Forty years ago modern contraception was sold to women as
part of a liberation package: at last they would be in control of their
fertility and their lives. The pill was their passport to fewer children, economic
independence and, as it soon appeared, the kind of sexual freedom that
previously only men had enjoyed.
Already, however, governments had bought the pill
for another reason: as a means of thinning the ranks of the poor. To reduce the
burden of supporting them the United States government, for example, has funded
birth control for those on welfare or near the poverty line ever since 1972.
Today, both agendas are incomplete; if anything, they are
more formidable than ever. Millions of women the world over are raising
children on their own; countless others have endured an abortion, suffered a
sexually transmitted disease, lost their fertility, developed cancer. Birthrates
have plunged — although not as much as desired among the target populations —
but welfare spending continues to grow as states replace fathers and
breadwinners in an increasing number of homes.
To address these problems the American President has
authorised a bold new scheme. From August 1st next year, all contraception and
voluntary sterilisations will be free, sort of. All new health insurance plans
will have to fully fund those things: private insurers will not be able to
demand co-payments from clients who use contraception but must build the cost
into premiums paid by all clients; and the small amounts stumped up by some of
those receiving public assistance through Medicaid will be dropped.
Part of the novelty of the scheme lies in its definition of
contraception as “preventive health care”. Announcing the great leap forward, Health
and Human Services Secretary Kathleen Sebelius put it in a
nutshell: “These historic guidelines are based on science and existing
literature and will help ensure women get the preventive health benefits they
People who disapprove of contraception are understandably
furious at this move, although it has been heralded by at least two decades of
discourse about “sexual and reproductive health” (“birth control” does have a
slightly authoritarian ring to it) and by an even longer lead time for the
“unintended pregnancies” that are supposedly a health issue.
However, it was Nancy Pelosi, one of President Obama’s top
team, who blurted out the real reason for the policy when she was asked two
years ago why the stimulus bill had a whole lot more funding for contraception
in it. “Family planning services reduce costs,” she said. That she meant
welfare rather than health costs — as most Americans immediately understood —
was confirmed when Obama dropped the funding from the bill.
Now it’s back in health drag and as a permanent entitlement,
but who is it actually meant for? Free contraception can hardly make a
difference to the poor, who have had free or cheap contraception and
sterilisation, and cut-price abortion, for 40 years — with nothing much to
show for it other than a massive increase in fatherless families. Adolescents
are certainly a target population, as Bob Laird’s article
shows, but who else?
Surely it has to be the new poor — that part of Middle
America financially undermined by unemployment and, as highlighted in recent
reports, by the decline of marriage. A few decades ago the non-professional
middle class used to marry at much the same rate as college graduates. Today,
44 per cent of births to high school graduates are out of wedlock, compared
with only 6 per cent among college educated mothers. The family culture of middle
Americans is looking more and more like that of the poor.
A family planning doctor writing in
the New York Times in support of the new policy provides a small glimpse of
this hard-pressed class. Vanessa Cullins writes that her daughter, a divorced
mother of three, cannot afford her contraceptive of choice — the IUD —
because her insurance plan (she actually works for a health insurance company)
requires her to make an upfront payment of $1200 towards the cost. So she has
to settle for the contraceptive injection. (The ob-gyn mom evidently is not
earning enough to give her daughter a hand.) In this way, the writer pointed
out — with a seriousness that would be comical were it not so tragic — “health
insurers continue to charge fees that make it difficult, sometimes impossible,
for women to prevent unintended pregnancy.”
How difficult is it for a divorced mother of three to avoid
getting pregnant? Quite difficult, if she has re-entered the post-pill sexual market
(distinct from prostitution). There she is competing with younger women for a new
partner whose price is almost certainly going to be sex — not just at some
future point in the relationship, but from the beginning. Sex, needless to say,
which must involve no chance of pregnancy, or at least, no chance of a live
baby. Marriage? Probably not. Cohabitation? Maybe…
It’s in this market setting, described
by economists, that we confront the failure of the other contraceptive agenda:
liberation. Men in fact still have the upper hand in sex and women find
themselves paying a high price, materially and emotionally, for the
relationship they hope for. And that’s to say nothing of the cost that children
bear. Increasingly for the lower middle class, that relationship is likely to
fall short of marriage, not last, and, if it produces a child, to result in one
parent leaving the home by the time the child is 16.
And that is not all. By entering the market young, today’s
women also run a high risk of some of the pathologies mentioned earlier: abortions
and STDs (screening
for the human papillomavirus is one of the newly funded preventive care
services, along with counselling about STD’s) as well as a significant risk of infertility,
and cancer owing to exposure to artificial hormones over a prolonged period.
All this has been evident for decades among the poor. Yes,
birth rates have come down, but the poor are still with us, health and welfare
budgets have ballooned, more children are growing up without proper families
and homes, and women on average are less
happy than they were four decades ago.
Rather than doing their research among their pals in the
birth control industrial complex (the “science and existing literature”), Drs
Obama, Pelosi and Sibelius should have got out into Middle America and
confronted the damage that contraceptive culture has already done. They should
have interviewed some of the women stalled in uncommitted relationships and
feeling they must risk the birth of a child anyway before it is too late, or
trying a second or third gamble in the sexual market; the women who must be
asking themselves, “Is this all?”
Will a “free” script for the pill or an IUD treatment make them
feel better? Not likely.
Liberation? What liberation?
Carolyn Moynihan is
deputy editor of MercatorNet.