On October 30, 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 bullhorns, 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 policymakers — 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 President-elect 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 nonprofit 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 US 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. Instead, those type of policies are often championed by these groups.
Nevertheless, I considered this hypocrisy once again, as I made my way towards the Belasco 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 consensus 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 nonprofit, non-governmental organization 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 health, 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 well-being 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 affect change in health outcomes. And that change includes improving the social status of women and girls. This understanding aligns with the United Nations Millennium Development Goals, which includes stated goals that directly impact this population. For example, Planned Parenthood’s work actually covers four 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 independence, 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:
- Colorado is a pioneer in terms of birth control access;
- Walkable communities and a general focus on active living;
- Decriminalization of marijuana — and utilizing 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 safeguard and work to improve the health of women and girls, who account for 50.4% of the United States population. This is the main focus of Planned Parenthood, which has offered life-saving services to women who would not otherwise be able to access care. Seventy-nine percent of 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 than they did in 2016.
- In 1916, many women did not have a post-secondary education, but now women earn the majority 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 abstinence 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 Parenthood 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 were millions 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 responsibility 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” 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.
41% of unintended pregnancies actually occur due to inaccurate use of birth control, and this points to three things: (1) women continue to want and have a need for access to family planning services and resources; (2) most women are utilizing these services; (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.
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