Family Planning Isn't a Condom and a Pamphlet

Note: I wrote a slightly different piece under this title on ye olde blogge back in August, but given the emphasis on discussion of contraception going on, I thought it was worth reiterating and mulling over further.

When your specialty as a foster family is taking large sibling groups, you hear a lot of stuff you'd rather not. The typical comment involves forced sterilization, and it is hard sometimes not to have a little sympathy. Of the kids we've taken or been called about, we've had three groups of five and three of four, and almost all have involved very young mothers, sometimes with the stated intention of having more children - and limited capacity to care for them. It brings out the worst in people - this is the stereotype of the "welfare queen" who keeps having babies to get money and services.

It seems to have brought out the worst in Judge Christina Harms of Massachusetts, who recently ordered an abortion and sterilization for a mentally ill woman (her parents were seeking guardianship to enable them to require she have an abortion, but sterilization was Harms' own idea), despite the woman's own claim that she was opposed to abortion. Fortunately, the ruling was overturned - because I don't think any of us want to live in a society where judges can order abortion and sterilization.

Like most people, I look at the mothers and fathers of the children who come to me and wish they could make other choices. It would be hard not to look at the situation of the severely mentally ill parents who have lost four chlidren already, whose next child will be taken from them from the hospital, and who have asserted their desire to have 10 children together as sad and awful and to wish otherwise. They cannot parent - but that doesn't change their desire to give birth, and it is unutterably sad, both for the children who will lose their parents and for the mother and father whose only experience of parenting is of having babies inside of them.

The 21 year old mother of five children, ranging from 6 1/2 to five weeks too is someone I wish other things for - a former foster child herself, never adopted, she was struggling to keep her children fed and to meet their medical needs. It would be so easy to say she should be sterilized, so easy to say that she should be forced onto birth control.

At the same time, however, it frustrates me how rapidly we move from saying that we should help her stop having babies and how infrequently we come to the question of what else these women and men need - how little we care about the rest. We are quick to righteous anger, and slow to indict ourselves - to ask where we were when the circumstances that created our present situation began - and they did have a place of origin, but not in the success or failure to get contraception.

I am protective of these mothers and fathers - they are the beloved parents (because even flawed parents are beloved by their children) of the children in my homes. It appalls and astonishes me that people say in front of the children that they should not have been born, that their parents are bad for making them. I understand it, but I also see in this righteous reproductive rage a shifting of responsiblity that troubles me a great deal.

We are talking, as a society, a great deal about contraceptive access. There is no question that this is something I utterly support - but what we talk about less are the circumstances that make contraception relevant. A number of demographic studies have found that contraception is not the single largest factor in women having the number of children they want to have - and we can see this historically.

The demographic transition in America occurred during years when contraceptive access was almost unavailable - between 1800 and 1930, American women went from having 8.5 children per woman to having less than 3. While infanticide was probably a factor here, it was almost certainly less significant in 1930 than in 1800, and yet women managed to make a shocking shift in the number of children they have.

That does NOT mean I don't think contraception access is incredibly important, or that it shouldn't be paid for by employers, It does mean that contraception is not in the end the most defining factor in terms of reproduction. We can see this in the high rates of childbearing among the most vulnerable populations in the US - the poorest, the least supported people in the US often have the highest rates of childbearing, and while some do lack contraception access and medical care, that's not all that's lacking. If we are to talk about reproduction meaningfully, we need to talk about all the things that enable us to choose our family size.

"Get those women on depo-provera" reveals a lot more about the speaker than it does about good policy. The underlying assumptions we make from a still-comparatively wealthy and secure position don't necessarily reflect poor women (and men's) realities. Indeed, the circumstances of the poorest and most vulnerable women in America (and the poorest and most vulnerable people are almost always women and children) may have much more to do with our future than we think they will. In order to have a future where women have choices about their fertility, we will have to recognize that family planning doesn't begin in the clinic, as important as clinics are - it begins well ahead of that.

Let's think about what needs to happen for women to control their fertility fully, and to make "good choices." - the choices they are judged so harshly upon.

1. They need to have the full ability to give consent - to say "no" and have that "no" respected. That means they must have men in their lives who wholly respect and support women, they must respect themselves enough to believe that their "no" should be honored. They must be safe from domestic violence and sexual violence in the whole of their lives. They must live in a society that supports women, including poor women and young women and women who are labelled negatively for their choices and one that believes in making them safe and helping them achieve consent.

2. The circumstances of women's lives must be such that they do not have to trade sex for food, a place to sleep, basic comfort, safety, food for their children, or other needed supports, because those who depend on sex to get those things cannot say "no" or demand that contraception be used or safe sex be practiced.

3. Women need good access to medical care, both preventative and urgent. They need to not be afraid that doctors will report them to immigration, will criticize their lives or judge their bodies and lifestyles harshly. They need to be able to get medical care when they need it, without fear of losing a job because they took time off. They need to have accessible care in their communities in places they can get to with people who treat them well. They need to not have to walk through protesters and harassers in order to get basic reproductive and sexual health care. They need to have full access to a full range of medical care - including treatment for substance abuse and mental illnesses that cloud judgement.

4. Women need to be educated about risks and benefits, and have a balanced, non-condescending, respectful presentation of information in language they can understand. They need to be able to afford reproductive and sexual medical care, and any devices or treatments they need. They need know how to use these things safely and well. At the same time, the power to control their bodies has to be placed respectfully in their hands - that includes the power of bodily integrity, the power to choose the kinds of medical care they will use, and the ability to make decisions about what they do and do not put in their bodies.

5. As children, girls and boys both need families to love and care for them, and to learn ways of receiving love and care that don't involve giving birth to children. They need to know, as they grow, that some adult will continue to be there for them and that others will provide love and care into adulthood, that they will have a place in the world and don't have to invent that place wholly and alone with whomever they can find.

6. Boys need to be taught to respect women, to respect the integrity of women's bodies, and that fathering is an active verb, not a sexual act. They need to see men who care for and nurture children. and to receive the message that they are fully responsible for their children and their partners. They need to be able to choose love actively, not sex reflexively, and to honor and respect women and men.

7. We must respect the right of women to make choices about their bodies that we would not make. "Choice" does not mean "the requirement to have an abortion when everyone thinks you should" - any more than it means "no right to choose abortion." "Family planning" doesn't mean "give all poor black teenage girls an IUD" it means "allow women to make decisions, and then respect them." That means allowing for people to choose differently than you would, and allowing for errors of judgement. Coercion does not make women freer, and it doesn't enable them to make better choices - fundamentally a society that respects and believes in women doesn't have to approve of every decision women makes, but it must respect their right to make it.

8. In order for men and women to make good choices, society has to model good choices. We cannot take the most vulnerable, poorest, least well-educated people in our society and say to them "you made lousy choices and we will judge you and punish you" - society's choices in regard to its poorest people have not been good either.

When we demand that people take responsibility for themselves, we must remember that someone failed to take responsiblity before - someone failed to adopt the 12 year old girl who eventually became a mother of five. Someone failed to provide funding for the drug clinics that might have helped her get off drugs. Someone taught the fathers and mothers the messages they learned about sex and children. A thousand of us might have stepped up at any time and changed the way this worked - and each of us did not. A whole society, a whole culture might have stepped up and offered more. Those choices deserve judgement too - and they deserve consideration as we enter an era of less wealth and fewer resources. We are, in the end, mostly held responsible for our choices - but who pays the price changes over time. Who will it be next time?

I know very little about the women whose children come to my home, and often what I do know is unbearably sad - that they were 14 year old homeless foster children with babies, that they are struggling with mental illness, poverty, domestic violence, hopelessness. I rarely get to know them well enough so that we can truly see into their lives and often the only help I can offer at that point is to care for their children - care they want to do themselves, but lack the tools for.

I do know this, however, that if want to be able to care for our children in an era of diminishing resources, it will require sustained and conscious choice from all of us. If we want to take care of the most vulnerable in our society, if we want to enable future generations to do better, despite our difficulties, we must provide supports that our society presently does not for many poor women and children. As more of us become poor, as the future of our own sons and daughters is implicated, perhaps we can begin to do better - but we ought to have done better already, and must recognize the consequences of our own bad choices, both collectively and individually.