True Choices: access to safe and legal abortion is the end rather than the beginning of women's childbearing choices

(Originally published in Conscience Magazine)

FOR AN OUTSIDER, US POLITICS around choice seem oddly divorced from reality. At its most reductionist, choice in this country means merely that a pregnant woman can choose to buy herself an abortion. In a slightly more expansive line of argument, the cost and conditions related to the medical procedure are considered as limitations to choice. But rarely does the debate critically examine the other aspect of choice: whether actually having a child is viable, financially and professionally.

To me, this is the crux of the matter. I have never questioned that women are entitled to free and legal abortion as part of a continuum of necessary health care. But I believe it is tragic when women choose to terminate pregnancies they would have continued if society had provided them with the necessary support. But what would that support look like?

In Latin America there is a popular saying: "Every newborn comes to the world with a loaf of bread in their hand." Anyone who has ever looked at the cost of childrearing knows that this is not true. Apart from the basic supplies such as diapers, food and housing, children need care and education. At a minimum, women and children need access to prenatal health care, childbirth facilities with trained staff and infant health care. And there is a time issue too. Women need time off to give birth, and parents need to spend time with their children, to care for them when they are sick and to participate actively in their rearing and education generally.

The United States provides few legal protections for any of these--largely uncontested--needs. There is no law to guarantee paid sick leave or vacation, and as a result half of the US workforce must pay for their own sick days, and 20 percent for their time off for vacation.

There is no law to protect paid maternity leave, and there are no allowances for time off to breastfeed. Federal law affords 12 weeks of unpaid extended sick leave to be used as parental leave, and only for those who are eligible, which excludes about 40 percent of American workers.

There are no general provisions for health care--not even, in most states, for children. Today, some 8.7 million children in the US have no health insurance.

Childcare options are mostly private, at least until the child is four years old, and private infant-care options are limited. "The infant-care shortage in this country is amazing," says Veronica Arrealo, co-chair of the Now Mothers/Caregivers Economic Rights Committee. "As soon as that pregnancy test comes in with two lines, the first call you should be making really is to the infant-care facility, because it is generally about a nine-month wait to get a slot."

Money and time are probably two of the main concerns of those thinking of expanding their families. In most high-income countries, public policies recognize and support that. A 2008 publication from the Institute for Women's Policy Research (IWPR) in Washington, compares legislative frameworks on these issues in high-income countries to the United States, and looks briefly at their impact on key equality indicators. (Ariane Hegewisch and Janet C. Gornick, "Statutory Routes to Workplace Flexibility in Cross-National Perspective," Institute for Women's Policy Research, 2008)

The contrasts are sharp. In all countries examined--Australia, Austria, Belgium, Canada, Denmark, Finland, France, Germany, Greece, Ireland, Italy, Luxembourg, Netherlands, New Zealand, Norway, Portugal, Spain, Sweden, Switzerland, the United Kingdom and the United States--only the United States does not provide for paid parental leave. Most allow the right to a gradual return to work on a part-time basis. Many countries entitle parents to tailor the parental leave to their needs, with options such as taking the leave in one block with an allowance, or working part-time over a longer period; reducing the working day during a set time period or extending the paid leave period into unpaid leave, with job guarantees.

Not surprisingly, parents in these other high-income countries tend to spend more time with their children. Ariane Hegewisch, one of the authors of the IWPR report, notes that the proportion of married couples with children in the United States who work 80 hours a week or more is twice as high as in the next European country. "The question of choice really is a question of whether you have time to combine work with having a family," she says, "which is not really something you have in the United States."

Legislative protections for paid parental leave and part-time options, in fact, have a direct impact on women's choices because they don't force women to "choose" between being a mother and being a professional. The IWPR study shows that women with college degrees in the United States are less likely to have paid employment than women in any of the other 20 surveyed countries, implying at least in part that where more legislative protections are in place, more women get to take advantage of their education in formal employment.

What is perhaps less well-known is that many lower-income countries have much stronger legal protections for paid parental leave and options than the United States. Costa Rican and Salvadoran law, for example, provides for three months leave after an infant is born, at 80 percent and 75 percent pay respectively. Most Latin American countries require employers to allow breastfeeding mothers the time and physical space to nurse their children generally for at least a year after childbirth. And paid vacation and sick leave are protected by law almost everywhere in the region.

Having parental rights protections enshrined in law is no guarantee of time and support. For one thing, the protections are generally linked to continuous, fulltime employment, which has always been more common for men than for women. Perhaps more importantly, more and more workers--men and women alike--find themselves in more precarious situations, in part-time or temporary contracts, or are otherwise excluded from the statutory provisions that might protect their choices.

But in terms of societal understanding and support of parenting, the question is not to what extent legal protections are properly implemented, but rather if they exist at all. Few would contest that time and quality child- and health-care options are necessary for good parenting. The question is who we, as a society, believe should pay for them. It is this societal understanding of parenting responsibilities that is expressed in the law.

In the United States, the main cost of childrearing falls to the individual family or woman, because, in general, Americans think of parenting exclusively as a personal choice whereas European and Latin Americans do not. This fundamental difference in the way people think about children and families is what determines what real choice means.

Paradoxically, it may be precisely the culturally ingrained respect for seemingly free individual choices in the United States, without reference to contextual limitation such as money and time, which has led to a lack of political support for legally sanctioned parenting options. In her book, The Price of Motherhood, former New York Times writer Ann Crittenden exposes the myth of choice as one of the main reasons for the prevailing "hands-off parenting" policies in the United States: "The sidelined ambitions, the compromises mothers live with that their husbands never had to make, all justified on the grounds of women's choice ... It's their choice. No one 'made them do it,' so no one has to do anything about it."

But if you dig a bit deeper, perhaps the real opposition or political discomfort with regard to the provision of childcare and parental work flexibility options in the United States is linked to perceptions of who is seen to benefit from a stronger support network. And this, again, is closely related to how welfare policies and parenting choices are covered in the mainstream media.

Consider the case of Nadya Suleman. Ms. Suleman, already a mother of six children under the age of 7, gave birth to octuplets in January 2009 after in-vitro fertilization. Ms. Suleman's octuplets were the second full set of octuplets to be born alive in the United States and the birth was newsworthy because of that.

What is interesting is that the media coverage about the case, in particular as expressed in opinion pages and editorials, pits choice against choice. For some, Ms. Suleman is seen as epitomizing "good motherhood," making a disinterested choice to continue a multiple pregnancy that could have seriously and permanently damaged her health. For others, her choice is based on individual greed and an alleged desire to leech on society by having children she clearly can't afford to feed, clothe and house without support.

In contrast, the explicit reasoning behind European welfare policies that affect parental choice is rarely individual. Often, there is reference to a broader macroeconomic argument--that all economies need to produce the next generation of workers. At times, this argument is expressed as nationalism or poorly veiled racism: one way to reverse falling birth rates and prevent diversity in the workforce is to promote parenting through tax breaks, work-time flexibility and childcare options.

Interestingly, though, many of the basic parental support policies in Europe such as paid sick leave, paid paternity leave and caps on work hours precede the falling birthrates in the 1990s, and the corresponding concern with population composition and growth. Commentators link the motivation for these policy changes to a European notion of collective responsibility and to industry-wide union organizing that focused on establishing a social floor through permanent legislation instead of, as in the United States, through bilateral contractual obligations that can be and often are renegotiated in times of economic difficulties.

Which brings us back to the overwhelming American focus on individuality, and the resulting limited understanding of parenting as separate from a national interest in the new generation. Women's organizations in the United States have, in fact, long challenged the notion of Americans as naturally individualist. "I struggle with the word 'choice'," says Erin Mahoney, chair of the Women's Liberation Social Wage Committee. "When we emphasize the individual choice of parenting, we take away the fact that we, as women, are doing real work to rebuild society. Every child that's raised in this country is the next mailman, the next nurse. It's not the responsibility of individual women to do that work alone."

There have been times in American history where the national interest has superseded individualism, with direct consequences for the provision of childcare. In the 1930s, the federal government sponsored nursery schools under the Works Progress Administration program, which was expanded to cover daycare as a war-time necessity during World War II. Even now, women employed by the US military enjoy access to legally mandated quality childcare, a provision that, to a large extent, was motivated by a need to maintain trained personnel and prevent turnover in the military in the interest of national security.

Generally, though, in the United States children remain the exclusive concern and responsibility of their parents. And choice remains a codeword for legal but often inaccessible abortion services. Logically, one would therefore expect women in the United States to choose to have smaller families than in Europe. This is not the case. Though the birthrate has been declining in the United States, it remains higher than in most European countries. In fact, Japan and about 20 countries in Central and Eastern Europe are experiencing negative population growth (when we exclude the impact of immigration and emigration).

"The central question is why people continue to have children when it is so hard," muses Ariane Hegewisch. "And conversely, there is no evidence that everyone in Europe has 16 kids, just because they can."

One reason may be that while politics in the United States is traditionally unconcerned with women and equality, children are, at least in political rhetoric, a strong motivator for change. Just recently, the corporate bailouts and economic rescue plan, while seemingly inconsistent with American individualism, have been justified by reference to the next generation.

Perhaps the policies that protect women's choices as mothers would be more palatable to American policymakers and to the public at large if they were articulated as necessary for children. "When you deny support to mothers, you punish the children," says Hegewisch. Veronica Arreola from now agrees: "All of the things we advocate for: childcare, infant care, health care, sick leave, etc. All are things that, when it comes right down to it, are about caring for our children."

In my experience interviewing hundreds of women about their childbearing choices, access to safe and legal abortion is the end rather than the beginning of that choice. Women talk to me about food for their children, time to play and concern with paying for their children's education. They talk about expensive birth control and childcare and about limited healthcare options. They talk about how difficult it is to decide when and if to become a mother. And they talk about abortion as an option where other options have failed. Public policy on choice should reflect all of these essential concerns.