Politics in Practice: A Review of Judith A. Houck, Looking Through the Speculum: Examining the Women’s Health Movement (U Chicago Press, 2024)

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In Looking Through the Speculum: Examining the Women’s Health Movement (University of Chicago Press, 2024) Judith A. Houck provides a timely analysis of how late-twentieth-century feminists challenged the patriarchal foundations of the U.S. healthcare system. Houck traces the contours of the women’s health movement from its emergence around 1969 to its persistence into the early twenty first century. She explores how political goals honed in the first few decades of activism (such as the right to bodily autonomy and the feminist reclamation of medical knowledge) were implemented through organization and institution building. The book focuses on four key women’s health “projects”: cervical self-exam, abortion, lesbian health, and racial (in)equity in the movement. Its eight chapters offer a granular account of how feminists created (and repeatedly recreated) clinical spaces that would center their health needs, expertise, and political goals.

Houck’s exploration of the “struggles and successes of bringing feminist dreams into clinical spaces” is facilitated by her book’s unique organizational logic (14). Each chapter is part of a pair, the first tracing the development of the political theories and ideals of one of the aforementioned feminist health projects, and the second asking how this project was put into practice in the setting of a Northern California feminist health clinic. Chapters one and two show how the theory of feminist self-help (axiomatic to the women’s health movement) translated into diverging approaches to health care provision at the Santa Cruz Women’s Health Collective and Women’s Health Collective of Humboldt Open Door Clinic. Chapters three and four ask how visions of feminist abortion care met with medical resistance at the Chico Feminist Women’s Health Center. Chapters five and six explore the challenges of theorizing “lesbian health” and the limitations of identity based healthcare at the Lyon Martin’s Women’s Health Center in San Francisco. Chapters seven and eight consider the racial inequities of the women’s health movement through the lenses of Black feminist self help and institutional restructuring at the Santa Cruz Women’s Health Collective.

This paired chapter structure has several affordances. The focus on a small group of clinics allows Houck to delve into the many challenges of implementing often nationally or internationally circulating feminist health politics in locally specific institutional settings. What happened, she asks, when the ideals of lay and participatory healthcare met with the immediate and diverse health needs of community members? And how did feminist clinics, as workplaces, replicate racial and classed power structures of traditional medical settings? Houck’s attention to how these clinics navigated the “increasingly conservative regulatory landscape” of health and medicine of the last decades of the twentieth century—and, in a few places, of the early decades the twenty first—offers a much-needed backstory to the struggles of health centers serving those marginalized by gender and sexuality today (7). The stories of what happened to these feminist health clinics have a lot to teach us about the increasing power of the medical-industrial-complex over the past fifty years.

Looking Through the Speculum contributes new insights to a rich body of scholarship on the women’s health movement by scholars such as Hannah Dudley-Shotwell, Wendy Kline, Sandra Morgen, Michelle Murphy, and Jennifer Nelson.^[1] Their comparable works track how the women’s health movement grew out of a number of decentralized projects, including but not limited to the Boston Women’s Health Book Collective’s Our Bodies Ourselves, the Jane Collective’s Abortion Service, Carol Downer’s promotion of cervical self-exam and menstrual extraction, the National Black Women’s Health Collective, and the feminist clinic movement. Houck’s focused accounts of how the feminist practices of self-help and abortion care were implemented in clinical spaces over the course of the late twentieth century adds new knowledge to these much-discussed histories. But especially worth attending to, I would argue, are Houck’s contributions to the under-studied histories of lesbian health and Black women’s self-help.

Despite the fact that, by some accounts, “lesbians dominated the movement,” the topic of lesbian health was seen by many second-wave women’s health activists as an area of neglect replicating the heterosexism of the women’s movement more broadly (156). It could be said that this historical neglect has been reproduced by historians themselves: Houck points out that she is the first scholar to give lesbian women’s health activism “sustained attention” (6). Chapter five, “Lesbian Health Matters!” riffs on the multiple meanings of the word “matters” (importance, a set of issues, the materiality of the body).^[2] In doing so, this title encapsulates both the urgency with which activists claimed the need for lesbian specific healthcare research and action, and the breadth of understandings of what that care should look like. As Houck shows, in the early years of the women’s health movement the question of lesbian health was precisely that. Before the 1980s the only published research on lesbian health was in psychiatry; the only lesbian-specific healthcare aimed at conversion. But with the rise of grassroots feminist and gay health activism and of professional networks such as the Gay Nurses Alliance (founded in 1973), those with experiential knowledge of the damaging effects of homophobia began to demand greater knowledge production and action around the issue of lesbian health. What, they wanted to know, were the health issues that most impacted lesbians? Did lesbians have specific health needs that differed from non-lesbian women? This chapter offers a fascinating account of the many health projects that sprung from such questions, from the first national lesbian health survey in 1984 to the creation of lesbian-serving feminist sperm banks.

Noting that “it was unclear who counted as a lesbian,” Houck also shows that the late-twentieth-century project of lesbian health was stymied by the ambiguity of the category (150). This was further compounded by the classed and racialized assumptions about who lesbians were and to what extent sexual identity shaped their health needs. The stakes of such categorical uncertainty are thrown into relief in chapter six’s discussion of the Lyon-Martin Health Clinic in San Francisco, which was created to serve an imagined community of (mostly white, mostly middle-class, cisgender) lesbians who never made up more than half of the clientele. As Houck details, the goal of providing “a clinic of our own” often stood in tension with the needs of those who used its services, such as low-income heterosexual women of color seeking primary gynecological care and trans women who participated in Lyon-Martin’s HIV/AIDS programs (186) . While the clinic workers were happy to serve “anyone who needed women’s health care,” in the 1990s its board sought (unsuccessfully, it should be said) to exclude trans people of all genders from the clinic (209). Houck’s evident curiosity about how the constituents of Lyon-Martin navigated often conflicting notions of identity and coalition opens the door for future research projects. For example, her chapter left me wanting to hear the perspectives of those being served by and/or excluded from Lyon-Martin and other “women’s” health spaces.^[3]

Houck closes the book with a less symmetrical and arguably less effective pairing, described as exploring “the explicit expansion of the feminist health movement to involve and serve more women of color” (13). Chapter seven details how Black women’s health activists of the 1980s developed practices of self-help to support Black women’s emotional and physical health. Houck’s interviews and archival research on this topic contribute new knowledge to the history of Black women’s health activism, challenging assumptions that the women’s health movement, and self help in particular, was white women’s project.^[4] For example, Houck asserts the political significance of Lillie Allen’s widely attended “Black and Female: What is the Reality?” workshops at the first Black Women’s Health Conference at Spelman College in 1983. For Allen and the “Self-Help Groups” her workshops inspired, self-help was less about medical information sharing (i.e. via looking at each other’s bodies) than about the transformative power of speaking openly with other Black women about the embodied impacts of racism. But while many Black women’s self-help groups did not center gynecological knowledge production, others—such as the DC-based Black Women’s Self-Help Collective (BWSHC, 1982-1985)—saw cervical self-exam as a key step in the broader project of Black women’s liberation. The BWSHC presented itself as “both a support group and an incubator for social action” and shared the practice of self-exam with women in contexts such as Black women’s groups, health fairs, and prisons (243). To some members the group’s focus on sharing knowledge about the physical body (Houck shares that cervical self-exam was part of each bimonthly meeting) was vital and life-affirming. To others, it took up valuable time that could have been spent on projects of greater political importance.

Given the structure of Looking Through the Speculum, I had expected the questions raised by groups such as the BWSHC to be taken up again in the following chapter. For example, how should Black feminist health groups balance discussions of economic and social determinants of health with the promotion of gynecological self-knowledge? Instead, in chapter eight Houck turns from the topic of Black women’s self-help to consider the efforts of mostly white-run health clinics to hire and serve more women of color, with a central focus on the Santa Cruz Women’s Health Collective. The history of how women of color (and here predominantly Latinx women) changed the SCWHC from within is undeniably important, but the asymmetry of the pairing left me wondering what it would have looked like for this chapter instead to have explored issues of institution building in spaces created by and for Black women or other women of color.

Looking Through the Speculum arrives at a moment in health politics that demands historical awareness. Some of this awareness is corrective, as scholars Kelly O’Donnell and Naomi Rogers show in their critique of the Dobbs opinion’s distorted history of abortion.^[5] But as I was reminded when I taught Houck’s book last year, history is also there for inspiration. While my students – when asked – said that they could not imagine participating in a group cervical self-exam (and much less in a bookstore!), they were amazed by the ongoing relevance of the actions and arguments of early women’s health movement activists.^[6] The critiques made by the movement (of the dismissal of women’s pain by doctors, of the disproportionately high rate of medical injustices faced by Black women) and the questions it asked (How can activists combat the gatekeeping of medical expertise? Whose bodily autonomy is valued in this country?) felt as fresh to my class as they seemed to feel to feminist activists fifty years ago.

Our post-neoliberal era of rampant health inequities, staggering medical debt, and forced births might seem to contain less hope for the possibility of change than was circulating during the wave of 1960s radical activism that inaugurated the women’s health movement. The idea of creating community-led and affordable health clinics may feel but a distant dream in a moment when abortion clinics (and not necessarily even feminist ones) are closing all over the country and being replaced by predatory crisis pregnancy centers.^[7] I hope that Houck’s account of the women’s health movement will reach a wide range of readers, from seasoned health justice organizers to curious undergraduates. These activists’ determined, imperfect, and willful refusal to accept the inequitable status quo of US healthcare might be just the dose of inspiration we need right now.

Notes

1. There are of course other excellent books on the women’s health movement that (unlike those mentioned) focus on one organization or site of activism. For example, see Laura Kaplan’s The Story of Jane. Pantheon, 1995, and Kathy Davis’ The Making of Our Bodies, Ourselves: How Feminism Travels across Borders. Duke University Press, 2007. ↑
2. This title is taken from Mary O’Donnell et. al’s 1979 book of the same name. ↑
3. While reading this chapter I found myself thinking about Jules Gill-Peterson’s work on Trans DIY healthcare and health activism in the late twentieth century. ↑
4. For an account of Black women’s health activism prior to emergence of the women’s health movement and other radical health projects of the 1960s and 70s, see Susan Smith, Sick and Tired of Being Sick and Tired: Black Women’s Health Activism in America, 189-195. University of Pennsylvania Press, 2010. ↑
5. See O’Donnell, Kelly, and Naomi Rogers. “Revisiting the History of Abortion in the Wake of the Dobbs Decision.” Bulletin of the History of Medicine 97, no. 1 (2023): 1-10. https://dx.doi.org/10.1353/bhm.2023.0000. ↑
6. I refer here to what Houck describes as the “origin story” (2024, 19) of the feminist self-help movement, the moment when Carol Downer first demonstrated cervical self-exam to a group of feminists at the Everywoman’s bookstore in April 1971. ↑
7. For a discussion of the rising number of CPS and the role that proximity plays in pregnant peoples’ reproductive decision making see Carly Thomsen et al. “Presence and absence: Crisis pregnancy centers and abortion facilities in the contemporary reproductive justice landscape.” Human Geography 2023 16:1, 64-74. For an account of abortion activism that evades legal and geographical limitations, see Naomi Braine, Abortion Beyond the Law: Building a Global Feminist Movement for a Self-Managed Abortion. Verso, 2013. ↑

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Featured image caption: Women’s liberation march, Washington, D.C., 1970. (Courtesy Library of Congress)