The Economic Crisis: A Generation of Reproductive Health “Horror Stories”

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The Economic Crisis: A Generation of Reproductive Health “Horror Stories”

Carole Joffe

From surrogacy and egg donation to inducing labor, the economic crisis is driving women to do things with their bodies that they otherwise would not do.

generation has its own favorite brand of horror stories.  Its own
special set of circumstances that prick its conscience and goad it to

These words were written by
the historian David Rothman 30 years ago, in an essay called "The
State as Parent." Rothman’s argument is that  Progressives
of the early 20th century saw the social ills of that period — desperate
poverty which led to children begging on the streets and widows having
to place their children in orphanages, unregulated workplaces that were
both unsafe and exploited child laborers — as  issues that
cried out for state intervention. But progressives (with a small "p") 
in the 1970s saw too much state intervention as the problem. The horror stories for the latter were the threat to individuals’
and families’  autonomy, because of the social policies
of confining against their will those who were "different" — the
mentally ill, or the homeless — or the too quick willingness to transfer
children from parental to state custody because of dubious charges of

Rothman’s intriguing formulation leads me to ask myself, At this moment,
what are the emblematic  "horror stories" demanding action for  reproductive justice activists?  For the dismal period
of the Bush years,  the horror stories have been endless, and are well known. The glue that tied all the Bush-era reproductive
atrocities together — from the global "gag rule," to the unqualified ideologues appointed to crucial government positions, to
the provision of health care to fetuses but not to the pregnant
women carrying these fetuses — was the commitment to reward the Religious
Right fanatics that made up the President’s base.

as we enter a new era, with the end of the Bush presidency coinciding
with the worst economic crisis since the Great Depression,  I see different types of reproductive horror stories emerging. These stories
transcend the abortion divide. They speak squarely to the economic devastation
facing Americans across the political spectrum, and how this crisis
impacts people’s reproductive lives.  Three recent items
in the news serve as examples.

Sex. Abortion. Parenthood. Power.

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The first is the story of Starla
, a pregnant Ohio woman, who was informed she would soon
lose her job and her health insurance.  She rushed to a hospital,
requested a medication to induce labor, and had an emergency
Caesarean section, two days before her health insurance expired.
Not only was Darling upset about having a C-section birth — "I was
forced into something I did not want to do" — her insurance company refused
to pay for the birth.   Now this unemployed woman, two months
behind on her rent, is facing medical bills of more than $17,000.

second story, from the Wall Street Journal, concerns the increase in women seeking to donate eggs or serve as surrogate mothers, a rise
attributed to economic hard times.  "Whenever the employment
rate is down, we get more calls," said an said a spokeswoman for an
agency in Chicago, who reported a 30% rise in calls. "We’re even
getting men offering up their wives."

of the most high profile recent cases of women using their
eggs and uteruses to cope with economic difficulties came to light in
a much-discussed New York Times magazine story of a
writer who hired a middle-class woman, from a two-earner household, as a surrogate mother. The story revealed that the woman who served as a surrogate was doing
so to help pay for her daughter’s college tuition. The daughter in
turn was contributing to her college costs by selling her eggs.

These stories are particularly striking to me because in each case, the
economic crisis is driving women to do things with their
bodies that they otherwise would not do (a phenomenon, of course, that
always rises in economic hard times).  True, some women prefer
elective C-sections to vaginal birth, but Starla Darling clearly
was not one of them.  With egg selling and surrogacy, the motivations
are always a little murky — is it altruism and/or a desire for financial
compensation? — but the current spike in inquiries is making clear
that many women are now drawn to this option because of the latter,
and that seems the case with the mother-daughter pair mentioned above.

other kinds of economically driven reproductive horror stories might
we expect in the immediate future, as more people are thrown into poverty? 

The main lesson for reproductive health scholars of the Great Depression
of the 1930s was the dramatically lowered birth rate (in an era in which
both contraception and abortion were illegal).  We can speculate
that the period just ahead will similarly be one in which people will
try desperately to limit family size.  There will be more demand
for both contraception and abortion. There will very likely be a rise
in attempts at self-induced abortion, as women find that they can’t afford
to pay for the procedure, or, depending on where they live, simply can’t
afford to get to an appropriate facility. 

Sadly, some people will miss the opportunity to have the number of 
children they wish for.  Even more sadly, some will likely forego
childbearing altogether.  A higher proportion of children will
be born into families that will not have the resources to adequately
take care of them. Incidents of infant and child abandonment, even infanticide,
may well rise. 

challenge facing the new Obama presidency with respect to reproductive
justice is therefore a complex one: undoing the many limitations
on contraception and abortion put in place by the Bush administration
making it possible for the economically distressed to
have a full range of reproductive options, including having and raising
children.  Hopefully, in the early 21st century,
we will rediscover what Progressives concluded 100 years ago — that 
times of massive economic dislocation call for an activist government
which helps people have the family lives they wish for.