—Barbara Katz Rothman
As someone who spends her life, her career, arguing against over-medicalization, taking too much of life and turning it into a medical problem requiring you to “ask your doctor” if this or that pharmaceutical product might be right for you, this is a rough moment. Because just now, watching the dismantling of the first stab the US has ever made to be like every other developed country and provide medical services to all of its population, I feel like an old bad Jewish comedy routine I used to hear. Two old Jewish women sitting around a Catskills hotel, complaining about the awful food. Terrible! No taste! Not fresh! And the portions are so small!
This whole scene is like a joke—or it would be if it were funny. But it’s not funny. We’re dealing at the same time with both sides of this and they are both very very real. Much too much of life, especially and specifically what is called “women’s health care,” is over-medicalized. And women can’t get enough of it.
I put the phrase “health care” in shudder quotes all the time now, because we are rarely talking about either health or care, but about medical services. Some of those services improve health and some do not. The things that genuinely and absolutely do improve health—access to clean fresh water, good housing with fresh air and light, unprocessed food grown in a safe environment, safe places to walk and run and bike and swim—those things are entirely separate from the public debate about “health care”.
But those things are slipping further out of reach of many of us as more Americans are mired in a kind of poverty that would be shocking if we allowed ourselves to look at it. I walked down 35th street from 5th to 6th avenue to get the subway after my class last night and watched a couple of men sorting through the cardboard boxes outside an Amazon delivery area. They were picking their bedding, finding a comfy spot under scaffolding in 30 degree weather with the schools having declared their closings for today’s blizzard. Around the corner from the Empire State Building. I see it every week as I head home late on Mondays. “America!” My immigrant great grandpa used to say, sighing and shaking his head, amazed at the wonders of the new world. And ‘America!’ I say, sighing in despair.
So health care isn’t happening—those guys are camping out as best they can while New Yorkers are arguing about where to put the homeless shelters. And how to fund them. And how many more we need than we will provide. Women, with and without children, make up a large portion of our homeless population—and who knows how many more of our all-but-homeless, put up by relatives and friends, scraping together enough for one more month’s rent, living on the edge of homelessness all the time.
Many of the women in that situation want very badly not to have a child, or not to have another child, maybe ever again or maybe just until they are better settled. And we are taking away the medical services they need—contraception. But why is contraception a “medical service”? We —as a country, as citizens and as consumers—allowed medicine as a profession to assume a monopoly on the provision of these services. It is demonstrably easier to fit a diaphragm than a shoe—they are circles after all, lacking the variations in width and depth that a shoe has. There are injectable LARCs, long-acting reversible contraceptives, shots one injects into a muscle, that are 99% effective in preventing pregnancies for two or three months, depending on the one chosen. I needed to do some injections on myself once – someone in the doctor’s office handed me the kit, told me to read the instructions. A friend suggested trying it on an orange first…I learned. An IUD is inserted through the cervix, and you have to be really careful not to misplace it. You can become a body piercer, learn to put jewelry through noses and labia and penises and nipples, after a quick course in sterile technique.
We have an enormous problem with unemployment, people who badly want jobs. Good, thoughtful, careful people. If one of them wants to go on GoFundMe, or borrow money from some friends, they can become a body piercer and see if the local shop will let them in. Or maybe raise enough money to rent their own shop. But if they want to fit a diaphragm, give the next LARC injection to a woman who has been on it for a year, or insert an IUD – not happening.
Ask your doctor. The doctors we have shortages of. The doctors who are going into better paying areas of medicine. The doctors whose fees we cannot afford. The doctors no longer covered by our collapsing Insurance system.
How much does it cost, in education, insurance, offices, all of it, to medicalize contraception? What is it like to be in a clinic that provides contraceptive services to poor women? Compare it to the warm, friendly atmosphere in your local tattoo and piercing shop, where they try to make you comfortable, talk to you, explain what they are doing.
Yes, medicalizing contraception has many costs. But right now, as Planned Parenthood is defunded, as the Affordable Care Act is being destroyed—my main complaint has to be that the portions are so small.
Barbara Katz Rothman is Professor of Sociology, Public Health and Women’s Studies at the City University of New York. She is the author of A Bun in the Oven: How the Food and Birth Movements Resist Industrialization (NYU Press, 2016).