America Has a Long History of Pitting Politics Against Public Health

Planned Parenthood President Cecile Richards. Photo courtesy PBS.

Yesterday when Planned Parenthood President Cecile Richards faced a Congressional committee investigating a misleading viral video about the organization, she was forced to defend the reproductive health services Planned Parenthood provides. During the questioning, Utah Representative Jason Chaffetz displayed a chart that showed Planned Parenthood’s abortion rates increasing while its cancer screenings declined. He said the chart was from Planned Parenthood’s annual report, but Richards said she’d never seen it before—it quickly turned out that the inaccurate graph was not from Planned Parenthood, but from an anti-reproductive rights group called Americans United for Life. Whoopsie. 

This is far from the first time that public health has been pitted against politics in America. Richards has joined the long history of female public health professionals who have found themselves having to defend their work to politicians. For over 100 years, birth control and women’s access to healthcare have been pawns in the toxic environment of American political discourse. Here is a brief look at five women who worked in public health and faced political obstacles when attempting to promote the greater good. 

Lillian Wald: Advocate for the Tired and Poor
After attending the birth of her sister’s child, Lillian Wald was inspired to become a nurse. In 1891 at the age of 24, she graduated from the New York Hospital Training School, and immediately went to work as a nurse at the New York Juvenile Asylum—an orphanage for children aged four to 14.

Wald identified as a “public health nurse”—a term she coined in 1893 to describe nurses who worked outside of hospitals, primarily in poor and middle-class communities, responding to referrals from physicians.  Public health nurses were not simply involved with the treatment of patients, but focused primarily on preventative care and maintaining health.

Also in 1893, Wald began teaching classes in home nursing and hygiene to immigrant women in the Lower East Side tenements, and established the Visiting Nurses Service along with her friend and colleague Mary Brewster.  By January of 1894, Wald and Brewster had visited more than 125 families. The following year, Wald moved to 265 Henry Street and founded the Henry Street Settlement House—an organization still in operation today.

Wald was also instrumental in developing many of the innovative programs at New York City’s public schools, including implementing special needs classes for students who were differently physically and mentally abled, as well as the city’s first school nurse. Wald continued her advocacy work throughout the rest of her life, becoming involved with causes such as working conditions for women, providing vocational training for immigrant and disadvantaged individuals, health insurance for employees, race relations and civil rights, factory reform, children’s rights, the peaceful resolution of disputes, and women’s suffrage, among many others. 

This great work apparently didn’t sit well with some people. Wald was been labeled a “radical” on many occasions for her progressive activism—including her support for Emma Goldman. However, no overt political action was taken against her until 1919. In the wake of the American reaction to the spread of communism, she was listed in a document presented to the U.S. Judiciary of 61 people who allegedly supported the German cause before World War I. Wald was cited as an “undesirable citizen” suspected of “pro-Bolshevik” sentiments.

Despite the pushback, Wald continued her work at the Henry Street Settlement and on her many causes until her own health failed in 1925. In 1937, her 70th birthday was celebrated with a radio broadcast during which Sara Delano Roosevelt read a letter from her son, President Franklin Roosevelt, praising Wald for her "unselfish labor to promote the happiness and well being of others." What a different a little hindsight can make. 

Dr. Marie Equi: From Medical Doctor to Political Prisoner
In the early 1900s, Marie Equi was a medical doctor in the American West who devoted herself to providing compassionate care to working-class and poor patients. Dr. Marie Equi’s advocacy later became political as she became involved in the suffrage and labor movements. Equi and her longtime partner, Harriet Speckart, adopted and raised an infant, an early public example of a family with same-sex parents. 

One of the first 60 women to become a physician in Oregon, Equi opened a medical practice in Portland in 1905, focusing on women and children’s health. In addition to her medical practice, Equi also began providing abortions to women of all socioeconomic statuses between 1905 and 1915. She managed to avoid prosecutions, despite several attempts of city and state authorities to force her to cease performing the procedures. 

In her later life, Equi became increasingly involved in the labor movement, participating in protests—including one where she was clubbed by a police officer after she became enraged that a pregnant woman had been forcefully moved by the police. 

Her activism evolved into protesting the United States’ entrance to World War I. At that stage, Equi was charged and convicted under the Espionage Act because the government saw her as a threat to national security. She began her sentence at San Quentin State Prison in California when she was 48 years old, where she was the only female political prisoner. Once she was released from prison, Equi returned to her medical practice. 

Margaret Sanger: The Reproductive Healthcare Icon
A daughter of Irish immigrants, Sanger was the sixth of 11 children, and spent much of her childhood assisting with the care of her younger siblings.  After college, Sanger began working as a nurse in New York’s Lower East Side tenements. She frequently treated women whose health had deteriorated as a result of frequent childbirth, miscarriages, and dangerous self-induced abortions because of the dearth of information on how to avoid unwanted pregnancy. Sanger made it her mission to make birth control information and contraceptives available and legal; in fact, she coined the term “birth control.”

Sanger founded and authored several feminist publications, including The Woman Rebel in 1914, which advocated a woman’s right to birth control, and subsequently resulted in her violating The Comstock Act of 1873, which prohibited the trade in and circulation of “obscene and immoral materials.” Rather than serving a five-year jail sentence, Sanger fled to England, but returned in 1915.

In October 1916, Sanger opened the first birth control clinic in the United States in the Brownsville neighborhood of Brooklyn. Nine days after the clinic opened, Sanger was arrested under the Comstock law, but released on $500 bail. Subsequently, she was arrested again, along with her sister Ethel Byrne, and the rest of her staff were arrested for distributing contraceptives.  Byrne was convicted and sentenced to 30 days in a workhouse, went on hunger strike, and became the first woman in the United States to be force fed.

Sanger was also convicted as the trial judge held that women did not have “the right to copulate with a feeling of security that there will be no resulting conception.”

When she appealed the conviction, the court would not overrule the previous verdict, but did allow for an exception in the existing law to permit doctors to prescribe contraception to their female patients for medical reasons. 

Sadly, in the early 1920s, she found common ground with eugenicists in arguing for the importance of birth control.  In 1929, she helped create the International Planned Parenthood Federation, a precursor of the Planned Parenthood Federation of America that still operates today. Planned Parenthood, of course, finds Progressive Era eugenics principles “objectionable and outmoded”—though right-wing people still regularly attack the organization for Sanger’s connection to eugenics. 

Dr. Kazue Togasaki: Doctor to Her Fellow Detainees
As a child, Dr. Kazue Togasaki witnessed the 1906 earthquake in her hometown of San Francisco. She earned a bachelor’s degree in zoology at Stanford University in 1920 before continuing her studies at a nursing program. Despite graduating first in her class, she was unable to secure a job as a nurse. As Togasaki explained in an oral history interview, the climate in San Francisco at the time “was just that they ‘didn’t use’ Japanese nurses; the staff wouldn’t have it.”

After working as a secretary and as a fundraiser, she spent one year studying public health nursing at the University of California, but stopped pursuing nursing work as she always was looked over for jobs in favor of white applicants. She continued her education when she enrolled in Women’s Medical College in Philadelphia in 1929, and became a general practitioner after graduating in 1933. Togasaki was one of the first two Japanese American women to earn a medical degree.  She then faced another form of discrimination: When the government ordered the internment of tens of thousands of other Japanese Americans during World War II, Dr. Togaski was sent to an internment camp. She helped run the medical services at the Tanforan assembly center near San Francisco. The army had not thought about female health-care needs, so when faced with a pregnant woman in labor, Dr. Togasaki organized onlookers to tear a door off a laundry room that she then used as a delivery table. During her month-long detention at Tanforan, Togasaki delivered 50 babies, and led an all-Japanese-American medical team. She then was forced to relocate five times to other assembly and relocation centers before being released in the fall of 1943.

Once permitted to return to San Francisco, Togasaki opened a medical practice in her neighborhood, commenting that “everybody was happy to see a Japanese woman doctor.” Togasaki practiced medicine in San Francisco until she retired at 75, delivering more than 10,000 babies throughout her career. 

Joyceleyn Elders

Dr. Joycelyn Elders: Rubbed Out of Office for Trying to Prevent the Spread of AIDS
Dr. Joycelyn Elders made history as the first person to become board certified in pediatric endocrinology in the state of Arkansas, the first African American Surgeon General of the United States, and the second woman to head the U.S. Public Health Service. A longtime advocate of public health—particularly in the areas of immunization and sex education—Elders was appointed Surgeon General by President Bill Clinton in 1993.

However, she was soon forced out of office. Elders suggested the exploration of the possibility of the legalization of certain drugs, and supported the distribution of condoms in schools, making her a constant target for Republican criticism. 

At a United Nations conference on AIDS, Edlers condoned the idea of teaching schoolchildren to masturbate as a way of avoiding spreading HIV/AIDS and reducing risky sexual behavior. Elders’ remark on masturbation was as a response to a question asked by Dr. Rob Clark, a psychologist attending the AIDS conference, about the prospects for “a more explicit discussion and promotion of masturbation” as a means to limit the spread of the virus. Elders started her answer by asserting herself as a “very strong advocate” of teaching sex education in schools “at a very early age.”

She continued: "As per your specific question in regard to masturbation, I think that is something that is a part of human sexuality and it's a part of something that perhaps should be taught. But we've not even taught our children the very basics." In a 1994 telephone interview, Elders told The Associated Press that she had intended to relate that masturbation is a natural part of human sexuality—not that schoolchildren should be taught how to masturbate. But that didn't seem to matter to the politicians. Just as some media organizations were getting ready to report Elders’ comments, President Clinton forced her resignation, buckling under Republican pressure. Once her remarks began to circulate, the Clinton Administration made it abundantly clear that her resignation had not been voluntary. Once again, politics trumped public health. 

Photo Credits: All photos courtesy creative commons, except the photo of Dr. Togaski, which is from the Photo from the Online Archive of California.

by Elizabeth Yuko
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Dr. Elizabeth Yuko is a bioethicist and writer. 

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