(Editors Note: This paper was originally delivered to the American Public Health Association. Dr. Rodriquez-Trias founded the movement against sterilization abuse internationally--and that effort led to stopping it in the first in Puerto Rico, then the US. Her ideas were internationally recognized. She came to Chicago in 1975 and spoke to a CWLU organized healthcare meeting. She was instrumental in establishing new healthcare standards for women.)

Six weeks ago the N.Y. papers carried a brief story on a 23-year old Puerto Rican woman who was seen twice at the Emergency Room of the Bronx Municipal Hospital for abdominal pain following the insertion of an intrauterine device. On the second occasion her husband insisted on admission which was denied. A few hours later, she died at home of a massive internal hemorrhage.

The event is certainly not an unusual one in our health care system, and the defenses of the individuals who are part of this system are well erected against attack. One doctor’s response dramatizes the unfeeling— ness that characterizes the professional who is generally much more concerned with his image than with what happens to the patient. He was quoted as saying, “Based on the information we have, I can’t see at this time what was done wrong with diagnosing Mrs. Castro. She was thoroughly evaluated twice by very good people who made their best diagnosis to the best of their ability”. “We stand on what was done at that time.”

Another response, much more insidious and dangerous in its content was observed on the second visit to the Emergency Room by the young woman’s husband who stated that the physician implied that she was faking and needed psychiatric intervention. Perhaps this should not surprise us. The same medical school that is responsible for care at that Municipal Hospital has on its staff two prominent pediatricians who edited a text of Pediatrics that indexes “Puerto Rican Syndrome” as a term for hysteria.

But it is not my purpose today to describe one after another instance of Institutionalized racism and sexism, but rather to explore with you and the other panelists, our growing awareness of the root causes of racism and sexism in the health care field. I shall attempt to discuss women’s health rights within the context of my experience as a pediatrician in a Black and Puerto Rican ghetto where I meet other workers and members of an embattled community. The struggle for health rights may then be seen in the social context, for these are as any other rights, real only when the society provides a concrete form for their exercise of the inadequacy of health services for all Americans is not idle rhetoric, it is a recognition of the seriousness of our social responsibility and belies the anger and frustration at a system that makes it impossible for us to function well.

As in our role as workers, a new consciousness of the socioeconomic determinants of the system is emerging. The contributions to the literature by feminist writers analyzing our social role and its relationship to the health care we get, are uniquely valuable. The historical approach used by Barbara Ehrenreich and Deidre English in their Witches, Midwives and Nurses, A History of Women Healers and their Complaints and Disorders, The Sexual Politics of Sickness, helps clarify our present state re: the medical system.

The Role of Women as Producer of Children

Our childbearing functions, once the province of the community based midwife, are now controlled and regulated by the medical establishment. This together with our visits to the doctor for our children, accounts for the fact that we make twice as many visits as men.

The availability of services to poor women, and particularly to third world women, makes for sharp class distinctions as to frequency of visits, be they prenatal, routine gynecological health maintenance or any other kind. The distrust that women rightly feel toward doctors undoubtedly contributes toward lower utilization As an example of the class distinction in utilization is the fact shown by Dr. Helen Chase and co-workers in their exciting study on Risks, Medical Care and Infant Mortality, that in New York City less than two percent of the Black and Puerto Rican mothers had “adequate” prenatal care. Though we may question the definition of “adequate” which included delivery on a private service, the fact is still outstanding.

Once more the socioeconomic realities bear unveiling. Neither time, nor presenter’s abilities, nor audience and fellow panelists’ patience allows for a complete analysis of the economic structure of the health care system. If most of us will agree that in the United States it is profit motivated, then I may go on with an example of how its control over us is a logical outcome of its profit seeking. However, we also know that relationships among phenomena in the social scene can be extremely complex and become understandable only if we look at the goals of those controlling the society as well as the compromise that they make in order to continue ruling. The official policies on population control, of which birth control is but one aspect, have changed as social goals have changed, in the zig-zag pattern of many social changes, this or that direction being taken because of pressure from groups, national expansionist imperatives, needs to control certain unruly population groups, wars, depressions and all such events.

A brief sketch of this evolution of policies on birth control may help discern the pattern in this one important aspect of our health care needs.

From the persecution of the Socialist nurse, Margaret Sanger, in the second decade of the century for her agitation in favor of birth control, to the pushy endorsement of birth control by an aggressive United States government and the big profits in the world wide sale of pills, intrauterine devices, foams, gels and what have you, has been fascinating change. The women who fought valiantly and effectively for birth control information could not have imagined the control that the medical and pharmaceutical concerns would establish over their daughters, granddaughters and above all, over women of other cultures that they in their respectable middle class worlds did not take cognizance of.

The pill tested by Searle in Puerto Rico from 1956-60 in doses considered too dangerous for the United States market, was rapidly pushed in the sixties into a big money making item.

As with women’s acceptance of sterilization in Puerto Rico, so that in the past two decades the percentage of women of childbearing age who are sterilized has reached thirty-five, the acceptance of the pill here and elsewhere, has been determined by availability, marketing, convenience and propaganda. The need and demand for birth control is obviously real and we take what there is and what we have been primed to accept.

The proliferation of programs in the United States and in the third world countries receiving aid from the United States make clear that the intention of population control is political.

That funds can be appropriated for population control in areas where even minimal health care is not available, is a clear contradiction. The failure to tackle the root causes of poverty is recognized by us. Laura Anderson speaking in testimony before the Commission on Population Growth and the American Future in a May 1971 hearing, declared the following:

We know that population control can be used to defuse discontented elements in the society. Mass migrations have often had this effect on the societies left behind, while on occasion an opposite one of creating ferment at point of arrival. A good example of this is the mass migration of Puerto Ricans to the United States which was manipulated by means of labor contracts, lowered air fares, government sponsored recruiting programs, etc., and which provided a source of cheap labor here as well as an escape valve for the potentially revolutionary situation on the island. Once here, of course, the source of cheap labor is often unemployed, the economic situation is precarious, reduction in welfare rolls becomes the official slogan and birth control becomes the program for the ghetto dweller.

So it is as third world women we are caught in the contradiction between a healthy desire to decide when and how to have children and social policy, not controlled by us, which seeks other ends. Feminists are highlighting this contradiction with increasing fervor. In a report by Lolly Hirsch on the World Population Conference held in Bucharest in August 1974 she states, “The United States government position is that population growth of OTHER parts of the world must be controlled.

The United States has tried to control specific populations by various means :