Lessons from the Participatory Clinic: Architecture and Abortion at the Feminist Women’s Health Centers
As we approach the 49th anniversary of the Roe v. Wade decision, abortion rights in the United States are as tenuous as they have ever been in the last half-century. Nowhere is the precarity of this civil right more visible than in the state of Texas. Over the last few months, Texas legislators have banned abortions after the six-week mark, a point at which many (if not most) pregnant individuals will not yet be aware of their pregnancy. The bounty hunter system now inscribed in law allows civilians to reap financial reward for suing either individuals who seek an illegal abortion, or any party—doctor, spouse, friend, taxi driver—who aids them in procuring this most essential health service. Though the ban was struck down by U.S. District Judge Robert Pitman on October 6, 2021, it was quickly reinstated pending further review in the district appeals court. While this legislative ping pong game unfolds, untold numbers of women, trans and non-binary Americans will be forced to carry an unwanted pregnancy to term, or resort to getting an abortion out of state—an expensive undertaking that is financially out of reach for many low-income abortion seekers. Pending the Supreme Court’s decision in the current Dobbs v. Jackson Women’s Health Organization case, this situation in Texas may shortly be replicated in more U.S. states.
What can architects, historians, and members of their allied fields do in the face of these ongoing injustices? In her book Contested Space: Abortion Clinics, Women's Shelters and Hospitals, feminist architect and researcher Lori A. Brown proposed a possible method that employs cartographic projections as aids to visualizing the crisis of care that abortion seekers face. Brown’s maps demonstrate, in spatial terms, both the ramification of legal codes that proscribe the design of abortion clinics as well as the socioeconomic implications of a rapidly shrinking landscape of abortion clinics. I would like to acknowledge this critical, publicly oriented framework; developing a cartographic politics of visibility is a necessary strategy in the project of women’s health justice. Due to the political climate we find ourselves in, however, I would like to suggest that we may also need to nurture a politics of radical interiority and forms of collectivity that serve communities at risk. Indeed, in this time of renewed attack on abortion, this form of spatial politics is increasingly necessary and pragmatic.
This provocation is inspired by the research I have undertaken on the Feminist Women’s Health Centers, a collection of women’s health clinics which, at various points, operated in California cities, including Los Angeles, Oakland, Chico, Redding, Sacramento, Santa Rosa, Santa Ana, San Diego, and Concord, as well as in Tallahassee, Detroit, and Atlanta. Founded by Lorraine Rothman and Carol Downer in 1972, the Los Angeles Feminist Women’s Health Center (FWHC) was the first FWHC and the first explicitly feminist women’s clinic in the country. It served as a testing ground for self-help approaches to women’s health, which promoted grassroots women’s health education, pelvic self-examination, the self-regulation of menstrual periods, and small group-administered abortion.
Though in its earliest days the L.A. clinic announced its presence proudly to the street with signage [Figure 1], feminists working within its four walls were most profoundly invested in creating an interior space where women could build community, receive and give care. Such an inward-facing disposition in making the feminist clinic—alternatively called the self-help clinic or participatory clinic—was not based on a desire for exclusion, but rather on a realistic acknowledgement of the inhospitality of the public sphere and existing medical spaces towards their feminist ideals. This attitude was both born out of and confirmed by a series of traumatic events, including the involuntary sterilization of many immigrant women at the L.A. County Medical Center, a police raid of the L.A. FWHC in September of 1972, and many subsequent attacks on FWHC clinics across the country.
Figure 1. Los Angeles Feminist Women’s Health Center on South Crenshaw Boulevard, formerly the Crenshaw Women’s Center, c. 1972. Women’s Health Specialists of California records, SSC-MS-00790, Smith College Special Collections, Northampton, Massachusetts.
Self-help, what historian Michelle Murphy has defined as a theory placing unique “emphasis on the epistemic authority of experience,” was a guiding tenet within the FWHCs.[1] In the radically re-envisioned pedagogical paradigm of the self-help clinic, learning through physical encounter was emphasized above abstract knowledge production. Indeed, beyond reacquainting themselves with the physical matter of the body, women involved in the participatory clinic viewed engagement with the built environment as instructive in the broader project of building feminist collective autonomy. Self-help literature of the time like Our Bodies, Ourselves too emphasized the importance of the material processes of self-help, invoking the possibility of forming feminist approaches to design in and “through the production of tangible objects.”[2]
“An inward-facing disposition in making the feminist clinic—alternatively called the self-help clinic or participatory clinic—was not based on a desire for exclusion, but rather on a realistic acknowledgement of the inhospitality of the public sphere and existing medical spaces towards their feminist ideals.”
At the Los Angeles FWHC, internal community building methods and a pedagogical investment in learning-while-making were combined to produce a design approach that feminist architectural theorists Hélène Frichot and Isabelle Doucet have called a “critical-embodied practice.”[3] When applied to architecture, critical-embodied practice signifies a situated and relational approach to reimagining and reorganizing existing environment-worlds—a direct repudiation of a Modernist form of engagement predicated on distance, hierarchy, and expertise. Such a definition may be aptly applied, for instance, to feminist approaches to redesigning circulation patterns within the participatory clinic.
In preparation for an early expansion of the L.A. FWHC on Crenshaw Boulevard, Carol Downer and Lorraine Rothman traveled to New York City to tour abortion clinics. One of their observations about these facilities was the fact that they were organized in a manner resembling an assembly line—visitors would arrive and sit in the waiting room, progress to the examination room for their procedures, and exit out the clinic’s back door. This layout, Downer and Rothman felt, added to the dangerous mystique of the procedure, as patients were unable to see or speak to women post-operation. In response, the L.A. FWHC established a cyclical pattern of movement; women entered and exited using the same door, sometimes lingering to discuss their experiences, partaking refreshments provided by clinicians. This new approach to interior circulation, being rooted in an embodied understanding of space and its social consequences, “empowered women to ask questions, observe how other women were doing, and support each other.”[4]
The implementation of new circulation strategies was also part of a broader interest in mediating the relationship between bodies and buildings. Tackable walls were common in early FWHC interiors [Figure 2], rendering the walls and vertical elevations of these spaces dynamic and reactive. The texture of these surfaces was formed by a document bricolage; community rules, shopping lists, key chains, and anatomical diagrams populated walls in non-hierarchical stratification. When combined with the thick curtains and closed blinds that were typical privacy measures in FWHCs, this dense, lateral piling-up of surface-hung documents formed a protective enclosure—a container designed to nurture the co-evolution of women and the spaces they occupied. This layer of protection allowed for what cultural theorist Zoë Sofoulis has called potential spaces—space existing in between inner and outer worlds where creative experimentation is possible. Walls were the first layer of this zone of possibility, serving as both barriers from the outside world and mediums for creative accumulation and co-education in the practice of self-help.
Figure 2. A woman sits inside the Los Angeles Feminist Women’s Health Centers on one of its multiple initial locations on South Crenshaw Boulevard, the precise location is unknown, c. early 1970s. Women’s Health Specialists of California records, SSC-MS-00790, Smith College Special Collections, Northampton, Massachusetts.
The design of exterior walls and barriers at the FWHCs took on a new degree of significance as anti-abortion activism gained steam throughout the United States in the mid-1980s and 1990s. One of the first episodes of architectural violence against a Feminist Women’s Health Center took the form of an arson attack at the L.A. FWHC in 1985, reducing much of the building interior to ashes. In the same year, anti-abortion activists hung a dead, neighborhood cat from the Santa Ana clinic’s front door. During the late 1980s and early 1990s, the Redding FWHC was subjected to four arson attacks, the Santa Rosa FWHC was held hostage by anti-abortion protesters for eight hours, and the Chico FWHC fought a decade of legal battles to protect patients from picketer harassment. In 1992, two Molotov-cocktail firebombs were launched at the Sacramento FWHC, damaging the clinic and neighboring office units. These events, according to the National Abortion Federation, were among a sum total of 585 incidents of vandalism, 29 bombings, 124 arson attacks, and 80 butyric acid attacks that plagued abortion clinics nationwide in the 17 years following 1977.
Feminist clinicians had no more luck soliciting government protections for their health centers during Ronald Reagan’s presidency than they do today. In a 1984 interview with the Washington Times, a conservative newspaper, Reagan’s FBI Director William H. Webster refuted popular demands that anti-abortion violence should be categorized as an act of domestic terrorism, which the FBI itself defined as “the unlawful use of force or violence against persons or property to intimidate or coerce a government, the civilian population or any segment thereof, in furtherance of political or social objectives.” Claiming that anti-abortion violence fell outside of this protocol because it was not caused by a definable group or activity, nor directed specifically towards a government agency, Webster slighted his own department’s definition of terrorism, justifying his decision to deny feminist health workers federal aid.[5]
Left to fend for themselves, FWHC clinicians took on new design projects to protect their fellow health workers and patients—reinforcing the façade as a barrier from the outside world. In Redding, a fence was constructed inside the portico of the clinic [Figure 3], protecting the building frontage and forcing patients to park in the more secure backyard. In Chico, a free-standing façade stood proud of the Victorian, single-family home the clinic inhabited [Figure 4], giving it a more banal aesthetic all while concealing apertures into the patient consultation rooms. These architectural gestures, though not entirely aesthetically pleasing, may be thought of as pragmatic responses to the conditions of extreme anti-abortion activism. What’s more, they made possible the continued project of nurturing an inclusive, affirmative, and welcoming interior space in the participatory clinic, where women seeking clinical services and women dedicating their lives to the practice of self-help could be in community with one another. Architecture, in these instances, provided a protective service, lending women’s health and abortion services the heightened degree of anonymity necessary for their continuation.
Figure 3. A fence runs through the portico of the Redding Feminist Women’s Health center, date unknown. Women’s Health Specialists of California records, SSC-MS-00790, Smith College Special Collections, Northampton, Massachusetts.
Figure 4. An exterior façade addition at the Chico Feminist Women’s Health center, date unknown. Women’s Health Specialists of California records, SSC-MS-00790, Smith College Special Collections, Northampton, Massachusetts.
The dual design strategy discussed so far—of external protection and internal collectivity—is perhaps nowhere better represented than in the history of the FWHCs than in Lorraine Rothman’s design for the Del-Em. A technological device created for the purposes of menstrual extraction, the Del-Em [Figure 5] served the double function of menses control (the passing of a menstrual period in a single sitting) and early-stage abortion. Menstrual extraction was designed as a modification of the more common abortion method dilation and curettage (D&C), in which the cervix is dilated and a curette is used to remove uterine tissue. Instead, menstrual extraction would remove the contents of the uterus through suction, a gentler procedure which could be completed in the absence of anesthesia. In the FWHC, women would use the Del-Em—comprised broadly of a plastic syringe, combination valve, and cannulas—on a monthly basis to extract menstrual blood from the uterus at the beginning of menstruation, thereby avoiding the bother of pads and tampons for the rest of the week. They also learned how to use the same procedure to complete early-stage abortions, both before and after the Roe v. Wade decision of 1973.
Figure 5. A woman demonstrates how to use a Del-Em, a device for menstrual extraction invented by Lorraine Rothman, date unknown. Women’s Health Specialists of California records, SSC-MS-00790, Smith College Special Collections, Northampton, Massachusetts.
“Architecture, in these instances, provided a protective service, lending women’s health and abortion services the heightened degree of anonymity necessary for their continuation.”
Figure 6. Pages from Lorraine Rothman’s patented “Method for Withdrawing Menstrual Fluid.” Patent 3,828,781, filed December 6, 1971, issued August 13, 1974.
On December 6, 1971, Rothman filed a patent application with the U.S. Patent and Trademark Office for a “Method for Withdrawing Menstrual Fluid” [Figures 6 & 7]. In the document, she claimed the Del-Em as a device “whereby substantially all of the menstrual fluid incident to a normal monthly ‘period’ may be removed in a small fraction of an hour.” Abortion, however, was not mentioned. The patent’s carefully selected wording and imagery signified the dual, inner and outer, ambitions that feminist clinicians espoused regarding menstrual extraction. Externally, the Del-Em was portrayed as an innocuous device used to manage menstrual cramps and bleeding. Within the feminist self-help movement, however, the Del-Em symbolized a sweeping reclamation of control over women’s reproductive capacities, as well as the expansion of self-help praxis. Illustrations included in the patent also obscured the political intentions behind the device, calling attention instead to its material thicknesses, points of connection, and functional performance. Save for one enlarged isometric view of the tail of the cannula, the patent rendered the device in section—showing the inner workings of the suction-producing device and receptacle. In one patent figure, the uterus was rendered in section as well, bringing it into the same plane of graphic expression as the rest of the device—an amalgam of lines and poché. What was, in popular culture, discursively imagined as the site of life and death was recast as a material extension of a biotechnical apparatus—a system component rather than a site of political confrontation.
Though there is much for designers and historians to learn from the legacy of the Feminist Women’s Health Centers, most prescient, I think, is for us to take note of the way in which self-help clinicians were able to create and nurture clinical spaces that manifested, materially and architecturally, their feminist ideals. Their complex strategy involved a dual process of building up protective infrastructure—whether architectural or rhetorical—while also incubating affirmative spatial practices and material environments within the cloistered clinic itself. Despite the odds, FWHCs were sites of great richness, laden with technologies, bodies, germs, documents, furniture, and ideas. And yet, I would also like to acknowledge here the risk that FWHC suffered in committing to self-help as a radically independent model. By moving women’s health care outside of the domain of state and private sector medical facilities, the FWHCs may have unwittingly played into the hand of a burgeoning neoliberal scheme of governance in the U.S., aimed at divesting in public systems of health care.
Figure 7. Pages from Lorraine Rothman’s patented “Method for Withdrawing Menstrual Fluid.” Patent 3,828,781, filed December 6, 1971, issued August 13, 1974.
In our current moment, when abortion rights are increasingly precarious, we—members of feminist and queer communities—will need to fight for government funding to sustain radical health clinics where abortion services are freely provided, as we cannot afford for these spaces to be categorized as peripheral or unworthy of state support. Such a provocation underscores the importance of legislative struggles in states like Texas, as well as the ongoing constitutional battle in the Supreme Court. To this end, architects must stand alongside and support feminist lawyers and legal activists, but that cannot be their only form of work. My hope here is to insist that architects and their co-conspirators in design may also have something specific to contribute to the fight for abortion rights and access: their speculative ability to imagine and craft feminist clinical environments that privilege collectivity over hierarchy, critical-embodied perspectives over distant and detached ones, and unconditional care in the face of scarcity.
The abortion clinic we deserve is not only a medical site, but also a site of community, political organizing, and architectural imagination. Feminists—both inside and outside of the discipline of architecture—must insist on designing abortion clinics on our own terms. Indeed, developing these terms will require us to turn inward, to inaugurate new methods of consciousness raising that attend to both our differences and similarities, to nurture a system of mutual aid, and build infrastructures of care that meet our needs and desires.
Notes
[1] Michelle Murphy, “Immodest Witnessing: The Epistemology of Vaginal Self-Examination in the U.S. Feminist Self-Help Movement,” Feminist Studies 30, no. 1 (2004), 118.
[2] The Boston Women’s Health Book Collective, Our Bodies, Ourselves: A Book By and For Women (New York: Simon and Schuster, 1973), 9.
[3] Isabelle Doucet and Hélène Frichot, “Resist, Reclaim, Speculate: Situated Perspectives on Architecture and the City,” Architectural Theory Review 22, no. 1 (2018), 5.
[4] Daphne Spain, Constructive Feminism Women’s Spaces and Women’s Rights in the American
City (Ithaca, New York, London: Cornell University Press, 2016), 123.
[5] “Terrorist Bombings Decline; Abortion Attacks Excluded,” Washington Times, December 12, 1984, 14.
Citation
Overholt, M.C., “Lessons from the Participatory Clinic: Architecture and Abortion at the Feminist Women’s Health Centers,” PLATFORM, December 13, 2021.
