How One Clinic Is Fighting For A Reproductive Health Revolution
Women’s Health Specialists (WHS) Executive Director Shauna Heckert doesn’t parse language; she’s in reproductive health care because it’s the pathway to liberation.
“For me, health could be the cornerstone of the revolution,” Heckert told me. “Women are always going to have the best ideas for themselves and the children that they’re raising. When we put the power back in women’s hands, we’re all going to win, because women will be looking at their villages, their families, and their communities, and working in a nurturing way.”
The ability of clinics — particularly independent clinics — to fulfill this mission of meeting people where they are and caring for their communities is quite literally on trial this week. The Texas law made famous by the filibuster in the summer of 2013 arrived at the steps of the Supreme Court on Wednesday. Not even a vacancy left by the late Justice Antonin Scalia could delay Whole Woman’s Health v. Hellerstedt from being heard — and ultimately determining whether or not the massive state of Texas will be down to a handful of clinics in a few short months.
Nearly a million people in need of regular reproductive health care could be without a trusted team of caregivers from their community. As the president and CEO of Whole Woman’s Health Amy Hagstrom Miller has said repeatedly since the case began, nothing can replace having a clinic nearby.
“I think it’s important to point out that abortion is legal in this country,” said Hagstrom Miller. “And so every woman deserves to have access to whatever method for terminating her pregnancy safely she might choose in her local community.”
What makes local, independent clinics so different, so vital to the overall well-being of those they serve? Can health care, in fact, be the revolution, as Heckert so confidently and matter-of-factly said to me recently? Spending just a little time with her to learn the history of WHS not only made me believe it; soon, I also found myself asking how to enlist.
Reproductive Care Post-Roe
Putting health in women’s hands has been the mission of WHS since the clinic group opened its first location in underserved Chico, California 40 years ago. The founders had been helping to provide pregnancy testing and other services to the community when a sister clinic in Oakland offered to help them expand into a full-spectrum facility.
“We came to be in the mid-’70s — this was the height of the women’s movement in this country. And also the women’s health movement. Our Bodies Ourselves had just come out, and then in 1973, Roe v. Wade came. We were doing pregnancy testing, but there was no place for women in Northern California to go for abortion care — in fact, you couldn’t even really get birth control.”
Despite abortion being legalized in the state of California in 1969, the law required patients to get a psychiatric evaluation that declared they would be an unfit mother before being granted access to care. The laws were both new and full of hoops, so only doctors in metro areas like Los Angeles and San Francisco were providing abortions, leaving many in the vast, 1,000-mile-long state unserved. Patients were driving and flying in from all over the country and Mexico, but many areas were left completely without care — leaving lower- and some middle-income people with nowhere to go for an abortion or even contraception.
“Birth control offered through physicians in private practice was for women with insurance, not women on public assistance,” Heckert told me. “And it certainly wasn’t for women who were unmarried and reproductively active — you know, sexually active young people somewhere between their first kiss and first child. They weren’t going to see those women.”
Over the past four decades, reproductive health clinics have survived arsons and undercover attacks by anti-abortion extremists posing as patients, the further corporatization of health care, and a name-brand culture that makes it hard for independent facilities to stay open. Through all these bumps in the road, WHS has continued to provide care for the community they serve with a philosophy that remains unchanged: “to promote positive images of women and provide our clients with a new perspective on their bodies and health.”
The most recent bump in the road was an ominous symbol left on the clinic doorstep last month for the WHS staff. The clinic’s legal monitor Shireen Dada Whitaker, who also runs their social media and coordinates the clinic escort program, wasted no time boldly posting about it on Facebook:
“This morning clinic workers found a dozen metal hangers spread out in front of our clinic door. We will not be intimidated by such a ridiculous prank. These hangers are sobering reminders of why the work we do is so important, and they also are just what we needed to hang up our clinic escort vests! Thanks, pranksters! #thisclinicstaysopen #clinicescortsareheroes”
While no one has claimed responsibility for the “ridiculous prank,” and Whitaker says it doesn’t seem like the style of any regular picketers, it happened just as the biggest harassment season — the annual 40 Days For Life campaign — was about to kick off. This is the time of year between Ash Wednesday and Easter Sunday when staff and volunteers have to be more vigilant and expect the unexpected. Anti-abortion groups aim to have “vigils” at clinics around the clock, and use the additional shift needs to recruit new volunteers to stay involved throughout the year.
The significance of the incident is also amplified by the fact that Tennessee resident Anna Yocca is sitting in prison awaiting a mental-health evaluation and possible trial for attempted murder after using a hanger in an attempt to self-abort this past September. Cherisse Scott, founder and CEO of Tennessee-based reproductive justice org SisterReach, wrote at RH Reality Check about what she remembers and what she sees now:
“As a Black woman who knows exactly what a lack of abortion access before Roe meant for Black women, I cannot help but cringe at the thought of what tragedy we will face if Tennessee does not reconsider its position in interfering with women’s health-care decisions.”
Recent studies confirm what we already knew: When someone doesn’t want to be pregnant, they will find a way to end the pregnancy despite the potential danger. Coat hangers were the symbol of the movement to decriminalize abortion up to Roe v. Wade, when health care seemed to finally be a Constitutional right. WHS was born out of this paradigm shift that handed individuals the reigns to their bodies.
Whitaker, whose duties also include community outreach, told me that the philosophy and approach to care are why she’s so committed to her job despite the current atmosphere of abortion provider targeting:
“One thing I can say from personal experience, just from going to the health center as well as teaching about it, is that we offer every form of birth control while still being conscious of letting people know, ‘Hey, this is hormonal, it could cause depression. So if you have any conditions that might affect, seriously think about it. If you have problems with it, come back in.’”
Whitaker and the other WHS staff bring their personal experiences with the health industrial complex to their work.
“[Away from WHS,] I had to teach my provider’s nurse what a cervical cap is because that’s what I use currently. That’s something that we offer at the clinic, along with all the new diaphragms. The only thing we don’t offer is sterilization, but of course we refer out for that,” said Whitaker. “We have an adoption plan and prenatal care. We try to offer everything pregnancy- and STI- related.”
Full-spectrum care isn’t the only service WHS provides. During our interview, Heckert returned to the phrase “well woman” several times. In addition to hiring from within the community so that patients can feel comfortable, WHS engages in outreach and education programs that help people take their health into their own hands. The goal is to empower people while destigmatizing and demystifying how bodies work and feel.
“We started what we call a well woman clinic, which was larger than birth control,” Heckert told me. “We’ve always had two issues; one is that women needed to have a place to come to get an abortion in a respectful, supportive way — safe, all of that. And then the other side is that we needed a place where we as women could go to get true reproductive health knowledge and birth control.”
Part of that knowledge was teaching patients what their bodies do when they aren’t sick, and aren’t in need of fixing or patching up.
“That’s why we were so turned on by self-examination; it gave all of us a whole new view of our bodies that wasn’t medicalized,” Heckert explained, excitedly describing the WHS policy of sending patients home with their own speculum so they could take real control of their bodies by learning how they look and feel on a regular day. “We realized that our bodies were ours and that nobody really could take care of our bodies the way we could.”
Clinics Under Siege
The particular hands-on health-care approach utilized by WHS is unique to independent clinics and clinic groups. They provide a style — a choice — available in far too few areas. As Molly Redden covered at The Guardian last year, clinics are closing even in “safe, blue” states. Redden counted more than 50 clinic closures in 2014, with over half in blue states. One of the most ignored factors? How expensive they are to run. To be frank, no one is getting rich running a full-spectrum reproductive health clinic; most clinics lose money on every abortion procedure they perform, trying over the decades not to raise rates because they know the financial hurdles their patients already face.
These financial hurdles, combined with the toll of fighting oppressive, unnecessary laws — almost 400 introduced last year alone — hurt independent clinics disproportionately. Without national name recognition, they don’t always have the fundraising power to survive the challenges, fly doctors in from out of state, and keep up with payroll. When I asked Whitaker what was so important about independent clinics, she sighed and said: “That they exist at all.”
Anyone who has ever shopped for a doctor in any specialty knows how important having a choice of approach, insurance provider, location, language availability, sub-specialty, and other factors can be. Personally, I had to shop for more than 18 months in doctor-rich San Diego with an insurance plan taken basically everywhere in order to find a primary-care physician who was a good fit. For people without my atypically vast experience with doctors, hospitals (I had my first surgery at age five), insurance companies, and the medical industry in general, the additional concern of needing to feel at home in order to open up is paramount.
“We don’t have an agenda . . . We say, ‘Here are your options and we’ll help you walk down that path, together — but it’s your path.’ It’s very, very different than what you’ll find in most places,” said Heckert.
“Peer-to-peer informational counseling can only be accomplished by a woman speaking to another woman,” Heckert continued. “We hire nurses and physicians to work and do the care, but we think that the women who are the backbone of what we do here have to not be part of the medical industry. We have something to share: You are your own best screener; you are the person who can and should make decisions about your health care.”
Whitaker added that part of not having an agenda is not policing people’s personal lives. “We’re not trying to prevent teen pregnancy,” she cited as an example. “We’re just trying to get people the information so they can make the best decisions for themselves.”
Teen parenting and sexuality advocates at organizations like Strong Families spend a frustrating amount of time explaining that young people have the right to control their bodies and futures just like everyone else. The standard cheering when teen pregnancy rates are down, and the pushing of long-acting birth control on young people, contributes to stigmatization rather than support, education, or empowerment. It is extraordinary how intentional WHS clinics are in creating an environment where patients of any age, background, gender, income level, citizenship/documentation status, or religious affiliation can feel comfortable. They don’t want to be a place where you shuffle in once a year or when you’re in a crisis, then shuffle out having had just your basic needs met; they see what they do as truly empowering their patients and being an integral part of their well-being.
“Until women are really in the driver’s seat of their own health care, you’re going to see these kinds of bizarre contradictions — where someone has a forced birth control and another couldn’t get it no matter how hard she demands it,” said Heckert. “And that’s because somebody other than you is making a decision about what you can have.”
Supposedly, Roe v. Wade ensured that the person making decisions about your health care would always be you, but the right to privacy that serves as the backbone of Roe left a lot of wiggle room and a trimester framework for restricting access to abortion care. The longer I spoke with Heckert, the clearer it became that both so much and so little has changed since the early days after Roe.
“There are so few women-run clinics left in the country; it’s like we’re on an island,” she said. “We were a model of health care — and we still are, but we don’t have very many sister clinics anymore, which is not a great thing.”
Heckert casts a wide net when outlining how this island was created: a patriarchal culture, capitalism, shaky Supreme Court decisions, Reagan, Bush Sr., and coverage bans like the Hyde Amendment.
“Oddly enough, we haven’t come very far,” she said. “Some of the things from when we started out are still happening today — patriarchy, capitalism, sexism. Women’s liberation and those things don’t go together.”
Despite the ongoing frustrations and long road ahead to the end of stigma around abortion care and other reproductive-health needs, Heckert got excited describing what has changed since the early days of WHS.
“I do see bright spots. When we started in the health care and reproductive rights moment, we didn’t know anything,” said Heckert. “There’s so much knowledge now — about how an abortion is done, how easy an abortion is, that abortion doesn’t have to be done in hospitals. These are things that are much more generally known than ever before. There’s also a lot more access to information.”
Access to information: a fitting bright spot for a woman who sees revolution in community-based health care designed to empower through education. Let’s hope it’s a revolution that penetrates the walls of the Supreme Court and spreads to every corner of the country.
Lead image: flickr/anqa