Our Bodies Ourselves and the Women’s Health Movement in the United States: Some Reflections

As a cofounder and past executive director of Our Bodies Ourselves (OBOS), formerly known as the Boston Women’s Health Book Collective, Inc., I offer a few reflections on the influence of second-wave feminism on health policy.

The second-wave women’s health movement (WHM) in the United States had its origins in the late 1960s, when women’s groups, providers of health services, and their allies organized to legalize abortion. Many of these groups soon engaged in other health issues as well, establishing health centers controlled by women and self-help organizations that advocated policy changes. (For more about this advocacy work, see the box on page 845.) Some produced publications, the most notable of which was Our Bodies, Ourselves¹ by the Boston Women’s Health Book Collective, later known as Our Bodies Ourselves. Newsletters that intertwined education and advocacy included HealthRight (New York, NY), WomenWise (New Hampshire Feminist Health Center, Concord, NH), and the Santa Cruz Women’s Health Center Newsletter (Santa Cruz, CA).

THE REFLECTIONS OF ONE WOMEN’S HEALTH ACTIVIST YEARS LATER.

To me the heart of OBOS [Our Bodies Ourselves] was always the power of women to gather around kitchen tables and to surface our own understanding of our bodies and our contexts and not submit to those who said our knowledge didn’t matter. One of the ways of helping women—but just one—is advocacy for health policy changes. But as we have won those victories, have we also lost something? I think of health centers and their voluntary beginnings when providers and patients were one community and fought together as equals for the expansion of access to marginalized peoples. Winning FQHC [federally qualified health center] status and getting federal dollars was a huge victory, but the unforeseen result was a division between provider and patient. Patients no longer think of CHCs [community health centers] as “theirs.” This generation of women needs to know the history of self-help, the early and illegal providers of abortion and midwifery care, the fierce womanhood that protected each other in doctor’s offices and the halls of Congress. What is it that women do for each other that transcends the scientific/medical? What is “care?” Can we get back that original spirit of the women’s health movement? I hope so! —Meizhu Lui, Highlander Research and Education Board, Hamakua Health Center Board, Hawaii County Advisory Committee on Aging

The Boston Women’s Health Book Collective grew out of a women’s liberation conference in 1969 at Emmanuel College in Boston, Massachusetts. Informal for several years, this group incorporated in early 1972 to sign a contract with Simon & Schuster to produce the first commercial edition of Our Bodies, Ourselves (a newsprint edition had been distributed by the New England Free Press from December 1970 to early 1973). OBOS cofounders were White and primarily middle-class veterans of the civil rights and antiwar movements who had a growing consciousness about the concerns of poorer women and women of color. The issue of White privilege within the group was not systematically addressed, however, until the 1980s and 1990s.

A unified national voice for the WHM began in 1976 with the founding of the National Women’s Health Network (NWHN), and Our Bodies, Ourselves became a primary resource for activists in the WHM.

Helen Rodriguez-Trias, MD, past president of the American Public Health Association, was among the early prominent women of color to recognize the importance of feminism: “Women,” she said, brought a feminist perspective to health issues by “examin[ing] power relationships among individuals and between individuals and systems.”^2(p567)

Rodriguez-Trias also emphasized the importance of class and race. In 1975, for instance, she noted that although the WHM “was very diverse . . . the more public positions articulated by the movement didn't include the experiences or concerns of women of color or of poor women.”^2(p567)

During the 1980s, women of color began creating more local and national organizations to focus on issues related to women and health. Examples include the National Black Women’s Health Project (now based in Washington, DC, as the Black Women’s Health Imperative), the National Latina Health Organization (Oakland, CA), and the Native American Health Education Resource Center (Lake Andes, SD). In 1992, six organizations formed the national Women of Color Coalition for Reproductive Rights,³ and in 1997 SisterSong Women of Color Reproductive Justice Collective was formed by 16 organizations of women of color.

EARLY SUCCESS STORIES

Although groups like OBOS and the NWHN grappled internally with issues of race and class, they began to influence policy in other areas. Here are just two of the early success stories.

Patient Package Inserts

In the early 1970s, lack of information about high-dose estrogen birth control pills and the growing awareness among women about problems associated with their use led to organized protests, including disruption of special hearings by congressional committees. Barbara Seaman, author of The Doctor’s Case Against the Pill, and Alice Wolfson, who met at one of these hearings, cofounded the NWHN along with Mary Howell, Belita Cowan, and Phyllis Chesler. The NWHN subsequently led a successful effort to secure patient package inserts for oral contraceptives and other estrogen products, arguing that inserts were an essential component of informed consent. (This program was subsequently eliminated by the Reagan administration but resumed during the Clinton administration.)

The Pharmaceutical Manufacturers Association and the American College of Obstetricians and Gynecologists sued the Food and Drug Administration (FDA) to block the distribution of these patient package inserts. In response, four women’s and consumer organizations, led by the NWHN, entered the case as codefendants with the FDA. The case was won, and patient package inserts for estrogen products were retained.

Sterilization Abuse

Sterilization abuse became a focus of debate during the 1970s, when advocates, journalists, and community organizations documented and publicized the degree to which women, especially women of color (including Native American women on reservations), were sterilized without informed consent and often following threats of losing public benefits. This publicity led to federal regulations to curb the incidence of abuse in federally funded hospitals. These regulations included a 30-day waiting period, provision of information in a language clearly understood by the woman, and prohibition of the use of hysterectomy solely for sterilization. These regulations were somewhat effective. (Much of the documentation for the role that the NWHN and OBOS played in these hearings as well as with the recruitment of experts to write the federal guidelines is now in the OBOS archives at the Schlesinger Library at the Radcliffe Institute.)

Advancing Women’s Health at the Federal Level

Groups such as the NWHN and OBOS created greater public awareness of policy issues concerning women’s health. For instance, they helped garner support for the Women’s Health Equity Act, a package of bills introduced in Congress in the early 1990s. Although only elements of this package were enacted, this activism led to later successes advancing women’s health research, service provision, and prevention programs in such areas as breast and ovarian cancer, sexually transmitted infections, contraception, infertility, osteoporosis, and adolescent pregnancy. Vivian Pinn, who was director of the Office of Research on Women’s Health (ORWH) at the National Institutes of Health (NIH) for 20 years, has also noted on numerous occasions the key role of OBOS and the NWHN in the establishment of ORWH:

These two groups, along with other advocacy organizations, altered public consciousness about women’s health needs and paved the way for the founding of ORWH. Their participation in ORWH meetings and conferences further enhanced conversations about women’s health research. (Vivian Pinn, personal communication)

This kind of input is chronicled, for example, in the proceedings for the Science Meets Reality Workshop held in January 2003 at the NIH.⁴

ONGOING CHALLENGES

The NWHN and OBOS have collaborated on many campaigns over the years (e.g., to block FDA approval of silicone-gel breast implants and flibanserin, a drug promoted for “female sexual dysfunction”). Although these campaigns were not always successful, the media attention they attracted educated the general public, and the low sales of flibanserin (now marketed as Addyi [Sprout Pharmaceuticals, Raleigh, NC]) can be attributed to this attention. Both organizations continue to promote a better integrated, evidence-based maternity care system through adopting best practices, licensing and regulating certified professional midwives, and reducing unnecessary obstetrical interventions, such as medically unindicated cesarean section.

Reports from federal agencies sometimes reflect the input of WHM activists. The December 2018 report on strong start centers from the Center for Medicare and Medicaid Innovation exemplifies how advocacy on behalf of midwifery is helping to create a better evidence base for interventions that improve birth outcomes the most.⁵

Although the WHM is much smaller now than a few decades ago, its influence remains. For example, Our Bodies, Ourselves was the model adopted by the group that produced Trans Bodies, Trans Selves,⁶ and OBOS cofounder Wendy Sanford was asked to write the afterword for this unique resource. OBOS’s colleagues in other countries have translated and adapted Our Bodies, Ourselves into more than 30 languages during the past few decades. When I was invited recently to speak at the 20th anniversary celebration of the Women’s Health Department in Vienna, Austria, the e-mail invitation noted, “Our Bodies, Ourselves has been so influential for the women’s health movement and therefore also for the foundation of our department. Our department was founded in 1999. We are part of the City of Vienna administration. But our roots are in the women’s health movement.” This e-mail reminded me of the importance of collaboration among those who work both inside and outside the powerful institutions whose policies shape our lives. I hope someday to see a more systematic chronicling of such efforts spawned by the WHM and groups like OBOS and the NWHN.