Les Lilas, and women everywhere, are under attack

In France, women’s health and autonomy are under attack. When Francois Hollande ran for office, he made great promises. He promised that the maternity hospital “Les Lilas,” would not close down after having been the target of the conservative financial restructuration. Now he’s backtracking, and women’s reproductive rights are likely to be compromised.

The maternity hospital “Les Lilas” is located in a diverse area in the North of Paris. Les Lilas was built in 1964 with the feminist agenda to serve women’s needs. A privately run not-for-profit hospital, Les Lilas serves and participates in the public health care system. Les Lilas has historically been the symbol of women’s struggles for reproductive rights.

Today, the team of medical staff offers, with equal enthusiasm, obstetrical, gynecololical and abortion services to all women regardless of their social status or ethnicity. Their approach is integrative, making women’s needs and desire a priority. The feminist and militant aspect of the care they deliver departs from the current trend of cutting public services, including health care.

During the Sarkozy years the idea of profitability was extended to medical care. This was new for the French health care system. Sarkozy’s administration introduced a tariff arrangement that relegated care behind accounting. Now, President Hollande, having forgotten promises to save Les Lilas, has submitted the hospital to the same neoliberal profit motive.

Les Lilas needed funds for necessary renovations. These renovations were delayed making the hospital more dependent on credit for financing. Then, a tariff system was implemented devaluating abortion, which is a great part of its activity. Basically, the tariff devalued all health care services offered to women. This conjunction of devaluations typifies how women’s lives are undervalued in general.

Then, more regulations came to unfairly impose medical services upon Les Lilas, which forced the maternity hospital to invest money it did not have. These measures increased the hospital’s debt.

Across France, these conditionalities have forced many maternities to regroup, turning hospitals into “usines a bébés,” or baby factories.

When Les Lilas first needed some renovations, it had no debt. In fact, it was financially stable and had agreements to secure the future. With a debt forced upon it, the services provided to women are only measured in financial terms. With that shift, the hospital loses value.

The community, women and men, have joined together to counter this evolution. A collective committee has been formed; the staff of Les Lilas has been active using many media to show what this struggle means. Demonstrations have been organized with the support of many feminist and political groups. The last demonstration gathered 3000 people.

Isabelle Louis, of the French Movement for Family Planning and a member of the collective committee, told me that the negotiations with the regional health authority were difficult. Although the fund for renovations had been promised, the health authority now argues that running a deficit makes the delivery of that fund impossible. They use a new language of neoliberal accounting to confuse negotiations. The people used to be the actors and now they have become the developers. Isabelle Louis remarked how this neoliberal economic language has negated the social. This language talks of indicators of success, progress, and realization to respond to deficit with efficiency. However, this language has no term to analyze the health and well-being of the women who rely on “Les Lilas.”

Isabelle met with socialist Claude Evin, former minister of health and now general director of the regional health agency. He admitted that his obsession is to build more retirement medical homes than maternity hospitals. Of course, retirement facilities, unlike maternity hospitals, are part of a great market open to private investments. Isabelle has found the solution, “Let’s deliver babies in retirement medical centers!”

This tale is exemplary of the massive undertaking of neoliberal ideology on public systems. Women are under attack. In France, the progressive health care system and the reproductive health policies are threatened. France today, the United States yesterday, tomorrow … ? All of us, everywhere, need to pay attention to these signs.

(Photo Credit: La Maternité des Lilas Vivra)

Casual Rape: Who prosecutes the abusers that endanger women’s health?

In a consultation with her gynecologist a woman reports informally that she needs confirmation that she is free of all sexually transmitted diseases. It wasn’t really rape she pleads with a mix of fear and shame. She should not have been there, but he said she was pretty. It all happened so quickly, in a split second. Then she screamed, and he stopped. He is an administrative supervisor of 30 years; she is an employee of only 6 months. Elusive statistics on casual rape show 90% remain unreported. The data implies the existence of many fellow victims at her work place. This information, along with her negative test result, did little to assuage the permanent violation of body and mind that she carries each day back to the work place. Fear of exposure, retaliation, loss of job and personal safety becomes her new mode of existence. The physician bound by the limits of health privacy and absence of appropriate resources to help becomes an impotent appendage of the system, unable to address the social pariah, a system that traps the victim and the health care professional in a prison of secret public health epidemics of rape.

Here the prison isn’t a figure of speech. The two work in prison, and she is an inmate.

As mandated by the Prison Rape Elimination Act of 2003, the Bureau of Justice Statistics publishes regular statistical reviews and analyses of incidents and effects of prison “sexual victimization.” In its 2011-2012 report, sexual abuse rates remained fairly constant, with 4% in prisons, down from 4.5% in 2007; and 3.2% in jails, which is the same as 2007. Since incidents of sexual abuse are notoriously under reported and because the high volume of admissions in local jails making these detainees invisible to BJS surveyors, the statistics represent only a small percentage of prisoners’ abuses.

There is a need for a different kind of dialogue that would expose the marginalization of people that allows, and promotes, sexual abuses to go on behind closed doors. The important confidentiality of the physician’s office contrasts with the dearth of instances for sexual abuses to be rendered public without fear and shame. As we recall, pregnant women may be prosecuted and sent to jail for supposedly endangering their fetus, but who prosecutes the abusers that endanger women’s health?

We need to start a change in the paradigm of power that makes so many suffer.

(Photo Credit: ThinkProgress / Just Detention)

Expose the attacks on the undocumented and on women in France

While in the United States, attempts to hurt, reduce and constrain women’s bodies are multiplying (as the recent bill in Virginia to impose vaginal sonogram on women who seek an abortion demonstrates), two recent developments in France show that the politics of constraint and control of the body and in particular of women’s bodies are also expanding in Europe.

In France, undocumented immigrants, “les sans-papiers” have access to health care, through “l’aide medicale d’Etat” or AME (State Medical Aid), if they have been in France for at least 3 months. While this seems to be better than many other places in the western world, some barriers that have been erected to divide and control immigrants and residents.

For example, it used to be that in order to register, people could go to any regular center of the national health coverage “les caisses d’assurance maladie,” and there were many of them. Recently, new rules have been introduced. Since the end of 2011, in Paris only two centers have been processing applications to be registered in AME. After two months, the Observatory of Foreigners’ Right to Health, ODSE, has reported a series of problems. These include long waiting lines, starting in the middle of the night, summary selection of applications, loss of applications, mounting administrative red tape. All these difficulties contribute to delaying indispensable coverage and access to health care for people who are already among the most vulnerable.

Another recent development directly affects women’s health and well being. In 2001, a bill was passed that gave women’s reproductive rights a great boost. The new law includes provisions for anonymous access to contraceptive and abortion services for minors and without parental consent. It also provides for an ambitious sexual education program, lately the distribution of money to enforce this law has been problematic. Recent reports have shown the importance of sexual education through school as well as free and easy access to centers where women and men can access information on the various questions related to sexuality.

The law itself is beyond repeal, but that does not mean it is safe from dilution. Although officially budgeted for the 2012 fiscal year and voted by the parliament, apparently, 500 000 Euros slotted sex ed programs has disappeared. The Sarkozy administration must have misplaced it!

So how are these two issues related? Both are about creating barriers for some women to access services that allow full social participation and meaningful exercise of their rights. They are about relegating to the back seat some selected populations who are excluded through constraining policies on their bodies, which are, thus, made invisible in body politics of the nation. The reshaping of existing social advances concerning reproductive rights, health care for all, has become the priority of neoliberal governments. It follows the pattern that has already been developed for emerging countries, cutting public services. It is important to identify policies that follow this pattern. It is important to expose them in order to lessen the impact of the US neoliberal transformation anywhere it is being exported.

(Photo Credit: Femmes En Lutte 93)

W/Health: Constructions of delusional perceptions

The recent release of Deadly Spin by Wendell Potter, former head of corporate communications for CIGNA, has triggered media interest in trying to explain why there is no sound universal health care system in the United States nor does one appear on the horizon.

In fact, this book could be re-titled “The Confessions of a Public Relations Hit-man.” Potter was, as he writes, a “spinmeister” for the health insurance industry, in particular Humana and CIGNA.

He reveals some of the methods that are commonly used by corporations to “create perceptions without any public disclosure of who is doing the persuading or for what purposes.” He discloses the fundamental tools of the spin-business utilized by industries (health insurance, oil, tobacco, etc.) to manipulate so-called “public opinion” with faulty information, statistics and worse. Words and phrases like “propaganda”, “fear mongering tactics”, and “consumer” appear regularly. This spin-business has found support and sustenance in the absence of political examination of the current US society.  Potter is critical of the process but rarely, if ever, critical of the neoliberal thinking that vindicates it. In The Birth of Biopolitics: Lectures at the College de France, 1978 – 1979, Michel Foucault argued “liberalism in America is a whole way of being and thinking.” Potter’s book confirms this critique of `liberalism in America.”

In my attempts to summarize what Deadly Spin exposes, I realized that what it does not expose is equally important. Potter exposes in great detail the technique and the technology of crafting messages made to diminish actual stories of mistreated people to a mere discussion of their economic viability. He also exposes the collusion between corporate power and political power in the United States, showing how corporations get involved in writing bills aimed at controlling their own power.

Potter exposes PR groups, such as APCO, that specialize in “influencing decision-makers and shaping public opinion by crafting compelling messages and recruiting effective allies”. For instance, Michael Moore produced a truthful documentary, Sicko, on the suffering of American citizens who were denied financial coverage of their medical needs. Moore focused on American citizens who had health insurance and how they were vulnerable to the health market emphasizing that access to care was a financial privilege. APCO worked strenously with Potter’s PR team to produce propaganda against Sicko and succeeded in reducing the impact of the film.

A turning point in Potter’s professional life occurred when he came across a RAM (Remote Area Medical) clinic and saw with his own eyes the ways in which people seek care were packed and packaged. Tellingly, the clinic was installed in animal stalls. Nothing prepared him for what he saw.

What the book does not reveal is the link between neoliberal dogma as religion and the reduction of people to consumers of health care. What if Potter had the same revelation in Philadelphia, where he lives, where there is massive poverty, where life expectancy, in some areas and especially in African American communities, is lower than in Bangladesh? What if Potter hadn’t had to travel to the distant rural zones to see the health care situation?

Potter reviews the history of health care reform without revealing the profound effect of racial and social discriminations. His framework remains free enterprise, service, such as there is, remains service to the consumer. He fails to reveal that the neoliberal Public Relations industry has also worked in the worldwide promotion of the same market based health care. Cigna was among the health insurance companies that invested in countries where Structural Adjustment Programs imposed the destruction of public social services, including health care. CIGNA was one of the health insurance companies that grossly benefitted from those deregulations.

Potter also does not address reproductive health and rights, except to note that women’s policies cost more because of pregnancies. In this, he mirrors the decision of the Obama administration to bargain away coverage for abortion and reproductive health as well as immigrants’ health in the passing of an ill conceived and inadequate health care plan.

Nonetheless I appreciate and respect his personal and emotional inquiry. He is right when he says that journalism has become corporately infused. Corporate, and I would add nationalist as well. He gives many examples of PR constructions and distortions of realities meant to keep people in the dark with regard to their health care system, “selling the illusion of coverage,” constructions and distortions that were never denounced or investigated properly by journalists. Those distortions have formed the faith in the power of the neoliberal economy. In the United States, opposition to that faith is subtly silenced. Wendell Potter comes short of acknowledging this relationship. Instead he remains focused on the manipulation of news media, maybe because he started his career in journalism and has now returned to it as a senior fellow on health care at the Center for Media and Democracy.


(Photo Credit: PR Watch)


Security of Sex: New Oklahoma Abortion Law

Yesterday, October 7, 2009, the Oklahoma legislature passed a law requiring that private and identifying information be published online for women who have had abortions in state in order to deter women from having abortions.  While this is only one of a plethora of restrictions on women’s right to choose in Oklahoma, it is a particularly dangerous one.  The law has no actual scientific purpose, the manner in which the data is collected is practically unusable for any objective research, instead it is meant to shame and endanger women who seek this medical procedure. It even goes so far as to ask women why they are getting the procedure and outlaws any sex-based abortions.  Though women’s names are not published, information such as their age, race, level of education, marital status, number of previous pregnancies, and the county in which the abortion was performed.  Such information could easily identify a woman living in a smaller town.  No woman should have her medical history judged in the public square and the idea that this will deter abortions shows an unfathomable misunderstanding of pregnancy and abortion in this country.  Abortions are not sought simply by promiscuous teenagers that the overly paternalistic legislature is trying to make “take responsibility”.  You have to be 18 or have parental consent in Oklahoma anyway.  Abortions are sought by women for a wide variety of reasons including incest, rape, health of the mother, viability of the fetus or inability to care for the child.  Irrelevant of the reason, it’s private.

Likewise, the paperwork is incredibly long and puts an additional burden on already overstretched doctors and nurses at the handful of clinics in the state.  The publication of this information is a potential violation of HIPPA and the Oklahoma Constitution and while there are likely to be suits to overturn the bill, they will not be able to have an effect for some time.  The law goes into effect on November 1st.

Regardless of your feelings on the abortion debate, publishing women’s private medical history with information that could easily identify them is a gross abuse of power by the legislature.  It is not a matter of religion and scare tactics that drive women’s health procedures further underground are never for the public good.  Abortion will be reduced when the need for them is reduced through accessible and affordable contraceptives, education regarding contraceptive use and family planning as well as prevention of sexual abuse.  We need to let our legislators know that this is not acceptable.  Please look up your representatives here: http://www.lsb.state.ok.us/.  Write and call them immediately and let them know that you do not want this law.  Pass this information on to every Oklahoma voter that you know.  Below are several articles and the language of the law itself.


(Photo Credit: Michael Cross / KOSU / NPR)