Building a new Bodies

When Our Bodies, Ourselves first was published, appalled conservatives tried to yank the tome from small-town library shelves. Today, however, mention the book to your sister, your mother, or even your grandmother (if she's hip), and you're likely to hear the word bible.

The idea for the book was born in 1969, when talk of equal rights swirled in coffee shops and basements, when "sisters" gathered to rally for change. In the spring of that year, 12 women from the Boston area founded a group, the Boston Women's Health Book Collective, to run conferences about the undertreated subject of women's health. To go with the conferences, they wrote a course book, complete with evocative, even provocative, anecdotes from real women; sketches of the female anatomy; and forthright photos. Four million copies and many translations later, the book has ditched its more militant artwork -- a closed fist within the woman symbol adorned its original introduction -- and added a confessional preface by Gloria Steinem.

But not everything has changed. When originally published in 1970, Our Bodies, Ourselves (then titled Women and Their Bodies) pushed a controversial agenda: it urged women to take control of their bodies and thereby take control of the male-dominated health-care system. The system has come a long way, but certainly not all the way: today, for instance, even though women use the medical system more extensively than men do, most health studies continue to be performed on men.

It's hard to find a woman who's not a fan of Our Bodies, Ourselves, although not everyone is happy with the Boston Women's Health Book Collective. A year ago, four women of color filed a complaint with the Massachusetts Commission Against Discrimination, alleging that they were treated unfairly while employed by the nonprofit group, which is, for the most part, still run by the white, middle-class women who founded it. The charge remains under consideration as Our Bodies, Ourselves for the New Century -- with an increased focus on diversity and back-cover blurbs by African-American and Hispanic women's health-care leaders -- arrives in bookstores.

Paula B. Doress-Worters, 59, is one of the Boston Women's Health Book Collective's founders, an original author of Our Bodies, Ourselves and a member of the 1998 revision committee. From her Newton home, she spoke with us about the new edition and the ongoing fight for equitable women's health care, which looms as urgently as ever.

A: I think that women have begun to expect that there is information out there for them. When we started, we had to compile a lot of this information because there was hardly anything. And now there are a lot of books that talk about women's health.

There are also many more women doctors. When we started doing our work, only 6 percent of physicians were women, and now it's somewhere between 22 and 25 percent; meanwhile, large numbers of women are going to medical school. As a result, there are more professionals for women to turn to. . . . But at the same time, we have to realize that those women are undergoing the same kind of socialization and training as male doctors. They have some of the same biases. We still have to realize that not every doctor is the same.

Q: So after all the struggle to get women into medical school, they're perpetuating the same treatment that you were fighting against in the '70s?

A: Some are. If they're at an HMO, they might be more focused on the time that's passing and its effect on their profitability. They might be more focused on the disease and not the person. Man or woman, it really depends on the practitioner. That's why we still have to be careful consumers.

Q: What do you see as the biggest threat to women's health care today?

A: I think the profit-making trend in medicine is a big threat. First of all, a lot of women are uninsured. It's daunting to get medical care if you're not insured. We've been calling for universal health insurance since our first edition, but there's just so much resistance in this country. It's a collectivist solution and, unfortunately, we're not a collectivist country. Plus, the fact that people are willing to trust the corporations to create a fair, equitable, accessible, quality health-care system is baffling. It just amazes me.

Q: Why are women bearing the brunt of this?

A: Because women make most of the doctor visits. Many of our normal life events are ones that come under the medical system, like getting birth control or getting an abortion, prenatal tests and childbirth. Throughout our lives we need to have access to the medical system. Of course, we're also the ones to bring children to their medical appointments, and then, as we get older, our parents and other relatives. We're the health brokers in our families; when that care is not accessible, we have to take time away from our jobs not only to attend the medical appointment but also to figure out how to get it. It's pretty major.

Q: What obstacles have you encountered translating the book for other countries?

A: There have been controversies a few times with adaptations and translations of the book in countries where the culture is very different. They wanted to reprint the book with a certain chapter left out -- often it was the lesbian chapter or the rape chapter, as if there were no lesbians or rape in their country! [Laughs] But if someone wants to translate our book and call it Our Bodies, Ourselves, they have to include every chapter. They can adapt the materials so it works better for their culture, but they have to include everything. If they really feel it will be useful for their country but just won't get published because of censorship, then we help them prepare the information, but they have to call it something else.

Q: Is there still resistance to the candid talk about abortion?

A: There is. Sometimes when we're invited to speak and a Catholic hospital is involved, there is discouragement of our talking about abortion. But one of our policies is, we will not be told what we can and cannot speak about. We're also very careful about drug-company money; sometimes a drug company is sponsoring a talk and they don't want us to be critical about hormone therapy for menopause or something like that. We've never taken money from any organization that wants to direct what we say.

Q: What were your goals for the new edition?

A: We wanted to get the book beyond white, middle-class, educated women. We've tried to reach a more diverse group. The women who worked on the book are more diverse than ever before, and the book reflects that. We also tried to reach out to low-income women and work with them, because one of the big problems with medical care today is economic discrimination. We wanted to make sure the book spoke to the needs of women who aren't getting enough nutritious food, who aren't getting access to the care that they need, who are facing racism and other kinds of discrimination in their lives as well as in their medical care.

Q: But isn't it a little idealistic to think that a poor woman with kids to feed is going to spend $24 on a copy of Our Bodies, Ourselves?

Q: In light of the discrimination complaint, are you worried the book's focus on diversity will be interpreted as hypocritical?

A. No, not really. Just because there's a complaint doesn't mean there's any merit to it. We made a special effort to have the women of color who were on staff contribute to the book. We've drawn our writers from a diversity of leaders in the women's health movement.

Becoming a more diverse society is a long process, and there are struggles along the way. People joined our organization believing that it is a true collective, even though we told them it's just our history. There's still a lingering dream that people will be able to have more say here than is actually possible. Things have been blamed on racism, but it's more about how the organization is evolving. It's growing pains.

Q: The word collective does have a throwback feel to it. How does your organization see itself in 1998?

A: The truth is that in order to sign a contract with a publisher, we had to be incorporated as a nonprofit corporation. So we had to pick a name and stick with it. But over time, we've become less and less a collective. We do have those collective ideals, though; I can't think of one chapter in the book that was written by just one person. It's more like a collaborative than a collective now.

But it's hard. Our culture today is so bottom-line focused. The publishing company doesn't want to send pairs of us around to do the publicity, which at first we argued over. We're known as a collective, and if we talked together, this would give a sense to the public of how we work together. But we're working with a publishing company that's backed by a corporation that's been bought out by another corporation that's not even in the book business. It's tough, but if we still keep our ideal right in front of us, we can create a product we're happy with.

A: Our vision for this book is very similar to the vision we had at the beginning. It's about understanding your body, understanding the changes your body's going through, and not leaving it up to someone else to interpret your experience for you.

Q: How do you feel when you look at this newest edition?

A: I think it's great! When we first started meeting in the '70s, we used to imagine that we would continue meeting for our whole lives, sitting in our rocking chairs having these meetings. [Laughs] And here it is, almost 30 years later, and we're not in rocking chairs, but we're still producing this book! And a lot of younger women have become involved to keep it fresh. It's exciting to see that the project will continue and take new forms.

Q: It's interesting that the book includes a call to action in addition to presenting information.

A: That's how we distinguish ourselves. Most of the major stresses in our lives we can't deal with alone. So we ended almost every chapter with information about hooking up with support groups and organizations that deal with a particular disease or issue. That way, we really encourage women to get involved and not to be in isolation.

Q: What is the effect of racism on sexuality and health?

A: It's hard for those of us who are white women to even comprehend how much impact racism can have on women of color. It can be life-threatening. A medical practitioner may have a perception of you and decide you are or you aren't the type of person who might have a certain disease, like HIV, simply because of the way you look.

Q: Do you think it's taken longer for alternative medicine to reach the mainstream because many aspects of it, like midwifery, are woman-dominated?

A: It probably had something to do with it in the beginning, but I think it's more that the medical society wants to keep control over the things that have traditionally been under its bailiwick. They don't want to see them farmed out to other groups unless their doctors can supervise it. They've brought midwives into urban centers where many women are uninsured, but it's always to fill in where there are not enough doctors. If a woman wanted to choose a midwife, who in fact may have a better track record with births than many doctors, it becomes a difficult thing to do because the doctors don't want to see that business go.

Q: Was there a moment when you realized the impact this book could have on women?

A: It happens all the time. Whenever I'm introduced to someone and say what I do, people will say, "Oh, that book really changed my life." But one of the most heartwarming letters was from a woman from California who wrote to us. She had sat down with the book and her three teenage daughters and talked about some of the material in it. It was the most open conversation they had ever had.

Q: How far do you think we've come?

A: We've come an enormous way. That's clear. When we started doing this project, there was an assumption that work was always secondary for women, that our partners' careers were more important, that we often didn't have choices about whether or when we should have children. Just the idea that we can have control over our reproductive lives through understanding our bodies is itself an enormous step forward.

Q: How far do we have to go?

A: There's an enormous way to go. I think our lives today are being controlled by technology and medicalization and the whole profit-and-loss mentality. There's a tendency to get pulled into it because we're made to believe that this is modern, this is progress. In the '70s, we had this perception that things were really unfair, that we didn't have an equal chance. We wanted to be made equal. Now I think we're being lulled into thinking that this is what equality is, that this is as good as it gets.

But the fact is that it could be a lot better. If we felt entitled to understand where these ideas are coming from and examine them, we could really figure out what's best for women and get together with other women to make those changes. We still live in a sexist, patriarchal society. The problems may be a little more subtle, but we still have to be vigilant.

Alicia Potter is a freelance writer living in Boston. She can be reached at apotter@tiac.net.