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Tey Meadow and Elizabeth M. ArmstrongBack to OpinionTey Meadow and Elizabeth M. Armstrong

Public health, private donors

A small group protest outside the Susan G. Komen for the Cure headquarters in Dallas, Tuesday, Feb 7, 2012. Photo: AP/Rex C. Curry

Believe it or not, the Komen Foundation and Mayor Michael Bloomberg have something in common: both are in the business of controlling the access of over 170,000 American women to basic preventative healthcare.

When the story broke last week that the Susan G. Komen for the Cure Foundation planned to withdraw its funding from Planned Parenthood, many progressive women, including us, felt betrayed. Many of us marched under their banners, soliciting donations from friends and family and paid the surcharges for goods adorned with their ribbons. We trusted that the banner of “women’s health” promotion applied to the whole woman, not merely the parts that didn’t unduly concern religious conservatives.

The series of angry rants about this betrayal in our Facebook and Twitter feeds was quickly replaced by electronic hand-clapping when NYC mayor Michael Bloomberg forked over a $250,000 matching grant, an effort to ameliorate the losses sustained by the organization. “Politics has no place in healthcare,” he declared.

By the end of the week, we learned that Komen reinstated its funding to Planned Parenthood.  Today, Karen Handel, the ultra-conservative VP of the Komen Foundation, resigned following a firestorm of criticism about her role in the decision. In the meantime, Planned Parenthood saw a windfall of private donations, surpassing Bloomberg’s call for matching funds to the tune of some $3 million from individual donors. Unprecedented public discourse about the role of politics in the distribution of funds for women’s healthcare ensued.

All’s well that ends well, eh feminists? Not so fast.

There is a much bigger issue in all this that’s receiving no airtime at all. Why on earth do we allow the desires of powerful private donors — whether individuals or foundations — to control who has access to lifesaving preventative healthcare?

By now, critiques of “the pink ribbon” are fairly widespread. In her book, “Pink Ribbon Blues: How Breast Cancer Culture Undermines Women’s Health,” sociologist Gayle Sulik argues that the market-driven culture of breast cancer prevention “pinkwashes” the kinds of information we receive about how to evaluate our own personal risks. (General Electric, the maker of pricey mammography machines, for example, overstates the cancer survival rates in their promotions for early detection.) This market controls what sort of research is undertaken and what treatment protocols are adopted by medical practitioners. Breast cancer awareness month itself was invented by AstraZeneca, a manufacturer of oncology drugs! (They also manufacture carcinogenic pesticides, but that’s another story…)

A recent analysis of collaborative relationships between private foundations and for-profit corporations in the global health arena highlighted the potential for collusion and undue, invisible influence over health policy agendas. But corporate conspiracies aside, we are deeply troubled that the expedient answer to this problem appears to be private donor financing and a public discourse that separates out preventive services from other medical services essential for promoting quality of life for women, including contraception and abortion.

To the extent that key aspects of women’s reproductive healthcare remain a totally privatized enterprise, funded and maintained by private philanthropy and corporate largesse, in the absence of government funding, women’s health will always be subject to the hatchet at the whim of private interests. The fact that other wealthy elites can bestow those services back on the women who desperately need them doesn’t itself make the situation any less precarious. We should not rely on private interests, even well-meaning philanthropic ones, to finance public goods like preventative care. Private foundations spent $22.5 billion on health care in 2009; this spending went disproportionately towards women’s and children’s health, the very populations which are, in fact, most vulnerable to the whims of political favor.

At the end of the day, though, it is poor women, not politicians, who suffer. As Komen itself said, only last year, Planned Parenthood is, in many areas, the “only place that poor, uninsured or under-insured women can receive these services.” We need to be talking about how to ensure that Planned Parenthood, and ALL of its necessary life-saving and life-improving services are both protected from funding shortages and insulated from the vicissitudes of political posturing.

The Obama administration took a huge step in the right direction last year, when it mandated that private insurers cover preventive services, like breast and cervical cancer screening and contraception, without copays or deductibles.

But we need to go further. We need to re-think the division of women’s health care into silos. On the one hand, we have “reproductive health care,” which is code for contraception, abortion and STI testing and treatment, and on the other, we have “maternity care,” which includes prenatal and peripartum care. “Women’s health” is the residual category, for everything that doesn’t fit into giving or preventing birth — things like mammograms, heart health, osteoporosis, and so-called “well-woman visits.” In truth, aren’t all these things of a piece? Most women will need just about every one of these health care services at some point in their lives.

This division is both unnecessary and unethical. It allows for the siphoning out of politically unpopular areas of women’s lives (and bodies) from publicly-funded healthcare programs, virtually ensuring that private funding will be the sole means through which organizations can provide them to poor and uninsured women. Let’s stop carving up women’s bodies into discrete clinical domains and start providing not just well-woman care but whole-woman care.

The provision of life-saving preventative medical care, and, frankly, the provision of safe abortions to women who want them — both legal, necessary services for maintaining the quality of women’s lives — should not be subjected to the political whims of elite private donors.  Women are more than just the sum of their body parts. And the provision of women’s health care needs to be more than just the sum of individual donations. We can’t care for whole women by focusing on or paying for health care bit by bit. If we care about saving women’s lives, we need to untie the ribbons and start thinking about the whole package instead.

Tey Meadow is a Cotsen Postdoctoral Fellow at the Princeton Society of Fellows. She is currently working on a book about the parents of gender nonconforming children.

Elizabeth M. Armstrong is an Associate Professor of Sociology and Public Affairs at Princeton University. She is the author of “Conceiving Risk, Bearing Responsibility: Fetal Alcohol Syndrome and the Diagnosis of Moral Disorder” (Johns Hopkins University Press, 2003).