Contraception and the Class Divide
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Among the many stunning things I've learned since joining the NARAL board last fall is that roughly half of all pregnancies worldwide are unintended. This isn't a surprising number if we're talking about women in developing countries where access to contraception is poor, or big families remain a cultural priority. It's more sobering, though, when you realize that this same number also applies in the richest nation on earth — even here in Washington State, which is one of the most progressive and innovative states within that nation.
Who gets to choose the timing, spacing, and limits of their families and who is forced to deal with whatever comes has become one of the starkest class divides within American culture. Years of research have made it clear that the vast majority of those unintended pregnancies are happening to women who, by dint of poverty, lack of information, or distance lack access to reliable contraception. Closing that gap begins with understanding who is having those babies, and why; and creating policies that empower them to take control over their reproductive lives.
And that last part is the hard part, because just handing them a pack of pills doesn't begin to address the real problem.
Being middle class in America is, more than anything else, about having a strong belief that you're mostly in control of your own fate. Middle-class values reward planning, diligence, and foresight. We are encouraged to pursue credentials that can take years to get, plan out our careers, save up to buy homes, save up some more for our kids' educations, and plot the growth of our assets toward our own retirements. Middle-class jobs lean toward management and knowledge work that gives us some balance of authority, responsibility, and control: in most situations, we're used to having some say in the outcome. Exercising consistent and prudent control over your life is how you join the middle class, rise through it, and ultimately (so we're told, anyway) transcend it.
It's not a coincidence that the rise of the modern, industrial American middle class a century ago coincided very closely with new contraception technology (the diaphragm) that gave married couples their first real shot at planning the arrival of their children, as well. This was a key moment in the rise of the entire nation, because a kid who's born into a settled family with adults who've already created a home, built stable careers, and have enough emotional and financial capital to take on the burden of their care will probably do very well. All her needs — for food, medical care, education, stimulation, and love — are highly likely to be met, and her chances for a successful life are high. Our 20th-century empire was built on several successive generations of such people. Conversely, a badly-timed pregnancy can disrupt the most careful plans — derail an education, destroy a young couple's small savings, truncate career opportunities, and even take the family off the middle-class track entirely — creating adverse stress on the kid, with repercussions that.
Middle class people understand this intuitively. An unplanned pregnancy is a massive loss of control; and having a baby you're not ready to welcome is a potentially life-altering shock. In a middle-class family, having your teenage daughter turn up pregnant is understood as a catastrophe that threatens her entire future. Contraception and abortion are eagerly accepted because we know that controlling our fertility is the keystone that holds all of our other elaborate life plans in place. It's a load-bearing part of the structure that holds us up in the middle class.
As soon as you step down a notch on the economic ladder, though, all of this changes. Surviving as a member of the working class or the classes under it means, more than anything, accepting with grace the knowledge that you will never be in control of very much that happens in your life. It's all in the hands of fate: whether you have a job, what your working conditions are, how much you're paid, how long you can keep it; whether you can find safe, decent housing, and how long you'll be able to stay there; how far you can get ahead with your savings before the car breaks down and wipes you out. If you're trading your physical labor for money, every day brings the prospect of an injury or illness that puts an end to your productive life. Practically, if you don't feel like you're in control of much, you may not feel much urgency about using contraception reliably; or, even if you do feel it, your life may be too disorganized for you to manage it. A pregnant teenager in this class doesn't have much of a future to look forward to anyway, so how can a baby do anything but bring a little happiness into it?
The fatalism engendered by this settles into families, becoming the most intractable part of the cycle of poverty — a learned helplessness that doesn't expect much, and gets passed down through the generations. Researchers exploring attitudes toward contraception call this attitude "what happens, happens." At best, babies just come when they come, and we'll all just scoot over to make room for them. At this economic level, the social capital provided by your network of family and friends is the surest form of wealth you have, so why not expand the circle by one more? At worst — often, with a boost from authoritarian religion that overtly encourages this kind of passivity in the name of "God's will" — any attempt to take positive control over your fertility (and thus, your future) comes to be seen as an outright sin.
This is why, even though Obamacare has now made even the most expensive and reliable forms of contraception available to underclass women throughout the country, the rate of unintended pregnancy might not fall in the years ahead nearly as far as we'd like to hope. Future posts will explore the issues of access (which remain very real), changing technology, political opposition, and other factors that conspire to keep this number high. But if we want to get to a world where every baby is planned and welcomed and loved as it deserves to be, we need to begin by realizing that the problem exists across a wide class divide — one in which both sides are understanding the issue very differently.
To the middle-class policy makers promoting policies that increase access to a full range of reproductive care, it seems obvious to assume that if you build the infrastructure to ensure universal access, they will come. Who wouldn't want to take this foundational step in getting control over their future, especially if they were living in precarious straits? But to the people they're creating these policies to help, another baby doesn't significantly change their prospects one way or the other — it was dismal before, and now it's just as dismal with one more of us to shoulder the burden.
Here, as happens so often in politics, to understand what's possible, you have to begin by understanding how people reckon their own futures. Assuming that they will respond to a policy or value a resource the way you would is how do-gooders get their bad name. There's very little question that society does better when more babies are planned for and wanted. But there are a lot of reasons — some spurious, some actually quite reasonable — why the people having those babies may not agree with our assessment of their situation.