"It is our goal that every woman receives the type of empowering health care that feminist health care centers currently provide." It is an admirable aim and the Consortium of Feminist Reproductive Health Centers does seem fueled, through unity, by a renewed sense of purpose to accomplish it. And what is feminist health care? Francine Thompson, Health Services Director at the Emma Goldman Clinic in Iowa City, one of the remaining 15 feminist health centers and a consortium member, puts it, "There are many feminists out there providing health care. There are few organizations that have an organizational commitment to feminism. This is what I think makes the feminist health centers different. ….policies and decisions, whether they are medical, financial, regarding employees/benefits need to be looked at through the ‘feminist lens.'"

But how far must the "feminist lens" bend to refocus on the survival of feminist health centers? Is the foundation on which feminist health centers are built outdated? More urgently, will the remaining 15 feminist health centers in this country be able to weather the challenges set before them before it's too late?

There are those challenges that seem obvious. As Thompson remarks, "I think that it is mostly about dollars – not necessarily a reflection on the centers. Today….an analogy is Wal-Mart vs. the downtown corner store."

Blue Mountain Clinic in Montana, another of the last fifteen centers, finds itself in such a predicament on the eve of its 30 year anniversary. Raquel Castellanos, the clinic's executive director, is stepping down and says that in the past five years major increases in malpractice insurance and lower and lower Medicaid reimbursement rates all are taking an insidious toll on small, medical facilities. Feminist women's health centers, which operate independently without the assistance of a larger network or national office, face enormous financial obstacles that larger health care entities like Planned Parenthood, for example, do not. Feminist women's health centers must fundraise heavily from individual donors and foundations in order to support the work they do, and face a smaller donor base willing to contribute funds to abortion providers ("the doers of the deed" as my co-workers used to not-so-delicately put it). And grant money from foundations is more often than not tied to particular programming and not specifically to direct service provision.

In addition, as Marcy Bloom mentioned in part I of this article last week, the number of low-income women requiring subsidy to pay for their health care is rising dramatically. Abortion rates are increasing by 20 – 30% nationally among low-income women and the number of women who require publicly-funded contraception is also increasing. This means that feminist health centers must rely progressively more on the meager reimbursements from Medicaid and other health care subsidy programs for lower income Americans; reimbursements that rarely even cover the costs of providing the services for the centers.

And the barriers that low-income women face when attempting to access abortion services, means greater pressure on the feminist health centers as well. The Hyde Amendment, sponsored by the soon-to-be-retired Rep. Henry Hyde and passed into law in 1976, bars federal funding through Medicaid for abortion services. So who ends up subsidizing abortion care for the most marginalized and underserved women in this country? Independently run abortion funds like those a part of the National Network of Abortion Funds and, of course, the feminist women's health centers.

Carol Downer, the Los Angeles Feminist Women's Health Center's first executive director, tells the story of the Atlanta Feminist Health Center's embroilment with the IRS in the early 1990's. "The IRS was investigating the center and so the health center hired their own accountants to pore through years of billing and accounting. What the center found shocked them." The Atlanta Feminist Health Center was giving away approximately 30% of their services for free: phone counseling, public presentations and education, subsidy for services when women could not afford it, etc. For anyone who has ever worked at a feminist women's health center this should come as no surprise, however. It was often a point of pride and consternation for the leaders of Aradia Women's Health Center (AWHC) in Seattle, my employer for three more weeks until its closure, that the center subsidized abortion care for its clients (patients) in upwards of $500,000 some years. The fact is, AWHC made no money providing any of its care whether it was pap smears, sexually transmitted infection testing, family planning or abortion services. Our discounted fee schedule, our unique health care model that ensured that every woman who came through our doors received as much as time as she needed for her appointment, and finally our belief that all women have a right to empowering, high-quality, compassionate health care regardless of their ability to pay, helped to create a wonderful health care model that was, ultimately, not a viable business model.

And while feminist health centers have always prioritized cultural and linguistic competency as intrinsic values, the feminist health care movement (as well as the health centers themselves) has traditionally been one directed by white women. Historically slow to respond to the health priorities of women of color, the movement has essentially pushed women of color to form their own health care advocacy organizations (Sister Song, National Latina Institute for Reproductive Health, National Asian Pacific American Women's Forum). Over the last few years, I have seen feminist women's health centers (my own included) struggle with how best to prioritize women of color's health care needs, offering everything from web sites, medical forms, and pamphlets in a variety of languages to providing special clinics on specific days to particular populations. This too, is an area in which feminist health care centers must change and grow in order to progressively respond to community need.

Ultimately, it is not solely up the health centers to create change. If these centers are to survive, it will require a surge of societal support that must come from outside the centers. Campaigns like "The Hyde Campaign: 30 Years is Enough," begun by a coalition of pro-choice groups to overturn the Hyde Amendment is a start in trying to dismantle the funding structure that supports (or doesn't support) abortion care. There are the many providers-in-training who have been directly affected by feminist health centers and who plan on continuing its legacy of compassionate, culturally competent health care for women. There are also small, collectives of young, third-wave feminists like The Doohickey Project and the Pomegranate Health Collective that refuse to let the concept of feminist health care die. But it's also up to all of us who support reproductive rights advocacy and education with our dollars, our volunteer time and our voices to look to the feminist health centers as deserving of those contributions of money and energy. Beverly Whipple, executive director of Cedar River Clinics incisively defines one of the most valuable elements of feminist health centers when she says, "…it has to do with pride. We have a lot of pride around providing abortion services. Providers like Planned Parenthood are more proud of preventing them. It's a deep difference."