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Carole Joffe: The Economic Crisis: A Generation of Reproductive Health "Horror Stories"

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How the economic crisis will impact women's reproductive decisions.
* Cross-posted from

"Each generation has its own favorite brand of horror stories. Its own special set of circumstances that prick its conscience and goad it to action."

These words were written by the historian David Rothman 30 years ago, in an essay called "The State as Parent." Rothman's argument is that Progressives of the early 20th century saw the social ills of that period -- desperate poverty which led to children begging on the streets and widows having to place their children in orphanages, unregulated workplaces that were both unsafe and exploited child laborers -- as issues that cried out for state intervention. But progressives (with a small "p") in the 1970s saw too much state intervention as the problem. The horror stories for the latter were the threat to individuals' and families' autonomy, because of the social policies of confining against their will those who were "different" -- the mentally ill, or the homeless -- or the too quick willingness to transfer children from parental to state custody because of dubious charges of neglect.

Rothman's intriguing formulation leads me to ask myself, At this moment, what are the emblematic "horror stories" demanding action for reproductive justice activists? For the dismal period of the Bush years, the horror stories have been endless, and are well known. The glue that tied all the Bush-era reproductive atrocities together -- from the global "gag rule," to the unqualified ideologues appointed to crucial government positions, to the provision of health care to fetuses but not to the pregnant women carrying these fetuses -- was the commitment to reward the Religious Right fanatics that made up the President's base.

But as we enter a new era, with the end of the Bush presidency coinciding with the worst economic crisis since the Great Depression, I see different types of reproductive horror stories emerging. These stories transcend the abortion divide. They speak squarely to the economic devastation facing Americans across the political spectrum, and how this crisis impacts people's reproductive lives. Three recent items in the news serve as examples.

The first is the story of Starla Darling, a pregnant Ohio woman, who was informed she would soon lose her job and her health insurance. She rushed to a hospital, requested a medication to induce labor, and had an emergency Caesarean section, two days before her health insurance expired. Not only was Darling upset about having a C-section birth -- "I was forced into something I did not want to do" -- her insurance company refused to pay for the birth. Now this unemployed woman, two months behind on her rent, is facing medical bills of more than $17,000.

The second story, from The Wall Street Journal, concerns the increase in women seeking to donate eggs or serve as surrogate mothers, a rise attributed to economic hard times. "Whenever the employment rate is down, we get more calls," said an said a spokeswoman for an agency in Chicago, who reported a 30% rise in calls. "We're even getting men offering up their wives."

One of the most high profile recent cases of women using their eggs and uteruses to cope with economic difficulties came to light in a much-discussed New York Times magazine story of a Times writer who hired a middle-class woman, from a two-earner household, as a surrogate mother. The story revealed that the woman who served as a surrogate was doing so to help pay for her daughter's college tuition. The daughter in turn was contributing to her college costs by selling her eggs.

These stories are particularly striking to me because in each case, the economic crisis is driving women to do things with their bodies that they otherwise would not do (a phenomenon, of course, that always rises in economic hard times). True, some women prefer elective C-sections to vaginal birth, but Starla Darling clearly was not one of them. With egg selling and surrogacy, the motivations are always a little murky -- is it altruism and/or a desire for financial compensation? -- but the current spike in inquiries is making clear that many women are now drawn to this option because of the latter, and that seems the case with the mother-daughter pair mentioned above.

What other kinds of economically driven reproductive horror stories might we expect in the immediate future, as more people are thrown into poverty?

The main lesson for reproductive health scholars of the Great Depression of the 1930s was the dramatically lowered birth rate (in an era in which both contraception and abortion were illegal). We can speculate that the period just ahead will similarly be one in which people will try desperately to limit family size. There will be more demand for both contraception and abortion. There will very likely be a rise in attempts at self-induced abortion, as women find that they can't afford to pay for the procedure, or, depending on where they live, simply can't afford to get to an appropriate facility.

Sadly, some people will miss the opportunity to have the number of children they wish for. Even more sadly, some will likely forego childbearing altogether. A higher proportion of children will be born into families that will not have the resources to adequately take care of them. Incidents of infant and child abandonment, even infanticide, may well rise.

The challenge facing the new Obama presidency with respect to reproductive justice is therefore a complex one: undoing the many limitations on contraception and abortion put in place by the Bush administration and making it possible for the economically distressed to have a full range of reproductive options, including having and raising children. Hopefully, in the early 21st century, we will rediscover what Progressives concluded 100 years ago -- that times of massive economic dislocation call for an activist government which helps people have the family lives they wish for.

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