How Not to Address Teen Pregnancy

This past weekend, New Zealand found itself in the midst of a loud public debate over the case of a  teenager who procured an abortion with the support of her school counselor, without  informing her parents. The parents were angry, and much was said about the ethics, propriety, and legality of the situation.

The main issue was not whether abortion should be legal there (it is) or whether the state may be justified in limiting access (it  does).  The question was whether parents have a right to interfere with (or at least know about) their daughter’s decision.  New Zealand law says they don’t.  In the United States, over 40 state legislatures and the Supreme Court have come to the opposite conclusion.

In the United States, as in New Zealand, the arguments for parental involvement laws include an assertion that they contribute to lower teenage pregnancy and abortion rates, and that they improve family communication.  There is no evidence to support this. The clearest documented impact in the United States of these laws has been an increase in the number of minors traveling outside their home states to get abortions in states that don’t mandate parental involvement or  have less restrictive laws.

Moreover, the American Academy of Pediatrics has noted that parental involvement laws don’t  promote family communication, though  they  increase the risk of harm to the adolescent by delaying access to appropriate medical care.  In fact, most teenagers who seek abortions—in particular younger teens—voluntarily seek their parents’ involvement, regardless the law.  And research has shown that adolescents who are strongly opposed to informing parents for fear of a negative or coercive response tend to predict family reactions accurately.

A stronger argument for parental involvement is that an abortion is a serious medical procedure, and the child should be able to count on her family for support. This is indisputable.  What is under dispute in the recent debate in New Zealand—and what should be under dispute in the United States—is whether these laws help increase that support, or whether they can have the opposite effect.  Just because the US Supreme Court has said that parental involvement laws are constitutional doesn’t mean they are helpful either in preventing pregnancy -- or in helping a young girl who finds herself pregnant.

Many American politicians decry the US teenage pregnancy rate, which is roughly three times the rates in  Germany and France, more than four times  the Netherlands rate, and 50 percent higher than New Zealand’s. 

There are good reasons to seek to prevent teenage pregnancy. First of all, early pregnancy can have adverse physical health consequences.

And having to care for  a child affects access to education, employment, and public life for the young mother—and perhaps for her baby as well. Changes in the mother’s life from an unplanned pregnancy can be surprising and even oppressive. And teenage pregnancies are more often than not unintended.

There are plenty of good answers to what to do about high teenage pregnancy rates. They include ensuring that teenagers both know how to prevent pregnancies (scientifically based sex education) and have access to the means to do so (modern contraception).  There are also more intangible factors, such as positive body image for girls, policies that promote gender equality, and greater openness about sex. Studies have shown that countries that score high on all of these points tend to have lower levels of teenage pregnancy and in many cases abortion.

The United States has a long way to go to ensure access to age-appropriate, comprehensive sex education and modern contraception, and US teens could certainly use support in developing positive notions of their bodies, gender equality, and healthy sexuality.

But rather than investing in these areas, state legislatures are marching forward with more and more legal restrictions on access to information and abortions, including parental notification or consent,  and mandatory waiting periods and sonograms.  These laws are heavy in government intervention and  don’t deter teen pregnancies.   

US legislatures would be better off considering what policies would best protect the rights of the pregnant girl to have the health information and services she needs, to be consulted and heard in matters that concern her, and to have her best interests protected by the state. These questions were raised this weekend in New Zealand.  It is high time they are raised in the United States as well.

Regulating Abortion May Be OK But Not To Avoid Sex-Selection

(Originally posted on the Huffington Post)

Sex-selective abortion raises a multitude of overlapping ethical concerns regarding eugenics, population control, and provider privilege or knowledge. It was also, until recently, an issue we linked mostly to China, Korea, and India. Not anymore. Recent news coverage indicates that the son-preference that has led to sex-selective abortions abroad is alive and well in some ethnic communities within the United States.

This has generated a new discussion about what to do -- indeed, what to think -- about the practice here.

This week, one commentator -- William Saletan -- raised an essential issue in that regard: "Absolutists on both sides need to think carefully. If you're pro-life, how far are you willing to go in regulating abortion? If you're pro-choice, how far are you willing to go in leaving it unregulated?"

Full disclosure: I am a pro-choice European transplant to the United States. I am also a human rights advocate and researcher, and have spoken to dozens of resource-poor women about their reproductive choices. My answer to Mr. Saletan's question is invariably colored by this background and experience. And it falls in two parts.

1. The effect of abortion regulations depends on the context and motivation.

Regulation on abortion, or any other medical procedure for that matter, isn't bad per se. From a human rights perspective, the regulation of medical procedures and interventions is legitimate and indeed often necessary so long as they are based on full respect for the full range of human rights.

In the context of abortion, this, in some cases, has more to do with the context of the regulation than with the regulation itself. Many pro-choice commentators in United States have traditionally criticized the trimester-based regulation on abortion that is the norm in most of Western Europe. Generally, the criticisms are based on the fact that restrictions imposed on access to abortion after the first trimester in those European countries subject female decision-making to medical authority.

I have never had a problem with the European model as such. For one thing, it is, most often, implemented in the context of universal health care, comprehensive sex education, and parental benefits such as leave and childcare support. As a result, women seem to have more control over their parental choices to start with. For another, the social workers and doctors who make up the panels to whom women must apply if they want an abortion in the second or third trimester are generally directed to base their decision on the best interest -- health, life, broadly speaking -- of the woman involved. While there surely is much to criticize about the European model, it is not the fact that regulation exists.

By the same token, the relative lack of blanket bans or federal regulation on abortion in the United States does not mean that abortion access is easy, or, indeed, that woman can decide on their fertility without interference. In fact, studies indicate that the United States rate of unintended pregnancies is higher than the world average, and much higher than that in other industrialized nations.

Moreover, despite the apparent illusion that abortion is unregulated in the United States, it is actually already pretty heavily regulated. Many women and girls face serious legal or financial obstacles to accessing safe abortion services because of burdensome regulations, lack of providers, insufficient funding, or political opposition. Also, US restrictions on abortion, whether at the state or federal level, are not motivated by concern for women, and are often implemented in a context in which lack of access to health care generally and to contraceptives specifically make it even harder for women to control their fertility prior to a crisis pregnancy.

2. Regulating sex-selective abortion by banning it would not eliminate the practice.

In the face of news that the gender balance of certain ethnic groups in the United States is starting to tilt, it is perhaps tempting to hope that banning sex-selective abortions would safeguard the gender balance of future generations. However, the criminalization of abortion for whatever reason has in the past led only to underground and unsafe practices. In fact, the criminalization of sex-selective abortion would put the full burden of righting a fundamental wrong--the devaluing of women's lives--on women.

The fact is that many women who choose to abort a fetus because it is female believe they will face violence, exclusion, or stigma if they don't produce a boy. Some--rightly or wrongly--see the financial burden of raising a girl as detrimental to the survival of the rest of the family, a sentiment that can outlast generations even after an ethnic community has been transplanted to the United States.

The solution to the prevalence of sex-selective abortion is to remove the motivation (emotional or real) behind the procedure by advancing women's human rights and their economic and social equality. Choosing the blunt instrument of criminal law over promoting the value of women's lives and rights will only place further burdens on individual women for something that essentially is a social wrong.

So, in short, I support regulation that serves the purpose of furthering the human rights of women to health, physical integrity, equality, as well as the right to decide when and if to become a mother. I also support regulation that brings down the need for (and number of) abortions.

My experience tells me a blanket prohibition of abortion of any kind -- even if to limit a practice as ethically questionable as sex-selective abortion -- would accomplish neither.

A Timely, and Perfect, Mother's Day Gift

(Originally posted on the Huffington Post)

Leading up to Mother's Day, the commercial world would have us believe that flowers and jewelry are the best gift a mother could receive. Yet most mothers I know (including myself) don't need roses or bracelets.

We need time.

Time to be with our children. Time to care for them when they are sick, or just take them to the doctor for routine check-ups. Time to participate in our children's education as active learning partners, and to be constructive members of Parent Teacher Associations.

Unfortunately, the United States provides few legal protections to enable women--or men--to have this much-needed time with our children. There is no law to guarantee paid sick leave or vacation, and as a result half of U.S. workers must pay for their own sick days, and one out of five lose pay if they take any vacation time. There is no law to require paid maternity leave, and there are no allowances for time off to breast-feed. Federal law provides eligible workers with 12 weeks of unpaid extended sick leave to be used as parental leave, but about 40 percent of workers don't even qualify for that.

In fact, American lawmakers are loathe even to contemplate paid maternity benefits. In 2002 the Senate Foreign Relations Committee voted on whether the United States should ratify the international women's rights treaty (formally called the Convention on the Elimination of All Forms of Discrimination against Women, the CEDAW). The alternative was to remain in the company of Somalia, Iran, Qatar and a few others as one of only 8 countries in the world that refuse to accept its provisions.

At that time the Senate Committee concluded that, yes, the United States should ratify, but only if we can opt out of the commitment to paid maternity leave or other maternity related benefits. An overcrowded fall Senate schedule prevented the treaty
from being considered by the full Senate, and the United States still has not ratified the treaty.

This contrasts sharply with other high-income countries--such as Canada, Denmark, Australia, and Spain, all parties to the treaty--where the law provides for paid parental leave without exception, often with the right to return to work gradually, on a part-time basis. Many high-income countries entitle parents to tailor parental leave to their needs, with options such as taking the leave in one block with a paid 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 other high-income countries tend to spend more time with their children. The percentage of families with two working parents who work 80 hours a week or more is twice as high in the United States as in the closest comparable European country.

What is perhaps less well-known is that many lower income countries have much stronger legal protections for paid parental leave and related issues than the United States. Most Latin American countries require employers to allow breastfeeding mothers the time and physical space to breastfeed for at least a year after childbirth. And paid vacation and sick leave are protected by law in most of the region.

Of course, legal provisions don't necessarily translate into effective protection. Many women in Latin America can't take advantage of their legal rights because they work in undocumented jobs or because they have to work several full-time jobs to make ends meet.

It is, however, noticeable that all the talk about family values in the United States doesn't seem to translate into actual legal protection, and that lawmakers in other countries--rich and poor--seem to have a much better grasp of what it really takes to be a good parent: time and support.

The good news is that our Senators soon get another chance to show they get it. The Obama administration has sent the women's rights treaty for review by various government agencies, and the Senate is likely to consider approving it by fall. When they do, they may look back at the 2002 transcripts and feel tempted to carve out similar exceptions on paid maternity leave and benefits. But when that time comes, the Senate Foreign Relations Committee members should think about Mother's Day and ask themselves: what do mothers need?

Here's a hint: it's not flowers. It's time.

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.

US Women Also Have Human Rights Issues

(Originally posted on the Huffington Post)

On October 10, 2003, after years of abuse at the hands of her former partner, a 35-year-old woman in Hungary decided to seek intervention in a way American women can currently only wish for. The woman, identified as A.T., filed a petition with a United Nations body on women's rights. The body promptly asked her government to prevent further harm while they considered her case. Subsequently, it directed Hungary both to take measures to guarantee her physical and mental health and to ensure protection and justice for all the nation's victims of domestic violence.

The petition, was filed with the UN Committee on the Elimination of Discrimination against Women, known as CEDAW. It diligently analyzed Hungarian law and court proceedings, and concluded that available remedies both in A.T.'s case and in general were too weak, too slow, and too begrudgingly implemented.

Women living in the United States cannot appeal to CEDAW, though, when their rights are inadequately protected by US law. Why? Because the United States still, almost 30 years after it came into force, has not agreed to be bound by the provisions of the Convention on the Elimination of All Forms of Discrimination against Women, which created the committee.

The Convention is a global treatise on women's equality. It reflects the consensus of the international community on what specific protections and actions states must take to ensure equality between men and women. The treaty has been ratified by 185 UN Member States, placing the United States in the dubious company of Iran, Nauru, Palau, Qatar, Somalia, Sudan, and Tonga as the last states that have not ratified it. The convention was signed by President Carter in July 1980, but was not considered by the Senate Foreign Relations Committee till 1990. It was favorably voted out of the Foreign Relations Committee twice: once in 1994 and once in 2002. The convention has been awaiting comments from the Justice Department ever since. Senate rules require the treaty to be taken up in Committee again before it goes to full Senate vote.

Opponents of ratification cite a general opposition to international treaties as infringing upon national sovereignty. But they also contend that the convention includes provisions that are offensive to "American" culture. They contend that ratification would force the United States government to provide abortion on demand, to intrude in family situations and to legalize sex work.

The first argument is sometimes used to oppose the very concept of international human rights. Such arguments maintain that every nation is free to pursue whatever policies it wants, even slavery and apartheid. Such arguments are hard to defend in the context of modern international relations. Perhaps more to the point, the very act of ratifying a treaty, and thereby agreeing to uphold universally recognized standards, is a classic exercise of national sovereignty - a declaration that a nation believes in and will uphold these standards.
With regard to the clash between US culture and the specific provisions of the Convention, the opposition is also wrong:

Abortion. The CEDAW Convention protects a woman's equal right to life and health, and to decide on the number and spacing of her children. The full protection of these rights will in some cases require access to abortion services, and will also require the state to provide such services to some. The United States is already bound by international human rights commitments in this regard through its ratification of the International Covenant on Civil and Political Rights, and through its membership of the Organization of American States. The ratification of the CEDAW Convention would not substantively alter existing obligations.
Intrusion of privacy. The CEDAW Convention requires the nations to end practices based on the idea of the inferiority of either of the sexes. This provision is key, and indeed Human Rights Watch research shows that even the best policies are not effective if they are undermined by existing prejudices. Moreover, US federal law on violence against women, education, and other issues, already includes the need for government oversight of what at some point was seen as private matters.

Sex work. The CEDAW Convention contains a provision requiring states to take all measures "to suppress exploitation of prostitution of women." Human Rights Watch's research on this issue indicates that the criminalization of women involved in sex work tends to expose them to specific types of exploitation--including extortion by police. Various countries have fulfilled this particular CEDAW obligation in many ways, including decriminalizing sex work while clamping down on trafficking, providing health care options for sex workers and investigating police abuse.

Back in Hungary, since A.T.'s case was filed in 2003, the government has both held awareness-raising sessions for police officers about domestic violence and developed a more stringent mandate for police to deal with domestic violence. Moreover, the CEDAW Committee's analysis and recommendations have provided much needed fuel to domestic groups seeking to reform the law. Women in the United States should be able to benefit from this kind of support too. The Obama administration and the US Senate should make ratification of the Convention on the Elimination of All Forms of Discrimination against Women a priority.