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Category Archive: News

  1. Providing care to people who use drugs

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    by Eva White (she/her) University of Maine Social Work student and Mabel Wadsworth Center intern

     

    Take a moment to consider the following scenario… 

    A person calls a health clinic and tells the front desk associate they’d like to have an abortion. They estimate their gestation at around eight weeks, they were assigned female at birth, and when asked about prior health conditions, they share that addiction runs in their family. They disclose their insurance information, birthday, address, and any other information required to establish them as a patient at this health center. They tell the clinic they’d prefer a procedural abortion instead of a medication abortion, and they thank the front desk person for their time. On the day of their appointment, the clinical assistant calls them from the waiting room and engages in typical pleasantries before beginning the pre-abortion counseling routine. 

    During the portion of the counseling wherein the patient is expected to disclose any prior medication use, the patient reveals to the clinical assistant that they injected heroin an hour prior to their appointment. When asked further about their heroin use, it becomes understood that the patient is a regular, recreational user of heroin and other opioids. The clinical assistant asks a few more patient- and condition-specific questions and the counseling portion of the appointment is finished. The clinical assistant leaves the patient to wait for a few minutes while she consults with the doctor about the best course of action. During this discussion, the CA and doctor determine how to safely proceed with the appointment while considering the patient’s individual needs. Now, it is time to administer medications if necessary and continue with the procedure.

     

    Some people may feel judgmental after considering the above scenario. Some may feel shocked that the clinical assistant didn’t abruptly show the patient the door when they revealed their drug use. Some may feel nervous, because if a health center is offering care to someone that uses drugs, they cannot be legitimate and safe…..right? 

     

    Now, please consider the following scenario…. 

    A person calls a health clinic and tells the front desk associate they’d like to have an abortion. They estimate their gestation at around eight weeks, they were assigned female at birth, and when asked about prior health conditions, they tell the associate that dangerously high blood pressure runs in their family. They tell the clinic they’d prefer a procedural abortion instead of a medication abortion, and they thank the front desk person for their time.

    During their pre-abortion counseling, the clinical assistant takes the patient’s blood pressure and finds it to be quite staggering. The CA asks the patient a few patient- and condition-specific questions, leaves them to wait for a couple minutes, and finds the doctor. She consults with the doctor about the client’s current condition and together, they develop a plan for how to safely continue the patient’s appointment. After a conclusion is reached, it is time to administer medications if necessary and continue with the procedure. 

     

    How are these two scenarios different? How are they the same? It is reasonable to assume that for many people, the latter scenario is quite normal. In fact, it would be considered malpractice for the clinical assistant to show this person the door after they disclosed a prior medical condition and still expected to receive care. In fact, it is any medical professional’s responsibility to cater to their patient’s needs. If a patient has an allergy, this is accounted for in their care. If a patient has staggeringly high blood pressure, this is accounted for in their care. If a patient has a pacemaker, this is accounted for in their care. If a person uses recreational drugs, this is accounted for in their care.

    The point of this exercise in consideration is twofold. The first intention is to dig up the fact that many people are affronted and almost personally offended by the idea that someone who uses illicit substances has the exact same right to healthcare as someone who has never touched a pipe, needle, or pill. The second intention is to describe exactly why it is safe and legitimate for healthcare workers to serve patients that use substances. It is understandable for someone to wonder if it is safe for a patient to undergo an abortion procedure while on heroin. Are they truly able to consent to the procedure? Is the procedure impossible to carry out because of the drugs in their system? 

    When any patient is served by a medical facility, the implication is that their care will be catered to them as an individual. If they have high blood pressure, an allergy, a heart condition, depression, or any other medical condition, it is expected they disclose that information to their provider. This is not so that they may be shamed for a lack of exercise, family history of diabetes, or drinking too much coffee; it is because some medications, surgeries, or medical practices are contraindicated when certain conditions are present. For example, in a study on female military Veterans, it was found that 29% of the women presented with a medical contraindication to combined hormonal contraceptive use (Judge et. al, 2018). The contraindications listed were smoking, hypertension, and migraines. The point of this study was not to indicate that people who smoke should be turned away at the door of a sexual health clinic. The point was to illustrate the myriad options these people have other than CHC and how to use these other options safely. Just as with any other contraindication, it is possible to work with and around a person’s drug use to offer them services safely. 

    Are people that use drugs able to give consent to their healthcare providers? There are forms to sign, medications to take, and pokes and prods that must all be understood and consented to when someone visits any doctor. Sometimes, being high on some kind of substance prevents someone from giving informed consent; their cognition may be impaired, their physical ability to sign something might be hindered, or their emotional state is so heightened that they are unable to listen to and absorb important information. This is not always the case when someone is on substances. Peoples’ capacity to make informed decisions may not actually be affected by their substance use. In fact, if people regularly use or misuse substances, they may not be impaired by those substances and find that they become impaired when sober from that substance. For example, it has been found that regular THC (marijuana) users do not experience acute neurocognitive impairment when given a set of tasks to complete while high on the substance. (MacCallum et. al, 2021). In another study that researched assessments designed to test someone’s decision-making capacity, it was found that in most cases of substance misuse, it is entirely unnecessary to assess their capacity and actually violates ethical principles (Kumar et. al, 2022). 

    People that use drugs are humans. Humans deserve healthcare and kindness. At any healthcare facility, doctors; practitioners; nurses; and social workers should be trained to serve all populations, including people that use drugs. Doctors are expected and able to work with patients with diabetes, liver failure, blindness, deafness, borderline personality disorder, eczema, coronary heart disease, and PTSD. They spend hours deliberating with nurses about the best course of treatment for patients with contraindications and ask question after question to patients about their needs. They try new medications, use hypoallergenic supplies, and implement trauma-informed practice with patients. Why is substance use any different from another medical need? Substance use is stigmatized to an extent that prevents people from seeking healthcare services because they are afraid of being turned away, they are abused by providers, or their needs are not otherwise met. This is unacceptable, inhumane, and something that must shift in the healthcare field. 

     

    Judge, C. P., Zhao, X., Sileanu, F. E., Mor, M. K., & Borrero, S. (2018). Medical contraindications to estrogen and contraceptive use among women veterans. American Journal of Obstetrics and Gynecology, 218(2), 234.e1-234.e9. https://doi.org/10.1016/j.ajog.2017.10.020

     

    MacCallum, C. A., Lo, L. A., & Boivin, M. (2021). “Is medical cannabis safe for my patients?” A practical review of cannabis safety considerations. European Journal of Internal Medicine, 89, 10-18. https://doi.org/10.1016/j.ejim.2021.05.002

    Kumar, R., Berry, J., Koning, A., Rossell, S., Jain, H., Elkington, S., Nagaraj, S., & Batchelor, J. (2022). Psychometric properties of a new decision-making capacity assessment tool for people with substance use disorder: The CAT-CAT. Archives of Clinical Neuropsychology, 37(5), 994-1034. https://doi.org/10.1093/arclin/acac010

     

  2. Improving essential contraception access in Maine

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    By Lydia Townsend (she/her) University of Maine Women’s, Gender, and Sexuality Studies student and Mabel Wadsworth Center intern

     

    Ensuring that all people have access to contraceptives is crucial in supporting reproductive autonomy. Providing individuals with contraceptives that best suit their needs allows them to be in control of their future – deciding when and if they wish to be pregnant. Not only does access to contraception provide autonomy, but it is also key to the health and safety of all individuals involved. Contraceptives are important tools in preventing unintended pregnancies and, in the case of barrier methods like condoms, sexually transmitted infections (STIs). 

    Contraceptives come in many forms, ranging from barrier methods, to pills, to injections, to intrauterine devices (IUDs). This variety in forms is necessary and essential, as each person’s needs differ, and some contraceptives may be better suited for them than others. Condoms and dental dams, for instance, reduce the transmission and spread of STIs, and condoms can be utilized for penetrative sex. The hormonal contraceptive injection, Depo-Provera, can be especially important for individuals who are experiencing reproductive coercion. It is a form of contraception that cannot be removed or as easily withheld by an abusive partner or parent. IUDs are beneficial for individuals who do not want to have to remember to take a pill each day and/or who want a form of birth control that lasts numerous years. Birth control pills are a good option for those who may not want to be on birth control for an extended period of time or will easily remember to take a daily pill. Additionally, both IUDs and pills come in varying ratios of hormones, some even without hormones, providing an option to individuals who may be more sensitive to hormonal changes. While some people don’t tolerate hormonal contraception well, others may see benefits ranging from reduced acne to improved mood.

    Just recently, the FDA approved the first ever over-the-counter hormonal birth control option in the US, known as the Opill. This is a progestin-only oral contraceptive that will now be accessible without a prescription, a crucial step in ensuring reproductive autonomy. Over the counter oral contraceptives are already accessible in over 100 countries, the United States is just now following suit. Not only will the Opill be available at local pharmacies, but also for purchase online, which helps to eliminate access barriers. 

    The approval of the Opill helped to inspire a bill (LD2203) here in Maine, a bill that would expand access to contraceptives for all. The bill, put forth by Representative Poppy Arford, specifically calls for health insurance companies to cover the cost of over-the-counter contraception, including condoms, emergency contraception, and the newly approved Opill. In providing these options to individuals, without having to pay out of pocket or receive a prescription, reproductive autonomy is being protected. This bill would help to ensure that Mainers have access to over-the-counter contraceptives, helping to eliminate potential financial barriers. 

    This bill is particularly important for marginalized people who want contraception but face barriers in access. These barriers are compounded by factors such as socioeconomic status, race, ethnicity, and gender and sexual identity. Through expanding coverage to these additional forms of contraception, individuals will now be able to access the contraception they wish to without having to worry about issues such as cost. Additionally, this bill is important to Mainers as we currently face a healthcare shortage here in the state. In recent times, it has become extremely difficult to find a provider who does not have a month(s)-long wait list, let alone one who is actually accepting new patients. In specifically expanding coverage to include the Opill, individuals who desire to be on the birth control pill are able to do so without having to wait months to be given a prescription. As we also know, Maine is a relatively rural state and therefore without a car or method of transportation, accessing a healthcare provider can prove to be a difficult task. The framework of this bill helps remove these potential barriers, allowing people to access an oral contraceptive at their nearest pharmacy. In having insurance cover the costs of these contraception options, autonomy will be given to individuals, allowing them to make decisions regarding their own reproductive health.

  3. Feminist Future

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    By Katie Card (she/they) University of Maine Women’s, Gender, and Sexuality Studies student and Mabel Wadsworth Center intern

    At the time of writing this, it’s the fall of my junior year in college. Five semesters down, three more to go (at least, that’s the hope). I’m over halfway to the “real world,” where I’ll spend the rest of my life… working. That thought looms over me, that something that has been part of my life since I was four– school– will be over soon, and that I’ll be more or less on my own from there on out. For some, the idea of finishing up schooling and doing something with all they’ve learned, making a change in the world, is exhilarating. We’re expected to know what we want our life to be like far too early. But what about those who don’t know, who can’t for the life of them make a decision, especially one so important as a career?

    I’m a Women’s, Gender, and Sexuality Studies major, with a minor in Media Studies (which is within communication and journalism; not New Media, which it is commonly confused for). Every time I’m asked the standard, “So, what are you studying?”, I almost immediately know how that conversation will go: 

    “Huh, what’s that?” Either genuine confusion or just not even attempting to process it.

    “Oh, um, ok,” usually with disgust and/or disappointment. 

    Or, the most common, “What are you going to do with it?”

    I’m sure most of the people who respond with the latter don’t mean any harm with that question. Sure, some may be, because it is a field often looked down upon by others, seen as useless or stupid or some SJW bull (growing up in rural Maine, I’ve gotten that vibe more times than I can count). Others are genuinely curious– it’s not a prevalent major by far, and sometimes people have just never heard of it. To answer that question with a Liberal Arts field is to open up a Pandora’s Box of questions about what you want to do with your life once you graduate. Apparently majoring in something not business, education, or STEM related is abnormal to some.

    I grew up with the expectation that I would attend higher education. College and university may not be the right fit for everyone, but access should not be based on privilege. I had, and still have, that privilege– white, middle class, able-bodied, had educational and extracurricular opportunities that others were not afforded. I don’t want to brag (I hate attention), but I was a good student, and teachers expected certain things from me. So, when I said I would be attending my state school to study Women’s, Gender, and Sexuality Studies, the discomfiture was palpable. Why didn’t I try to get into “better” schools? (They’re too costly, too far from home, I didn’t want that stress, state schools are not bad schools.) Why didn’t I want to go into engineering, mathematics, computer science, biology, chemistry, law, medicine? (Because I’m just not interested in those fields.)

    Why did I choose WGS? Because it interests me. Because the concepts that these courses focus on directly apply to and impact my life. Because I grew up confused, knowing I was different from those around me but too scared to find out why. I chose Women’s, Gender, and Sexuality Studies because I wanted to

    WGS to me is liberating, it puts words and theories to experiences that I, and people like me around the world, have lived through. It creates a space where I know my identities will be accepted, even if I can’t put words to them all the time. These are not topics that I was taught growing up, and I have chosen this for myself. 

    I know that others don’t have the liberty to feel the same: Some go on to higher education so they can find a good career path, something that can support them financially, even if they don’t enjoy it, because they need to. It’s how you get by in our messed-up, capitalist society. But I didn’t want that. I don’t want that. I didn’t want to be in a field of work that I despised, even if it paid well. There’s more to life than work, right? 

    Do I know what I’ll do once I graduate? I won’t lie to you and say yes. I haven’t the faintest idea what I want to do with my life, and at times it’s incredibly nerve racking. But why should I be expected to have my life all planned out at the age of 21? I didn’t go into WGS expecting to get a massive payout at the end: I went into it because I knew I would enjoy it, that I would spend my 4 years here studying a topic I genuinely love and am interested in. 

    So, what am I going to do with it? I don’t know. And isn’t that beautiful? To have all those possibilities ahead of me?

  4. Midwives and Magic

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    By Katie Card (she/they) University of Maine Women’s, Gender, and Sexuality Studies student and Mabel Wadsworth Center intern

    When one thinks of witches, they probably think of a few common characteristics: a woman with a pointed hat, riding a broomstick, stirring a cauldron, living in the woods and casting hexes. The dominant understanding of witches and witchcraft has not been a positive one– people, typically women, accused of witchcraft were said to be in league with the devil, indulging in “sexual sins,” and causing the death of others, particularly children, as well as famine and disease. 

    Not very feminist, right? The exact definition of witch varies from person to person, culture to culture, and experience to experience–but there is the common link of existing outside of societal norms while engaging in nature-based spirituality. ‘Witch’ itself was often used as a catchall to justify the persecution and demonization of specific populations, such as women (an estimated 75-80% of those killed during witch hunts were women), those belonging to non-Catholic faiths, and those who show some sort of ‘power,’ like healing.

    It is this power that leads witches to be feared– women with power threatened patriarchal systems. Of course, this in and of itself shows how our concept of witches is heavily influenced by white, Western colonial gender binaries, where men and masculinity were seen as inherently superior, and women and femininity were seen as inherently inferior. Going against or living outside of these norms was seen as deviant and dangerous. Even then, many accused of witchcraft were healers– the popular iconography of a witch over a cauldron mixing together potions ties into cooking and herbalist practices, tasks associated with the domestic sphere women were commonly relegated to.

    Before going on to discuss herbalism and midwifery, it is incredibly important to note that witch trials and accusations of witchcraft were anti-Semitic in nature, along with being misogynistic (although those terms would not have been used at the time, the oppression still existed). One cannot look at the history of witchcraft and witch trials without acknowledging these roots. 

    The Black Plague, lasting from roughly 1347 to 1352, was caused by bacterium-carrying rats aboard trading ships, spreading rapidly among humans due to the lack of hygiene and questionable medical practices of the time. With a lack of healers and assistance, panic spread, unleashing waves of persecution against specific social populations, ones that religious and political authorities claimed were at fault in order to find some sense of control: beggars, pilgrims, and, in particular, Jewish communities were used as scapegoats and blamed for the plague. “Before witchcraft became a dominant scapegoat for misfortune in Europe, it was Jews who were often said to be demonic, evil individuals who poisoned wells, spread plague, and ate children” (salemwitchmuseum.com).

    Based on this unfounded belief that Jewish populations were the ones responsible, they were tortured and burned. Religious and political elites alleged that they poisoned wells, and encouraged that violent measures be taken against Jewish populations. 

    The European witch hysteria that we often think of did not start until the mid-15th century, and prior to that time, “‘witch’ was a catch-all term that referred to a wide variety of accused heretics or generally non-conforming ‘others’ in Christian European society…” (heyalma.com). The iconography that we associate with witches today is itself anti-Semitic in nature– the pointed hat coming from cone-shaped pointed hats called judenhut; weekly Sabbath meetings were seen as devil worship (think of nighttime witches gatherings); the large hooked nose and unruly black hair, stereotypes used to classify and demonize Jewish individuals.

    Jewish people and witches share, “the struggle of being othered, demonized, and persecuted based on Christian superstition, mythologization, and stereotyping” (heyalma.com). Jewish people were considered inferior, untrustworthy, and passive. The image of the female witch was the culmination of countless anti-Semitic beliefs. Rumors that witches were among groups of “plague spreaders” began to spread throughout Europe, such as in France, Spain, Germany, and England. Like the burning of Jewish communities, witches were tried, tortured, and executed due to unfound suspicions that they would cause another plague.

    Remember how women accused of being witches often practiced healing within the domestic sphere– cooking, apothecary-work, and herbal remedies. It is said that it is womens “… prominence as ‘cooks, healers and midwives’ that made women in general ‘vulnerable to the charge that they practiced harmful magic’” (Ehrenreich and English). Before the time of modern, “professional” medicine, herbal practices were commonplace, with rural societies relying on neighbors and apothecaries for medical care. “Witch-healers were often the only general medical practitioners for a people who had no doctors and no hospitals and who were bitterly affected with poverty and disease” (Ehrenreich and English). Physicians at the time were not trained in obstetrics and gynecology, so those tasks fell to midwives and neighboring women. 

    There was a popular belief at the time within professionalized medicine that healing without having formally studied was dangerous. Mind you, this formal study was in institutions that believed in the concept of humors and hysteria. Yet, throughout much of history, women have been forbidden from studying “professional” medicine. As medicine became more and more professionalized, women were being pushed out of the healing sphere altogether. In the 1800s, seeing health care as a way to profit, “white male physicians began to explore childbirth with greater interest. Their approach was based on a colonialization framework, which devalued birth as ceremony and focused instead on the physical aspect of wellbeing” (ohsu.edu).

    Midwives assisted in childbirth, and had vast knowledge of fertility and reproduction, including contraception and abortion. These practices were women- centered, focusing on the unique, individual human-side of childbirth. However, they were ridiculed as ignorant and dirty. But, even then, “a study by a Johns Hopkins professor in 1912 indicated that most American doctors were less competent than the midwives… they also tended to be too ready to use surgical techniques which endangered mother or child… But the doctors had power, and the midwives didn’t. Under intense pressure from the medical profession, state after state passed laws outlawing midwifery and restricting the practice of obstetrics to doctors. For poor and working-class women, this actually meant worse— or no— obstetrical care. (For instance, a study of infant mortality rates in Washington showed an increase in infant mortality in the years immediately following the passage of the law forbidding midwifery.)” (Ehrenreich and English).

    Now, that is not to say that hospital-based health care is inherently bad or evil– there just needs to be proper acknowledgment of the beginnings of professionalized medicine, where midwives and women-healers were pushed out of the medical sphere by privileged (upper-class, white, cis-hetero) men, with efficiency and capital-gain prioritized over individualized, patient-centric care. 

    Not every witch is a midwife, and not every midwife is a witch, but their history’s remain entwined. ‘Witch’ was used as a catch-all, a way to other those who lived outside societal and religious norms, and the possibility of women having power threatened patriarchal society, and was thus demonized. Witchcraft practices, such as the brewing of potions, have their origins in herbal medicine and healing, when neighbors were heavily relied upon for medical care– much like midwives were the primary source of reproductive and sexual care. The knowledge and practices of midwives were looked down upon merely because they were women, just as so-called ‘witches’ were considered dangerous for their power.

     

    Sources:

    Ehrenreich, Barbara, and Deirdre English. Witches, Midwives, & Nurses (Second Edition): A History of Women Healers

    “A Brief History of Midwifery in America,” OHSU Center for Women’s Health 

    “The Antisemitic History of Witches,” heyalma.com 

    “Witch Trials and Antisemitism: A Surprisingly Tangled History,” Salem Witch Museum 

     

  5. Reflecting on the Maine 131st legislative session

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    Now that the uncharacteristically long Maine legislative session has wrapped up, it feels like a great time to celebrate the wins we’ve had with bills that help fulfill our state’s motto: “The Way Life Should Be.” You’re probably already familiar with LD 1619, an important bill for abortion access in the state that received a lot of attention, but you may not know about some of the other exciting bills that were signed into law over the last months! Along with other proactive abortion bills, we saw many pro-trans bills become law in Maine, providing a sharp contrast with anti-trans laws that have been implemented across the country. Read below to see some of these new laws! Bills with an asterisk (*) are the first of their kind in the United States.

    LD 1343: Sponsored by Bangor’s own Rep. Supica, this bill makes it so that no town or municipality can pass local ordinances to restrict abortion access.
    LD 616: This law strengthens protections for healthcare providers so that they may offer care to people traveling to Maine for abortion care safely, without threats to their ability to practice medicine.
    LD 935: This bill requires private health insurance to cover abortion care without cost-sharing, or before you’ve hit your deductible.
    *LD 956: This bill improves LGBTQ+ data collection in healthcare settings, which has been shown to improve health outcomes for LGBTQ+ people.
    *LD 942: This bill requires nonbinary inclusion on state forms and databases.
    *LD 1507: This bill will require the state to offer reissued marriage certificates following gender marker change and gender self-affirmation on death certificates.
    LD 1040: This bill makes MaineCare coverage of gender-affirming care state law (rather than just an executive order).
    LD 489: This bill updates how the Maine Human Rights Act protects trans youth in schools.
    *LD 535: This bill improves gender-affirming care access for trans youth by allowing access to gender-affirming care without parental consent or notification for 16- and 17-year-olds. This is similar to Maine laws regarding abortion access or contraception for minors.
    LD 1683: This bill provides a path for civil recovery (as opposed to working through the often retraumatizing criminal justice system) for victims of “stealthing,” or the act of nonconsensually tampering with or removing a condom during sex. This bill also includes considerations around sexual assault when evaluating parental rights.

    These important new laws would not be possible without the work of the legislators sponsoring and cosponsoring the bills, the organizations that advocated for them, or the individuals that provided testimony.

    There are other new laws to be celebrated as well, along with pieces of legislation that did not become law to mourn. LD 199 sought to improve the health and wellbeing of all Mainers by removing restrictions for access to MaineCare for immigrants, and did not pass in the legislature. LD 2004 was a bill that would have amended the unjust 1980 Maine Indian Claims Settlement Act and provide members of the Wabanaki Nations with the protections that all other federally recognized tribes are provided. While LD 2004 did pass in the House and Senate with a strong bipartisan majority, it was vetoed by the Governor and the veto was not overridden when brought back to the House and Senate. Both new Mainers and members of Wabanaki Nations deserve better.