Since 1971 Judy Norsigian has been part of the Boston Women’s Health Book Collective, also known by the name of its signature publication, Our Bodies, Ourselves (OBOS), and she currently serves as the organization’s executive director. This year marks the fortieth anniversary of the publication of the groundbreaking book (now it its ninth edition), which has offered straightforward and detailed guidance on health and sexuality to women for the past four decades. In recognition of the pioneering role OBOS has played in women’s health and well being in the United States and around the world, co-author Judy Norsigian was named the 2011 Humanist Heroine by the Feminist Caucus of the American Humanist Association at the AHA’s 70th annual conference in Boston, Massachusetts, on April 9, 2011. The following article was adapted from the talk she gave in accepting the award.
Thank you for this honor. I bring greetings from the OBOS staff, the board, and the founders. As you can imagine, it’s quite a village that’s raised this “child”—these books, materials, and projects.
The period before the women’s health movement really came into being in the United States can be characterized by a number of so-called common practices in medicine and in the culture at large. The 1960s was a time now thought of as enlightened and full of activism, yet it was also a time when unmarried women couldn’t legally obtain birth control in many places. When men and women shied away from speaking about sexual pleasures and problems, when women were routinely excluded from clinical drug trials, and when physicians didn’t think their female patients were capable of understanding detailed diagnoses. It was a time when privileged white women could only seek sterilization if they’d already had a certain number of children and when poor women and women of color might be sterilized without their knowledge or consent.
In a workshop titled “Women and Their Bodies” held at a 1969 women’s liberation conference in Boston, a group of women began to address many of these concerns. They continued to meet, organized gatherings in various community settings, and began to research topics of interest. They started several informal courses and produced mimeographed papers that changed over time, as more women shared their experiences and transformed these papers into collectively written documents. Eventually, the papers were bound together in a newsprint booklet titled Women and Their Bodies, published by the New England Free Press in December of 1970 and sold for seventy-five cents. With the March 1971 reprinting, the title was changed to Our Bodies, Ourselves. Women all over the country were eager for this firsthand, straightforward guidance about their health and sexuality, and the popular booklet sold nearly 250,000 copies, mainly by word of mouth, in just a few years. Women shared the information with their family, friends, and doctors. They also used the book in efforts to challenge the medical establishment to improve the care that women received.
In early 1972 we legally incorporated as the Boston Women’s Health Book Collective in order to sign a contract with Simon & Schuster, which has been the book’s commercial publisher since 1973. We also produced two companion volumes—Our Bodies, Ourselves: Menopause (2006) and Our Bodies, Ourselves: Pregnancy and Birth (2008)—and have collaborated with dozens of women’s groups across the globe to assist in producing some twenty-nine foreign editions.
Incidentally, Our Bodies, Ourselves has endured numerous banning attempts (some quite successful) in high schools and public libraries across the country. Especially notorious was the Moral Majority’s major attack on the book in the early 1980s, when Jerry Falwell dubbed it “secular humanist garbage” in one of his fundraising letters. Falwell listed a number of “obscene” quotes from the book, including one about masturbation being important for sexual pleasure as well as excerpts from the chapter written by a lesbian group. He even labeled a quote about “putting people before profit” as obscene! This shows that the Moral Majority’s agenda wasn’t just about opposing reproductive freedom, but also about challenging larger social justice efforts such as those launched by the women’s movement.
The Moral Majority aside, after we made common cause with public health officials, with folks doing research, with anybody who was interested in transforming the landscape with respect to women’s health, sexuality, and human relationships, we started to realize that we had a very complicated picture, growing only more so as our access to the media became more limited. Over time, we noted that major talk shows obtained more and more of their advertising revenue from drug companies and other commercial interests that were not too pleased with the messages OBOS was conveying, and in a few cases we were told privately by producers that this was a likely factor in our not being invited back onto the talk shows that previously had welcomed us. And so, increasingly, the activism of the women’s health movement is most apparent on the Internet.
Looking to the major challenges facing women’s health advocates today, the following areas are of major concern:
- The ongoing need to defend women’s reproductive rights, including access to accurate, reliable information about health and sexuality. The current sea of conservative, anti-choice, anti-sexuality activists, in both the religious and political arenas, makes our work here that much more difficult;
- The pharmaceutical industry’s growing influence over the prescribing practices of physicians as well as the plethora of so-called “direct-to-consumer” ads for prescription drugs aimed directly at the lay public (needless to say, balanced and accurate information is typically lacking here);
- The culture’s growing obsession with body image and extremely narrow view of ideal “body type” has led to unprecedented use of elective cosmetic surgery (often with serious risks attached) as well as unhealthy weight-loss dietary schemes;
- And the need to secure high quality, accessible, and universal healthcare for everyone. Even in the absence of a single-payer model of healthcare—something like a “Medicare for All” approach—there are still some reforms we can work towards, for example, promoting best practices that both reduce costs and improve outcomes.
To address these challenges and problems, women’s health activists are engaged in myriad efforts, some of which I’ll highlight here, beginning with our response to the over-promotion of female sexual dysfunction (FSD) by the pharmaceutical industry.
The idea of female sexual dysfunction emerged after Pfizer extracted one rather inexact question from a long survey and then reported, via a major PR campaign, that 43 percent of American women suffer from so-called FSD. This has led to a profound misunderstanding about the many factors that contribute to female sexual satisfaction. These include: understanding one’s own anatomy (where the clitoris is, for example), what kind of stimulation works best for a particular woman, what kind of environment is essential to producing a comfort level that allows for the experience of sexual feelings, and so forth. There are so many things about sexual relations that have nothing to do with an underlying biomedical problem. Some scholars have referred to the promotion of FSD as an excellent example of “disease mongering,” where drugs are prematurely promoted as solutions for conditions that are still poorly defined even in medical terms.
In response, the New View Campaign (www.newviewcampaign.org) has launched a series of initiatives to educate the public about the claims that women’s sexual problems are primarily biomedical, requiring biomedical solutions, and what in fact the evidence shows. Their testimony at several FDA hearings was likely instrumental in the resulting denial of approval for new drugs aiming to treat FSD. As the hunt for a “pink Viagra” continues, the New View activists—many of them academics—will be important voices to follow.
Elective cosmetic surgery is another area of concern. Because the FDA has failed to adequately protect women from the risks of silicone breast implants, some groups, including my own, are reaching out to women to counter the misleading promotion of breast implants as 100 percent safe by both plastic surgeons as well as the breast implant manufacturers. In one modest effort, OBOS has partnered with Carol Ciancutti-Leyva to bring her excellent documentary, Absolutely Safe (www.absolutelysafe.com), to college campuses and communities across the country. Screenings and discussions that have included the filmmaker also invite students, faculty, and healthcare workers to use free copies of the documentary in their local efforts to educate women about the risks of breast implants. (Please get in touch with us if you’d like to arrange a screening in your community.)
It’s a myth, by the way, that only rich women have “work done” to enhance their appearance. Some two-thirds of those who undergo cosmetic surgery report family incomes under $50,000, and 40 percent of women become repeat patients. Also, 91 percent of those seeking such surgery are women, and 84 percent are white. You may also be interested to know that in the United States, cosmetic surgery is more popular on the west coast. (Incidentally, China is now the leader in breast augmentations, followed by the United States, Brazil, India, and Mexico.)
Healthy pregnancy and childbirth are two more issues for which women’s health activists strongly advocate. Because we have created an unfortunate climate of fear and doubt surrounding pregnancy and birth, and because there are so many inappropriate financial incentives to utilize unnecessary (and often expensive) medical interventions during pregnancy and birth, we now face a major crisis in maternity care. The United States spends more money per capita on maternity care than any other industrialized nation, and yet we have worse outcomes than most of these other countries. Many groups concerned about this are now calling for the introduction of best practices in maternity care, and my own organization is active in promoting more midwifery care as part of the solution.
A few examples of inappropriate interventions that have contributed to the expensive nature of maternity care and may contribute as well to poorer outcomes are:
- The growing practice of unindicated induction of labor (versus induction for medically compelling reasons), which has led to the birth of more premature and low birth-weight babies.
- The lack of access to vaginal birth after cesarean (VBAC), so that many women are now forced into having a repeat surgical delivery even when they want to have a VBAC, and even if their own physician supports this sound decision. Efforts to change hospital policies to expand access to VBAC are now underway.
- The increasing use of “elective” cesarean section. This practice is known to increase problems for both the mother and the baby, but many obstetricians do not counsel women adequately about the true risks involved. One approach to encouraging more physiological birth practices is to promote midwifery care both inside and outside the hospital. A short video that we produced last year, “Why Choose a Midwife?” (available at www.ourbodiesourselves.org), underscores some of the reasons why greater access to midwives would enhance women’s birthing experiences and likely improve outcomes as well. New Mexico is the state with the largest proportion of vaginal births attended by midwives, and their birth outcomes are impressive despite the substantial poverty and limited resources in many communities there.
Two more areas of concern related to women’s reproductive health are the rising rates of commercial egg “donation” and commercial surrogacy. As more and more young women are solicited to provide eggs for couples undergoing in vitro fertilization, and as IVF clinics frequently do not provide adequate informed consent, it is essential that women’s health advocates provide more balanced sources of information. In particular, there is still inadequate research regarding the safety of drugs used to suppress ovarian function in advance of administering other drugs that hyperstimulate the ovaries to produce multiple eggs for extraction. A recent documentary called Eggsploitation chronicles the experiences of several highly educated young women who experienced serious and long-lasting negative consequences from such multiple egg extraction procedures. Because the financial incentives are sometimes very strong—up to $100,000 and more has been offered to women with the right set of characteristics—more and more young women are drawn to the lucrative aspects of so-called egg donation.
Another recent documentary titled Made in India, produced by two young Brooklyn filmmakers, very sensitively confronts some of the ethical challenges and unfortunate abuses that have arisen from a growing surrogacy industry in India. The rapid increase in medical tourism, which allows people in Western countries to hire a surrogate in India, has brought together reproductive justice advocates from many different countries to help propose regulations and oversight mechanisms that would mitigate some of the worst abuses.
Of course no discussion of women’s health challenges would be complete without mentioning the ongoing attacks being waged across the United States on abortion rights. We’re witnessing Planned Parenthood under siege, losing public funding, and finding it difficult to sustain high quality services. Numerous pro-choice groups both old and new are rallying to defend a woman’s “right to choose” and college campus activists often include young men among their ranks. Ultimately, this critical cornerstone of women’s reproductive autonomy will require the election of pro-choice officials who are able to resist attacks from the religious and conservative right.
A deeply disturbing trend of late is the increasing sexualization of young girls—even those as young as five, six, and seven years old. Media portrayals, advertising, and provocative images on the Internet and elsewhere all now contribute to a climate once again encouraging both girls and boys to think of girls primarily as sexual objects. The Sexualization Protest: Action, Resistance, Knowledge (SPARK) Summit, held in New York City in October of 2010, brought together a diverse group of activists and scholars, including many young teen girls, to explore how best to counter the disturbing trends that ultimately undermine young women’s ability to thrive and maintain healthy relationships. Visit their website to see how fast this movement for change has been growing: www.sparksummit.com.
In addition to addressing the above concerns through public information campaigns and distributing valuable information through our books, OBOS is also involved in efforts to ban carcinogenic substances in cosmetics, and to end the use of rBGH growth hormone in dairy cows. There is increasing evidence of harm to human health from the use of rBGH, and it causes problems such as mastitis in cows as well.
One final issue I’d like to mention is that in many surveys of women across the globe, they identify violence as the biggest threat to their health and wellbeing—not cancer or inadequate maternity care or lack of access to healthcare in general. And this is primarily about violence perpetrated by men against women. Many groups working on violence are now focusing more on how best to engage men as agents for change. One excellent example of men trying to take more responsibility in this arena is the White Ribbon Campaign, now a global phenomenon. Here in Massachusetts, the Men’s Initiative at Jane Doe, Inc., has sponsored the highly successful White Ribbon Day effort that has included the governor, past governors, star athletes, law enforcement officials, and other men seeking to build a movement of men committed to reducing violence against women.
Women have always been under threat from conservative forces—especially religious fundamentalist groups—and that threat seems to be increasing now. But I am encouraged by how activists both young and old are mobilizing in response. Even if the mainstream media outlets are ignoring such progressive movements for change, it is happening—on the Internet and in local community actions. This kind of citizen action has always characterized the women’s health movement and it continues to give me hope for the future.
Judy Norsigian is the executive director and a co-founder of the Boston Women’s Health Book Collective. She is a co-author of Our Bodies, Ourselves; Our Bodies, Ourselves: Menopause; and Our Bodies, Ourselves: Pregnancy and Birth. She speaks and writes frequently on a wide range of women’s health issues and served on the board of the National Women’s Health Network for fourteen years. She currently serves as a board member for Public Responsibility in Medicine & Research, an organization dedicated to advancing the highest ethical standards in the conduct of research.