Nonfiction: A Professional Troublemaker’s Guide for Young Activists

MAKE TROUBLE
Standing Up, Speaking Out, and Finding the Courage to Lead
By Cecile Richards with Lauren Peterson
304 pp. Touchstone. $27.

Cecile Richards — the outgoing president of Planned Parenthood — may look calm and unflappable with her trademark blue suits and neat cap of golden hair, but she’s a troublemaker from way back. As a sixth grader in Dallas she refused to say the Lord’s Prayer in class. As a junior high schooler in Austin, she wore a black armband to express solidarity with the Moratorium to End the War in Vietnam, infuriating the principal. The rest is history. “Make Trouble” takes us through Richards’s life in activism and politics: Before Planned Parenthood, she had a full and varied career that included union organizing, starting the progressive organization America Votes and working for Nancy Pelosi. But there’s lots more, including loving depictions of family and friends, from the legendary Texas journalist Molly Ivins to her mother, Ann Richards, the “frustrated housewife” who became the beloved first (and so far only) woman governor of Texas.

Richards paints some vivid pictures of life in politics, too. For example, despite misgivings, she reached out to Ivanka Trump after hearing that she might want to help Planned Parenthood. They met at a Trump golf club in New Jersey, where Ivanka and her husband, Jared, offered her a deal: If Planned Parenthood stopped performing abortions, funding for birth control might go up. “Jared and Ivanka were there for one reason: to deliver a political win. In their eyes, if they could stop Planned Parenthood from providing abortions, it would confirm their reputation as savvy dealmakers. It was surreal, essentially being asked to barter away women’s rights for more money.”

Books by public figures, especially when written with help from others — Lauren Peterson is a speechwriter — are often pretty deadly, but “Make Trouble” manages to be genial, engaging and humorous. (“It was almost like dealing with kidnappers,” is how Richards describes the months of waking to find yet another doctored video claiming to prove that Planned Parenthood sold fetal tissue.) She’s good at sharing credit and giving praise — especially to her husband, the longtime labor organizer Kirk Adams, who was always game to move to a new city, take on a new adventure and pitch in with raising their three children. Her portrait of Nancy Pelosi as a nice person, a thoughtful boss and a brilliant strategist largely responsible for the passage of the Affordable Care Act (without the Stupak amendment that would have banned insurance coverage for abortion) is a pleasant corrective to the increasingly common view of her as an incompetent witch.

As its title implies, this is not just a memoir but a call to action. Richards wants you to know that you too can make social change. She also wants you to know that a life of social activism is fun. She offers career advice (“never turn down a new opportunity”) and even travel tips (“try to know where the best ice cream is in any given airport terminal”). Considering how often progressives are portrayed as joyless scolds, this is a message that needs to get out more. There’s a lot of satisfaction in activism, even if you don’t win every battle.

Those battles are something I wish Richards had gone into more deeply. Although she opens with her appearance before the congressional committee investigating Planned Parenthood for profiting from fetal remains — the same committee that investigated Hillary Clinton over Benghazi, with as little to show for it — her take is basically upbeat. She and her daughter may curl up in bed and weep together on election night 2016, but a few pages later she’s knitting a pussy hat for the women’s march held the day after Donald Trump’s inauguration. She doesn’t spend much time analyzing the current state of reproductive rights in this country, the number of abortion clinics closing or the continuing threat to defund Planned Parenthood and cancel Obamacare’s expansive birth control benefit (which has no co-pay requirement), to say nothing of the hundreds of state restrictions on abortion passed in the last few years.

Richards is absolutely right that Planned Parenthood is popular — one in five American women has visited one of its clinics. Almost all women have used birth control at some point, and one in four will have had at least one abortion by age 45. Given those facts, I would have liked to read why she thinks the enemies of reproductive rights have been so successful. The once pro-choice Trump — who said Hillary was willing to “rip the baby out of the womb” right before birth — is in the White House. As a congressman, Mike Pence wanted to shut down the federal government in order to defund Planned Parenthood; today he’s the vice president. She describes as a big win the storm of outrage that resulted when the breast-cancer charity Komen Foundation decided to drop Planned Parenthood from its list of recipients (it had to backtrack within days). But she doesn’t say that the woman behind Komen’s ill-fated plan, Karen Handler, defeated Jon Ossoff in a much-publicized Georgia congressional race. Nor does she mention the 2015 murder of three people at a Colorado Springs Planned Parenthood clinic by a deranged abortion opponent.

“For the first time in my life, I’m wondering whether my own daughters will have fewer rights than I’ve had,” Richards writes. She’s hardly the only one to have that fear: After the election, Planned Parenthood experienced a 900 percent increase in requests for IUDs from women looking for birth control that would outlast the Trump administration. It is not going to be easy to undo the damage that every day seems to bring to women’s rights, status, opportunities and well-being, but if you’re looking for books to fill you with energy for the long haul that lies before us, this one is a great place to start. After all, with a man in the White House accused of sexual harassment by over a dozen women and Health and Human Services staffed from top to bottom with opponents of reproductive rights, what better time to make trouble?

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Global Health: Study Finds Lower, but Still High, Rate of C-Sections in China

China’s extraordinarily high rate is a result of its former one-child policy, changing medical care conditions and its increasingly capitalist economy.

According to the study’s authors, many parents and grandparents demand C-sections to assure that births take place on a lucky day in the astrological calendar, or because they believe that a surgically removed infant is more likely to be perfectly formed.

More than 99 percent of all women in China now give birth in hospitals — 30 years ago, only about half did. But they typically have gone through labor in open wards with no husband or family present, too few nurses and no pain relief. C-sections are an attractive alternative, said Dr. Susan C. Hellerstein, a Harvard Medical School obstetrician and one of the authors.

Doctors made more money from fees and “tips” from families if they operated, the researchers found. And if they performed scheduled surgeries rather than risk vaginal births, doctors felt they were less likely to be accused of malpractice, which is a criminal offense in China, or to face angry families demanding compensation.

Vaginal births can quickly go wrong if, for example, the cord wraps around the baby’s neck.

The study was led by doctors from China’s national statistics office, Peking University, Harvard Medical School and New York University’s Wagner School of Public Service.

The 2010 W.H.O. survey erred by relying on figures from just 21 hospitals, mostly in cities, said Dr. Jan Blustein, a health policy specialist at N.Y.U. and co-author. The new study tallied 90 percent of the country’s births over seven years.

While a few cities like Shanghai had astronomical rates, half of all Chinese still live in rural areas where home births are more common and distances to hospitals are greater, so actual rates are closer to the ideal 10 to 20 percent range.

In Tibet, however, C-sections are so rare that mothers and children who could be saved from death are undoubtedly not getting the operations, Dr. Hellerstein said. C-sections save lives in breech or multiple births, for example, or when a mother has dangerously high blood pressure or a fetal heartbeat fails.

But babies born by C-section are more likely to hospitalized for breathing problems and more likely to suffer asthma and obesity later in life, possibly as a result of not getting microbes present in the birth canal. Mothers who have had C-sections also are more likely to hemorrhage or to have a uterine rupture in the next pregnancy.

Since 2009, China has been trying to control medically unnecessary cesareans by educating patients, doctors and midwives, and by warning individual hospitals when their rates are too high, said Dr. Jianmeng Liu, director of the Office for National Maternal and Child Health Statistics of China and a study co-author.

China’s C-section rate, the authors noted, is close to that of the United States, where it is slightly over 32 percent.

That rate is higher than it should be, and higher than in many European countries, the authors said. Some mothers choose C-sections to avoid labor pains, they said, and too many doctors suggest them for convenience and for fear of facing malpractice suits.

In 2015, China ended its longstanding one-child policy, allowing two per couple.

“All these older women wanting a second baby after a C-section is going to be a big challenge,” Dr. Hellerstein said.

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