The Washington PostDemocracy Dies in Darkness

The health-care system’s second-class citizens

Alicia Mundy is the author of “Crystal Mesh: How Addiction to Money Turned Medical Device Makers and Doctors Into Street Dealers,” due out in October.

As I was writing this review, Alabama had passed a draconian law that bans abortion except in cases where a woman’s health is at serious risk. The Food and Drug Administration had approved a new prescription drug injection to increase women’s sex drive and end what some ads called the “tragedy” of low libido. And OB/GYNs around the country were offering “vaginal rejuvenation” through laser procedures that narrow the vaginal opening to create “a more youthful, pre-pregnancy state” — a technique that has prompted an FDA warning on safety.

If there was any doubt of an audience for Jennifer Block’s advocacy book, those recent events should lay that notion to rest. In “Everything Below the Waist: Why Health Care Needs a Feminist Revolution,” Block reveals the travails of women trapped by a medical profession that poorly serves their needs. Despite the growing presence of female doctors, many women still suffer from the neglect and chauvinism of paternalistic male physicians, resulting in both undertreatment and overtreatment of symptoms and illnesses.

While advocating for women, Block also argues that the women’s movement has not delivered the magnitude of change in female care that’s needed. Fifty years after the start of the feminist revolution, American women are still second-class citizens when it comes to health care. In one of her opening vignettes, a 46-year-old woman undergoes a minimally invasive hysterectomy at a major medical center. Two days later she complains of severe pains, and her heart rate jumps. Her doctor’s response is to send her home with a prescription for anti-anxiety pills. Two days after that, the woman is rushed into emergency surgery, and doctors find that her intestine had been damaged during the hysterectomy. She leaves the hospital with a colostomy bag. “You may already be familiar with this story,” Block writes. “Woman needs medical care. Woman is ignored. Woman has to fight.”

Block notes that “there are no sacred cows in this book,” and that includes America’s fertility industry, where women endure open-ended treatments for a diagnosis of “unexplained infertility.” That leads to budget-busting artificial insemination, embryo freezing, repeated injections and surgery. Block tracks down a doctor in Pennsylvania, Danielle Miller, who produces better outcomes by taking the time to find the underlying reasons that women can’t get pregnant. The difficulty could be linked to hormonal imbalances or endometriosis — a diagnosis, says Miller, that is “not difficult. It’s just complicated.” And, for the doctor, less lucrative.

Block, a former editor of Ms. magazine, was also editor of the revised “Our Bodies, Ourselves,” the original women’s health-care bible. Her 2007 book, “Pushed: The Painful Truth About Childbirth and Modern Maternity Care,” delivered a scathing critique of “medicalized” childbirth in the United States. In a 2017 Washington Post article, she detailed the controversy over the birth-control device Essure, regarded by some as a breakthrough in contraception and by others as a serious danger to women. After reports of many women suffering significant side effects, Bayer, the maker of the device, announced in July 2018 that Essure would no longer be sold in the United States starting in 2019.

In blunt language, Block addresses the consequences of the movement to criminalize abortion and limit women’s access to clinics. “Ninety percent of counties in the United States have zero abortion clinics,” she writes. “Mississippi and six other states have just one for the whole state.” The result: “Underground abortion is a thing again.”

In her last chapter, “The Case for Home Abortion,” Block meets with nurses, doulas and midwives in a secret place surrounded by specula, cannula and syringes to learn how an abortion can be safely performed early in pregnancy. “Over the past five years, a decentralized group of providers has multiplied to a few hundred,” she writes. Her instructor wishes to remain anonymous out of fear of “law enforcement and anti-abortion vigilantes.” Block practices on a sola papaya, a fruit that resembles a pregnant uterus and is apparently used around the world to teach a “method of modern reproductive health care: manual vacuum aspiration.”

Block wants readers to understand that women have always had access to birth control and abortion — just in unconventional ways. “In Chicago,” she writes, “the self-trained underground group Jane Collective performed thousands of at-home abortions without incident before Roe.”

One of the most interesting people in the book is Carol Downer, a mother of six and co-founder of the Federation of Feminist Women’s Health Care Centers. Downer was an influential activist in the 1970s and leader of the original women’s self-help movement. She and others “hopped up on tables with a mirror, flashlight, and speculum to show other women how to view their own cervices,” Block writes.

Downer and her camp believed that medical fluency and control over one’s own biology were fundamental to the pursuit of civil rights. The radical arm of the women’s movement led to the publication of “Our Bodies, Ourselves” and, Block explains, “to direct actions against high-dose birth control pills, diethylstilbestrol, the Dalkon Shield, the exclusion of women from clinical research, and the isolation of women in maternity wards.”

Block uses Downer’s saga to show how divisions within the women’s movement played a role in women’s loss of control over their health care. In 1971, Downer was ostracized at the National Organization for Women conference and told not to get too graphic at the meeting promoting self-exams. After abortion became legal two years later, self-helpers such as Downer were seen as “retro.” Mainstream feminists were focused on expanding the role of women in health care: They should become doctors, not just play doctor with a plastic speculum.

Feminist health activists now “regret this turning point,” Block writes. Today, about 60 percent of OB/GYNs in the United States are females. But about a third of women in the country will have hysterectomies before they are 60, nearly a third of pregnant women have C-sections, and maternal mortality rates are increasing.

The book’s upsetting anecdotes, startling statistics and terrific interviews will leave you outraged or simply sad.

Block concludes with a call for “physiological justice” and a new feminist health-care movement. This is the book’s weak spot. Block doesn’t explain how a national movement to help women take back their health care would coalesce. Telling women to question their doctors and research their options sounds like former special counsel Robert Mueller telling Americans to read his 400-plus page report. Good idea!

Still, “Everything Below the Waist” is a must-read for women, especially any woman who might ever need to see a doctor.

Why Health Care Needs a Feminist Revolution

By Jennifer Block

St. Martin’s.
324 pp. $27.99