Civil Rights in Health
For Nicholas Wright, the 1960's represents the birth of civil rights in health as well as the coming of age of the civil rights movement.
"There was a real concern that poor women in the South had not had access to maternal and child health and family planning services. The issue was how to get these services to people in the Southeast, where there weren't enough doctors. Fortunately, there were tremendous public health nurses in most of the rural counties who ran things in very creative and humanistic ways. I was always tremendously impressed meeting and working with these women."
From 1964 to 1966, Wright was an EIS officer at Grady Memorial Hospital in Atlanta, working in a postpartum family planning clinic
that used specially trained nurses to give informal classes on family planning as an integral part of the postpartum visit. The program was managed out of Emory's obstetrics-gynecology department, which had received a grant in 1962, initially to provide free spermicidal foam and later, a new plastic 'Lippes loop' IUD for mothers who wished to space the births of their children and/or to limit their family size.
"At that time, oral contraceptives were not widely available and they were too expensive," recalls Wright. "There was tremendous demand for the IUD because it was more affordable and convenient. It was hard to keep up with the demand."
From the beginning, Wright's EIS assignment gave him the opportunity to contribute to a growing public health imperative, the provision of family planning within maternal and child health services as well as an integral part of postpartum care. At the same time, he was exposed to the country's struggle with extreme poverty – something Wright had not seen while growing up in Long Island. It was also during this period that, at the age of 28, Wright saw overt racism for the first time, in the form of separate drinking fountains and separate doctor-office entrances and waiting rooms for blacks and whites. Back then, Georgia was a much more rural state, with relatively few doctors to meet the needs of the population, particularly the poor.
Wright remembers one nurse well – Hazel Hutcheson from the Georgia State Health Department – who accompanied him on a road trip to a tiny county south of Macon to train a young doctor in IUD-insertion and clinical gynecology at the public health clinic. "Late in the day, just after we finished training the doctor, and he had left, Ms. Hutcheson and the county public health nurse told me that about 20 more women had suddenly appeared and were waiting hopefully outside the door. Word that family planning services were available got out very quickly in those communities," Wright recalls. "Though these communities were very conservative, the women trusted the public health nurses to advise them correctly on how they could have more control over their fertility."
Although Wright and his colleagues did some early studies on pelvic infection, the overwhelming need was to service Grady's large postpartum population. Wright, with help from several dedicated nurses, volunteer gynecologists, and pediatric resident Bob Hatcher, EIS '66, who later would lead the much expanded, more comprehensive Emory University Family Planning Program, began to meet the exploding demand of women to gain
control of their reproduction.
Grady soon became a model of family planning activities, and the Maternal Child Health division of the Georgia Health Department began to develop family-planning activities in each of the state's 159 counties. Wright visited at least 50 of these public clinics in 1965-66 to train physicians and nurses in clinical family planning skills. Following his EIS service, Wright accepted a position with the Population Council and later served as resident advisor in family planning to the governments of Sri Lanka and Thailand.
Wright was one of the early contributors to what became the CDC Family Planning Activity, originally envisioned by Alexander D. Langmuir, M.D., M.P.H. and carried out by Carl Tyler, EIS '66. Under Tyler's leadership, CDC led the way in domestic epidemiologic research on many family planning issues, and later became active in international family planning and population work. Findings from authoritative research done by EIS officers was useful in Wright's technical assistance activities in Asia and elsewhere.
"We've made tremendous progress in providing well-tested, effective, and safe family planning methods to women and men around the world. Birth rates have declined in countries where almost no one anticipated success in the 1960's," Wright says. "With the right organization and planning, family planning can quickly become the norm, even at relatively low levels of economic development. And simply with better spacing of children and fewer births per woman, there have been significant reductions in maternal, infant, and child death and disease."
Wright, who currently lives in Williamstown, Massachusetts, continues to consult for various international development and human rights organizations, runs an oriental rug business, and hopes to contribute to the pre-med program at Williams College. "In addition to the traditional practice model, pre-med students need to be exposed to some of the new models of practice that are increasingly common. And all of these models will increasingly incorporate large doses of epidemiology and prevention. Fortunately, epidemiology is a good fit in a liberal arts curriculum."
"It's helpful to have a public health view, to understand prevention better, to emphasize prevention as well as treatment," Wright says. "CDC has made prevention respectable doing such high-quality research. It's critical that doctors appreciate this because they see individual people at points where a little advice or counseling can sensitize them to protect themselves from illness later. Prevention belongs to clinicians as surely as it does to public health practitioners. Family planning is part of that story."
