AFTER I GOT word of Helen’s death from lung cancer last December, I began a process of looking back over the many years that we worked together, from 1974 through approximately 1989, and the many years since we had seen each other.
I wanted to recognize and honor what Helen and her political contributions meant for me, for women generally, for women of color and for the women’s and health movements.
In this, I was joined by many friends and colleagues who all felt a profound debt to Helen and painful loss at her passing. Many of their comments and remembrances are reflected here.
Her death came as a great shock. Somehow I had thought myself secure in knowing that Helen would always be there, with her formidable powers of persuasion, incisive logic, wit and grace, for those many hundreds, probably thousands, of us who worked beside her in CESA (Committee to End Sterilization Abuse), National Women’s Health Network, Latino Caucus of the American Public Health Association, New York State AIDS Institute, to name only a few.
Her energy and seeming omnipresence made it unfathomable that Helen would no longer be there to mentor young women seeking confidence and direction, or as a great motive force in health and women’s issues. Now it will be up to each of us to embody some aspect of Helen’s work and carry it forward.
I first met Helen in 1974 when a close friend and I went to one of the early meetings of CESA at an apartment in Greenwich Village.
After a stint working with an abortion rights group whose superficial analysis left us feeling frustrated, and an energizing trip to China with the Guardian newspaper, we were looking for just the right place to continue reproductive rights work with a diverse group and distinct class-based analysis. CESA was certainly that place.
Helen’s views were well-formed long before we met her in CESA. A product of her personal struggle to become a physician, especially while raising four children as a wife and mother, through years of delivering health care to poor communities and several decades of work for Puerto Rican independence and other issues, Helen’s views were firmly class-based, and pragmatic.
As Helen said at the Reid Lectures at Barnard College in 1976, she believed that in order to change the health care structure, it was first necessary to “identify and confront the forces that oppress women and others who are without power,” both within and outside each of us.
She reflected that her early years in the United States and medical training in Puerto Rico allowed her to “understand the relation between elitism in medicine and questions of hierarchy and status in the American colony. The medical profession reproduces the hierarchical structure of the surrounding society; in the colonial setting, where the power lies outside the colonized nation, medicine reinforces the dependence and oppression of the people.”
Helen’s own life took her from New York City, where she was born in 1929, to Puerto Rico until she was 10. The family returned to New York, where her mother, a progressive schoolteacher who was unable to get a license because she was bilingual, took in boarders to make ends meet.
Helen went to medical school in Puerto Rico because of the scholarship programs available there. Her schooling was interrupted for seven years when her brother refused to continue helping her, after she went on strike along with the other 6,000 students to protest the school’s refusal to allow the nationalist leader Don Pedro Albizu Campos to speak.
In the interim she married and had three children (Jo Ellen, Laura, David), then finished her medical education.
As one of the most experienced people at CESA, Helen helped formulate what was, until then, an almost unique viewpoint in the women’s movement, and brought that analysis to the orthodox left and other progressive groups.
CESA analyzed sterilization abuse from every perspective to find out how different groups with different life experiences benefited from, reacted to, or were targeted by coercive sterilization campaigns and all the other elements, social, economic, legal and technological, that go to make up reproductive choice.
Women were not simply an undifferentiated “class” who experienced legal discrimination. But most women had suffered at the hands of the medical system.
If they were white, they were denied sterilization and had difficulty finding safe, legal abortions. If they were from communities of color they found only sterilization to be freely available, as in Puerto Rico, or forced upon them as with the Relf sisters, two barely adolescent African Americans on welfare.
When we sought to explain these phenomena, we found ourselves in sync with welfare rights, civil rights, consumer rights, women’s health, feminist, Native American, Puerto Rican and anti-imperialist organizations, and almost everyone else except the professional medical and population organizations.
Helen also stressed, and actually introduced to us, the historical aspect of political analysis, which plunged us into an examination of the eugenics laws, those now-discredited statutes that allowed thirty-seven states and some territories to involuntarily sterilize tens of thousands of those thought to be congenitally “defective,” or poor.
This led us in turn to an examination of the roots of the eugenics movement in Planned Parenthood, the Association for Voluntary Sterilization, Population Council and others, and explained their opposition to informed consent for sterilization.
As a consequence, we emphasized the differences between birth control as an individual freedom and population control as an oppressive policy, thus exposing the cynical use population agencies had made of women’s organizations that were fighting for birth control.
Historical analysis was also necessary to overcome what was seen as a racial divide among women. Without understanding the economic determinants underlying women’s choices, and the history of racially targeting certain populations for sterilization or other birth control campaigns by government and population agencies, we would have been without a comprehensive analysis that took class and race into account.
In coming to terms with the history of eugenics, its modern survival in the population agencies and the different conditions and preferences of women, CESA was able to formulate an inclusive notion of “choice,” one that spoke to single working women trying to keep their families together as well as to those who wished to remain childless.
CESA’s analysis made it possible to form alliances with women of color, thereby bridging a gap between women of color and mainstream feminists.
This analysis, largely Helen’s, made CESA a group diverse in its ethnic and professional membership and gave us the credibility and expertise to successfully lobby legislatures and government agencies, and to win over almost every constituency that was not overtly hostile.
Helen made presentations to professional groups, spoke at conferences all over the country and gave testimony in Washington, D.C. that helped to sway the Department of Health, Education and Welfare (HEW) to adopt in 1979 regulations governing informed consent for Medicaid sterilizations.
HEW’s regulations were almost identical to those first written by Helen and others, adopted in New York City’s Health and Hospital Corporation in 1975.
To position the issue and the organization for a broad effort, several adjustments had to be made. At the outset, and for several years afterward, CESA had a very strong tie to the Puerto Rican independence movement, particularly the Puerto Rican Socialist Party.
This connection grew out of the historical circumstance that the U.S. government had so heavily pushed sterilization, to the exclusion of other options, that 35% of Puerto Rican women of childbearing age had been sterilized.
As the analysis deepened, it became clear to Helen and others that CESA would better be able to attract support and educate broadly if it were not seen as part of the Puerto Rican independence movement, but as an unaffiliated organization. We reoriented ourselves and pushed on to examine sterilization campaigns elsewhere, e.g. India, Latin America and here in the form of the eugenics movement of the early 20th century.
Helen saw the necessity of working on many fronts at once. CESA operated as an “outside” organization, demonstrating and marching, while its sister “inside” organization, the Ad Hoc Advisory Committee to the Health and Hospitals Corporation (HHC) on Sterilization, wrote and laid the political groundwork in the public hospitals for the first set of sterilization guidelines.
Helen, who was then an HHC employee, Chief of Pediatrics at Lincoln Hospital in the Bronx, was a member of both the inside and outside groups, which worked in tandem with a loosely coordinated strategy.
The advisory committee and CESA were then working to convince the City’s Department of Health to support legislation extending the HHC guidelines to all facilities. As the struggle intensified, and HHC was named a defendant in a lawsuit brought by doctors to invalidate the guidelines, Helen resigned her position on the advisory committee so as not to complicate or compromise its efforts.
The advisory committee also bore the imprint of Helen’s view of political struggle. In addition to Helen, the membership included her close friend, the late Esta Armstrong, who was chief of Prison Health and special projects within HHC; attorneys from the Center for Constitutional Rights; other physicians from HHC; and most importantly, members of the hospitals’ community advisory boards, people who lived in the affected communities who greatly broadened the committee’s perspective.
When I attended a conference in 1991 on the implementation of the sterilization guidelines within the HHC hospitals, I was almost dumbstruck that all the providers in attendance spoke of them as if they had always been part of the health care landscape.
It is a tribute to Helen’s organizational instincts that she and the other advisory committee members included front-line caregivers in this effort from the very beginning, and scrutinized the health care delivery system to select the crucial points for intervention.
Throughout all this whirlwind of activity, Helen worked first at Lincoln Hospital, then as a director of an adolescent health program at St. Lukes-Roosevelt Hospital. She had a lively social life, took up running in Central Park and brought up the youngest of her four children, Daniel, who was living at home.
She enjoyed her jobs, saying that she loved to see patients and believed that they reciprocated those feelings.
We were at Helen’s apartment on West End Avenue for one of our many CESA meetings late one evening in July 1977, when New York City suffered its second electrical blackout. We went into a panic: How would we get home? Or even call once the phones went out?
It was beastly hot, the dark streets exuding menace; Helen, cool as a cucumber, invited us all to stay on the couches, floors, bathtubs, wherever we could fit. We did and awoke to find things largely back in order.
I remember that when Helen moved to a larger apartment on West End Avenue, she redesigned the kitchen to be large and open, the center of her home. She entertained often. Numerous parties and our many meetings were frequently accompanied by snacks and cafe con leche.
Helen was never too busy to help. One health activist who headed the health committee at New York NOW recalls frequently checking with Helen to ensure that flyers and health related publications were medically accurate and made good political sense.
On the dark side, one of Helen’s early marriages had gone badly, causing a great deal of pain to her and her children. She confronted the difficulties head-on, and went forward with her career and personal life.
After her years at Roosevelt, Helen moved on to the New York State AIDS Institute, married again, was elected President of the American Public Health Association, served on the Board of Directors of the National Women’s Health Network, wrote a new preface to the 1998 edition of Our Bodies Our Selves, served on the OBOS advisory board, moved to California, founded the Pacific Institute, and with CESA member Carmita Guzman, helped found Taller Salud (Health Workshop), a women’s organization in Puerto Rico.
Helen did everything with finesse and grace. Whether serving dinner, debating a political point or telling off someone from an opposing camp, she did it gracefully. She was always in command of herself, even when terribly angry, never losing her composure no matter the provocation.
I am firmly convinced that Helen’s work and insights changed forever the terms of the debate about reproductive rights. The population agencies have recognized that they cannot coopt women’s or feminist organizations; women’s health organizations recognize that they must be diverse in membership and platform; and the discussion of choice, now nuanced, encompasses economic determinants and technology, as well as legal limitations.
Helen stands as a role model, activist, professional, mother, wife, mentor, theoretician. Her life, so rich and complex, cannot be easily summed up. But we can all take a cue from her to go forward with love, dedication, intelligence and grace.
ATC 101, November–December 2002