Can contraception make America better?

Carolyn Moynihan
26 Aug 2011
Reproduced with Permission

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 need."

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?