University of Connecticut OpenCommons@UConn Doctoral Dissertations University of Connecticut Graduate School 4-24-2014 “Cada paso es un obstáculo. ” -- Women’s Experiences Accessing Publicly Funded Abortion in the Wake of Policy Changes in Catalunya Bayla Ostrach University of Connecticut - Storrs, [email protected] Follow this and additional works at: https://opencommons.uconn.edu/dissertations Recommended Citation Ostrach, Bayla, "“Cada paso es un obstáculo. ” -- Women’s Experiences Accessing Publicly Funded Abortion in the Wake of Policy Changes in Catalunya" (2014). Doctoral Dissertations. 346. https://opencommons.uconn.edu/dissertations/346 “Cada paso es un obstáculo.1” -- Women’s Experiences Accessing Publicly Funded Abortion in the Wake of Policy Changes in Catalunya2 Bayla Ostrach, PhD University of Connecticut, 2014 Access to safe abortion is critical to women’s and public health. Women around the world encounter obstacles when they seek abortion care, which contribute to health care inequalities that disproportionately affect poor and marginalized women. The most marginalized women tend to encounter the most obstacles to abortion. In 2010, the Spanish government enacted policy changes affecting abortion availability in both Spain and Catalunya, an autonomous region with a contested relationship to Spain. These reforms expanded legal access to abortion and included it in the public health system for the first time. Using a mixed-methods approach combining quantitative surveys and demographic data with qualitative interviews and intensive participant-observation, this research explored women’s, providers’, and advocates’ perceptions of women’s experiences with the process of navigating the public health system to obtain legal, publicly funded abortion in Catalunya, in the wake of policy changes enacted between 2010 and the second half of 2013. Participants described the often- difficult course they had to follow to receive vouchers for care in the Catalan health system, as well as other logistical, social, and economic obstacles. Participants also reported that women mobilized social support and resisted structural inequalities inherent in the health care system, in order to successfully overcome obstacles, in the context of a widespread economic crisis in Catalunya and Spain that provoked austerity-related cuts to health care. Growing support for full Catalan independence also informed participants’ experiences. 1 “Each step is an obstacle.” – A phrase uttered by multiple participants. 2 Out of respect for the emic view passionately expressed by locals, I use the preferred Catalan terminology and spelling, “Catalunya,” rather than, “Catalunya, Spain” or “Catalonia” throughout this dissertation. “Cada paso es un obstáculo.3” -- Women’s Experiences Accessing Publicly Funded Abortion in the Wake of Policy Changes in Catalunya4 Bayla Ostrach B.A., University of Oregon, 2003 M.A., Oregon State University, 2010 A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy at the University of Connecticut 2014 3 “Each step is an obstacle.” – said by multiple participants 4 Out of respect for the emic view passionately expressed by locals, I use the preferred Catalan terminology and spelling, “Catalunya,” rather than, “Catalunya, Spain” or “Catalonia” throughout this dissertation. Copyright by Bayla Ostrach 2014 APPROVAL PAGE Doctor of Philosophy Dissertation “Cada paso es un obstáculo.5” -- Women’s Experiences Accessing Publicly Funded Abortion in the Wake of Policy Changes in Catalunya6 Presented by Bayla Ostrach, B.A., M.A. Major Advisor _______________________________________________________________ Merrill Singer Associate Advisor _______________________________________________________________ Pamela Erickson Associate Advisor _______________________________________________________________ Samuel Martinez (signed version on file at Homer Babbidge Library, University of Connecticut) University of Connecticut 2014 5 “Each step is an obstacle.” – A phrase uttered by multiple participants. 6 Out of respect for the emic view passionately expressed by locals, I use the preferred Catalan terminology and spelling, “Catalunya,” rather than, “Catalunya, Spain” or “Catalonia” throughout this dissertation. Acknowledgements - This dissertation would not have come to fruition without the generous assistance of the following: First and foremost, my legendary adviser, Dr. Merrill Singer – an inspiring, supportive, and encouraging mentor and friend who challenges me to expand my thinking about Critical Medical Anthropology, the political-economy of abortion, health care, health systems, health policy, and countless other topics, who taught me how to draft a publication manuscript and made me laugh during the many rounds of revisions that inevitably follow, and who reminds me, through his own example, why the “applied” part of Applied Medical Anthropology matters. Merrill, you truly live up to, and exceed, your reputation. Great thanks to my other committee members and outside readers: Drs. Pamela Erickson, Samuel Martinez, Kim Price-Glynn, and Jocelyn Warren, who unfailingly provided insightful, thoughtful, and timely feedback. I thank my incredible cohort, other grad students, associated cheer-squad members, and the Temple B’nai Israel community in Willimantic: especially Erika Phillips, Manette Sandor, Shir Lerman, Rich Colon, Cara Vickers-Kane, Miriam Drew, Rav Jeremy and family, and David Golden, for not letting me give up even when things got really bad during that second year, and for helping with childcare, meals, shoulders to cry on, much-needed distractions, hikes, and company while grading. Gratitude to Tracey Andrews, who knew the secret to making things happen in the UConn Anthropology Department. The fieldwork on which this dissertation is based would have been wholly impossible without the Society of Family Planning’s generous research grant, the consistently helpful problem- solving of SFP’s marvelous Marlo Polonsky, my fiscal sponsor for the SFP grant, the Network for Reproductive Options, and UConn’s Tinker Foundation, for a small fieldwork grant. For countless hours of childcare, visits and meals, moral support, crucial financial support during the write-up phase, and last but certainly not least, for moving to Barcelona to help with childcare and enable me to do international fieldwork as a single mom, I sincerely thank my incredible parents, Marion Malcolm and Stefan Ostrach. For keeping me going at the worst of times, and celebrating with me at the best of times, I owe a life-long debt of gratitude and friendship to Joy Getman, Alicia Boekhorst, Walidah Imarisha, David Newman, and Lisa Thomas. For offering me homes away from home, a place to go on holidays, and those wicked entertaining accents, Khat Mandeville and family. For providing last-minute, quantitative data analysis help – thank you again, Erika Phillips! For inspiring new thinking about what makes a good ethnography, much appreciation to Eva Melstrom, Heather White, Tong Xin, Rebecca Garza, and Robert Christian, all soon-to-be graduates of the Boston University School of Medicine’s Medical Anthropology master’s program. I enthusiastically thank the generous, knowledgeable, and committed people who facilitated my data collection, especially Dr. Santiago Barambio, Silvia Aldavert, Yolanda Trejo, Miriam, Deli, Sonia, and Beatriz, and Dr. Jordi Roca i Girona and his staff at the Universitat Rovira i Virgili. My time in the field, and my life in general, were greatly enriched by the passionate and supportive friends I found there: Carolina Clemente Villar, Katia Blue, Guillem Murcia López, and the many amazing Catalan Jews who welcomed me with open arms at Congregation Bet Shalom -- you all made Catalunya home, i ets tots en el meu cor. Very warm abraçadas and moltes gracies to Maria Olivella, who helped me find the enchufes needed to set up my fieldwork, and to Roisin Davis, who connected me with Maria. Words cannot adequately express my appreciation, empathy, and admiration for the women of Catalunya who did whatever they had to do in order to obtain publicly funded abortion care in the context of economic crisis and policy changes, and took the time to share their experiences with me. Their accounts of how they overcame obstacles are a constant reminder of why research is not enough – the findings must be used to improve access, too. Table of Contents (numbering varies in Digital Commons version) Abstract. (unpaginated) Title Page. .. .i Copyright Page. .ii Approval Page. .. iii Acknowledgments. .iv Table of Contents. .v Frontispiece: Excerpt of Marge Piercey poem. vii Introduction: Policy & Practice. .Page 1 Chapter One: Catalunya, Crisis, and cuts. .. .Page 38 Chapter Two: An Uneasy Collaboration Between Public And Private Care. Page 64 Chapter Three: Las Dones (The Women) . .. Page 103 Chapter Four: ¿I Ara Que? (And Now What?) . .Page 151 References. .Page 183 Appendix I: Original Castilian text of participant quotes. Page 194 Appendix II: Data Collection & Analysis. .Page 200 Appendix III, Campanya Pel Dret a l’Avortament response to Gallardon. Page 204 Tables & Figures Table 1. .Page 33 Table 2. .Page 34 Table 3. .Page 35 Table 4. .Page 76 Table 5. .Page 106 Table 6. Page 107 Table 7. Page 116 Table 8. Page 118 Figure 1. .. .Page 153 modified Grounded Theory schema/concept map 1. .. .Page 201 modified Grounded Theory schema/concept map 2. .Page 202 “I will choose what enters me, what becomes flesh of