Sea of Familiar Strangers

I was lost in the Forbidden City in a sea of familiar strangers. Beijing’s vibrant reds and yellows assaulted my eyes. Under the watchful eye of Chairman Mao, whose portrait hovers over the entrance, I traveled to another world. 

I had never seen such ornately decorated buildings as those at the Forbidden City.  Fantastic stone carvings created bridges spanning man-made moats. Gardens blossomed with a kaleidoscope of colors and defied the notion that things fade with time. I was awed by golden statues and relics so enriched with a culture I only had been able to grasp secondhand. I entered a world in which any peasant in Imperial China would have been killed for getting within 100 feet. I went with the flow of the crowds through the 961-meter-long palace, feeling oddly at home. It was only after passing through the third inner gate that I realized I had lost my family in the crowds. 

 My family should have stuck out like a sore thumb. The entire tour group should have been easily found, composed as it was of average, middle-aged, white American couples with children who, unlike them, were Chinese. I am, along with all of the girls on this trip, the byproduct of China’s infamous One Child Policy. 

I was adopted by a middle-class American couple after enduring roughly a year of my life in an overcrowded orphanage in southeast China. My parents tried their best to instill in me a cultural identity that they just didn’t have. They enlisted me in Chinese heritage programs with Central Ohio Families with Children from China. Six-year-old me didn’t appreciate the effort. Instead of paying attention and trying to learn Chinese, the Zhuang culture (my ethnic heritage), or oriental dance, I played in the gym. Now I wished I had learned Chinese.

For the first time in my life, within the walls of China, I was surrounded by people who look like me. I was no longer the easily identifiable Asian girl surrounded by white faces. Lost in the sea of familiar strangers in the Forbidden City I was free: No one attributed my intellect to my ethnicity. No one assumed I knew karate.  No one told me I didn’t really look Chinese. I was lost in the comfort of being “normal.” However, while trying to ask for help, the realization hit me like a wave: I wasn’t really their normal. I could pass as “one of them” until I had to speak. I’m like a copy of a book with the same cover but translated in a completely different language.

I’m stuck in some liminal ground between Chinese and American culture. 

My family and tour group, with valiant efforts to find me, ran throughout the Forbidden City hollering my name in what must have seemed the stereotypically loud American way. “Mia, girl from America” blared on the loud speakers but fell deaf on my ears as I was caught up in the turbulence of the crowds. I wandered through the last gate of the city and looked outwards – gray cityscape framed by gold and red gates fit for an emperor.

The waves of people broke and my tearful tour group of relieved parents engulfed me. I was hauled out from the sea of familiar strangers and into my mother’s arms. One of their own was found in a great expanse of lookalikes. 

Being Chinese alters my perspective on the world, and how the world sees me, but I’m so much more – an artist, an academic – not just an Asian. I want people to acknowledge the privilege provided by my white parents and the social obstacles faithfully shackled to me by my Chinese birth. I want people to see me for my vibrant reds and yellows.

Mia Cai Cariello (she/her/hers) is a Chinese transracial, transnational adoptee from Guangxi province. She is a third-year Women’s, Gender, and Sexuality Studies major with minors in Studio Art, Human Rights, and Asian-American Studies at The Ohio State University. Mia is a Morrill Scholar and is currently the President of two organizations on The Ohio State University’s campus – Transracial Adoptees at Ohio State and Take Back the Night at The Ohio State University. 

My Name Is…

My name is Mia Cai Cariello

And I want you to know,

I was born in China, Guangxi Province 

As 吴彩卓

I wasn’t even old enough to know

That my own government wanted me to go

It would take a year for them to ship me out 

People would have you believe my life would blossom and sprout

That the stars aligned

when I was adopted to the U.S. in 1999

It was told to me that in this new country I could sew a new future…

A future with freedom and liberty

No police censorship or brutality 

Freedom to be who you want and need to be 

Everyone hand in hand 

equality – achieved.

But that’s just the American dream

Playing constantly on the world-wide screen

propaganda masking the imperialist scheme

I was taught that the US is the greatest country on Earth 

But then why am I still judged by the place of my birth? 

Kids Making fun of my eyes with a slight slant

kids being given the seed of racism to plant

Early on 

Acting like my whole ethnicity is a phenomenon- 

That’s meant to entertain them. 

Yelling Ching Chong

Acting like I don’t belong

Saying all Asians look the same 

And when they’re called out

All their excuses are so fuckin lame 

Tired of people assuming I can speak fluent Chinese

Like a language with 30,000 characters can be picked up with ease

Tired of people assuming all I eat is rice 

and that I’d be their china doll if they just act nice

Tired of being told I don’t look like a “real Asian” 

As if there’s only one specific look.

Like I should be studying out of some sort of handbook

Would you like me better if I took a page from your Asian look book

In a qi pao, sari, kimono, or hanbok?

Tired of being told that I am not a real Asian because I’m an adoptee

Spitting names like banana or Twinkie

The adoptee experience is real and the dismissal of it is ominous

Because Our collective Asian identities are still a plethora 

of experiences that are not homogenous  

I may not be innately gifted at math

But I know I am more than the sum of my parts

it’s hard to believe so many people still play a part in the perpetuation of our subjugation – constantly chaining us with limitations, fixations on how we must be from a different nation, questioning our affiliations, forcing our assimilation, migration, but still profiting off imitations of our culture. 

I guess I can’t blame people for thinking Asians have made it, 

When the only image they see is Crazy Rich Asians

But I gotta get something off of my chest,

Our struggles are glossed over 

For the story of the model minority —

I want you to see 

Our existence in this country is missing some facts

How many people even knows about The Chinese Exclusion Act? 

Were you taught about Executive Order 9066

Or were Internment camps glossed over in the name of politics?

Do people know our demographic has the largest wealth disparity? 

Not all of us are living a life of luxury 

The Asian image is tailored to pale skin and exotic 

and all the fetishization is nauseating and toxic 

I’m tired of playing this game 

That results

In the perpetuation of white supremacy 

Telling me to open my eyes wider so that I can see

I can already see

And the answer is simply and beautifully me

We don’t need to change our eyes

go down a size

Or Whiten our skin 

To be worthy 

Worthy of love and respect

Our self-worth I will kill to protect 

Don’t be fooled by the lies you’ve been told

Self-love and dignity are worth their weight in gold,

But my liberation isn’t complete 

Freedom for my fellow People of color must be concrete

Stereotypes try to lock the truth uptight,

Trying to keep it out of the light

We are not separate from one another’s struggle 

we have a place next to our black and brown sisters and brothers

We can be limitless

but we must continue to fight 

To ensure that all who follow us can forever revel in the light

Mia Cai Cariello (she/her/hers) is a Chinese transracial, transnational adoptee from Guangxi province. She is a third-year Women’s, Gender, and Sexuality Studies major with minors in Studio Art, Human Rights, and Asian-American Studies at The Ohio State University. Mia is a Morrill Scholar and is currently the President of two organizations on The Ohio State University’s campus – Transracial Adoptees at Ohio State and Take Back the Night at The Ohio State University. 

“The Poorer Sick”: American Gynecology and its Irish Subjects in Mid-Nineteenth Century New York City

By Charlotte Rich

In April 2018, crowds gathered on Manhattan’s Fifth Avenue to watch the dismantling of the statue of J. Marion Sims (1813-1883), the so-called “Father of Gynecology.” [1] The monument was constructed in 1892 to celebrate Sims’ contributions to gynecological research, including developing groundbreaking surgeries to treat women from Alabama to New York City to Europe. [2] For over one hundred years, the statue stood across from Mt. Sinai Hospital and the Medical Heritage Library as an uncritical monument to Sims. It honored his tireless research as the foundation of modern gynecology, alleviating the suffering of millions of women, in his lifetime and ours.

The monument, however, made no mention of the countless women whose bodies and labor enabled his research, by serving as both experimental subjects and unpaid, uncredited nurses. In 2006, historian Harriet Washington’s groundbreaking research drew activists’ attention to the untold reality of Sims’ experimentation, in which he used enslaved black women as his experimental subjects. [3] In protests, op-eds, and posts on social media, activists called for broader recognition of the brutality of his experimentation on enslaved black women, who were not credited in the monument. The dismantling of Sims’ statue represented a public reckoning with the largely forgotten contributions of enslaved black women to American medical history.

While the removal of Sims’ monument was certainly a victory for historical representation, it also constituted the erasure of the majority of Sims’ experimental subjects. In addition to his enslaved black subjects, Sims treated and experimented on hundreds of Irish immigrant women in New York City. In 1853, following his work in Alabama, Sims moved to New York City where he founded the Woman’s Hospital, a charitable research institution for the treatment of women’s reproductive disorders. [4] When founding the Woman’s Hospital, J. Marion Sims saw it as a platform through which he could fine-tune his own surgical techniques that he developed through experimentation on enslaved black women. [5]

The development of medicine during this period has often been framed as the triumphal advancement of surgical techniques, the expansion and reformation of the hospital system, and the creation of life-saving techniques for women’s diseases and the dangers of childbirth. However, prioritizing patients’ experiences as part of this history complicates these pure narratives of progress. The historical coincidence of Famine-era Irish immigration and major medical reforms, including the founding of new disciplines like gynecology, facilitated experimentation on countless Irish patients, which enabled the success of research institutions like the Woman’s Hospital.

With even a cursory glance at the Woman’s Hospital’s patient casebooks, which provide demographic information for patients, one notices a significant trend: the largest nationality represented in the hospital’s patients were Irish immigrants. The founding of the Woman’s Hospital’s in 1855 coincided with a wave of Irish immigration following the Great Famine. Hunger, destitution, and lack of economic opportunity that characterized Ireland after the Famine prompted many, especially young women, to emigrate to the United States. Because of insufficient access to health care, their physically demanding jobs, and unhealthy living conditions, Irish women frequently required reproductive health care upon arriving in cities like New York and could not afford the private physicians of the middle and upper classes. To put it simply, many Irish women in New York needed treatments for reproductive disorders, exactly when the Woman’s Hospital and gynecologists throughout the Northeast needed patients.

This historical coincidence created a relationship that was, in some ways, mutually beneficial. Poor Irish immigrants received low-cost or free treatments for debilitating conditions like fistulae, which allowed doctors to develop standardized surgical techniques to treat other women. [6] However, physicians often prioritized the professional advancement that developing a successful new surgery would accomplish over the wellbeing of patients whose bodies made that surgery possible. Even when a surgery successfully treated a patient, doctors’ own notes and published papers recount stories of abuse towards their immigrant patients. [7] Furthermore, many physicians drew from and reproduced nativist discourse in their published case studies of Irish patients, endowing these theories with medical authority. 

In spite of the prominent role that Irish women played in the history of gynecology, they have received scant attention in recent scholarship, and no mention in calls for the removal of Sims’ monument. The absence of Irish women from this contemporary debate was especially notable, given the statue’s location only about four miles from the first location of the Woman’s Hospital, the site of Sims’ Irish experiments. Furthermore, by focusing entirely on Sims’ statue, activists obscured the fact that Sims was only one of many gynecologists experimenting on vulnerable women. Irish women’s absence from this historical narrative and contemporary conversations about Sims’ legacy demonstrate how their sacrifices and contributions to the advancement of gynecologic and obstetric surgery continue to be taken for granted, and they remain voiceless.

My current research explores the role of Irish immigrant women as experimental subjects for American gynecological research in the 1850s-1870s. Despite the central role Irish women played in the development of this medical discipline as subjects, scholarship has largely ignored their contributions. Drawing from the Woman’s Hospital’s patient case books and annual reports; medical journals and physicians’ published works; and texts written by and about Irish immigrant women in New York, this thesis attempts to understand how Irish women influenced the development of gynecology. Why did Irish immigrant women constitute such a significant portion of gynecological patients in mid-nineteenth century New York City? How did medicine draw from and contribute to common conceptions about class, race, and gender as they related to Irish immigrant women? Building on the historical scholarship about enslaved black women as subjects of gynecological research in the American South, this will be one of the first in-depth studies to include Irish women in the narrative. Expanding this history will alter the understanding of American gynecology by demonstrating how dependent this period of medical specialization and advancement was on the bodies and health of Irish immigrant women. Furthermore, it will highlight how historians can use institutional medical records to uncover the experiences of Irish women, who were otherwise excluded from the historical record. 

Endnotes:

[1] P.R. Lockhart, “New York just removed a status of a surgeon who experimented on enslaved women,” Vox, April 18, 2018, https://www.vox.com/identities/2018/4/18/17254234/j-marion-sims-experiments-slaves-women- gynecology-statue-removal.

[2] “Dr. James Marion Sims Sculpture,” NYC Parks, April 16, 2018, https://www.nycgovparks.org/about/history/ historical-signs/listings?id=13315.

[3] Nadja Sayej, “J Marion Sims: controversial statue taken down but debate still rages,” The Guardian, April 21, 2018, https://www.theguardian.com/artanddesign/2018/apr/21/j-marion-sims-statue-removed-new-york-city-black- women.

Harriet A. Washington, Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present (New York: Anchor Books, 2006).

[4] Deborah Kuhn McGregor, From Midwives to Medicine: the Birth of American Gynecology (New Brunswick: Rutgers University Press, 1998).

[5] J. Marion Sims, The Story of My Life (New York: D. Appleton and Company, 1884).

[6] A fistula is a tear in the vagina or anus resulting from a prolonged or difficult birth. Women who suffered from rickets — a condition caused by the absence of Vitamin D in one’s diet — typically developed narrow pelvises and were therefore more likely to experience fistulae. While women of all classes, races, and ethnicities were afflicted with fistulae, this condition was more common among women who lacked access to nutritious diets, including enslaved black women and survivors of the Great Irish Famine.

[7] For examples, see: George T. Dexter, “Singular Case of Hiccough Caused by Masturbation,” Boston Medical and Surgical Journal (1845): 195-197; George T. Elliot, “Induction of Premature Labor with the Douche,” New York Journal of Medicine 2, no. 3 (May 1856): 331; and Thomas Addis Emmet, Reminiscences of the Founders of the Woman’s Hospital (New York: Stuyvesant Press, 1893).

Charlotte Rich is a senior at Wesleyan University. She is interested in studying the hidden social histories of medicine to explore the roots of race and gender inequities in contemporary American medicine.

Their Body, a Judge’s Choice: The Kansas Judicial Bypass Process Must Be Revised

By Marian Phillips

Warning: This piece contains sensitive subject matter pertaining to the legal processes that minors face when requesting abortion access. There are mentions of abuse (physical and sexual) and abortion. 

Reproductive rights are constantly debated within the political arena whether at the state or federal level. It is imperative to continually adjust and reformat legislation that dictates the rights that minors have over their reproductive health. Current policies set in place for minors seeking judicial bypass to receive abortion services in the state of Kansas are egregious to say the least. The current policies necessitate an entire revision of the definitions, restrictions, and requirements mandated within statute 65-6705 under Article 67 Section 5. A policy must be proposed to Kansas legislators to instate greater access to judicial bypass processes for minors seeking abortion and an adjustment of maturity evaluations that are conducted by doctors and judges. These changes must be done in order to offer greater opportunity for the minor to have their case expedited and granted.

         The state of Kansas, as stated in the 2015 statute 65-6705 under Article 67 Section 5, mandates that a minor who wishes to receive an abortion must have authorized consent from the minor and both parents (if they are married) or the minor’s legal guardian. The parent or guardian with primary custody may authorize the procedure. In the case that a minor is in a position where they cannot safely acquire authorization, they can seek to receive judicial bypass for the procedure. Once beginning the process of obtaining judicial bypass, a minor is asked to undergo a psychiatric evaluation prior to court proceedings. The evaluation is done in order to provide the court with reliable information on whether or not the minor sufficiently understands the procedure and is mature enough to make this decision. The state determines the maturity level of the minor by examining the minor’s judgement, perspective, age, personal finances, work, and their decision making prior to and during proceedings.

         There is an array of circumstances under which judicial bypass may be the only option for a minor. For example, if the minor has been assaulted sexually or physically by one or both parents, asking for authorization puts the minor at risk, and more. While these circumstances are listed in the current statute, there are others that have not been recognized and should be. Under Kansas legislature, minors who are seeking abortion and are immigrants, orphans, or “de facto orphans” whose parent(s) may be deceased, or imprisoned are not included. Due to this fact, these minors encounter a larger set of legal hurdles they must overcome before, during, and after requesting judicial bypass.

         While the maturity of the minor is mentioned many times throughout the legislation meant to aid in the abortion rights for minors, the term itself is never truly defined within the document. Maturity is entirely subjective, and some may view it as a minor being mature enough to take accountability and understand their rights within the court system to ask for judicial bypass. Others may view the choice as immature and as the minor not taking accountability for the actions that led them to become pregnant. While a doctor may relay to the court and judge that the minor is mature, the decision ultimately falls on the judge. This brings about more difficulty for the minor if the judge that is on their case is anti-abortion.

         In many cases, minors have been faced with judges who identify as being anti-abortion and, in some instances, prolong the minor’s case on the docket or outright deny judicial bypass without question. There must be a policy set in place stating that if a judge attempts to keep a minor’s case for judicial bypass on the docket, prolonging the pregnancy past the point of qualifying for the procedure, then the case must be expedited. All states have the ability to decide the length of time allotted for judicial bypass proceedings. These cases should not remain on the docket for over a month’s time.

         The need for expedited processing of judicial bypass cases is extremely important, and necessary. At this moment, the state allows for abortion procedures for pregnancies up to 20 weeks; after this point an abortion can no longer be done legally. The state of Kansas, to ensure the safety, health, and well-being of a minor, must instate a time limit based on an understanding of the length of time a minor has to legally be a candidate for an abortion. If denial of judicial bypass is proposed, this limit would provide the minor with enough time to request an appeal and continue fighting for their personal right to choose.

         As aforementioned, minors seeking abortion through judicial bypass come from a variety of experiences. Judicial bypass is a great means to assist minors who find themselves in difficult situations. Creating a clear definition of the maturity level – or even removing the maturity clause all together – alleviates subjective notions of too mature or not mature enough. In short, the state of Kansas must propose a policy that would ensure the safety of a minor and give the individual more autonomy than the current statute allows. By revisiting the abortion policies that currently exist in Kansas legislature, moving the state towards better policies that do not require parental consent or judicial bypass to receive an abortion, such as Oregon and California, may be possible.

Notes 

Friedman, Susan Hatters, et al. “Judicial Bypass of Parental Consent for Abortion.” The Journal of Nervous and Mental Disease, vol. 203, no. 6, 2015, pp. 401–405.,  doi:10.1097/nmd.0000000000000298.

“Legislative Resources.” Statute | Kansas State Legislature, 1 Jan. 1970, www.kslegislature.org/li_2016/b2015_16/statute/065_000_0000_chapter/065_067_000        _article/065_067_0005_section/065_067_0005_k/.

Parenthood, Planned. “Information for Minors.” Comprehensive Health of Planned Parenthood Great Plains, www.plannedparenthood.org/planned-parenthood-comprehensive-health great-plains/patient-forms/information-for-minors.

Redden, Molly. “This Is How Judges Humiliate Pregnant Teens Who Want Abortions.” Mother Jones, 24 June 2017, www.motherjones.com/politics/2014/10/teen-abortion-judicial   bypass-parental-notification/.Williams, Tine. “Planned Parenthood v. Lawall: Judicial Bypass Procedures Lacking Time   Limits Violates a Minor’s Constitutional Right to an Abortion.” Constitutional Law, 23 Am. J. Trial Advoc. (1999) Provided by: Wheat Law Library

A Backstage History: Reflections on Stage Management and Gendered Labor

By Rachael Nuckles

Before I devoted my life to full-time graduate school and academics, I was working hands-on in the world of technical theater as a stage manager and designer. It’s a world I hope to get back to after obtaining my degree, though maybe in a different capacity than before. Stage management often requires a considerable amount of emotional energy that isn’t always part of the job description. Sometimes taking care of yourself means taking a step back from something you love to focus on your health and wellbeing. For me, a break from stage management was certainly necessary in order to sleep more regularly, eat a little better, and prioritize my own emotions.

The American Association of Community Theater describes stage managers as people who “typically provide practical and organizational support to the director, actors, designers, stage crew and technicians throughout the production process. They also are the director’s representative during performances, making sure that the production runs smoothly.” [1] Recently, I endeavored to write a talk for an assignment about gender and stage management. In writing this talk I discovered two major considerations: first, there is very little written (at least that I can find) about the history of stage management. There are manuals and archival documents from which we might write a more legitimate history of the role and mentions within larger histories about technical theater more generally. We can also see mentions of stage managers in plays, sometimes under different terms. For instance, the word “prompter” is thought to define the closest role during Shakespeare’s lifetime, and in several of his works we can find reference to them. [2]

The second discovery I made, perhaps from my own experience on the job, is that stage management is a highly gendered position. The League of Professional Theater Women conducted a study from 2013-2018 which revealed that the only two technical theater positions dominated by women were stage managers and costume designers. These results were compiled after surveying thirteen different artistic categories (job positions) at twenty-two off-broadway theaters. For the 5 year period, women comprised approximately 72% of all costume design positions and 70% of all stage management positions. Every other category placed women significantly under the 50% mark, meaning that the positions were male dominated. [3] This is a fairly recent study, so it’s likely that numbers have not changed too much.

If there’s little on stage management history, there’s even less on women’s history in the position. One manual written by Larry Fazio notes that women in the U.S. were not given opportunities as stage managers until after World War II. [4] Although, one stage manager historian has discovered several instances of women stage managing much earlier. Jennifer Leigh Sears Scheier, whose brief blog post on women’s history in stage management is some of the only I have been able to uncover, describes women working as stage managers, prompters, or equivalents as early as 1754. [5] Fazio’s manual notes that after World War II, women stage managers were able to obtain jobs on Broadway and other equivalents. This is necessary to note due to the prestige associated with such institutions and the fact that most remain male dominated spaces. Other than the occasional factoid such as this, I have found looking for women’s experiences with stage management are difficult to locate.

Because there is so little written, I want to speculate on why stage management is one of two female dominated positions in technical theater. Modern stage management requires a nurturing, gentle persona, traits traditionally associated with femininity. Besides impeccable note taking ability and more administrative duties, I find that the caregiving requirement can dominate the day-to-day work of the stage manager. I want to borrow a definition of caregiving from Jessica Wilkerson’s To Live Here, You Have to Fight. She notes that caregiving involves an “array of activities and relationships involved in maintaining people both on a daily basis and intergenerationally.”[6]  The stage manager, quite literally the manager of all people involved in a production, maintains relationships of all kinds in order to make the process of putting on a show as smooth as possible. 

With this in mind, I wonder if we might consider stage management within the history of other, similar roles. Perhaps…the secretary? Annalyn Kurtz, an editor at CNNBusiness, writes that in 1950, the secretary became the most popular job among women. [7] It can’t be a coincidence that women stage managers also began to dominate in this decade. Furthermore, secretary and administrative professional positions have evolved to handle many of the same management duties as stage managers: running meetings, managing projects, composing correspondence.[8] While these connections between stage management and secretarial history have not necessarily been analyzed in any academic text, I think uncovering the relationship between secretary and stage manager will prove crucial to understanding our modern day gender disparities in technical theater positions. 

Going forward, I have two questions. First, did women become stage managers because the job required “feminine” qualifiers? Or, did the position become gendered once women began to dominate? As I continue my work as a student, before I get back to tech work, I hope I can get closer to an answer. Emotional labor, as found in stage management and other secretarial positions, can take a toll both mentally and physically and affect one’s overall health. This type of work has been disproportionately filled by women, as evidenced by our current health crisis and the labor of other professional women caregivers such as doctors and nurses. In fact, women make up 70% of health and social workforces globally. [9] As we continue to navigate uncharted waters, I urge you to thank your caregivers from stage managers to doctors regardless of gender. They all perform a thankless job which is crucial to our world’s overall health and wellbeing.

Endnotes:

[1] “Stage Manager.” American Association of Community Theater. Accessed April 6, 2020. https://aact.org/stage-manager.

[2] For some further reading on production during Shakespeare’s time, I’d like to recommend Stern, Tiffany. Making Shakespeare: from Stage to Print. London: Routledge, 2004. One of my favorite (and perhaps more recognizable) examples of the prompter appearing in Shakespeare’s work is in A Midsummer Night’s Dream’s play-within-a-play.

[3] Trujillo, Jackie. “A Look at the Theatre Industry’s Backstage Gender Gap.” New York Minute Magazine, December 20, 2018. 

[4] Fazio, Larry. Stage Management: the Professional Experience. Boston, MA: Focal Press, 2000. 5.

[5] Sears Scheier, Jennifer Leigh. “Women in Stage Management: Revolutionizing History with Inclusion.” Stage Directions, December 19, 2017. https://stage-directions.com/all/theatre-blogs/sm-history/women-in-stage-management-revolutionizing-history-with-inclusion/.

[6] Wilkerson, Jessica. To Live Here, You Have to Fight: How Women Led Appalachian Movements for Social Justice. Urbana: University of Illinois Press, 2019. 5.

[7] Kurtz, Annalyn. “Why Secretary Is Still the Top Job for Women.” CNNMoney. Cable News Network, January 31, 2013. https://money.cnn.com/2013/01/31/news/economy/secretary-women-jobs/.

[8] Eagle, Amy. “A Job Once Filled by Men Became a Pink Profession.” chicagotribune.com. Chicago Tribune, August 23, 2018. https://www.chicagotribune.com/news/ct-xpm-2006-04-26-0604260160-story.html.

[9] United Nations Population Fund. “COVID-19: A Gender Lens.” United Nations, March 2020. https://www.unfpa.org/sites/default/files/resource-pdf/COVID-19_A_Gender_Lens_Guidance_Note.pdf.

Rachael is a first year graduate student in the Women’s History program at Sarah Lawrence College. Her current research interests include girls’ cultural production and participation in subcultures, activist media technologies, and performance studies.

LGBTQIA+, Race, Class, Disability, and Region: The American Healthcare System

By Sidney Wegener

Every time I visit a doctor, I am asked a series of questions which include those about my sexual health. “Are you sexually active?” Yes. “Do you need a pregnancy test?” No. Oftentimes, a physician responds by informing me that even if I use protection I can still get pregnant. My response triggers confusion and a moment of awkwardness: I’m a lesbian; my girlfriend can’t get me pregnant.

If you are queer (non-heterosexual) or trans (non-cisgender) and able to see a doctor, this experience might sound familiar. Like me, you have likely faced similar, potentially much more severe, circumstances. Perhaps you, or your partner, are transgender, and the question, “do you need a pregnancy test?” causes discomfort. For queer, non-binary, and trans people going to see a doctor could put one at risk of maltreatment or refusal of treatment. Transphobic attitudes among healthcare professionals have caused over a third of transgender patients to experience harassment and rejection, severly impacting not only their physical well being but their mental health. [1] Almost half of transgender people have attempted suicide, and it is estimated that every time a queer or trans person experiences violence or abuse, the likelihood of self-harm increases by 2.5 percent. [2] The moment of confusion and mild embarrassment my physician experiences after I inform them I’m lesbian is sometimes humorous. However, there are many other moments for the LGBTQIA+ (Lesbian, Gay, Transgender, Queer, Intersex, Asexual, and more) community which are uncomfortable and/or harmful.

How queer and trans people experience the healthcare system is also directly impacted by race, economic accessibility, geographical location, and (dis)ability. Queer and trans people of color often struggle with racial discrimination, resulting in a lack of mental and physical healthcare support. Transgender people of color attempted suicide rates are thirty-three times higher than America’s general population; yet, access to mental healthcare services frequently remains out of reach due to a lack of insurance and providers. [3] As a result of systemic racism, homophobia and transphobia in the United States, queer and trans people of color are more likely to be working-class. This further puts them at an economic disadvantage and limits their agency to utilize healthcare services.

Indigenous queer and two-spirit folx are ranked among the highest at risk for discrimination in the United States healthcare system as well as attempted suicides. No Native or Indigenous tribe/nation understands queer, trans, or two-spirit folx the same; however, mistreatment and ostracisizaiton of their LGBTQ+ and Two-Spirit community members are generally not a part of cultural traditions.[4] Accessing healthcare as a member of the LGBTQIA+TS Indigenous community comes with the challenges of navigating a state/federal healthcare system and involves confronting providers who may not accept them as patients. Finding mental health support is critical for this community, assexual violence and abuse committed against Indigenous women, queer, trans, and two-spirit folx is at an astronomically high rate.[5] Financial instability and lack of health insurance further impacts those LGBTQIA+ youths who are homeless, often due to their families rejecting them. Roughly 40% of the youth/young adult homeless population in America are queer or trans. Members of our community who are Black, Latinx, without a GED, or single parents, face even more severe challenges.[6] 

The three million LGBTQIA+ people who live in rural or underserved communities which are impoverished or working-class are also less likely to have access to physical and mental healthcare.[7] Lack of geographical access is also a large contributing factor for people in rural areas of the United States. For queer and trans folx, who are often particularly isolated in rural communities, gaining access to adaquate healthcare can be extremely challenging. Healthcare providers are often located further distances away than they are in suburban or urban regions. Queer and trans people, who are more likely to be poor or working-class, might lack feasable means to transport themselves to a doctor’s office. In addition to geographic isolation, many rural towns and communities across the country hold homophobic, transphobic, racist, and sexist political and personal beliefs. One large challenge queer and trans people face is that fewer laws and regulations protect and support the treatment of LGBTQIA+ people among healthcare professionals, meaning they are more likely to be refused treatment, face harassment, or experience abuse.

Members of the LGBTQIA+ community who are also disabled physically and/or mentally also face many obstacles in accessing healthcare. Whether public transportation limits access or a mental disability requires assistance in navigating a confusing and complicated health insurance system, queer and trans people are at serious disadvantages. Depending on the state, disability services may not cover all of the healthcare needs of any given individual, and those states which do not have laws protecting the rights of disabled, queer, and trans folx put them at exterme risk of maltreatment and/or abuse. [8] What if you are transgender, Latinx, living in a rural area, wheelchair dependent, in need of personal assistance, member of the working-class, and your family does not recognize or support your gender identity? How do you access a healthcare physician? How do these circumstances impact your mental health and physical well-being? How do you survive? When we consider how the American healthcare system serves, or does not serve, members of the LGBTQIA+ community, it becomes critical to consider the intersectional nature of how each of us experiences healthcare differently. The challenges discourage many of us from accessing adequate healthcare whether for our minds, bodies, or both. However, advocating for those who are at risk of maltreatment, abuse, or care refusal are ways to help.

Many of the endnotes have sources which offer support and information for LGBTQIA+ folx and their allies.

[1] “Doctors don’t treat trans patients poorly because they are uneducated. They’re prejudiced.” LGBTQ Nation. https://www.lgbtqnation.com/2019/02/bad-attitude-trans-people-worse-ignorance-study-found/

[2] “Facts About Suicide.” The Trevor Project. https://www.thetrevorproject.org/resources/preventing-suicide/facts-about-suicide/

[3] “Attempted Suicide Rates for Multiracial Transgender People.” National LGBTQ Task Force. https://www.thetaskforce.org/attempted-suicide-rate-for-multiracial-transgender-people-thirty-three-times-higher-than-general-population/

[4] “Why LGBTQ Indigenous Communities Struggle With Healthcare for the Homeless.” TVO.org. https://www.tvo.org/article/why-lgbtq-indigenous-communities-struggle-with-healthcare-for-the-homeless

[5] “Ending Violence Against Native Women.” Indian Law Resource Center. https://indianlaw.org/issue/ending-violence-against-native-women

[6]“LGBTQ Youth Disproportionately Experience Homelessness.” Human Rights Campaign. https://www.hrc.org/blog/new-report-on-youth-homeless-affirms-that-lgbtq-youth-disproportionately-ex 

[7] “Where We Call Home: LGBT People in Rural America.” LGBT Movement Advancement Program. https://www.lgbtmap.org/rural-lgbt

[8] “Disability, Mental Health, Sexual Orientation, and Gender Identity: Understanding Health Inequity Through Experience and Difference.” Health Research Policy and Systems. https://health-policy-systems.biomedcentral.com/articles/10.1186/s12961-018-0366-1

Sidney is a first year MA candidate for Women’s History at Sarah Lawrence College. They are pursuing research on interracial lesbian relationships in United States women’s reformatories and penitentiaries during the early twentieth century.