Leadership and Activism for Women's and Children's Health:
The Philadelphia Story
April 29, 2003

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Session Summary

Maternal and Child Health in Philadelphia: A History (Janet Golden)

Lessons of Booth Maternity Center (Ruth Wilf)

The Consumer Movement (Cynthia Waters)

Activism for Women's and Children's Health (JoAnne Fischer)

(Re)Activation of My Birthing Cohort (Heidi Worley)

Session Summary

On April 29, 2003 Maternity Care Coalition hosted "Leadership and Activism for Women's and Children's Health: The Philadelphia Story," the special free session of its 2003 Professional Education Series, Women's Health, Children's Futures. Speakers presented the history of the women's health movement in Philadelphia from the early 20th century dispensaries in South Philadelphia to the challenges of forging a coherent women's health movement among young women today.

Linda Wright-Moore, Journalist, moderated the session. In her opening remarks, she shared the numerous connections among the presenters, all of whom are currently staff or volunteer committee members of Maternity Care Coalition. JoAnne Fischer and Janet Golden are both founding Board Members of Walter Lear's Institute for Social Medicine and Community Health, and Ruth Wilf was a founder of Booth Maternity Center, where JoAnne worked. By sharing such personal connections, Wright-Moore set the stage for this session, which touched the emotions of many of the audience members.

Maternal and Child Health in Philadelphia: A History
Janet Golden, Rutgers University

The first speaker of the evening was Janet Golden, Associate Professor of History at Rutgers University and author and editor of several books and articles on the history of women's medicine and motherhood. In her presentation, Golden took a historical look at the evolution of maternal and child health in the late 19th and early 20th centuries. From the founding of Women's Medical College in 1950 and the Women's Hospital of Pennsylvania in 1861, to the increasing numbers of outpatient hospitals in the early 1900s, Philadelphia was a city in which the maternal and child health services were abundant but oftentimes uncoordinated. Many people did not have access to preventive health care, and were often treated in their homes. The Department for the Prevention of Diseases was a revolutionary development in healthcare in Philadelphia. The DPD promoted health, offering vaccinations, clinics, oral hygiene and health, and "continuous supervision of the patient by the same physician."

Golden also shared the role of race and ethnicity in the history of healthcare in Philadelphia. In the late 19th century, the public's major concern was the poor hygiene and high rates of disease among Italian, Jewish, Polish, and other European immigrants who lived in South Philadelphia. As these groups began to adopt the hygienic mores of the white middle class, the focus shifted to the city's African American population. Segregated clubs and classes were formed to teach Philadelphia's black residents "proper" hygiene and health care. With Golden's fascinating photos and quotes, she presented a history with which many are not familiar. Most importantly, she demonstrated that issues of race, ethnicity, neighborhood, and class have historically shaped the provision of care in Philadelphia in many of the same ways they do today.

Lessons of Booth Maternity Center
Ruth Wilf, Pennsylvania Hospital

Ruth Wilf, nurse-midwife at Pennsylvania Hospital and one of the founders of Booth Maternity Center, discussed the history and mission of the Childbirth Education Association of Philadelphia (CEA), a charter member of the International Childbirth Education Association founded in 1960. A model of 1960s family-centered care, the Childbirth Education Association was devoted to childbirth education, welcoming the presence of fathers, natural childbirth as desired, and breastfeeding and rooming-in support. CEA flourished in Philadelphia, with an active Board of Directors, childbirth classes throughout the area, and more than 25 nursing mother groups in 1969.

In 1970, John Franklin and Ruth Wilf decided to found a birthing center at which all people could learn and practice the principles of the CEA. In 1971, Booth Maternity Center was founded, a center "dedicated to the belief that childbearing can be a celebration for the entire family in an atmosphere of joy and dignity." At Booth, nurse midwives were the primary caregivers, supported by obstetricians, nurses, and other health care providers. There were special emphases placed on individualized care, the whole family as part of the childbirth process, and clear communication and an equal standard of care for all the patients and families. In addition to prenatal care and birthing support, pediatric and mental health services were also available at Booth. As time went on, parents began to take a more active role at Booth. The first parenting group began in 1973, and parents created a Booth newsletter called "The Listening Booth." Sibling involvement in birth, vaginal births after cesareans, and nurse midwifery education were some of the other areas in which Booth was a pioneer. Coming out of the civil rights, consumer, women's rights, and students' movements, Booth was an extremely successful center that greatly influenced the lives of its supporters and clients. While Booth no longer exists, and women's health issues are influenced by the corporatization of healthcare, fears of pain, inconvenience, malpractice, and litigation, pioneers, such as doulas and lactation consultants, continue to practice and advocate for Booth's ideals.

The Consumer Movement
Cynthia Waters, Maternity Care Coalition

Cynthia Waters, Director of Maternity Care Coalition's MOMobile and Early Head Start programs, discussed the women's health and consumer movements of the 1960s and 1970s. After showing pictures of the generations of women healers and activists in her family, Waters explained that the women's consumer movement of the 1970s was based on information sharing, empowerment, affecting health policies, and changing the system. National women's organizations such as the Boston Health Book Collective and the Women's Health Right Coalition were formed to address the lack of information and adequate care that women health care consumers lacked. Dr. Helen Rodriguez Trias, a mentor of Waters', founded the National Committee to End Sterilization Abuse, an organization dedicated to eradicating the appalling statistics on the high rates of sterilization among women of color and working class women. In Philadelphia, a number of organizations such as the Women's Law Project, the Women's Health Concerns Committee, and Triple Jeopardy were founded to provide health care and information to women.

One of the longest running of such organizations was the Elizabeth Brown Blackwell Center for Women, founded in 1974 as a feminist, alternative health center focused on reproductive and gynecological health. With a mission based on the belief that health care was a right, not a privilege, Blackwell emphasized health maintenance, nondiscriminatory provision of services, and full reproductive care. Blackwell's staff and supporters were involved in leadership and advocacy around reproductive care, provided abortion services and care to women with disabilities, and promoted health education and self care. Although Blackwell has now closed, and women's health and feminism have found their way into American academic institutions and into mainstream political jargon, there is still much work to be done. Waters shared the stories of three African American women who currently live in North Philadelphia, each of whom struggle with racism and sexism in the health care system. Women of color must not be left behind. Women are still underrepresented in the health care professions, and we must continue to advocate for research to be done on women's health issues.

Activism for Women's and Children's Health
JoAnne Fischer, Executive Director of Maternity Care Coalition

JoAnne Fischer, Executive Director of Maternity Care Coalition, presented the history of Maternity Care Coalition (MCC). MCC was founded in 1980 by eight different community organizations to reduce preventable infant deaths by improving accessibility and prevention emphasis of existing maternity services, and by helping targeted neighborhoods to develop new community-based services. Throughout the 1980s, MCC conducted door-to-door outreach to low-income pregnant women to assist with accessing social services. In addition, MCC advocated for expanded Medicaid eligibility, reduced perinatal cocaine use, and the prevention of OB unit closures. MCC organized the first Philadelphia City Council hearings on infant mortality and started the MOMobile program in 1989. In the 1990s, MCC began to focus more on cultural diversity, establishing the Latina MOMobile in 1991. Advocacy efforts on maternal and child health issues increasingly became a core component of MCC's work, and MCC commissioned a performance piece on pregnancy and mental illness. Throughout the 90s, MCC programs continued to expand, and MCC became the Pennsylvania affiliate of than National Healthy Mothers Healthy Babies Coalition.

Today, Maternity Care Coalition remains a local and national leader in maternal and child health. Its programs have grown to include HIV prevention, smoking cessation, Early Head Start, Healthy Start, and public benefits education. MCC now has a major fundraising campaign, the Mother's Day Campaign, and has been received national recognition for excellence in our programs. But there still remains work to do. Many of the same issues - OB closings, infant mortality, low breastfeeding and immunization rates - that MCC was founded to address are still very much in the forefront of maternal and child health.

(Re)Activation of My Birthing Cohort
Heidi Worley, Maternity Care Coalition

Heidi Worley, MCC Director of Research, Education, and Advocacy, completed the session with a discussion on why women in her generation, in their thirties, are not more involved with maternal and child health activism. Women in Heidi's birthing cohort are having children later, having fewer children, or not having children at all. In addition, they have an overwhelming number of outlets for activism, and for many of them, the politics around childbirth are not personal. Heidi shared that her own path to activism has been shaped by her long-term involvement with community service, her academic and personal interest in the international human rights framework, and her participation with the conscientious consumerism movement. Heidi argued that to re-involve women from her generation, we must appreciate and celebrate the history of past maternal and child health movements, build evidenced-based strategies, incorporate men, utilize new technologies, translate old ideas into new paradigms, and always remember that the personal is political.