, and finally winning over and satisfying other layers.

True rights attainable only with a new mode of production

No mode of production based on extreme inequality and exploitation would be able to last long if it did not have ruling institutions, political systems, ideas, traditions, and so on, that protected and rationalized those economic processes. The ruling class does not just get to extract wealth; it also has to find stable ways to rule.

Forms of patriarchy operate powerfully at the base of capitalism, in how the system produces and reproduces itself on a daily basis. It also is a cornerstone at this superstructural level, and in particular, as a central element of the reactionary agenda. So how could patriarchy be ended under capitalism if it is so embedded at every level of the capitalist system? It is impossible.

Socialism, by contrast, eliminates the economic dependence on the family unit. Simply by changing who controls and owns the vast means of production, every person can now be guaranteed housing, food, healthcare, childcare, retirement, and other human needs as guaranteed rights. The gender pay gap and undervaluing of “women’s work” could essentially be overturned overnight. A government in the hands of class-conscious workers would also remove from power the lackeys of the billionaire bigots, and instead launch bold initiatives to advance women’s equality and liberation in the world of culture, ideology, education and politics.

This would be an ongoing process, of course, but it would be fundamentally different from the battle for women’s rights under capitalism. In the present, we fight for rights inside a system that reproduces patriarchal economic relationships daily, and under a ruling class that defaults to a reactionary agenda as a way to protect its exploitative rule. That is why “smashing the patriarchy” often feels so impossible. Under socialism, by contrast, the battle will be to win an egalitarian superstructure that will harmonize with a new economic system based on meeting the needs of all.

References

[1]See Dickinson, Hannah. (2019). “Social reproduction: A theoretical framework with organizing potential.”Breaking the Chains4, no. 1.Also availablehere.
[2] Ford, Derek. (2021). “The base-superstructure: A model for analysis and action.”Liberation School, November 22. Availablehere.
[3] Marx, Karl and Friedrich Engels. (1964/1978). “The German ideology: Part I,” in R.C. Tucker (Ed.),The Marx-Engels reader, 2nd ed.(New York: W.W. Norton & Company), 172.

The Reproductive Rallying Cry

By Audrey Elberger, Nathaniel Ibrahim, Simon Moncke, and Juan Gonzalez Valdivieso

Republished in modified form from The Specter.

On June 24, 2022, the Supreme Court overturned 50 years of precedent via a 6-3 decision in Dobbs v. Jackson Women’s Health Organization. The ruling established that states can restrict abortion as they please and without limits. The case Dobbs overturned, Roe v. Wade, constitutionally protected abortion rights through the first trimester with limitations in the second and third trimesters based on maternal or fetal health.

Planned Parenthood v. Casey later overturned this framework in favor of a viability analysis. That opened the door for states to implement abortion restrictions in the first trimester. So, even when abortion was a “right,” it really wasn’t.

Following the Dobbs decision, many online articles alerted people to “safe havens”: areas where abortion access remained protected. But these articles seldom acknowledged the fact that many lack the resources to visit safe havens. Since women, minorities, and the poor are disproportionately under-resourced, abortion access is indeed a race, class, and gender issue.

That the Supreme Court is openly hostile to the needs of these marginalized communities should come as no surprise. The institution was designed to safeguard elite interests while insulating itself from public opinion. This rift between the people and their government sharply narrows the range of political possibilities. Questions such as whether the state ought to guarantee material security for all are forever left off the agenda.

Perhaps that would change if enough Supreme Court justices had working-class interests. But the selection process makes this incredibly implausible. These days, Court appointees ascend almost exclusively from a consolidated legal class of Ivy League graduates. Currently, only one of nine justices — Christo-fascist Amy Coney Barrett — didn’t graduate from Harvard or Yale. But she still went to Notre Dame: a prestigious private institution with an endowment exceeding $20 billion.

The elite background of jurists is reflected in the Court’s penchant to side with the monied, reactionary, and powerful. It’s also reflected in which cases they even choose to hear. The Supreme Court, after all, carefully selects its cases. They receive around 10,000 petitions each year but typically only approve about 80 of them. That means cases relevant to working people are almost always sidelined.

This raises the question of how to amplify working-class interests. While the American political landscape is bleak, there are nonetheless proven strategies at our disposal. By implementing them, we can send a powerful message that our demands around reproductive rights must be met.

Throughout the United States, there are abortion funds accepting donations. Many of them use that money to help low-income people pay for otherwise unaffordable reproductive care. Abortion funds often work in conjunction with healthcare centers to fund not only operations themselves but also transportation and childcare. The National Network of Abortion Funds provides an incredibly thorough database of abortion funds listed by state.

Beyond fundraising, we can also wage the fight for reproductive rights in the streets. Direct action like protests, rallies, and teach-ins are being held by organizations across the United States. These groups may be fully geared toward the issue of reproductive health, as is the case with Planned Parenthood and Reproductive Freedom for All. Or they may be fighting for abortion rights within a larger anti-capitalist movement. Examples include the Democratic Socialists of America (DSA) and its young wing YDSA, among other anti-capitalist parties and organizations within the United States.

Within this broader anti-capitalist milieu, the struggle for reproductive justice exemplifies why labor organizing should lie at the base of all other grassroots efforts. Under an oppressive, capitalist, forcefully evangelical society, the individual sits powerless, unable to alter the institutions that uphold the status quo. However, by exploiting society’s unwavering reliance on endless growth, individuals can join forces with fellow workers to collectively withhold their labor until more desirable conditions are secured. While fundraising and direct action are indispensable, organizing workplaces is perhaps the best bulwark against elite capture of powerful institutions. What happened in the Republic of Ireland roughly a decade ago shows this.

For years, the island nation known for its social conservatism banned abortion in nearly all cases. In 2012, however, Irish activists organized a march for choice. Ireland soon saw massive demonstrations which attracted international attention. Even the United Nations began calling on Ireland to change its abortion laws. But the Irish government didn’t cave to this pressure. That’s when labor organizers turned to more radical measures.

On International Women’s Day 2017, thousands of women went on strike demanding better abortion laws. They managed to shut down the capital city of Dublin for four hours. This action put the Irish government on notice. The following year, they held a referendum on abortion rights with two-thirds voting to expand access.

Abortion rights in Argentina have a similar history. As in Ireland, the Catholic Church is a dominant force in Argentinian politics and has helped curtail reproductive freedom for decades. In 2016, however, women workers staged a mass strike. That was followed by huge demonstrations for abortion rights as part of a protest movement called “The Green Wave.” The Argentinian Congress finally legalized abortion in 2020.

Given these facts, us fighting for abortion rights must ask ourselves: Is my workplace unionized? If so, how can I join the union? If not, how do I start that conversation? The sooner unionizing efforts get underway in every workplace, the sooner the working-class and oppressed peoples can leverage their collective power in the name of a more just society.

Women's Reproductive Rights in Cuba vs the United States: A Comparative Analysis

By Valerie Reynoso

Cuba is an island in the Caribbean governed by a socialist state that has made strides in numerous aspects, including but not limited to socioeconomic equality, redistribution of wealth to the masses, advocacy for the end of apartheid in South Africa, and the end of the colonial rule in Angola during the 1960s. Cuba has served as an inspiration for the overthrow of fascist dictators in other Latin American nations such as Rafael Leonidas Trujillo in the neighboring Dominican Republic, along with an outstanding healthcare system that has even drawn attention from organizations such as the UN and UNICEF.

The United States, on the other hand, is a hegemonic Western nation with a capitalist-imperialist government that is rendered as the most superior in the world. The US is defined by the existence and persistence of systemic inequities, deepening class stratification, high rates of mass incarceration, homelessness, and poverty; as well as unique socioeconomic consequences faced by women, largely due to reproductive healthcare services not being universalized and not always covered by health insurance.

In comparison, Cuba outperforms the US in areas of women's reproductive rights and abortion access, given its complete legalization of abortion and other healthcare services to women for free. The US is unable and seemingly unwilling to meet the standards of Cuba, given primarily the Hyde Amendment and overall privatization ("profitization") of medical industries.

Cuba and Women's Health

The Cuban Revolution of 1959 brought radical change to the island in the form of new socialist socioeconomic and political structures, as well as a shift in the role of women in society and women's reproductive rights, distinct to pre-1959 Cuba. Cuban leader Fidel Castro believed that the liberation of women was vital to the socialist revolution. This idea stood in stark contrast to pre-revolutionary Cuba, which more closely resembled that of the United States, with regressive policies in terms of women's rights and reproductive care under General Fulgencio Batista. Prior to the rise of the Castro, abortion laws in Cuba were based on the 1870 Penal Code of Spain and had many restrictions, some of which were loosened in 1936 with the entry of the new Social Defense Code. This new penal code legalized abortion in the cases of endangerment of the life of the mother due to pregnancy, any form of rape, or serious medical complication of the fetus that would require the termination of pregnancy. During this time, Cubans who sought abortions due to health risks caused by pregnancy had to be granted permission from two physicians to get the procedure done.

Following the birth of the Cuban Revolution, Cuba became one of the first countries in the world to legalize abortion with full access in 1965, up to the tenth week of gestation, through their national health system. The Social Defense Code was replaced once again in 1979 with the adoption of a new penal code, which explicated what constituted as illegal abortion as well as punishments for those who conducted them. Illegal abortions were defined as those done under conditions that neglect health laws regarding abortion. Likewise, those caught in violation of said legal abortion regulations would potentially face three months to a year in prison. Abortions performed for profit, outside of accredited institutions, or by anyone other than a legitimate physician would result in culprits being subject to two to five years in prison. Abortions are also considered illegal in Cuba if executed without the consent of the pregnant patient and would result in two to five years of prison time for the executer of the procedure. If the non-consensual abortion is performed with force or violence, then the prison sentence is increased to up to eight years.

Likewise, menstrual regulation is implemented in the case that gestation is five weeks or less; women do not need to confirm their pregnancy, nor do minors need parental consent to receive menstrual regulation. Gestations of ten to twelve weeks would require confirmation of pregnancy to obtain an abortion and, along with that, the pregnant woman must be examined by a gynecologist as well as be given counseling from a social worker. For those who seek abortions services, parental consent is needed for women under eighteen, and permission from a medical committee is required for women under 16. A committee of obstetricians, psychologists, and social workers would have to approve a second trimester abortion in addition to the patient satisfying the regulations for a first trimester abortion. Moreover, in 1960, the Castro administration formed the Federation of Cuban Women (FMC), which was led by Vilma Espin, a revolutionary who resisted against the Batista regime and was also the partner of Raul Castro, Fidel Castro's brother. FMC has played a vital role in the advancement of gender equality and the enhancement of women's healthcare in Cuba.

The FMC has a membership that includes 85.2 percent of all eligible Cuban women and girls over 14 years of age. It is recognized as an NGO and as a national system for women, due to the overwhelming majority of Cuban women being participants, because the organization is not socioeconomically funded by the Cuban government, and because the federation has a hierarchy consisting of local, municipal, provincial, and national levels of representation and leadership. Along with endorsing the mass education of women, inclusion of women in the work force, and advocacy for legislative and social reform for gender equality, the FMC has also had a significant impact on the Cuban healthcare system and its regulations. One instance of the influence of the FMC on the Cuban healthcare regulations is their assistance in passing maternity leave laws in 1974, under which pregnant women are granted three months of paid leave. The FMC also played a role in the foundation of maternity homes for women to deliver their infants under the maintenance of primarily FMC volunteers who serve as trained attendants.

The FMC has proven to be successful in the mobilization and formation of solidarity amongst Cuban women, united under a common motivation to fight for women's rights to higher education, paid maternity leave, childcare provision, and free abortions and birth control.

The United States and Women's Health

In the US, the landmark Supreme Court case Roe v Wade was a victory for women's reproductive rights. However, the battle against women's rights are ongoing, with various conservative and right-wing interests, typically headed by men, continuing to mount a powerful opposition. Measures taken to diminish the impact of Roe v. Wade and strengthen anti-woman legislation like the Hyde Amendment have significantly changed abortion accessibility and affordability for women in the US.

Abortions were legal and frequently performed from the 18th century until approximately 1880 in the US. The idea that the fetus at conception and the early stages of pregnancy was a human life was not a conventional one held in US societies, nor the Catholic Church, for some time. The typical stance on this subject at the time was that it was centered on women's experiences and relations with their own bodies, rather than societal stances on what is considered immoral for women to do regarding abortion. The Catholic Church accepted early abortions before ensoulment; however, around 1869, began to denounce abortion, simultaneously when abortion became politicized in the US. In 1895, the church opposed therapeutic abortions, which were meant to save a woman's life. Abortions were outlawed in the US by 1880 due to pressure from medical groups, with the exception of cases involving medical complications that could endanger the woman's life.

Women in the US continued to seek abortions despite these newfound laws and those who could afford options often received services from practitioners in private homes. Those who could not afford private services were left with no other choice but to resort to near-lethal means out of desperation. Rates of women who obtained illegal abortions naturally increased with restrictions barring access to legal procedures. Between 200,000 and 1.2 million illegal abortions were conducted per year in the US in the 1950s and 1960s. Underground organizations that provided safe, illegal abortions were formed in the 1960s by individuals concerned about the well-being of the high number of women who dangerously sought to terminate their pregnancies. These organizations included the Clergy Consultation Service on Abortion and The Abortion Counseling Center of the Chicago Women's Liberation Union, also known as Jane. The Rubella outbreak in the US, which lasted from 1964 to 1965, endangered fetuses and hence was a major factor in a rehashing of the abortion debate in the country. This outbreak and the ongoing debate led to the passage of Roe v Wade in 1973.

Roe v Wade was decided on January 22nd, 1973 and ruled that state-sanctioned restrictions of abortion are unconstitutional. It was concluded that the criminalization of abortion under Texas statutes (for the most part) infringes upon the constitutional right to privacy women have under the due process clause of the fourteenth amendment. Numerous abortion rights activists wanted the case to be passed under the ninth amendment, so that it could be written in the constitution rather than malleable and subject to change. Although this case made legal abortion more available and safe for women in the US, barriers were still placed on them, including measures that were taken to restrict the effectiveness of Roe v Wade and socioeconomic disparities that made it more difficult for underclass women to receive services. Following Roe v Wade, several US states have enacted over 1,074 laws with the purpose of limiting access to abortion, with over a quarter of these legislations having been legalized between 2010 and 2015.

Part of the anti-woman crusade that was sparked by Roe v. Wade was the Hyde Amendment, which was passed in 1977 to prohibit the use of Medicaid to pay for abortions, excluding cases of rape, incest, or endangerment of the life of the mother. According to a study done in 1984 at the Guttmacher Institute, 44 percent of female Medicaid recipients who had abortions that year paid for them by using money they had initially saved for necessities, such as rent and food. Due to said women not being able to afford the costly prices of abortions, many were forced to save for a longer period of time for the procedure, which resulted in later, riskier, and more expensive abortions, or women being forced to carry unwanted pregnancies to term due to an inability to afford an abortion. This statistic increased to 57 percent of abortion patients paying out of pocket by 2010. The Hyde Amendment resulted in Medicaid-funded abortions decreasing from 300,000 per year to only a few thousand per year. As of 2010, seventeen states finance abortion care for citizens with Medicaid coverage, and 20% of abortions conducted in the US were funded with Medicaid in 2008. Additional barriers are posed to women in need of abortions per individual state. For instance, as of 2008, fifteen of the seventeen states that fund abortion care for its people have also established obstacles such as low reimbursement rates and delays in enrollment, which make it more difficult for women and providers to use Medicaid for abortion services.

Comparing Cuba and the United States

The changes Cuba experienced in its transition from the Batista regime to the Castro administration, as well as the changes in abortion legislation the US experienced from the 18th and 19th centuries to the late 20th century, demonstrates that Cuba was making drastic improvements in the conditions of Cuban women. While the Cuban government made tremendous strides in forging women's rights, the accessibility of abortion declined for women in the US during the same period.

The radicalization of the Cuban government implemented by Fidel Castro set the foundation for the drastic modification of women's rights that would occur in the island throughout the latter half of the 20th century and 21st century. The FMC led by Vilma Espin was crucial to the development of universalized healthcare and inclusions of free abortions and other reproductive health services that overwhelmingly affect Cuban women. Contrarily, the Hyde Amendment, malleability of the Roe v Wade case, and constant pressure from a male-driven, conservative crusade have proven that the profits of US medical industries and artificial morals of fundamental Christianity are paramount to the reproductive rights of women in the US, especially given how expensive abortions are and that Medicaid cannot be used to pay for it in a majority of cases.

The capitalism system which dominates American life is a system driven by infinite profit extracted from the finite resources of the planet and exploitation of the labor of the working class. This exploitation is deepened when members of this working class are part of other marginalized groups as well, such as women, non-white people, and disabled people; all of which make up the overwhelming number of patients struggling to obtain legal abortions in the US. Many of these women have the misfortune of resorting to dangerous alternatives out of need. In comparison, the socialist system Cuba operates under has clearly succeeded in ensuring that Cubans of any racial or socioeconomic background have access to high quality, universalized healthcare and abortions without barriers of any kind.

Statistics prove that in terms of abortion access and reproductive healthcare, Cuba has a model that is more superior than that of the US. Chapter IV of the Cuban constitution contains articles that explicitly enforce the socioeconomic and political equality of all genders, as well as state-funding of financial support for pregnant women. Article 44 states that all genders enjoy equal rights in all aspects of society; women are guaranteed equal opportunities to men and will have an equal impact on the advancement of the island; and the state also manages institutions like child centers, boarding schools, and homes for the elderly with the purpose of helping working families. Article 40 dictates that the Cuban state provide working women with paid maternity leave before and after childbirth, as well as job options that would be suitable for pregnant people and mothers.

As of 2014, Cuba has a total expenditure on health per capita of $2,475 ; and a total expenditure on health as percent of GDP of 11.1 percent for a population of 11,147,407 as of July 2017. The Cuban government has no intervention concerning fertility level, allows abortions on request for any reason, and provides direct support on contraceptives for its citizens. As of 1987, 70 percent of married Cuban women between the ages 15 and 49 use modern contraception, which is available in all government health institutions and through one agency called the Sociedad Cientifica Cubana para el Desarrollo de la Familia (SOCUDEF) that receives full support from the government. Under these measures taken by the Cuban government, in accordance with the country's constitution, the amount of legal abortions quadrupled from 1968 to 1974 with a percent increase from 16.7 to 69.5 legal abortions per 1,000 fertile women. 85,445 abortions were conducted among women between the ages 12 and 49 in 2016, which totals to 41.9 abortions per 100 pregnant women, which is half of the figures from 12 years prior to that. Even more so, contraceptive use has caused a decline in abortion rates in Cuba over the past 15 years.

In contrast, despite the increase in healthcare spending and decline in legal abortion rates in the US, the spike in illegal abortions and barriers posed by the Hyde Amendment indicate that US women still do not have full access to reproductive healthcare. The total expenditure of health in the US rose by 4.3 percent in 2016, at a ratio of $10,348 per person, and made up 17.9 percent of the national GDP. In addition to this, the national abortion rate decreased by 2 percent between 2013 and 2014, where there was a rate of 12.1 abortions for every 1,000 women aged 15 to 44, or 186 abortions per 1,000 live births. Frequent Google searches for self-induced abortions in US regions with low access to health institutions imply a spike in the obtainment of illegal abortions, although an exact statistic for this is difficult to determine given that illegal procedures are not easy to keep track of. In 2015, the Guttmacher Institute found that there were 119,000 searches on how to have a miscarriage as well as other phrases of a similar nature, such as how to self-abort, etc. In total, there were over 700,000 Google searches that year on how to conduct a "self-induced abortion." There were also 3.4 million searches for abortion clinics, 160,000 for how to find abortion pills through unverified sources, tens of thousands on herbal remedies for abortions, 4,000 on instructions for coat hanger abortions and a few hundred on abortion methods through bleaching the uterus. It was found that a disproportionately large number of these Google searches were in the state of Mississippi, which only had one abortion clinic in 2016. For perspective, the Guttmacher Institute reported that there are approximately one million legal abortions per year in the US. Based on this research, a correlation between economic insecurity and abortion seems clear. Online searches related to "self-conducted abortions" surged towards the end of 2008, during the financial crisis and great recession at the time. Legislative barriers also seem clear, as these searches increased by 40 percent in 2011, the year when 92 laws that restrict abortions were passed in the US.

Conclusion

Cuban women have free reproductive care and are provided abortions at their request for free as well, under one of the statistically best healthcare systems in the world. In the US, a significant number of pregnant women cannot afford nor have access to legal abortions; therefore, being forced to endanger their lives through illegal procedures. The Cuban state operates under a socialist system that places the lives of its women citizens before corporate or private profit, to the point where it is illegal for abortions to be conducted for profit in the nation and prison terms are possible for violators of this policy. The fact that access to abortion clinics in the US has dwindled, causing legal abortions to decline while searches for illegal abortions have drastically spiked, is yet another failure of the capitalist healthcare system in the country. Specifically, the US for-profit system has failed the women it is meant to serve and will only continue to fail them as these dangerous statistics further grow.

In addition to operating for profit, US healthcare and medical industries remain beholden to patriarchal (and downright misogynistic) values that are tied to its economic system. Capitalism is a system founded on imperial conquests of Global South nations and the enforcement of patriarchy and class stratification on these matriarchal, communal societies by European Crowns. These structures have disproportionately affected women, and especially women who are oppressed in other aspects of their being. This has resulted in the devaluation of feminized labor, usage of women as domestic tools for the social reproduction of working men, and now high costs of abortions as well as barriers that prevent women from getting them. All of this leads to already underpaid and underprivileged women risking their lives to get their necessities out of despair because the system that governs them does not value them.

As maternal mortality rates are skyrocketing in the US, Cuba boasts one of the lowest infant and maternal mortality rates in the world. As of 2015, Cuba has a maternal mortality rate of 39 deaths for every 100,000 live births and an infant mortality rate of 4.2 deaths for every thousand births. The probability of children under the age of five dying in Cuba is 0 per 1,000 live births based on data from 2015. In addition to this, in June 2015, Cuba became the first nation in the world to be praised by the World Health Organization (WHO) for their achievement in eradicating mother-to-child transmission of HIV and syphilis through medical innovation. The corollary benefit to this is enjoyed by pregnant women who may otherwise seek abortions due to them having HIV and not wanting to infect their baby. With this ability, and the expectation of a healthy baby, those mothers may now choose to carry full term. Since 2010, the WHO has been teaming up with Cuba and other nations in the Americas to execute a regional plan to get rid of mother-to-child transmission of HIV and syphilis. As part of this program, Cuba has guaranteed early access to prenatal care, HIV and syphilis testing for pregnant women and their partners, treatment for women who test positive for the infections and their babies, caesarean deliveries and substitution of breastfeeding-all of which is provided under the universalized healthcare system of the island. These statistics make Cuba the country with the lowest infant mortality rate in the Americas, in the Global South as a whole, and one of the lowest in the world.

On the other hand, as of 2015, the US has a maternal mortality rate of 26.4 deaths per 100,000 live births, up from around 17 deaths per 100,000 live births in 1999. Other Western nations rank much lower in comparison to the US regarding maternal mortality, such as 9.2 for the UK and 7.8 for France per 100,000 live births respectively. According to a six-month long examination conducted by NPR and ProPublica on maternal mortality in the US, more women in the US are dying from complications due to pregnancy than any other Western nation, and the US is the only country where this rate is actually increasing. While the neglect of women's health is certainly predetermined by the for-profit system, it is also systematically neglected by the US government and its health agencies. Only 6 percent of block grants designated for maternal and child health end up being used for the health of the mothers, as revealed by federal and state funding. This is despite the increase in spending in overall healthcare in the US. The fact that only a minimum percent of block grants that are meant to be used for maternal and child health is utilized to help them further illustrates how the well-being of pregnant women and abortion patients is not paramount in the capitalist healthcare system of the US. Additionally, US hospitals that must worry about "bottom lines" (like any for-profit company) can be extremely unprepared for maternal emergencies such as self-induced abortions having gone wrong, even if the hospital has an intensive care unit for newborns and their mothers. Medical training in the US is also suspect. Some US doctors may specialize in maternal-fetal medicine without ever having to spend time in a labor-delivery unit that would further develop their specialties.

Cuba's healthcare system is world-renowned for many reasons: It was among the first of nations to fully legalize abortion; it has successfully eliminated mother-to-child transmission of HIV and syphilis through medical innovation; it has implemented universalized healthcare such that all reproductive services are free for all citizens; it has scored low maternal and infant mortality rates; and it is a significant factor in creating one of the highest standards of living for women in the world. All of this is due to taking profit and personal interest out of healthcare by making it a social imperative and human right. In comparison, the US has systematically restricted women's reproductive rights, increased barriers for women who seek abortions, has one of the highest maternal mortality rates in the West, is forcing women who seek illegal abortions due to lack of access to legal services, and has implemented high costs for legal abortions and other basic services, therefore diminishing the quality of living for millions of marginalized women. All of this is due to putting profit above people while pushing patriarchal values that do not recognize women as human beings who should have full agency over their bodies.

Bibliography

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Encyclopaedia Britannica, Roe v Wade. 26 Apr. 1999.

Falk, Pam, et al. Cuba's Constitution of 1976 with Amendments through 2002. Oxford University Press Inc.

Ginsburg, Faye D. Contested Lives: The Abortion Debate in an American Community. University of California Press, 1998.

Jatlaoui, Tara C., et al. "Abortion Surveillance - United States, 2014." Morbidity and Mortality Weekly Report, Center for Disease Control and Prevention, 24 Nov. 2017.

Jones, Rachel K., et al. "At What Cost? Payment for Abortion Care by US Women." Women's Health Issues Journal, no. 23-3, 4 Mar. 2013. Elsevier.

Kassebaum, Nicholas J. "Global, Regional, and National Levels of Maternal Mortality, 1990-2015: a Systematic Analysis for the Global Burden of Disease Study 2015." The Lancet, vol. 388, 8 Oct. 2016.

Last Five Years Account for More Than One-Quarter of All Abortion Restrictions Enacted Since Roe. Guttmacher Institute, 13 Jan. 2016.

Montagne, Renee, and Nina Martin. "U.S. Has The Worst Rate Of Maternal Deaths In The Developed World." Lost Mothers: Maternal Mortality in the U.s., NPR, 12 May 2017.

National Health Expenditure Data. Centers for Medicare and Medicaid Services, 8 Jan. 2018.

Population Division of the Department of Economic and Social Affairs of the United Nations Secretariat. Cuba: Abortion Policy. The Population Policy Data Bank.

Reagan, Leslie J. When Abortion Was a Crime: Women, Medicine and Law in the United States, 1867-1973 . University of California Press, 1998.

Stephens-Davidowitz, Seth. Abortions at Clinics, or Somewhere Else. Guttmacher Institute, 5 Mar. 2016.

"The Federation of Cuban Women." The Federation of Cuban Women, Stanford University.

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WHO Validates Elimination of Mother-to-Child Transmission of HIV and Syphilis in Cuba. World Health Organization, 30 June 2015.

Misoprostol, Coat Hangers, and Trump: Foreign Objects in Our Wombs

By Assata Baxter

In the United States, one in three of us has had one. We don't share this. In the midst of making hard decisions, we bear the vitriolic harassment of those who have never and will never carry children, or those who chose to project the insecurities of their own decisions on others, before we can get to the door. We are blamed and shamed in clinic parking lots with pictures of 56 week old dead fetuses. We enter clinics alone without our partners' knowledge, weighted with surprises in pink lines when it's not yet our time. Or our partners hold our hands and say that whatever we choose they are beside us. Or depending where we are in a low-income country, there may be no clinics. So, we ask our friends if anyone has a doctor in the family who can write a prescription; anyone who knows someone who knows someone who works at a pharmacy. We look up which combination of pills it requires, and pray that it works. We go to sangomas in another village. We put our lives in the hands of "surgeons" and hope that we wake up with use of our reproductive organs… or that we wake up period. There are no certain answers. No "do-it-yourself" manuals. And every 8 minutes in low-income countries, one of us will die of complications arising from it.

We don't announce our decisions on Facebook, or post pictures to Instagram of the sonogram, of the fetus we have chosen not to keep. We may tell some close to us, but often we don't tell our best friends, our parents, our siblings, sometimes our partners. We are afraid their religion or recently recognized righteousness will get in the way of them hearing us…that they will guilt us into thinking otherwise, or it may change forever how they see us. We fear scarlet letter branding. We talk in hushed whispers if at all. Sometimes we find support groups. Sometimes we continue life as usual. Sometimes we are forever changed. While our experiences are different, what remains consistent is that abortion sits squarely at the juncture of ethics, religion, morals, science, gender and politics. And yet the discussion of the experience remains taboo.

I have had two abortions; one in Kenya, one in Djibouti, both "back alley" in the sense that they lacked medical supervision or prescription. I was not raped. My health was not in danger. Simply, neither the birth control, nor the morning after pill worked. I give you these moderating factors for two reasons. One, because the myth often goes that underserved populations use abortion as birth control. This was not the case. Further these very factors had both an impact on my conscience and impacted accessibility to any legal type of procedure.

My period was a week late. But, my period was always a little bit hard to calculate. It didn't cross my mind that I could be pregnant until week two. We always used protection, and our one accident, I had taken the morning after pill. I bought a take-home pregnancy test at the nearby market. I remember crouching on the floor of my apartment in south B, Nairobi watching the Test line appear. The test was supposed to take three minutes, but positives appear faster… and even the few seconds it took, seemed like a lifetime. I rocked back and forth, hugging my knees to my chest, crying… I called my boyfriend, shaking, inconsolable, tears pouring down my face. He rushed over and held me as I cried myself to sleep. I wished it happened like in the movies. The girl who finds herself pregnant always magically miscarriages. She never actually has to make a decision. She can share her story freely, with whoever chooses to listen, because miscarriages are not of our choosing. They are not our fault or our choice. They are met with sorrow or pity or empathy, because they are God's will or the will of the Universe or whomever we believe in. We hold no "fault".

But it did not happen like the movies. I bought three more pregnancy tests the next week. I convinced myself I had ovarian cysts, that I kept contaminating the urine sample, or that the pharmacy by my house was selling expired tests. By the end of the week, I started having dizzy spells. I was beginning to feel nauseous quite often, but I had three days off work before heading to rural Uganda for work, and so the race against the clock started. The next day I woke up I felt awful, and depressed. I wanted to see a doctor. That would be the only way to know for sure. We made an appointment at a nearby hospital. I explained the situation and they too thought that pregnancy was unlikely, particularly given the dates of my last period and encouraged me to do an ultrasound. I agreed. For once and for all, I would know.

My memories of the next few moments that day are very blurred. I remember hearing a heartbeat. I remember crying and heaving in some corner in the hospital. I remember I went home with a sonogram as a parting gift, that I have never brought myself to discard. But I did not want to have a baby, even after heartbeats and sonograms. I was 24, living and working in Kenya on 2000 USD a month, with an ocean separating me from my family, and financially supporting a sick mother back at home. I was six weeks pregnant, and I did not want to be a mother, then… the same way I am unsure if I want to be a mother now. I knew immediately what I wanted to do, but had no idea how to do it, and having chosen to abort, there was nothing more that I wanted than to stop being pregnant. In my mind, I kept thinking the longer I waited, the closer the fetus came to viability, or to what in my mind was personhood. However, figuring out what to do was not easy. There is no "Planned Parenthood" in Kenya. I could not make an appointment to discuss my options. Abortion is and was illegal in Kenya, and only viable to save a woman's life or preserve her physical health.

I was not willing to wait any amount of weeks to try and fly to another country and come back. I also was not willing to literally have a back alley surgical abortion. I had one or two friends I confided in, who might have known someone who had "the surgery". I was not willing to risk my future reproductive health or a return to consciousness being unsure of what had been cut, or poked or inserted inside of my body. Here there was no RU-486. We had to find a doctor who would be willing to write a prescription for the pills I would need to give myself a medical abortion. We could not get it in the pharmacy without a prescription. We found a doctor who was willing to write a prescription however the dosage was not enough. It was for only 200mcg. We made copies of the prescription. We bribed pharmacists to give us more until we had 800mcg. There were multiple websites with multiple directions. I chose one and stuck with it. I put a pill under my tongue, wrote a letter to my unborn child, and asked for her forgiveness and to come back when it was her time. I wore a pad for the rest of the night. And in the morning, it was just as if I started my period. And that was it. I no longer felt nauseous. I just had what felt like period cramps... At least I thought that was it. I headed to Uganda for work. The secret safe between my boyfriend and I.

For the next two days life, continued as somewhat normal. However the third day, I had cramps far worse than any period I had ever had. They were so painful that I had to bite on a towel to keep from screaming out, every time I used the bathroom. I struggled through my work day, taking multiple breaks per hour. I was dizzy, sweating, and nauseous. Day four, I had what I realize now was probably Class Two hemorrhaging. I woke up to blood everywhere in the sheets. I wouldn't stop bleeding. In a town in far West Uganda, coming from the bathroom, too weak to walk, I tried to crawl back to bed, but could not make it. So, I lay on the cold floor of a hotel room, entering and exiting consciousness until morning; bleeding uncontrollably, until a friend found me in the morning. I never did see a doctor, but the process of healing from both the physical and psychological wounds was a long one. The psychological wounds remained because the physical damage to my body, the anticipated lack of support, my suffering in physical and emotional pain in silence, the battle of my conscience, and the feeling of utter loneliness did not leave immediately. But I survived… which makes me a lucky one.

International Access to Abortion

Imagine that approximately 310,000 women undergo abortions in secrecy each year in Kenya alone, according to the East Africa Centre for Law and Justice[1]. 21,000 women are admitted each year as a result of complications related to unsafe abortions, which are usually undertaken in back alley clinics. 2,600 of these women eventually die. Research from the Center for Reproductive Rights has found that unsafe abortions account for 40% of the maternal mortality rate[2]. I was fortunate enough to have a supportive boyfriend, and enough financial capital to be able to afford both seeing private doctors, and paying the costs of both prescriptions and bribes. I know that is a privilege not all women have in Kenya. Due to restricted abortion legislation, even with the new constitution, women, less than having access to a medically safe procedure, do not even have access to the human contact that would provide them with the support and empathy they seek, and the tools they would need to make an informed decision.

In sub-Saharan Africa, 98% of countries allow abortions to save the mother's life, however only 33% permit abortion in cases of rape or incest and only two allow elective abortions for any reason. But, I will point fingers neither at Kenya, nor the continent of Africa. Kenya is not the only country with restrictive abortion legislation. In fact the countries with the most restrictive abortion legislation are found in Europe, Central and South America. The Holy See (Vatican City), Malta, Dominican Republic, El Salvador, Nicaragua and Chile do not allow abortion under any circumstances, even if the mother will die from complications prior to or giving birth[3].

According to Pew Research Centre, although in Europe about 73% of countries allow abortions for any reason, Ireland, Andorra (between France and Spain) and San Marino (Italy) only allow abortions in order to save the life of the mother. In Ireland, illegal abortion carries a sentence of up to 14 years in prison. And therefore, more than 5000 women each year are forced to leave the country to have abortions outside of Ireland [4]. These same studies have revealed that 26% of countries in the world only allow abortion to save a mother's life; and 42% allow abortions only when the mother's life is at risk in combination with "at least one other specific reason, such as to preserve a woman's physical or mental health, in cases of rape or incest, because of fetal impairment or for social or economic reasons" [5]. According to the World Health Organization 21.6 million women undergo unsafe abortions every year [6]. Of those, 6.9 million women were treated for complications from unsafe abortions. I form part of the 40% of women who experienced complications but never received treatment. Unsurprisingly, almost all abortion-related deaths occur in low-income countries, with the highest number occurring in Africa. The Guttmacher Institute, according to recent studies have found that 8-18% of maternal deaths worldwide are due to unsafe abortion, and the number of abortion-related deaths in 2014 ranged from 22,500 to 44,000 [7].

What these numbers and percentages mean, is that beyond any discussion about population control in low-income countries, at what specific age human life becomes viable, if abortion is morally right or wrong, the after-life consequences of our actions, is that women are literally dying trying to get abortions, often of the surgical kind.

Trump in Our Wombs

The 1973 Helms Amendment , created in the wake of the Roe v. Wade decision, prevents the use of American foreign aid for abortions. The caveat being that the money could still be used to fund family planning, or educate women about abortions, but could not be allocated to the procedure itself. On January 23 rd 2017, beneath our noses, President Trump signed an executive order which reinstated the "global gag rule". Effectively this rule bans federal funding for international non-governmental organizations that offer abortions, advocate for the right to an abortion, or even discuss abortion as an option to mothers. In the past this order known as the "Mexico-City Policy", has been instituted by Republicans and struck down by Democrats multiple times. Yet the massive degree of funding that will be affected by this gag order is absolutely unprecedented. The gag rule will apply to about $9.5 billion dollars in global health funding which will effect organizations mostly in low and middle income countries. These cuts may even effect HIV prevention and treatment, and maternal health care. Conservative estimates by the Guttmacher Institute project that the result will be 38,000 more abortions. Marie Stopes International estimates that the global gag rule will lead to an additional 2.2 million abortions worldwide, and given the restrictive abortion policies in 68% of countries, a vast majority of these will be unsafe abortions.

Basta de Rosarios en Nuestros Ovarios (No More Rosaries in Our Ovaries)

While it is impossible to project definitively, I wonder how many more women will die this way, unaccounted for, afraid, hemorrhaging to death on the floor of a hotel room, or during surgery in the room of a back office with no windows, where her body may simply be disposed of, to ensure the continued financial gain of the "clinic". This unnecessary maternal mortality is a direct byproduct of desperation in environments that stigmatize and demonize women for unintentionally becoming pregnant, for whatever reason, and then punish them by restricting access to services. On top of this, with funding basically drained to international and national NGOs who specialize in family planning, pregnancy prevention, and pre- and post-counseling, women, especially in low-income countries are left very alone. I took years to heal from my psychological wounds. I never once regretted my decision. But I almost lost my life in the process. Reproductive rights belong to those who are doing the reproducing. Trump's new policies are invading our wombs, reaching into our bodies to yank away reproductive rights with fetal heartbeat bills and global gag rules. As has happened historically, when autonomy over our own bodies is taken away, we as women find a way to take it back. Banning abortion, or cutting funding to organizations that even discuss abortion will not make abortion disappear, it will only result in the unnecessary death of tens of thousands of women a year, by knitting needle, Misoprostol and coat hangers.

Notes

[1] http://eaclj.org/about-us/7-fida-and-kclf-landscaped-comparison.html

[2] https://www.reproductiverights.org/initiatives/maternal-mortality

[3] http://www.care2.com/causes/the-5-countries-that-would-let-a-woman-die-before-getting-an-abortion.html

[4] http://www.pewresearch.org/fact-tank/2015/10/06/how-abortion-is-regulated-around-the-world/

[5] Pew Research Center http://www.pewresearch.org/interactives/global-abortion/

[6] http://www.who.int/reproductivehealth/topics/unsafe_abortion/magnitude/en/

[7] https://www.guttmacher.org/fact-sheet/induced-abortion-worldwide

Ensuring the Right To Reproductive Health: The American Public Health Association Takes A Stand With Planned Parenthood

By Cherise Charleswell

On October 30th, I walked along 14th Street in the heart of downtown Denver Colorado, a notably Progressive city, heading to hear the Opening Address of the 144th annual American Public Health Association (APHA) Conference; and out of the many years of this organization's operations, this proved to be one of the most controversial opening sessions. Before reaching the convention center I was bombarded by protestors who were yelling, shouting through bull horns, attempting to shove flyers into my hand, and also standing next to quite large placards with graphic images on them. One of the protestors who reached out to me, couldn't have been more than 7 or 8 years old. They all had assembled to protest the invitation of keynote speakers, Cecile Richards, Executive Director of Planned Parenthood; and I was of course on my way, along with many other public health professionals - a mix bag of clinicians, social workers, researchers, scholars, and policy makers - who more so than others, know the importance of the critical services that Planned Parenthood provides.

I have attended the APHA Conference for a number of years, and I could not recall a scene like this before, and it led me to wonder about these protestors, who choose to choose to show up, at the largest public health convening in the nation; in an attempt to convince the professionals, those working on the ground to improve health outcomes - that they know what is best. Much like Presidential Donald Trump, who boasts about not having to consult with anyone, and that he "knows more than the Generals"; it was a moment where the ignorant and uninformed, once again decided that they "knew best".

I had to ask - where were these protestors, why were they silent when APHA has speakers and initiatives around the topics of climate change, health inequity, gun violence, and so on; since they are so concerned about the preservation of life? I wondered if they are even aware of the fact that the United States ranks 26th among the Organization for Economic Co-operation and Development countries, in infant mortality rates,

A new report reveals that the United States has the highest first-day infant death rate out of all the industrialized countries in the world. Further, the 14th annual State of the World's Mothers report, put together by non-profit organization Save the Children, ranked 168 countries, and found that the United States had the highest rate of First Day death; finding that about 11,300 newborns die within 24 hours of their birth in the U.S. each year, 50 percent more first-day deaths than all other industrialized countries combined. These statistics can be attributed to pregnant women's lack of access to prenatal care - services that Planned Parenthood and other women's clinics provide. It is all too typical for groups like this, who are often religiously motivated to "Love the Fetus, and Hate the Child". Somehow, being Pro Life stops at the point of birth, and a testimony to this nonsensical way of thinking is that cuts in social safety net funding, and human services budgets, that would help children, as well as adults, who are undergoing hardships, never seem to be met with the same level of outcry and protest. In stead, those type of policies are often championed by these groups.

Nevertheless, I considered this hypocrisy once again, as I made my way towards the Bellasco Theater of the Convention Center; and the line forming just to reach the entry doors was massive. For the first time, I witnessed as the increases security measures were put in place. I couldn't recall having what seemed like APHA's entire staff on-hand checking our Conference badges - with calls to make sure they are on and facing up - in order to enter.

The Conference's theme was "Creating the healthiest nation: Ensuring the right to health", thus it seemed perfectly fitting that they would invite Cecile Richards, an ardent champion of women's rights, human rights, LGBTQ rights, and the rights to health; which are all linked. To understand this interrelationship one needs to first realize that health is far more than just the absence of disease. According to the World Health Organization (WHO) it is defined as a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity. So, health encompases all the factors that allows us to have an optimal well-being. Further, according to the WHO health (and access) to health is deemed a human right. The WHO states the following:

The right to the highest attainable standard of health" requires a set of social criteria that is conducive to the health of all people, including the availability of health services, safe working conditions, adequate housing and nutritious foods. Achieving the right to health is closely related to that of other human rights, including the right to food, housing, work, education, non-discrimination, access to information, and participation.

The right to health includes both freedoms and entitlements.

• Freedoms include the right to control one's health and body (e.g. sexual and reproductive rights) and to be free from interference (e.g. free from torture and from non-consensual medical treatment and experimentation).

• Entitlements include the right to a system of health protection that gives everyone an equal opportunity to enjoy the highest attainable level of health.

So, what are human rights? The United Nations Human Rights Office defined them as "Human rights are rights inherent to all human beings, whatever our nationality, place of residence, sex, national or ethnic origin, colour, religion, language, or any other status. We are all equally entitled to our human rights without discrimination. These rights are all interrelated, interdependent and indivisible". Unfortunately, and despite the general consenous across nations that states that there is a fundamental human to health; we still see opposition to this declaration at every turn, particularly when it comes to women's rights to reproductive health.

It is these issues that Cecile Richards was asked to come and speak about, and an APHA Conference was indeed a perfect place to address them. The American Public Health Association is a non-profit, non-governmental that champions the health of all people and all communities, strengthen the public health profession, and speak out for public health issues and policies backed by science. They are the only organization that influences federal policy, has a 140-plus year perspective and brings together members from all fields of public health; and their mission is "to Improve the health of the public and achieve equity in health status". In adhering to that mission, APHA has begun to increase and strengthen their efforts on advocacy around social determinants of ehalth, healthography (which links health outcomes to where one resides), and health equity. Out of necessity and the understanding that more than 75% of health and wellbeing is not attributed to genetics or biological factors, but social determinants of health, including health behaviors; APHA and many other public health organizations have stepped into this role. They have realized that the focus, outside of what is viewed as the "traditional" public health model are needed to effect change in health outcomes. And that change includes improving the social stauts of women and girls. This understanding aligns with the United Nations Millineum Development Goals, which includes stated Goals that directly impact this population. For example, Planned Parenthood's work actually (4) of the stated 8 goals:

• Goal 3 Provide gender equality and empower women.

• Goal 4 Reduce child mortality.

• Goal 5 Improve maternal health.

• Goal 6 Combat HIV/AIDS.

These goals come with the understanding that education, financial indepenendce, contraceptive use, and family planning options allow for social mobility; which is tied to improved health outcomes.

Much like the selection in speaker, the leadership of APHA couldn't have picked a more suitable city than Denver Colorado to host this 144th Conference. Denver - and Colorado in general - stands out as a Progressive Western state. In terms of public health and women's health, they are really excelling. There is an effort to maintain walkable communities, comprehensive and integrated mental health services; many of which focus on the specific needs of women, and more. Below is a short overview of how Colorado has led-the way or continue to excel in advancing public health:

· Colorado is the "thinnest" state having the lowest obesity rate. However, it must be noted that the rates in the State are still worse off than they were 20 years agp; which means that they are matching the alarming trajectory of obesity that is seen nationally. To understand why women, particularly women of color need to be concerned about obesity see the article Health Shaming: Feminist Rhethoric is in Need of An Intervention . Obesity is THE most critical obstacle to optimal health and wellbeing, and has a number of comorbidities that often lead to premature death, reduce function, reduce mobility, and reduced quality of life.

· Colorado is a pioneer in terms of birth control access.

· Walkable communities and a general focus on Active living

· Decriminlization of marijuana - and utlizing the $121 million in tax revenue to provide health services.

• · Baby -friendly hospitals.

A Look Back At The Status Of Women

In order to achieve or even consider this goal of "Creating the healthiest nation", there must be efforts that safe guard and work to improve the health of women and girls, who account for (50.4%) of the United States population. And doing so- is the main focus of Planned Parenthodd, which has offered life-saving services to women who would not otherwise be able to access care. Seventy-nine percent of our clients have incomes at or below 150 percent of the federal poverty level. Planned Parenthood, like other organizations dedicated to women's health and reproductive justice, do so with the understanding that the clinical services that they provide are indeed linked to other health indicators. These indicators help to determine the "Status of Women" and much has changed in that status since the inception of Planned Parenthood 100 years ago. Consider the following:

· Family size declined between 1800 and 1900 from 7.0 to 3.5 children . In 1900, six to nine of every 1000 women died in childbirth, and one in five children died during the first 5 years of life.

· In 1916, the leading cause of death for women was tuberculosis and complications from pregnancy and childbirth.

· Now contrast that to the fact that in 2016, women in the US live 30 years longer thatn they did in 2016.

· In 1916, many women did not have a post-secondary education, but now women earn the majroity of Masters and Doctoral degrees conferred in the US. Even more amazing is that Black women, despite the historical legacy of racism, sexism, classism, and anti-Blackness that they have been subjected to, are now considered to be the most educated group in the US. However, this advancement in education has yet to materialize into improvements in social and health status for a number of reasons.

What Has Accounted For This Change In Status?

The recognition that women's rights are indeed human rights - and the orchestrated efforts of social justice and reproductive health activists, public health advocates, as well as clinicians who provide compassionate and quality services outside of a restrictive religious model, which help to sustain the problems of stigma and shame that is tied to women's bodies and sexuality. These are the people who have mobilized and continue to advocate for the human right to health care for women. And they represent those who realize something as simplistic as, abstinence being an unrealistic form of birth control, and further - they recognize that telling women that they should only practice abstience is actually offensive; and ignores the fact that women also enjoy sex as a pleasurable experience, not one that is simply tied to reproduction.

Thus, this change in status was aided by the disassociation of sex from reproduction through family planning and reduction in family size. The point that these factors have helped to improve health outcomes across the life trajectory, as well as in the health of babies, is well documented and understood. See here,here, and here.

For that reason many interventions efforts focus on the dissemination of condoms, increasing access to birth control, as well as working to abolish practices such as child marriage. The underlying framework is one of reproductive justice, which works towards women and girls having every opportunity to thrive. According to Dr. Camara Jones, President of APHA, this is the basis for health equity. Which she defines as "the assurance of the conditions for optimal health".

An Overview of Planned Parenthood's Services

All of the failed efforts to dismantle and defund Planned Parenthodd are extremely short-sighted and uninformed, in that they focus on only one aspect of the services that the organization provides: Abortion. Never mind this tidbit shared by Cecile Richards, "80% of US counties do not have abortion providers". With the way that those who try to trump on women's reproductive rights try to frame abortions as some kind of epidemic, you would think that there was milions of providers. And the attacks against the organization are filled with misinformation, and do not consider the fact that abortions are one of the safest medical procedures in the US, and that they are also performed to save the lives of pregnant women. Again, the fact that pregnancy complications use to account for the vast majority of premature deaths of women, cannot be ignored.

Still, Planned Parenthood provides a plethora of health and educational services to women - as well as men. Yes! Men actually go to Planned Parenthood for services as well, such as affordable vasectomies; realizing that family planning is not a responbility that is tied to gender/sex. Here is a list of services offered by Planned Parenthood:

· Health Care Services: STD testing and treatment, contraception, mammogram screenings, pap smears (cervical cancer screenings), and accompanying health care

· Prenatal Services

· Health Education services

· HPV vaccinations

Here are also other exciting and innovative services offered by Planned Parenthood and other reproductive health organizations:

· Skype accessible consultations for birth control prescriptions - provided online.

· Telehealth abortion services - with mailed medications.

· The "Spot On" (LINK) app that serves as a period tracker, but also teaches users about birth control. It will also "ping" users when it is time to take their pill. And it is available for free download.

In Conclusion

41% of unintended pregnancies actually occur due to inaccurate use of birth control, and this points to (3) things: (1) women continue to want and have a need for access to family planning services and resources, (2) most women are utilizing these serves, (3) far much more needs to be done in terms of education of both patient and clinicians.

Therefore, it is imperative that we approach women's health and human rights with the understanding that access will continue to be key. Access to care, resources, and education. We have far to go to make health care access a reality for all, thus ensuring this right to women's reproductive health will also require changes in sociocultural attitudes to help to remove stigma and shame; and guarantee equity in access regardless of gender, race/ethnicity, income, immigration status, and where one resides. There are 18 available birth control methods, and they are utilized by 90% of American women, which makes the Affordable Care Act's universal coverage of contraceptives for all women, regardless of insurer; another monumental public health policy that will ultimately help to further improve the status of women.

With gains in education, income, body autonomy, and other health indicators, and overall Status - the future may prove to be FEMININE.