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Clinic Workers Strike for Your Health
by Lucy Matson
‘Science for the People’ Vol. 9, No. 3, May/June 1977, p. 20–25
In late August 1975, I took a job at Preterm, an outpatient abortion and gynecology clinic in Brookline. Having searched for a job since my graduation from UMass-Boston four months previously, I felt very lucky to be working at all and particularly in a women’s health clinic. I began as a receptionist, learned the admitting officer’s job, did some telephone counseling, and then in February 1976 began doing abortion counseling. At first Preterm seemed an ideal extension of my earlier commitment to safe, legalized abortion and to women’s increasing awareness of, and control over their own bodies. However, as I learned the details of Preterm’s operation I began to understand that good women’s health care was not the clinic’s highest priority.
Abortion Pioneers Turn Into Profit-Takers
Four years ago the Supreme Court recognized the tremendous public pressure in favor of legalized abortion. Today that right is threatened. Conservative legislators together with organizations like the Right to Life movement are attempting to overturn our hard-fought victory. These well-known opponents are, unfortunately, not the only cause for concern. Within the abortion rights movement are business people who see abortion as a respectable way to make a good deal of money. In this context the myth of feminist activism recedes quickly into the background as the familiar story repeats itself: workers versus management.
Preterm (short for pregnancy termination) began in 1970 as a research organization studying “the problem presented by the increasing population of the world, and the relation of contraception, abortion and sterilization to that population growth” (Preterm Institute Progress Report 1975, pg. 3) Harry Levin, member of the Rockefeller-funded Population Council and a small businessman in the furniture industry founded and directs Preterm Institute. In 1972, under his wife’s directorship, Preterm, Inc. opened its doors as a gynecology clinic and within six months of the Supreme Court decision was providing first trimester out-patient abortions as well. Under the general auspices of the Institute, clinics have opened in Washington, D.C.: Cleveland, Ohio: Pittsburgh, PA: St. Louis, Missouri: and Sydney, Australia.
In the early days Preterm clinic in Brookline operated on a flexible basis. The counseling staff (85 percent of the people now represented hy the union District 1199-Mass.) rotated through the various areas of the clinic—doing telephone, gynecology and abortion counseling on different days.
The problems that eventually led to unionization became evident all too quickly. Time and time again groups of women were hired for full-time positions which decreased to part-time jobs once the training period had ended—and after they had already left their previous jobs. Another staffing practice only allowed a counselor a few hours’ notice that she was to work on a particular day. Often this meant full-time hours but due to the technicality of the category, no full-time benefits. No regular work schedule was ever devised: you could work certain days one week and altogether different days and possibly fewer hours the next week.
The staff voiced its dissatisfaction in many ways. People spoke to Jane Levin individually and in several all-clinic meetings. She responded to every wave of criticism with empty promises of improvement based on the supposed family-style intimacy of all the people who worked at Preterm.
Initial Union Rumblings
As far back as the spring of 1974. frustrated by Levin’s attitude. employees began to research the possibilities of unionization. When the administration got wind of this they allayed people’s concerns temporarily with promises of reform. Reform, when it came that summer. wasn’t exactly what the workers had in mind. Employees were forced to choose between gynecology, abortion, or telephone counseling and stick with that choice.
The division of the clinic into independent units served two functions. It cut down on the group solidarity of the counselors since people who had worked together closely no longer saw each other, and it made people’s jobs much more repetitive, which drastically increased the turnover rate. This compartmentalization not only hurt the counseling staff but the quality of health care as well. Patients were dealt with less as individuals with different needs and more as items in a long procession of telephone calls and birth control questions.
Matters went from bad to worse in November 1974. In order to keep business profitable, Preterm cut the gynecology clinic in half, firing seven counselors. Seniority was completely ignored in the firings. In fact, it had all the appearances of a political maneuver: Jane Levin’s most outspoken critics were singled out for dismissal.
To Preterm, gynecology was not profitable enough. Abortion patients pay $150 per procedure, while gynecology patients pay only $30 at most.
Preterm’s defense of these cutbacks was not without its logic: gynecology is not profitable. Abortion patients pay $150 per procedure, while gynecology patients pay only $30 at most. In cutting back the gynecology clinic, the Levins were simply responding as any able entrepreneurs would. Gynecology is not only less profitable than abortion. but it also has the effect of undercutting the abortion market. To expect Preterm to champion gynecological work is rather like expecting GM to encourage mass transit. Like the decision to divide the clinic into separate departments. this step placed business concerns square!y over patient care.
The Union Is Elected
Shocked and frightened by the changing character of the clinic, 70 percent of the employees joined District 1199 in November of 1974. about one month after the firings. After the membership cards were signed, 1199 contacted the National Labor Relations Board (NLRB) to set up an election. On the eve of the scheduled election. in February 1975, Preterm challenged the right of everyone but counselors to vote. thereby reversing its previous stance of cooperation with the wishes of the employees. The NLRB ruled in favor of all but five employees.
Although the outcome of Preterm ‘s appeal to the NLRB did not decrease the size of the bargaining unit, it delayed the election. Between February and May 1975, when the election finally took place, management bombarded employees with anti-union literature. Arguments like “unions take away employees’ freedom” and “male-dominated labor organizations have no place in a woman-run clinic” had no effect on the workers. Of the fifty people voting, only three voted against 1199. One of the last letters circulated by Preterm before the election foretold the subsequent course of contract negotiations: “Question: Will the law compel the clinic to reach an agreement with the union? Answer: Absolutely riot! The Clinic does not have to agree to a single thing the union proposes so long as we bargain in good faith … We do not have to sign any contract which we do not believe to be in the Clinic’s best interest.” (“A Memorandum”, May 5, 1975, pg. 2)
This overwhelming victory was followed by months of painstaking discussion about the contract proposals the union would offer. No one had previous experience in writing or negotiating a contract and the clinic’s extensive hours made meetings difficult to arrange. Along with the usual clauses in union contracts (i.e., seniority, grievance procedure, maternity leave, wage increase, complete health coverage) the women at Preterm demanded certain specific improvements: a ceiling on the number of patients any counselor would see in a day, pro-rated benefits for the part-time workers Preterm relies so heavily on, and promises that volunteers would not replace members of the bargaining unit.
Difficult Contract Negotiations
When negotiations began in December 1975, the union representatives (two 1199 staff members and thirteen Preterm employees) met with Preterm administrators, Jane Levin and Diane Richards, and their lawyer, Leon Kowal. Within the first few meetings Kowal made his position clear: he would fight tooth and nail against each and every request the union made. Suchh “extreme demands” as the right of 1199 to post notices in an employee lounge met with staunch resistance from Kowal.
On International Women’s Day, March 1976, a member of the negotiating committee read a statement to the management committee, asking Kowal to refrain from calling members of the 1199 team “girls”. He exploded, “If you don’t want to be called a girl, don’t act like one.” The use of the word “girl,” while not terribly important in itself, symbolized for the workers Preterm’s attitude toward them and the union.
Later that day Eliot Small, 1199 president, had a conversation with Diane Richards, asking that she calm down Kowal. This attempt to smooth things over served as an excuse for Preterm to file charges against 1199 with the NLRB and to delay negotiations for three more months. The NLRB dismissed their case.
After four sessions in June, Kowal walked out of negotiations on July 12th, terming the eleven employees present at the session a “mob scene”. That night, employees picketed Jane Levin’s house. The next day Preterm received the union’s thirty day strike notice. (Health care facilities are protected by the NLRB so that workers must submit first a thirty day and then a ten day notice of their intention to strike to make a work stoppage legal.)
In the following month employees turned to the community for support. Referral agencies received calls, asking them to question Preterm on its behavior toward the union. Two fundraising benefits, a large article in a local weekly paper, and an hour discussion of the labor dispute on a local FM radio station began the task of alerting the public to Preterm’s anti-union tactics.
Realizing the worker’s commitment to reaching a contract, Preterm agreed to involve the Federal Mediation and Conciliation Service in negotiations, something the union had first requested in March. In retrospect this only seems a further stalling tactic: the clinic knew it would cease to function in the event of a strike and needed to placate workers long enough to gear up for a strike, though at the time it seemed a victory.
The first session with mediation took place in August 1976. The mediators asked 1199 to list all the agreements reached so far and those left to be worked out. The six agreed upon clauses were offset by about twenty-five areas of disagreement. Included among the unresolved issues were: all economic issues, maternity leave, job training, staffing, the role of volunteers, and discharge with penalties.
Reprisal and Reform
Meanwhile, working conditions at the clinic continued to deteriorate. As early as May, abortion counselors had begged for new staff, unsuccessfully. By summer the situation was critical. Preterm continued to schedule sixty patients daily although the entire staff couldn’t help each person adequately. If anyone called in sick the squeeze was even tighter. One Saturday five women waited for several hours. only to be told at the end of the day that no one could see them and they would have to reschedule.
In the gynecology clinic counselors were pressed to give up the practice of accompanying patients through the physical exam. They refused. So they found themselves trying to cope with as many as three patients simultaneously: racing from examining room to examining room to spend the essential minutes at the patient’s side. In different form telephone counselors experienced the same speed-up. Often the number of phone lines open to patient calls exceeded the number of counselors by two or three.
Management’s Attitude Toward Health Care
GOOD WORKING CONDITIONS ARE THE BASIS OF GOOD HEALTH CARE has been the principle around which the entire strike has centered. The strike has forced all of us to reconsider the kind of health care Preterm gives. I no longer feel that the care, even in the best of times, adequately meets the patients’ needs.
Focusing attention primarily on abortion eliminates the possibility of complete preventive health care. The gynecology clinic as it now exists would more honestly be known as a family planning clinic. Common infections are treated and birth control methods are prescribed: anything more complex has to be referred elsewhere. Because M.D.s are not the only medical personnel, Medicaid will not cover Preterm ‘s services and there are no deferred payments, so the many patients who use one of those financial arrangements for an abortion cannot be seen in the gynecology clinic. Fragmented health care decreases the effectiveness of what care you do receive.
In the abortion clinic patients pay $150 before being counseled about their decision. If they decide not to have the abortion, they can get their money back but too often the logic works, “Well, I’m here already so I might as well go through with it.”
Racism has never been discussed although many of our patients are black and Spanish-speaking. The one Spanish-speaking counselor said, “On two different occasions I was asked to push sterilization on Spanish-speaking women. Once this had been suggested by an administrator, who hadn’t even seen the individual woman’s chart. I guess it was assumed Spanish-speaking women just had too many children.”
Preterm’s commitment to abortion stops with the legal right to have an abortion. In effect, the clinic supports the status quo, because it fails to question or seriously challenge the conditions which give rise to ignorance and poverty in our society. In fact, according to Harry Levin no one really is poor: “They say they can’t afford an abortion … (but) even the welfare woman, or the domestic … the secretary, the clerk
-maybe they can’t afford $150 today, but you say to them, ‘O.K., let’s turn on tonight, (we) need a lid of dope and (we) need 20 bucks’: and they’ll go away and in half an hour they’ll come back with 20 bucks … It’s what you value” (The Abortion Business, pg. 53).
Understaffing has occurred periodically throughout Preterm’s history. Far from being the mistake of any particular supervisor. it seems to be a policy dictated by Jane Levin. Speed-up saves money. It also decreases employee endurance. The higher the turnover the more difficult organizing becomes. Through the summer of 1976 Preterm attempted to disgust the staff sufficiently so that the trouble makers would leave. They failed.
At the end of August a new coordinator was hired for the abortion clinic. Deborah Feinbloom brought many reforms to the clinic in her first weeks: a permanent work schedule, paid meetings, extra pay for extra work, paid job training. When she hired new staff she created as many full-time positions as possible. She scheduled enough counselors so that calling in sick did not throw the entire clinic into chaos. She has been Preterm’s most efficient union busting tool to date. All her reforms had been demanded by union members for years. She instituted them in such a way that new counselors were convinced that the grievances of the union activists were due only to poor supervision.
The Strike Looms
Five negotiating sessions with the mediators led to few agreements and many angry outbursts from Kowal. The mediators failed to inhibit either his temper or his contempt for the union people.
There was one small victory. Embarrassed by public exposure on its lack of maternity leave provisions. management agreed to a maternity leave clause. While it was pleasing to have won this clause. Preterm’s long opposition highlighted its whole attitude towards a union contract. Four months out of ten since the election spent away from the bargaining table, a complete disregard for union requests for information. no wage proposal at all—all these factors pointed toward the conclusion that Preterm never intended to
sign a contract.
People began agitating for a strike. Innumerable telephone discussions. an introductory meeting for new staff (twenty-one hired in September 1976). a written history of the union struggle. and other efforts culminated in a strike vote and a notice telegrammed to Preterm that a work stoppage would begin Tuesday, October 19th. 1976.
On October 15, the Friday before the strike. 1199 offered to submit all outstanding issues to a mutually agreeable third party whose decision would be binding on both sides. This would have averted the strike. Preterm. however. had no intention of averting the strike. The previous week they had placed an ad in the Boston Globe classified section seeking every job category of the people due to strike. On Saturday October 16, group interviews for future strikebreakers (scabs) took place across the street from Preterm. And on Monday, the day before the strike, two future scabs conducted tours of the clinic for other prospective strikebreakers. while union members sat in the offices of the Federal Mediation Service.
Not surprisingly Preterm rejected 1199’s offer of binding arbitration. Kowal gave two reasons: first, Preterm’s relatively small size and its nonprofit status. The union representative replied that the settlement would of course not exceed Preterm’s ability to pay. Kowal ignored this. Secondly. he said. Preterm is operated by people who have devoted their lives to it and they will not give up their control to some outside party. Kowal did offer four contract proposals at that time. One clause had already been agreed to, one was the present policy at Preterm, and two cut back on present policy. They offered to increase the number of hours employees had to work to be considered full-time. The union team felt betrayed—having made every effort to avoid striking. it had received a slap in the face by way of response.
At 6:00 a.m. on October 19th pickets began to arrive at the 1842 Beacon Street building. Preterm was ready. Approximately twenty private-duty Brookline police, two photographers hired by the clinic, and a police videotaping team were on hand. At 7:30 the strikebreakers drove up in a school bus: those same twenty or so who had been hired in September. The police linked arms and although the scabs were frightened they made it across the picket line.
Persistence and Solidarity
During the first two months of the strike picketers succeeded in cutting Preterm ‘s business down to about one-half of its prestrike level. Preterm’s business has since risen to about 90 percent of its prestrike level. Nevertheless, the amount of community support has been overwhelming and has given the fifty strikers the strength to keep up a picket line six days a week, ten hours daily. Perhaps the most moving act of solidarity came on the first Saturday of the strike. Half the nursing staff refused to cross the picket line. Unprotected by union membership, they gave up their jobs rather than work inside Preterm.
Thirty separate arrests have taken place: the counts are as various as trespass, malicious destruction of property, disorderly person, assault and battery on a police officer and failure to disperse. Every charge has been dropped.
Early in the strike Preterm began the process of getting an injunction against the picket line. In early January 1977 that request was denied, but only because 1199 promised not to do any of the things management alleges the union has done in the past. The clinic maintains a small police force on Saturdays (one policeman on weekdays) and they jump when Preterm so instructs them. However friendly the police seem toward the picketers, they have arrested people when told to do so and would undoubtedly testify in support of the Levins in the event of another injunction hearing.
Further complicating the picket line scene is the presence of a scab who tells patients that the clinic which strikers are referring them to is not clean and tries to convince them to go into Preterm. Another added attraction is the Right-to-Life movement who have set up their own picket line each Saturday since March 5th of this year. They tell patients “there’s a real live baby inside you” and pass out leaflets entitled Diary of an Unborn Child, which concludes “Today my mother killed me.”
On February 5th of this year, a tremendous amount of work by community supporters paid off in a demonstration of about one-thousand people. Marching past the 1842 Beacon Street building people chanted “How do you get good health care with the workers out on strike?” The two demands of the demonstration were a decent union contract for strikers and a return to comprehensive gynecological care at Preterm.
Contract negotiations occur about once a month, always at the union’s request. Nothing startling has yet been worked out. In fact, the government, through the NLRB, alleges that Preterm has failed to negotiate in good faith with the union. The NLRB took Preterm to trial on February 28th. A final decision can be expected in approximately a year’s time, at which point Preterm might be forced to reinstate all strikers, if it had not already done so.
At this time, the strikers need as much support as possible. Contributions and requests for information should be directed to Preterm Strike, care of Lucy Matson, 362 Washington St., Cambridge, MA 02139.
Preterm, it seems, would almost rather go out of business than agree to a modest union contract. In addition to the police and legal fees, which must be astronomical, Preterm is presently engaged in saturating television, radio, and newspapers with their advertising. The amount of money they have poured into breaking the union far exceeds the amount they would have lost in agreeing to the original union contract proposals. The issue, clearly, is not money, but power. While happy to give benefits to faithful workers, the idea of treating employees as equal human beings with certain rights is completely abhorrent to Jane and Harry Levin.