Beyond Stupak: Shocking Fertility Control Provisions in Health Care Reform Legislation

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Beyond Stupak: Shocking Fertility Control Provisions in Health Care Reform Legislation

Dorothy Roberts

The Stupak furor has obscured the shocking fertility and family control provisions in current health care legislation. The House bill actually authorizes a plan to monitor the childbearing decisions and family lives of low-income women.

This article was originally published on and is reprinted here with permission of the authors.  Gwendolyn Mink is co-author with Dorothy Roberts.

While the latest clash over health care reform has focused on
abortion funding, no attention has been paid to shocking fertility
control and family control provisions contained in current health care
legislation.  Many health care reform opponents are up in arms over
imaginary state intervention in medical care.  But the recently passed
House bill actually does authorize state intervention in a plan to monitor the childbearing decisions and family lives of low-income women.  

The House health care bill (H.R. 3962), contains a provision
affecting Medicaid recipients who are pregnant for the first time or
who have a child under two years of age.  Section 1713
allows States to use Medicaid funds for non-medical home visits by
nurses to advance certain goals affecting reproductive decisions and
family life.  The goals include: "increasing birth intervals between
pregnancies," "reducing maternal and child involvement in the criminal
justice system," "increasing economic self-sufficiency," and "reducing
dependence on public assistance." 

These goals of the home visitation program have nothing to do with
providing health care.  Instead, they are based on the false premise
that poor mothers’ childbearing is to blame for social problems.  The
proposed visitation program is eugenicist, deceptive, discriminatory
against low-income women, and utterly inappropriate to the medical work
of nurses.  

Roe has collapsed and Texas is in chaos.

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Under the program envisioned in the House bill, government-sponsored
medical professionals are charged with exhorting fertility control
among poor women, based on the mistaken premise that reproduction among
the poor leads to crime, neglect, low educational attainment, and
dependency.   Yet according to the government’s own statistics,
families receiving welfare have, on average, only 1.8 children; half
the families receiving welfare have only one child, and only one in ten
have more than three children.  

Although the data show that poverty is not correlated with family
size — and that childbearing does not cause poverty —  the U.S. House
of Representatives seeks to tell low-income women who receive medical
assistance how many children to have and when to have them.

The House health care bill codifies some of the worst stereotypes of
low-income mothers, suggesting that bad reproductive choices and
misguided family practices make their families poor.  Similarly, the
provision blames low-income mothers for raising criminals and accuses
them of maintaining unstable and neglectful home lives for their

Black mothers in particular have been subjects of deeply-embedded
stereotypes about sexual and reproductive irresponsibility that have
supported a long legacy of repressive state policies, including
sterilization and coerced birth control.  The mythical “welfare queen,”
portrayed as a black woman who deliberately becomes pregnant to
increase the amount of her monthly check, was propaganda used to
support welfare reform.  Several state legislators even proposed bills
requiring women to use birth control or undergo sterilization as a
condition of receiving welfare benefits.  Immigrant women and other
women of color have suffered similar injustices that devalue their
reproductive decision making, as well as their parental rights and
family practices.   

These statutory devices and impositions should sound familiar to
anyone aware of the 1996 welfare reform law.  It too pivoted on the
idea that regulating poor women’s reproduction would end their need for
welfare. Congress transformed welfare from a system of aid to a system
of behavior modification that attempts to control the sexual, marital,
and childbearing decisions of poor unmarried mothers by placing
conditions on the receipt of state assistance. Section 1713 interprets
literally the language of "pathology" from the welfare debate in its
plan to "cure" the putative effects of poverty by curing poor mothers’
fertility and motherhood.

We applaud the lawmakers who have banded together to take a stand
against inclusion of the Stupak amendment in the final bill. But we
urge them look beyond Stupak – to support a vision of reproductive
justice that extends beyond abortion and respects the childbearing
decisions and mothering of all women.  Health care reform must not only
ensure the right to abortion but also must protect the full spectrum of
women’s reproductive and family rights. Congress can start to promote
the well-being of all women by rejecting eugenicist provisions such as
the home visitation program. Any visiting nurse program in health care
legislation should stick to providing medical care regardless of
economic or social status.  Economically vulnerable women should not be
treated as sitting ducks for social engineers.