By Iris Wong
No matter what men think, abortion is a fact of life. Women will have them; they always have and always will. Are they going to have good ones or bad ones? Will the good ones be reserved for the rich while poor women have to go to quacks? Why don’t we talk about the real problems instead of phony ones?
– Shirley Chisholm, the first black woman to serve in Congress (New York 12th District) and the first black woman to run for President, in Unbought and Unbossed
Abortion is a part of life. The focus of abortion in political rhetoric, however, has traditionally centered on white, heterosexual women. It is past time to expand the general discourse to other marginalized communities, like people of color and the LGBT community. To do that, we need to move away from the reproductive rights framework towards the more inclusive reproductive justice framework.
Reproductive justice, a term coined in 1994 by African American women after the International Conference on Population and Development in Cairo, is an intersectional framework developed by women of color to describe their complex experiences of reproductive oppression. Loretta Ross, Co-Founder of SisterSong Women of Color Reproductive Justice Collective and co-creator of the term, wrote that reproductive justice “addresses the social reality of inequality; specifically, the inequality of opportunities that we have to control our reproductive destiny.” In other words, this framework acknowledges the fact that reproductive freedom is connected to other aspects of a person’s life. For example, inequalities that affect someone’s economic status like the gender wage gap, workplace discrimination, and homelessness can be as impactful as abortion rights. Ensuring equitable access to bodily autonomy requires deeper considerations of the full range of obstacles, challenges, and threats facing people who can become pregnant.
Given the intersectionality of reproductive justice, it is important for policymakers to understand this framework, too, and bring a comprehensive approach to policy implementation. In any policy debate regarding access to sexual and reproductive health (SRH) services, the engaged parties must have a preliminary understanding that these services cannot be segmented into different components and dispensed through legislation. The relationship between each service has wide-ranging effects on a person’s overall wellbeing, and a responsible policy agenda is one that recognizes the interdependence of the many dimensions of reproductive health. Any other approach puts a person’s reproductive health at risk, in turn harming their overall physical, emotional, and economic wellbeing.
It is important to note that transgender, intersex, nonbinary, and other gender non-conforming people may also need access to SRH services. Inclusive terminology like gender-neutral terms and pronouns like “they,” “them,” and “theirs” will be used as much as possible.
SRH services impact about 64 million people who are in their peak childbearing years (15-44 years old), and abortion is just one of the services they need. The Guttmacher Institute breaks down these 15 specific services into distinct groups: contraception (e.g. counseling, birth control method, etc.), preventative gynecologic services (e.g. Pap smear, pelvic exam, mammogram, etc.), STD/HIV service (i.e. counseling or test), and other (e.g. pregnancy test, prenatal care, abortion etc.). According to Guttmacher, 1 in 4 women will have an abortion in their lifetime. That statistic is often used to justify the focus on abortion in policy debates. However, more than 99% of women have used at least one form of contraception in their lifetime. This high usage rate is consistent across different races, as 89% of black women utilize contraception, while 91% of Hispanic women and 90% of Asian women do the same.
The peak reproductive years for people with uteruses closely overlap with their pursuit of educational and career aspirations. When people have access to all SRH services, they can make choices about their education and career that advance their socioeconomic status. There is not enough room (or time) to fully analyze this correlation between each service and its impact on economic outcomes in this post, so the following paragraphs will focus only on contraception for now.
Contraception provides the ability to plan when and how to have a family, which allows people who can get pregnant to pursue professional degrees, expand their job opportunities, and pave the path to higher earnings throughout their lifetimes. When the FDA approved birth control pills in 1960, it lowered the cost of career investment for people who can become pregnant and increased their labor force participation rates, lifetime earnings, and retirement security. A University of Michigan study showed that those who accessed the pill in the 1960s earned an 8-percent premium on their hourly wages by age 50.
Importantly, the history of the pill is problematic and its initial benefits mainly affected those who are white. Poor Puerto Rican women were used as trial subjects in the 1950s and many in the African American community saw the pill as serving the purpose of “black genocide.” That critique was not wholly unreasonable, as the approval for the pill came around the same time that thousands of poor African Americans were forcibly sterilized across the United States. Despite that initial fear, black women continued to use contraceptives in order to maintain their bodily autonomy and leaders like W.E.B. DuBois saw it as a way to topple oppressive social structures.
Without access to contraception, people who can become pregnant are at a higher risk of unintended pregnancies, which may lead to the lowering of educational and career aspirations that can threaten their economic security. Barriers to contraception access include, but are not limited to, lack of insurance coverage, out-of-pocket costs when insurance doesn’t cover contraception, and historical institutional mistrust of healthcare establishment for communities of color. The Affordable Care Act (ACA) requires health insurance to cover 18 contraceptive methods — including counseling — without out-of-pocket costs. But since women make up 64% of all part-time workers in 2017, they are more likely to work in jobs that do not offer health insurance as part of the employer mandate under the ACA. To make things worse, the Supreme Court ruled in Burwell v. Hobby Lobby Stores in 2014 that for-profit companies can deny health coverage of contraception based on the religious objections of the company’s owners. Understanding how the labor market and the justice system can obliquely influence access to contraception is especially relevant in the reproductive justice framework.
Without coverage, people who need these services have to pay the full price themselves. Total potential costs can sum to $800 per year for birth control pills, $1,000 every three years for an intrauterine device, and $6,000 for surgical sterilization. For about 15.5 million people who are in their peak reproductive years and live below 250% of the federal poverty level ($30,150 for a 1-person household in 2017), these high out-of-pocket costs effectively make them unobtainable, especially for women of color who earn less than white women.
The focus on contraception here does not mean it is unimportant to consider the implications of access to other SRH services. Lack of access to contraception increases the risk of unintended pregnancies — which is a leading cause for abortion — and the need for prenatal care if the pregnancy is carried out. SRH services also relate to resources that support parents to raise their children in safe, healthy environments like lactation accommodations in the workplace, paid family leave, and affordable childcare. All of these services and programs fit into the reproductive justice framework of allowing people to control their bodies and decide if, when, and how to be a parent.
Iris Wong is a Master of Public Policy candidate at the Goldman School of Public Policy with a focus on gender policies.