It seems Below the Belt is on a literate kick of late. But then, I’m a librarian; my nose is perpetually stuffed in at least one book or movie.

So, let me now link a relatively recent article on how patient care continues to suffer in the area of reproductive health with a 1976 sci-fi novel that manages both to describe the appalling nature of health care—particularly toward women—in our past and to envision a compelling utopia in which gender becomes just one more attribute.

Okay, then. So. The article discusses how not only pharmacists, but also physicians, are claiming their moral/religious beliefs require them to refuse involvement in various aspects of birth control, the morning-after pill, fertility assistance, and abortion. Although a few states have laws to protect patient rights in this arena, laws and medical policies typically privilege the medical professionals. This priority holds particularly true regarding the ever-controversial issue of abortion; Congress allows federally-funded health providers to refuse to provide abortion services, and of the 46 states with their own physician opt-outs, 27 recently broadened the refusal policies. But lest our anti-abortion readers think the legislation stops there, 16 states have refusal clauses for performing sterilization and 8 for prescribing contraception.

"This is about the rights of the individual, about our constitutional right to freedom of religion," says Frank Manion, an attorney with the American Center for Law and Justice, a legal group in Washington, D.C. Founded by minister Pat Robertson, the organization has represented health care providers and lobbied for laws that protect them. "We're not trying to deny anybody access to treatment," Manion adds. "We're saying, 'Don't make your choice my choice.'"

This is particularly problematic when insurance and income prevent some patients from seeking more comprehensive services elsewhere. Thankfully, some legislation seeks to protect patient rights. About one-fifth of states now require or strongly encourage emergency rooms to counsel about and/or offer emergency contraception to rape survivors. Although the effort failed, Virginia’s HB2842 would have required pharmacists to, oh you know, fill prescriptions. Obviously we have a long way to go, but people are wrestling with these issues.

And that bring me back to how far we’ve come since Marge Piercy wrote Woman on the Edge of Time. We aren’t quite as bad about putting (poor, minority) women into mental health facilities just for challenging the patriarchy in some way. Yay, us. Survivors of domestic abuse are now much better-supported, on the whole, in both medical and legal fields. The ethics of medical experimentation have vastly improved, although there remain concerns about the overparticipation of underprivileged groups.

But we still treat gender and race as significant, innate categories. We still glorify a tough masculinity. We still mistrust people’s ability to understand their own bodies and be involved in their medical and psychological assessment and treatment. We still tend to blame the individual for society problems. (Go back another century and we have Charlotte Perkins Gilman’s "The Yellow Wallpaper.")

So, not to sound like I don’t appreciate the progress we’ve made, but…that’s all pretty depressing to me.

I was, however, rather delighted by the utopia Piercy offers. Fluid, self-chosen, yet communal identity. Self-chosen, changeable names. Person/per for pronouns. Sexuality however consenting parties like it. The only real taboo is violence. Work enough to support the community but not so much to prevent growth and creativity. Respect the power of rituals. Value both inward and outward knowledge. Keep technology around to do what makes people miserable. Use resources responsibly. Don’t worry much about luxuries until everybody’s needs are met. Realize that beauty is productive. Teach by doing. Discourage competitive materialism. Encourage diversification of strengths. Yadda, yadda, yadda.

You know you’re intrigued.

I just wish the book gave more suggestions for how society moves toward even an imperfect utopia. (Yes, yes, seeming paradox, I know. But utopia’s not a final state; it’s a way of moving.) With all the dissatisfied radicals I know are out there, are we all stuck in some Field of Dreams waiting period? Dude, somebody’s got to start building. The conservative Christians already realize this. Enough with criticizing, let’s get to creating.

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