health

Originally posted June 29, 2016

In early September 2015, Blanca Borrego, an undocumented Latina immigrant accompanied by her two daughters, arrived at a women’s health clinic in Texas for a routine gynecological exam. Sitting in the waiting room for nearly two hours, Blanca’s anxiety and impatience grew to the point where she almost walked out of the office. Eventually, Blanca was met by local law enforcement officials who escorted her out of the clinic in handcuffs for allegedly using a forged driver’s license during patient intake. Blanca’s eight-year-old daughter watched in tears while her mother was taken away and a deputy told Blanca’s eldest daughter that their mother would face deportation. Blanca remains in county jail on a $35,000 bond.

Scenarios like Blanca’s – highlighting the impact of race, class, and immigration status on reproductive rights – are not always brought to the fore. Although reproductive rights activists say they advocate for all women, difficulties faced by white, middle-class, heterosexual women get more attention than those experienced by women of color, immigrant or transgender women, or those with disabilities. However, a movement for reproductive justice has emerged by and for women of color that offers new possibilities to bring previously neglected issues to light. Key challenges include tackling the reproductive experiences of Latinas – and looking for ways to do more to address their needs in reproductive health care and policy.A movement for reproductive justice has emerged by and for women of color.

Latina Realities

Understanding Latinas’ reproductive lives requires understanding how many forms of disadvantage intersect and create reinforcing disadvantages. more...

Originally published October 19, 2015

The American abortion debate features “pro-life” activists wielding pictures of fetuses and “pro-choice” advocates telling horror stories about women forced to travel for hundreds of miles to access safe abortions. The struggle seems an irresolvable moral conflict – and both sides claim to be “pro-women.” Pro-choice organizations advocate that abortion be kept legal and made increasingly accessible because women have the right to privacy in matters of reproduction. Pro-life groups argue that the acceptance of abortion unjustly pits women against their children.

My research takes stock of activists on both sides – and identifies those that focus not just on the moral aspects but also on the socioeconomic context of abortion. In fact, abortion is mainly an issue for less privileged women, and if more pro-life and pro-choice groups recognized the economic realities, there would be possibilities for compromise.  more...

Stigma refers to social views or treatment that undervalues people for having conditions like mental illness, or for engaging in behaviors such as substance abuse. Specifically, stigma happens when people express prejudicial views toward such vulnerable groups or take prejudicial actions. Individuals who are stigmatized may try to limit the effects of stigma by withdrawing from others, hiding aspects of themselves, or avoiding situations where their vulnerabilities may be revealed. Scientific studies increasingly find that worries about being stigmatized – along with actual experiences of stigma – adversely affect health and psychological well-being and keep vulnerable people from using preventive health care.

Even common experiences can make some people vulnerable to stigma. Although unintentionally becoming pregnant and having to make decisions about how to proceed with an unintentional pregnancy are issues that many American women face, these conditions can prove stigmatizing. Young women in the United States have especially high rates of unintentional pregnancy, and may worry about stigma for having an unexpected pregnancy in the first place, as well as stigmas related to the decisions that follow (parenting, adoption, or abortion). This may be a greater concern for women whose experiences are different from the norms within their communities.Even common experiences can make some people vulnerable to stigma. more...

“That’s the Hollywood secret! Don’t put food in your dumb mouth!” That’s how Amy Schumer, a 34-year-old comedian, mocks the tyranny of thinness in Hollywood and American society. As Schumer recounted on the television show Ellen, as she prepared for her film “Trainwreck,” movie executives hired a personal trainer to try to help her slim down. They gave her a meal plan that consisted of “a smoothie for breakfast, and then like for lunch you journal about that smoothie…like, there’s no food!”

At 5’7” and 160 pounds, Schumer’s Body Mass Index is 25.1, just barely over the current cut-off between “normal weight” and “overweight” and slightly below average for the current U.S. population. But she counts as heavy in Hollywood, where weight-based discrimination prevails and bigger bodies are devalued and rendered invisible in the contemporary United States. Unlike most women performers, Schumer has defiantly refused to resemble an “undernourished bird.” Her normal weight has not hurt her romantic life or her career. On its opening weekend, “Trainwreck,” the movie Schumer wrote and starred in, grossed $30 million. more...

Catholic hospitals are a large and growing part of the U.S. health care system. Considerable public funding flows to these institutions, but they deny many reproductive health services and some kinds of end of life care to their patients. Catholic rules limit care in far-reaching ways, well beyond what many patients and health care providers understand or expect. These realities raise important issues about the future of religious restrictions in U.S. health care.

Restricted Care in a Growing Sector

Between 2001 and 2011, the number of Catholic hospitals increased by 16%, while public and secular not-for-profit hospitals decreased. One in six patients in the United States is cared for in a Catholic hospital, and in 2015, seven of the country’s 12 largest nonprofit hospital systems were Catholic. Although Catholic hospitals provide the same amount of charity care as non-Catholic hospitals, in terms of the percent of total revenues, they provide less care to Medicaid recipients than other kinds of hospitals.

Like other hospitals, Catholic institutions receive considerable public funding, yet they limit patient care to fit the Ethical and Religious Directives for Catholic Health Care Services written by the U.S. Conference of Catholic Bishops. As a condition of employment or medical privileges, doctors, nurses, and other clinical personnel are required to follow these directives when caring for patients in Catholic facilities.Legal rights mean little without practical access to reproductive health services. more...

Originally published in January 2016.

Americans are engaged in a great gun war, one that has raged for at least four decades. The war has intensified to the point where citizens cannot agree on the most basic facts. How many guns do Americans own? Does carrying firearms do more harm than good? Do firearm regulations work?

Although the answers are hotly disputed, most Americans share the goal of reducing our unconscionably high rate of gun violence. In a politically challenging environment, it makes sense to pull together what is known about guns and gun violence and look for policy approaches that could garner broad support.Most Americans share the goal of reducing our unconscionably high rate of gun violence. more...

Since the late 1980s, a new type of “special court” has emerged in the United States. These are problem solving courts that aim to provide treatment instead of punishment – attempting to reduce future contacts with the criminal justice system. Drug courts were the first type to emerge and have proliferated by the thousands over the last three decades. In turn, the drug court model spawned a variety of specialty courts focused on other issues, including problems of mental health and domestic violence and the challenges faced by military veterans. As these new specialty courts have spread across the country, researchers have investigated their effectiveness and probed to see why many offenders seem to do well in such programs. Here I summarize what has been learned so far.

How Specialty Courts Operate

Each specialty court provides programming that is designed to address underlying issues that bring groups of offenders to court in the first place. Drug courts, for example, offer services that support sobriety, such as individual and group counseling and twelve-step programs. They also require participants to appear for frequent drug tests. Mental health courts provide access to a psychiatrist and to psychotropic medication as well as to individual and group counseling. Where needed, specialty courts attempt to connect offenders to additional services such as help with housing and education as well as training for employment. more...

State laws limiting funding for abortion and requiring additional steps for women seeking abortion have been enacted for almost four decades, but more new restrictions were put in place between 2011 and 2013 than in the entire previous decade. At times, new enactments add new restrictions on top of older ones, such as lengthening the time periods in laws that require delays for women seeking abortions from 24 hours to 48 or 72 hours. Laws of this sort not only mandate that women seeking abortions must wait after hearing state-mandated information, they often require the information to be delivered in person rather than over the phone, so women have to make two visits. As of February 2016, 27 states mandated waiting periods, four of them with a 72 hour delay; and 13 states had rules that necessitated two visits.

Research on Utah’s 72-hour Waiting Period

Arguments rage about these laws. Advocates in support of them maintain that waiting periods are necessary to ensure that abortion providers will give women the time and opportunity to change their minds, while others argue that the logistical difficulties caused by waiting periods and two-visit requirements may prevent women from having abortions they want. Who is right? So far, researchers have not developed sound evidence about women’s actual experiences with these laws.

To help address this research shortfall, we, along with colleagues, have studied Utah’s 72-hour waiting period law, which in 2012 became the first 72-hour mandate to go into effect. Our study recruited 500 women who came for the required first abortion information visit at four family planning facilities in the state. Women completed iPad surveys before receiving the state-mandated information and any abortion counseling the facility routinely provided. Three weeks later, the women completed telephone follow-up interviews. more...

A very large number of Americans are held in jails and prisons – some 762 out of every 100,000 residents. Although the United States has only five percent of the world’s population, it holds one quarter of all the world’s prisoners. However, the social burdens occasioned by so much imprisonment are not borne equally by all segments of the American population. According to recent estimates, one of every 15 black men is held in jail or state or federal prison, compared to one of every 106 white males. This racial disparity has a big impact on the life fortunes of white and black men – contributing to gaps in many domains, ranging from jobs and family life to health and mortality.

But the social reverberations of mass incarceration do not stop with the prisoners themselves. The consequences can be even greater for children, family members, and associates attached to those who are imprisoned. A burgeoning research literature suggests that having a family member sent to prison damages the mental and physical health of those left at home. The imprisonment of a family member means one less person to contribute to household support, increasing stress and making everyone less economically secure.The social reverberations of mass incarceration do not stop with the prisoners themselves.

Although researchers have documented these indirect social impacts from imprisonment, they have been unable before now to estimate how many adult women and men are connected to an inmate – and therefore, have not been able to specify the scope of negative consequences faced by people tied to America’s prisoners. Now, for the first time, data from the 2006 General Social Survey make it possible to estimate the reach and wider social impact of the U.S. prison system. We use this data and build on previous studies to explore the impact of imprisonment on the family members and associates of black and white prisoners. more...

Around the world we see encouraging declines in the number of people newly infected with the virus that causes AIDS (as the acquired immunodeficiency syndrome is called). But hard-won gains in preventing and treating this “disease that changed everything” are not equally distributed across places and groups of people. The AIDS crisis has, in fact, widened inequalities in health and wellbeing the world over. In poor nations, AIDS remains a leading factor contributing to health declines, because more than 95% of the 33.2 million individuals infected with the human immunodeficiency virus (or HIV) that causes AIDS reside in such countries. The spread of HIV/AIDS has been especially detrimental to women in poor nations. The number of women infected with HIV has increased dramatically in recent years, and young women in less developed nations are about twice as likely as men to become infected. Strikingly, AIDS is the leading cause of death among women of reproductive age.

How can we understand women’s special vulnerability to AIDS, especially in poorer countries? Theories of gender inequality provide clear insights by highlighting the ways in which women have fewer resources and less control than men over decisions about sex and health practices. In particular, women in less developed nations face many barriers in getting needed access to vital educational and health resources, including schools and contraceptives.The AIDS crisis has widened inequalities in health and wellbeing the world over.

If gender inequalities, poverty, and low levels of education and access to health care make for a deadly brew that undermines the wellbeing of women across the less developed world, these harmful forces can be exacerbated by events and trends that further social disorder. In many poor countries, civil wars and violence obviously undermine the health and longevity of women (as well as men). In addition, the spread of AIDS can be spurred by environmental crises and degradation – exacerbated in many places by global warming. So far, the potential impact of environmental degradation on the spread of HIV/AIDS has received insufficient scholarly attention. Drawing insights from eco-feminist perspectives, our work takes a step in the direction of correcting this deficit. more...