evidence that Lincoln Hospital provided insufficient and even dangerous medical care. They argued that the pivotal failure in this case had been lack of continuity of care, a common problem in an urban hospital catering to poor people without access to private physicians. Although Rodriguez had been treated for a drug addiction at the hospital and referred to ob/gyn for an abortion because of her pregnancy and heart condition, her case was unknown to the ob/gyn department. Better communication would have saved Rodriguez’s life. Think Lincoln and the Lords called for the ouster of the director of the Department of Obstetrics and Gynecology and for a worker-community board that would help design and oversee hospital policy. As a result of the protest, the director of ob/gyn resigned and an interim director took his place. Ultimately, however, the hospital retaliated against the activists, filing an injunction against the Young Lords and Think Lincoln that forced them to remove their complaint tables from the lobby.146
After the Rodriguez death, the hospital administrators took no actions to increase community control over hospital decisions although the Young Lords and Think Lincoln continued to organize around health care reform. The supportive residents and interns in the Department of Pediatrics experimented with increasing community involvement in their department. Mullan, another physician, Paul Bloom, and some former members of Think Lincoln helped organize a Pediatric Parents Association that would function like a Parent Teachers Association, allowing parents of young patients to have input in hospital policy. The group recruited parents in the hospital emergency room waiting area and in the pediatric clinic. A group of about ten parents met biweekly for several months to attend lectures about community health issues such as lead poisoning and to meet with physicians and staff. The parent group opposed budget cuts at the hospital and helped select the new house staff (interns and residents). After interviewing applicants, with particular attention paid towards candidates’ attitudes towards blacks and Puerto Ricans, the parent group made hiring recommendations to Dr. Helen Rodriguez, the new director of the Pediatrics Department and a strong advocate of community involvement in health care design and delivery. Less successfully, activist residents and interns also attempted to integrate worker input into the Pediatric Department. Nurses, secretaries, aides, and clerks, however, were suspicious of the physicians’ motives since they had never before been asked for their input. The nonphysician staff also brought their own hierarchy and disagreements among themselves to meetings, which inhibited free discussion. Unsurprisingly, many staff felt uncomfortable speaking freely among doctors in a workplace that had long operated along rigid lines of hierarchy and power. All of these factors contributed to a failed attempt to level hospital hierarchy.147
The physician residents and interns and the community activists, which included the Young Lords, pitted themselves against an intransigent group of hospital administrators who, in the end, stood in the way of any real transformation of Lincoln Hospital’s services, although they did succeed on a few fronts. Dr. Harold Osborne, an MCHR activist and intern at Lincoln, recalled that the interns were more successful at reforming the internship process than ending poverty-related health problems in the South Bronx.148 It was impossible to implement these sorts of reforms without some support from entrenched powers, even when those in powerful positions were also targeted for change. NHCs, with their federal mandate, congressional support, and national scope, were much more successful at bringing those with some entrenched interests in sustaining medical hierarchy—but also with interest in delivering quality medical care—together with community members who could help shape health center offerings to best meet their community’s needs.
Multiple studies support the contention that NHCs had many successes. One national study found that Boston, Chicago, and Portland hospital admissions were lowered for target populations. Researchers also noted a reduction in hospital stays as well as a reduction in the number of hospital days per capita. Several other studies showed a reduction of hospital admission up to 44 percent and a reduction of hospital days per capita from between 25 and 62 percent in communities with NHCs. Other studies of Medicaid users revealed that those using NHCs had 50 percent lower hospital rates than nonusers and reduced infant mortality rates, particularly among African Americans. These studies revealed too that when NHCs reduced hospital admissions, costs also fell in comparison to hospitals that employed high-tech solutions to low birth weight and premature births, such as neonatal intensive care units.149
There is less agreement about precisely which factors contributed to these improvements. Was it the geographical location of clinics in poor neighborhoods, the low cost to patients, the use of community outreach workers, or the use of community boards? It is outside the scope of this chapter to attach particular successes to specific reforms. It is also necessary to consider to what extent the NHC model really transformed health care delivery. Although health care and health improved markedly in neighborhoods with federally supported health centers, the solution was still hospital centered, technical, and entrepreneurial. Geiger, too, is critical of the form community health centers took over time as they lost their focus on community empowerment. He wrote, “After too few years the window that was open to expanded programs and community development began to close. This happened in part because of program costs and in larger measure because conservative national administrations were (to put it mildly) not overly interested in community empowerment and social change.” He explains that health centers became more traditional in their delivery of medical services rather than focusing on ending poverty or transforming social inequalities.150 Other critics of NHCs argued that although power was no longer held by individual physicians, it shifted to hospital corporations and insurance companies that made decisions about patient care rather than being distributed to community residents. Certainly, with the end of the War on Poverty, the gradual shift away from federal spending on social services in the 1970s, and the more onerous cuts in the 1980s during the Reagan presidency, community control of social programs no longer had many federal champions.151 Yet neighborhood health centers have continued to be a fundamental part of health care provision for the poor and uninsured in the United States. Today there are twenty million people each year who use community health centers. Twice as many will probably use the centers, with eleven billion new dollars from the Obama health care plan (the Affordable Care Act) and $2 billion in stimulus monies going to health centers. With this sort of long-term and future investment in community health centers, it is imperative that we attend to how and why health centers were created nearly a half-century ago and how and why they succeeded, even though success may have been uneven.
In the next chapter I turn to the feminist women’s health movement that grew, in part, from the health reform efforts of the civil rights and the New Left NHC movement. Feminists also built neighborhood-based health centers with local, federal, and private support, but they also challenged what they viewed as socially embedded gender hierarchies in health care delivery that were connected to a larger context of uneven social power between men and women. With less federal support than that garnered by NHCs, feminist women’s health centers also struggled to survive through the decade of the 1970s. When they provided abortions, their survival was threatened by a burgeoning and passionate anti-abortion movement.
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“Thank You for Your Help . . . Six Children Are Enough”
The Abortion Birth Control Referral Service
Community and neighborhood health clinics, grounded in the civil rights and New Left movements, provided intellectual, political, and practical experiential precedents for the women’s health movement. By the early 1970s, with the explosion of Women’s Liberation participation in cities around the country, feminists began to create new health institutions for themselves and other women. The feminists who built these institutions perpetuated the earlier health reform commitment to reaching people without access to health care. At the same time, they also wanted to expand women’s sexual and reproductive autonomy and dismantle sexual and reproductive double standards that seemed natural and normal to many but actually stemmed from deeply entrenched, yet socially constructed, gender roles. As women met and discussed which social mechanisms perpetuated sexist gender roles, they came to the conclusion that gender inequalities could not be transformed unless sexual and reproductive autonomy were also secured.
