U.S. Women’s Movements and Health Care Reform

Circulating Now welcomes guest blogger Beatrix Hoffman. Dr. Hoffman is Professor of History at Northern Illinois University and guest curator of NLM’s most recent exhibition, For All the People: A Century of Citizen Action in Health Care Reform.  With the extension to open enrollment at HealthCare.gov in the news, here is the first of two posts exploring key themes from the exhibition.

Feminist activists and women’s organizations have been involved in health care reform debates in the U.S. for over a century. While the struggle for reproductive rights is the most familiar part of this history, women have also advocated for other fundamental changes in the health care system, including maternity protection, preventive medicine and primary care, home care, and racial equality.

In 1893, nurse activists Lillian Wald and Mary Brewster founded the Henry Street Visiting Nurse Service in New York City. Wald, through her passionate writings and speeches, insisted that poverty and sickness were connected problems. The Visiting Nurse Service provided free or low-cost nursing care to the poor and immigrant population of the surrounding neighborhoods, and continues to exist today. Wald was also a leader of the women’s suffrage movement, whose first legislative victory after winning the vote in 1920 was the creation of the Sheppard-Towner Act to provide health education and home nursing to poor and rural mothers and babies. (Unfortunately, Congress cancelled the program in 1929).

A nurse from the Henry Street Settlement with a Chinese family in the Bronx, New York, 1930s National Library of Medicine

“Infancy and Maternity Care” and public health education are part of the planks presented by the National League of Women Voters during the 1920 Democratic Convention Courtesy Collection of the Oakland Museum of California

During the earliest debates around medical coverage for working people, in the 1910s, women leaders played an important role. The first health insurance bills in the U.S. were drafted by Olga Halsey, a researcher for the American Association for Labor Legislation who had extensively studied the new insurance system in Great Britain. Pauline Newman, a Lithuanian immigrant factory worker who became an organizer for the International Ladies’ Garment Workers’ Union, was a leading voice in arguing that health insurance legislation must include maternity coverage for working women. Newman was far ahead of her time in calling for new mothers to have a right not only to time off for pregnancy and childbirth, but also to wage replacement. Today, the U.S. is still one of the only countries that does not require employers to offer paid maternity or paternity leave.

The Urban League, a civil rights organization, co-sponsored this well-baby clinic to combat high infant mortality in African American neighborhoods, Detroit, MI, 1919 Courtesy University of Michigan-Bentley Historical Library

Pauline Newman, a Lithuanian immigrant, was a garment worker and union organizer before becoming director of the International Ladies’ Garment Workers’ medical clinic in New York City. Photo ca. 1910 Courtesy Kheel Center, Cornell University

The “second wave” feminist movement of the 1960s and ‘70s transformed the medical system by insisting on women’s knowledge and control of their own bodies. Women of color activists combined feminist and antiracist analyses to develop an inclusive definition of reproductive rights, arguing not only for the legalization of abortion and birth control, but also the right to be free from forced sterilization. The National Welfare Rights Organization, made up of predominantly African-American women, pushed for a Patients’ Bill of Rights and demanded equal treatment of the poor and Medicaid recipients by hospitals.

First edition of Women and Their Bodies course book, produced by the Boston Women’s Health Collective, 1970 Courtesy The Boston Women’s Health Book Collective

Women of color activists protest against forced sterilization, ca. 1971 Courtesy Kevin Begos and Southern Conference Educational Fund

Geraldine Smith of the National Welfare Rights Organization speaks to a reporter about her appearance before the American Hospital Association, 1970 National Library of Medicine

In the 1970s, feminist organizations began to call attention to the ways in which private health insurance discriminated against women. For example, the Coalition of Labor Union Women publicized reports showing that insurance companies charged women higher premiums for individual insurance, and 80% of individual policies excluded maternity coverage. These practices were finally outlawed in the Affordable Care Act (ACA) of 2010. The Affordable Care Act requires that insurance companies cover preventive screening exams and birth control without copayments. Although birth control coverage continues to face legal challenges by conservative and religious organizations, the ACA’s ban on gender discrimination in insurance and its elevation of preventive care reflect the long history of women’s health care activism in the U.S.