Mama's Got a Plan:

Maternity Care, Health Insurance, and Reproductive Justice


Obamacare, Again

 

Image Credits


Graphic and Fact Sheet. Abortion: A Reproductive Justice Perspective – AwakenMichigan

We continue to share cartoons created for other organizations. This one, on abortion jurisprudence before Hellerstedt, was created for AwakenMichigan: Reproductive and Sexual Justice Project. Stay tuned for a second post, created following the Hellerstedt decision!

 

 

Click pop-out button popout button to access download command bb10-support-download.png.original.

[Updated July 16, 2016, to add copyright designation.]
Source: Graphic and Fact Sheet: Abortion: A Reproductive Justice Perspective – AwakenMichigan


The Promised Land

40-years-in-the-wilderness-p1 40-years-in-the-wilderness-p2

Forty Years in the Wilderness

Forty years is a long time to seek a home. With Passover approaching and U.S. politics running wild, it’s tempting to view the biblical journey through the desert as a metaphor for current-day immigration policy – or global warming, or the nature of leadership. However, your cartoonist feels that a woman’s 40-year fertile capacity (more or less) lends itself nicely to a comparison with the journey to the Holy Land. So – let the menstruation train leave the station!

This is your life!

our-bodies-ourselvesIn the late 1970s, girls were less well informed on matters of reproductive health. Some of us were lucky enough to have mothers who gave us copies of Our Bodies, Ourselves, the classic women’s health book. It contained an menstrual-diagraminformative diagram of reproductive anatomy, with some helpful words about menstruation:

Starting to menstruate will always be different for each person – welcome to some, just the beginning of inconvenience for others.

Liberal mothers also gave their daughters copies of Judy Blume’s books; Are You There God? It’s Me, Margaret was the Platonic ideal of menstrual fiction.

fast-times-at-ridgemont-highNevertheless, the predominant source of information for pre-internet and pre-video-era girls searching for more relevant information than we received in our sixth-grade Kotex-sponsored filmstrips was, of course, movies and TV. In Carrie, Sissy Spacek’s wonderful and terrifying performance of menarche-triggered telekinesis did not convince us of our ability to cause knives to fly across the room (more’s the pity), but it did present some – wholly incorrect – estimations about the amount of blood involved in a menstrual cycle. Fast Times at Ridgemont High wasn’t specifically about menstruation, but it was about adolescent awakening. We couldn’t resist the photo of Phoebe Cates and Jennifer Jason Leigh discussing sex while slicing a sausage.

The 1972 episode of Norman Lear’s Maude, in which the title character considers – and obtains – an abortion, was a first in TV history. Yet to girls five years later, the shock was that Maude could get pregnant at all. Did people that old still have sex? Even in our surprise, however, we never considered what this might mean for our menstrual selves. Had we understood the implications – and had Costco existed at that point – we might have stocked up on truckloads of feminine hygiene products.

In that context, menopause does seem a lot like the Promised Land.

The Red Stuff

The Passover story is full of blood. We’ve taken certain liberties with the text, but the raw material, if you’ll excuse the phrase, was already there. The first of the Ten Plagues turned the waters of the Nile into blood. The final plague slew the first-born sons of all those who had not painted their doors with blood from the Passover sacrifice. This was hardly menstrual blood (although think of the lambs they might have saved!) – but still, as far as symbols go, blood is blood.

midol_combinedReturning to a more personal history, we repurposed this 1950s advertisement for Midol into a shape116px-rembrandt_-_moses_with_the_ten_commandments_-_google_art_project suggestive of the stone tablets Moses is about to smash in the background.
The bat mitzvah girl shown is perhaps less than thrilled with her new-found womanhood; she seems to be reading the phrase from Exodus 7:17, “and it will turn to blood,” with something of an attitude.

Her attitude might well derive from the difficulties girls faced – at least in the time and circumstances this cartoon presents – in adapting their lives to a menstrual cycle.

But in the end, what is our cultural aversion to blood all about? What makes blood so scary, or at least so significant? One might argue that most people who aren’t surgeons or phlebotomists are unaccustomed to encountering blood outside the body, and that we therefore find something transgressive in its appearance. But wait! Who sees blood every month! And what does it mean?

119px-holman_miriam_and_the_israelites_rejoicingMiriam rejoices after the Israelites have crossed the Red Sea. (We know it’s really the Reed Sea, but humor us, please.) Perhaps she is celebrating more than a narrow escape: that is, her own superiority as a woman to the men who perished. They can only fight and die, but she can create new people. How like a deity! In fact, her exclamation is ambiguous: is she apostrophizing the Giver of Life or does she consider herself the giver of life? Of course, all of this is your cartoonist’s invention, as Exodus does not feature Miriam celebrating her capacity for procreation.

A traditional morning blessing said by Jewish men thanks the Almighty for not creating them as
gabriel-cornelius-von-maxwomen. Could it be they protest too much? This prayerful man is having second thoughts, remembering the mother and child of his youth. When we penned the words “Uterus Envy,” we had no idea that this concept existed outside our cartoon. It turns out that neo-Freudian psychiatrist Karen Horney (1885–1952) got there first, creating the concept of Womb Envy.
What does Womb Envy mean to a woman who has had 40 years of a hard-working uterus? Not much. The Promised Land may represent the delights of fertility unachievable by Moses, while simultaneously symbolizing freedom from fertility to women who have been there and done that.

Image Credits

The title frame features the painting, Moses leading the Israelites out of Egypt, by József Molnár, 1861. This work is in the public domain.

Frame 5: Moses Viewing the Promised Land, by Frederic Edwin Church, 1846. This work is in the public domain.

Frame 7: The Story of Passover by Marking the Israelites Door Coloring Page is shared under a Creative Commons license.

Frame 8: Moses Smashing the Tablets of the Law, by Rembradt, 1659. This work is in the public domain. The photo, A Conservative bat mitzvah in Israel, is shared here under a Creative Commons license.

Frame 10: Miriam and the Israelites Rejoicing, an illustration from the Holman Bible, 1890. This work is in the public domain.

Frame 11: A Jewish Man in His Prayer Shawl, by Lesser Ury, 1931. This work is in the public domain.
Motherly Love, by Gabriel Cornelius Ritter von Max (1840-1915). This work is in the public domain.

Frame 12: Moses Views the Promised Land, an engraving by Gerard Jollain from the 1670 La Saincte Bible. This work is in the public domain.


Oh, Obamacare

As we were creating a cartoon about the complexity of the current health care payment system, we noticed media reports on common misunderstandings of the Affordable Care Act (ACA). The most recent was in the Michigan news weekly Bridge, which noted, “In Michigan, some counties with the highest Medicaid expansion and ACA usage gave Trump some of his largest victory margins …”
People have been known to vote against their own interests for the sake of broader principles, a tendency that politicians are happy to exploit. However, on the chance that voters were misled on simple facts, we bring you the following educational cartoon, put together lickety-split to be of service before the ACA can be repealed!

obamacare-101-p1

obamacare-101-p2

A few slightly more detailed facts:

  • Obamacare is the Affordable Care Act (ACA). Strictly speaking, it’s the Patient Protection and Affordable Care Act.
  • The ACA was the result of a series of compromises, but its goal was to provide health insurance coverage, either public or private, for anyone who did not have coverage through an employer-provided plan. In the past, options for the planless who were not eligible for public insurance (Medicaid, Medicare, TRICARE, etc.) included buying “individual” insurance on the private market at great cost, paying for COBRA through a recent employer at great cost, paying for care in cash at great cost, or going without.
    The ACA succeeded in insuring 20 million Americans. Of the 27.2 million (non-elderly) Americans who remain uninsured, 11.7 are eligible for financial help. For information about health insurance for the elderly, see the final bullet point below on “Medicare.”
  • The ACA bans insurers from refusing coverage to people with pre-existing conditions. In the past, people were refused insurance for reasons ranging from the tragic (had suffered from cancer) to the ridiculous (tested negative for a medical problem).
  • Because young and/or healthy people would naturally wait until they needed care to buy insurance, the ACA mandates that everyone have coverage. This ensures that the risk pool is not made up solely of very sick people who need expensive care.
  • In the past, only the poorest of the poor were eligible for Medicaid, except for certain special (and temporary) categories, like children or pregnant women. The ACA required states to expand Medicaid to people whose income was at 133% of the federally-determined poverty line or below. Following a challenge, the U.S. Supreme Court conceded that states did not need to expand Medicaid. Many states (green on our map) nevertheless did so because generous federal subsidies are offered for the purpose. But states that did not expand Medicaid caused many of their residents to remain trapped in the “donut hole” that existed pre-ACA: their income was too high for Medicaid, but too low to afford private insurance. It is worth noting that the decision to expand now rests solely with the states; those who blame the feds for the donut hole are blaming the wrong government.
  • The ACA reduces premium costs up front, by providing tax credits for households whose income is 400% of the federal poverty level. If an applicant’s income is considered too low for tax credits, that person is funneled toward their state’s Medicaid program.
  • Many people insured by public plans were unaware they were benefiting from Medicaid expansion, because their plans bore state-specific names that did not include the word “Medicaid.” Some examples: Husky Health Connecticut, MassHealth, Healthy Michigan Plan, Washington Apple Health, and many more. These state plans are Medicaid.
  • The ACA allows children to remain on their parents’ plans until the children reach the age of 26. William Shatner’s 1978 Saturday Night Live skit is referenced here purely for the nostalgic amusement of your cartoonist.
  • The ACA requires that free preventive care be included in all insurance plans.
  • We can identify and acknowledge many drawbacks to the ACA, many of which are continuations of problems that existed pre-ACA or resulted from compromises made in response to opposition challenges. But even political opponents who have been fighting like cats and dogs can agree on what’s wrong and how to fix it. Insurance premiums do keep increasing, just as they did in the past; however, the absence of an ACA cap on premium increases exacerbates the problem. Correspondingly, tax credits arguably should be adjusted to accommodate unaffordable higher premiums. This is purely a political problem and should be addressed accordingly. High-deductible plans are a reasonable choice for people who do not expect to use much care, but can be financially devastating for those who find themselves in need of medical attention. The answer, again, is to adjust the tax credit and premium caps to make better plans affordable to more people. Insurance does not guarantee health care, it is true. While the ACA contains provisions to increase access from the provider side, those preparations will require years to bear fruit. More immediate creative solutions are clearly needed. Finally: big government. This is a philosophical objection that begs for its own cartoon. Stay tuned!
  • Where is this all leading? Medicare for all. Medicare is the federal health insurance program for people who are 65 or older. “Medicare for all” suggests extending this insurance program to all Americans in a national single-payer health insurance plan – the kind favored by a majority of Americans. This proposal does not necessarily involve a centralized authority that employs providers and directs all medical care. Rather, it proposes combining the entire population into one insurance risk pool in order to take the greatest advantage of potential savings, particularly from administrative spending, which currently accounts for one of every three health care dollars spent in the U.S. Much more information on single-payer systems is widely available. We suggest starting with Physicians for a National Health Program.

We hope that The Affordable Care Act/Obamacare 101 has been useful to you. Please respond on our Facebook page if you have ideas for future cartoons on this subject – or any other!

Image credits


Graphic and Fact Sheet: U.S. Midwives – Now You See ‘Em, Now You Don’t – AwakenMichigan

We continue to share cartoons created for other organizations. This one, on the history of midwives in the U.S., was created for AwakenMichigan: Reproductive and Sexual Justice Project

Rather than composing a new fact sheet to accompany this graphic, we instead include a paper (see below) written in 2012 for the edification of the students in our Reproductive Justice class offered at the University of Michigan for several years through the Women’s Studies Department. First, however, a few explanatory notes on the graphic:

Page 1

Page 2

Page 3

Page 4

  • Frame 1. The Practicing Midwife is a journal found in the University of Michigan Libraries’ collection. Many of those images were used in the 2013 conference exhibit, Birthing Reproductive Justice: 150 Years of Images and Ideas. You can still view the online portion of the exhibit. In the middle photo, Geradine Simkins is shown holding her recent book, Into These Hands: Wisdom From Midwives (2011). Simkins is included here because she is a key figure in the revival of Michigan midwifery. Finally, no discussion of a women’s health issue would be complete without a copy of Our Bodies, Ourselves, most recently reissued in 2011.
  • Frame 3 is very complex and difficult to read – by design. For information on Certified Professional Midwife licensure, we refer you to The Big Push for Midwives. The ladies marching in the old photo are, alas, not really midwives, but members of the International Ladies’ Garment Workers, taking part in the Shirtwaist Makers Strike of 1909. Consider that to be artistic license on our part.
  • Frame 4 situates midwifery care inside the larger struggle for Reproductive Justice. We highlight the work of Tewa Women UnitedBlack Women Birthing Justice,  Strong Families, and every person who has stood up for Black Lives Matters. These individuals and organizations are all worthy of your support. Finally, the plant pictured is the Rose of Jericho, pointed out by Bellies and Babies as being particularly helpful to women in labor.

We are grateful to Marinah Farrell, LM, CPM, of Arizona, and President of the Midwives Alliance of North America, for her very helpful critique and suggestions. Thanks for midwifing our graphic, Marinah!

 

Source: Graphic and Fact Sheet: U.S. Midwives – Now You See ‘Em, Now You Don’t – AwakenMichigan


Ask the Right Question: The Malpractice Question — Friends of Michigan Midwives

Below is another cartoon in the Ask the Right Question series created for Friends of Michigan Midwives in early 2016. Whether midwives carry malpractice liability insurance is a frequent question of legislators. Michigan HB 4598, a bill to license Certified Professional Midwives, will receive a hearing in the Michigan Senate Health Policy committee on Tuesday, Nov. 29. It contains language that clarifies the legal relationship between midwife and physician, so that liability flows only to the person responsible for negligent care.

If you live in Michigan, or know someone who does, please make your way over to FoMM’s Facebook page for directions on how to help. Take note: If you are disheartened by the election, here’s a way to carry out five minutes of activism that can actually make a difference! 

[Updated July 16, 2016, to add copyright designation.]

via Ask the Right Question: The Malpractice Question — Friends of Michigan Midwives


Ask the Right Question: The Licensure Question — Friends of Michigan Midwives

Another cartoon in the Ask the Right Question series created for Friends of Michigan Midwives in early 2016! This one is especially pertinent because Mich. HB 4598, a bill to license Certified Professional Midwives, will receive a hearing in the Michigan Senate Health Policy committee on Tuesday, Nov. 29.

If you live in Michigan, or know someone who does, please make your way over to FoMM’s Facebook page for directions on how to help. Take note: If you are disheartened by the election, here’s a way to carry out five minutes of activism that can actually make a difference! 

[Updated July 16, 2016, to add copyright designation.]

via Ask the Right Question: The Licensure Question — Friends of Michigan Midwives