Chisko sighed and looked at Gordy, Merchant, and Blakely, shaking her head and smiling. “She needed help parenting and she needed money. The adoption agency billed her thousands of dollars when she pulled out. Volunteers made it work. An attorney friend of ours made the bill go away. When this woman spoke at our twenty-fifth-anniversary dinner, she thanked us. ‘You taught me how to trust,’ she said.”
Chisko’s voice cracked and her eyes were wet.
Gordy continued for her, “At first, we tried to serve our clients by finding them jobs and housing. But our clients weren’t always well received.”
“There were some angel donors for Rose Home,” Chisko said, gesturing around the room, which could comfortably have held another three dining tables.
“We opened Rose Home in 1986,” she continued. “We’ve had a woman stop in at thirty-five weeks’ gestation. Terrified of the health-care system. A twelve-year-old girl in foster care was gang-raped. She was being pushed by the state to have an abortion. She didn’t want it, so I helped arrange to take her into federal jurisdiction, where a federal judge gave Birth Choice custody of her. We brought her home and eventually we helped her get money so she could be reunited with her mom and move to a safer neighborhood.”
The story rang a bell. It had gotten a lot of national press. I remember cringing at the thought of how a twelve-year-old rape victim had been manipulated into carrying to term. I didn’t share this memory with the women.
Only later did I wonder why I was so sure this twelve-year-old girl I didn’t know would have been better off having an abortion than carrying to term.
Roberts described how Rose Home chooses its residents:
We see three hundred to four hundred women a month here at Birth Choice, plus another hundred or so at the north-side clinic. We do blood workups, check blood pressure and weight. We help the women get covered by Sooner Care and make prenatal referrals to St. Anthony’s. If they’re ineligible for insurance, we provide their prenatal care.
Some of our clients are struggling with domestic violence, or they’re couch surfing or living out of a car. We screen for these issues and offer housing to those who truly have no place else to go. We can’t accept severely mentally ill clients, which is a real problem. There’s nowhere to send these women. They have to be violent before they qualify for housing in a state group home. But we can’t handle them at Rose Home.
Because many of the women are fleeing violent relationships, the shelter’s location is undisclosed. They can bring their children with them, so long as they are under age five.
The residents almost always qualify for public assistance, which helps with funding. In weekly meetings with their caseworkers, the women articulate goals and plan their futures. They receive mental health counseling, drug abuse treatment, and vocational training. They get help making court dates, as many have open cases for abuse and neglect. There are quarterly meetings and ongoing support services even after they leave Rose Home.
“How many women live in Rose Home?” I asked.
“We can house five women at a time. And up to thirteen children,” Roberts answered.
“Doesn’t it break your heart, having to turn away so many needy women?” I asked no one in particular.
“It’s cheaper to have an abortion than to have a baby,” Merchant said.
“There’s no doubt that the bottom line encourages abortion,” Chisko added. “Even though there aren’t enough young people to pay for older people. Dr. Wilke’s Handbook on Abortion spotted this issue, as did Paul Marx’s The Death Peddlers,” Chisko continued. “And it’s true. The majority of our clients need food and clothes. But they’re not at Birth Choice for resources. They come because we help them feel worthy, cared for, and trusted.”
The rhetoric was new to me. I hadn’t thought about the way the high costs of raising a child are an incentive for abortion. It’s so obviously true.
Don’t get me wrong—the long interview wasn’t entirely a “kumbaya” moment, as we say in my family. Some of the things said left me stunned in disbelief. Like when Merchant said, “So many of our ills—violence in the world, weather phenomena, Obamacare—are all tied to abortion.”
When I asked whether they would support a complete ban on abortion, telling them briefly about Beatriz’s case, Chisko answered without hesitation: “I learned early on that if a woman is healthy enough to get pregnant, she’s healthy enough to go to term.” She recalled a woman with a heart condition who’d been advised to terminate. The woman had refused, and according to Chisko, she had her baby and is alive today.
She believed that Beatriz did not need an abortion to survive. Indeed, she sees Beatriz’s survival as proof of her point.
But when it came time to say goodbye, I mostly felt awed by what I’d witnessed there. The women of Birth Choice had aligned their moral compasses with a keen eye to the needs of the most vulnerable women in society. I loved them for it.
“If the law changes,” I asked, “If Roe falls and abortion becomes illegal, will Birth Choice still be here?”
“We’ll be here no matter what,” Chisko answered. “Women are always going to get pregnant and they’re always going to struggle.”
DEFAULT NORMS: THE CONTEXT IN WHICH U.S. WOMEN MAKE ABORTION DECISIONS
One of the most important things I learned from the women at Birth Choice was to view the decision to keep or to end a pregnancy from the perspective of a woman struggling to decide. In order to understand the impact of abortion laws, we must first consider the backdrop against which such decisions take place. That backdrop is easiest to see when one focuses on the experience of the most vulnerable women. The women at Rose Home.
Of course, the backdrop is there for everyone, not just for poor women, and not just in the context of abortion. There are norms and policies that shape and constrain our options in life. The backdrop norms informing decisions about abortion consist of our policies regarding motherhood and parenting. We mostly regard these policies as neutral. But when we see their impact on the most vulnerable women, we understand how one’s circumstances circumscribe the “choices” one actually has.
What Makes a Woman Consider Abortion?
“What makes a woman consider having an abortion?” I asked Samara Azam-Yu, executive director of Access Women’s Health Justice in Oakland, California.
“Women have been making hard choices forever,” she answered. She works with the poorest women in the state, helping them arrange travel from small towns throughout northern and central California to San Francisco in order terminate unwanted pregnancies.
There are people who spend their life savings, travel hundreds of miles to get procedures, and then don’t even have the money to get home. California has the highest poverty rate in the US. The economy crashed in 2008, and years later, the people I serve are running on fumes. Abortion is not really a “choice” for the women who call us for help. A baby will push the family deeper into poverty.
After seven years of working with women living on the thin edge of despair, Azam-Yu has almost as little patience for the rhetoric of “choice” as she does for that of “life.” The way she sees it, abortion decisions arise out of desperation.
Azam-Yu said, “There’s a Native American nurse at an abortion clinic in San Francisco who put it this way. She said, ‘If you have twins and it’s a bad year, you have to put one in the badger hole.’”
Until I met both Azam-Yu and the women at Birth Choice, I hadn’t realized the extent to which, by thinking and talking about abortion in hypothetical terms—the rape victim, the unwed teenager, the fetus with Down syndrome—we distort reality. We erase the complex network of factors underlying a woman’s decision to end her pregnancy.
A woman faces the surprise of an unplanned pregnancy as if on the tracks, with a locomotive barreling toward her. The only variation lies in how many other trains are coming at her from other directions.
Azam-Yu and the Birth Choice founders see the most vul
nerable women in society, the ones who, even before they got pregnant, spent their days trying to avoid incoming trains—housing, food insecurity, abusive relationships, addiction.
Azam-Yu told the story of a client she’d recently helped:
One woman came by bus from Arcata, in the far north of the state. She found someone to watch her kids for two days. Access Women’s Health Justice paid for the six-hour bus ride to San Francisco. Found her a place to stay the night. One of our volunteers drove her to the UCSF clinic. She got there, and was meeting with the pre-abortion counselor. After around half an hour she said, “I’m so sorry. I’ve changed my mind. Now that I’ve had time to think about it . . .”
Azam-Yu’s work with Access Women’s Health Justice has one approach to helping poor women resolve unplanned pregnancies. Birth Choice has another. Their clients are one and the same, though. So many things weigh on these women as they confront their pregnancies that it’s hard to know how best to help them.
“There’s so much chaos in our clients’ lives,” Azam-Yu said, after telling me about the woman who’d changed her mind about having an abortion, “that choices aren’t real until they are actually confronted with them.”
I want us to bear this woman in mind as we consider the way laws and policies set the ground rules and expectations for motherhood. She helps make visible the ways in which our policies about motherhood set the context in which women respond to an unplanned pregnancy.
Motherhood’s Default Norms
Think back to Chisko’s observation that “the bottom line encourages abortion.” She was calling attention to the costs associated with having a child. When asked their reasons for seeking abortion, women make reference to many such costs. Work, school, ability to care for others, and money—each factor is affected by policies; each reflects governmental priorities. Consider an obvious example: there is no paid maternity leave in the United States. And there’s no subsidized day care. Yet the majority of women in the country must work in order to support their households. These policies reflect a position that the costs of caring for children are a private responsibility, rather than a public obligation.
These policies seem neutral. But upon reflection, and certainly from the perspective of the most vulnerable women, we can understand these policies as reflections not only of governmental priorities, but also as factors that influence whether poor women will opt to have children.
In many countries worldwide, including most of Western Europe, governments pay families a monthly allowance for each child they are raising. Day care is affordable, as is health care. Both are government subsidized. Workers are guaranteed several months paid maternity leave. In some countries, mothers receive a year off from work, with pay, after having a baby. These policies are meant to encourage childbearing over abortion by offsetting the costs of having a child. These countries want more children.
Like Western Europe with its child allowances, the United States has a fertility policy. We know how much it costs to have a baby; we know how much it costs to raise a child. And for the most part, we refuse to subsidize that cost.
You might argue that we’re simply remaining neutral, allowing families to make their own private decisions about when and whether to have children. But what is the place from which “neutrality” is measured?
Let me make my point clear by telling you about California’s fertility policy. Like many states, until 2016, California had a “family cap” law as part of its welfare provisions.3 If you have a child within the first year after enrolling, you don’t get any additional support from the state.
Lawmakers around the country from both political parties support family caps as necessary disincentives for women who otherwise might have babies simply to increase their monthly income. Former president Ronald Regan called them “welfare queens,” and for almost forty years, the fear of lazy women having babies in order to live off the social dole has animated our collective imagination. Their choices seem like a form of reproductive blackmail.
Azam-Yu’s organization, Access Women’s Health Justice, waged a ten-year battle against California’s family caps. She recalled one of its former clients, Melissa Ortiz, who testified in a legislative hearing about the impact of the cap on her family. Ortiz was supporting four children on just $516 a month in aid:
When we first had the twins, the only person in my family getting aid was my oldest son. We didn’t have money to buy them car seats to get home [from the hospital]. . . . We didn’t have money to pay for diapers, wipes, shampoos, and toiletries. . . . I had to go to charities, wait in line, and hope that the charities had diapers that day. . . . I am constantly trying to pay just enough to not have [the utilities] shut off. . . . I am trying my best to be a great mom. I do not need to be punished for deciding to have children.4
In an era of bitter partisan animosity, family caps enjoy rare bipartisan support. In spite of the enormous wealth separating the United States from countries like El Salvador, US mothers like Ortiz have to ration their babies’ diapers in much the same way that I witnessed in El Salvador.
Having a baby in the United States is expensive. And the government is comfortable with the high price point.
“No one who’s at all savvy will say they don’t want poor women to have children, because that sounds eugenic,” Azam-Yu said. “But they will say, ‘There’s no money in the budget for that.’”
I don’t mean to suggest that only poor women struggle when confronted with an unplanned pregnancy, or that money is the only factor that shapes a woman’s response. Instead, I have described their struggles because they are so basic that they make it easy to see how policy choices (not to subsidize maternity leave, housing, day care, or even diapers) constrain American women’s mothering choices.
Once we recognize the costs of having children as constraints on motherhood, we can more readily see the context in which all women find themselves when facing an unplanned pregnancy. If we broaden the lens now to include all women, rather than only the poorest women, we can see the ways in which women who are better off have more options. Without a doubt, as we move up the socioeconomic ladder, these backdrop policies have less force. If she has a good job, a place to live, a strong relationship, or family ties, a woman has options, even if the government does not offset the costs of having a child.
A woman whose basic needs are met has time to think about her options. She can consider her best response to the train coming down the tracks. This does not mean that the train ceases to exist, though.
Abortion is not the result of a simple yes/no calculus. Rather, it’s the product of weighing competing costs. On one side of the scale are the costs of motherhood. On the other are the costs associated with abortion—costs that are largely determined by the legal regulations and restrictions on abortion.
REGULATING ABORTION: HOW DO ABORTION LAWS WORK?
In order to understand how the law shapes the cost of abortion, it is important to recognize the significance of both criminal laws and civil laws and regulations. The Supreme Court’s 1973 decision in Roe v. Wade barred states from making it a crime to have an abortion before viability. It left states free to regulate abortion, though, just as they would any other health procedure. And they did.
Abortion Laws as Nudges and Shoves
When the US Supreme Court determined that women had a constitutional right to abortion, and that states could not make abortion a crime, the Supreme Court tipped the balance away from motherhood and toward abortion. Before the decision, abortion was illegal in forty-eight states. After, it was legal in fifty. The law changed the balance; once abortion became legal, it became easier for women to choose abortion over motherhood.
Pro-life lawmakers have been working to tip the balance back ever since.
Behavioral economists talk about the complicated ways laws can influence human behavior, creating incentives or disincentives that cause humans to alter their default course of action.5 Professor Dan Kahan describes how
lawmakers try to shape human behavior by drafting laws that operate as either “gentle nudges” or “hard shoves.”6
As an example, he cites the way the law responded to the alarming findings of the 1964 surgeon general’s report, which for the first time linked smoking to cancer. Rather than banning smoking, which would have generated intense conflict because so many Americans smoked cigarettes, the law proceeded with gentle nudges: first, it included warning labels on packages; then the law banned cigarette advertisements on television. Only decades later, after the norms regarding smoking had shifted, did the law employ a “hard shove” by banning smoking in public areas.7
To understand how abortion laws work, we might see them as ways of nudging or shoving a woman toward or away from abortion. The very first congressional battle over abortion after Roe was decided is a great example of how abortion laws are intended to shift the balance—to nudge the pregnant woman away from abortion and toward motherhood.
Congress passed the Hyde Amendment in 1976, prohibiting the use of federal dollars for abortions, except in cases of rape, incest, or medical necessity.8 The law was important for symbolic reasons: abortion opponents didn’t want their tax dollars to be spent on abortion. But lawmakers also saw in the law an opportunity to tip the balance away from abortion. Here’s how Representative Henry Hyde explained his law’s goals: “I certainly would like to prevent, if I could legally, anybody having an abortion: a rich woman, a middle-class woman or a poor woman. Unfortunately, the only vehicle available is the . . . Medicaid bill.”9
It worked. Researchers later demonstrated the impact of restricting federal funding. They studied abortion rates between 1974 and 1988, examining what happened when the federal government and some states banned taxpayer funding for most abortions. When states denied public funding, they saw a 5 percent decline in abortion rates.10 The impact of denying funding is particularly stark among the poorest women. The study found that, without funding, 22 percent of abortions that would otherwise have occurred did not take place. By refusing to pay for poor women’s abortions, a state can get thousands of women to have babies instead of abortions.
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