7

The Choice Is Ours!

Sitting in the crowd at nosebleed level in the Wells Fargo Center in Philadelphia for the Democratic National Convention in 2016, high above the speakers, the roar of the standing-room-only crowd washed over me as I took it all in, the words, the ideas, the inspiration, the hope. A woman in a bright red dress walked onto the stage, waving to the massive crowd in the arena with her arm raised high over her head.

Then, Ilyse Hogue made history by saying what no woman had ever said on a national convention stage. Ilyse, the president of NARAL Pro-Choice America, stepped up to the mic and said, “I wanted a family, but it was the wrong time.” She explained a decision that she made years ago, while she was in graduate school.¹ “I made the decision that was best for me—to have an abortion, and get compassionate care at a clinic in my own community.” The crowd was riveted. Abortion stories are rarely shared in public.

“Now, years later, my husband and I are parents to two incredible children,” Ilyse continued. “And I’m not alone.” One in three women in our nation has had an abortion by the age of forty-five. “The majority are mothers just trying to take care of the families they already have.”

After covering more facts about abortion and reproductive rights, Ilyse brought down the house with one last comment. “You see, it’s not as simple as bad girls get abortions and good girls have families. We are the same women at different times in our lives—each making decisions that are the best for us. If we want families to succeed, we start by empowering women. Give us accurate information and access to health care. Keep politicians out of our business when we’re not ready to parent, and support us when we are.”

The crowd jumped to their feet in applause, surprised and thankful for Ilyse’s words. You see, despite the fact that a woman’s right to reproductive choice is an issue that the vast majority of people in our nation support (57 percent of Americans are strongly pro-choice)² and that the U.S. Supreme Court’s Roe v. Wade decision in 1973 said this right is protected by nothing less than the Fourteenth Amendment of the U.S. Constitution, a woman’s right to choose has been under continuous assault. Ilyse’s words in 2016 marked the first time a woman had ever openly talked about having an abortion at any nominating convention.³

But it’s not the first time women have talked about abortion. We secretly hug it out. Sit in solidarity. Take each other to appointments and never talk of it again. We’ve been there for one another. We all know in our core that being able to choose if we want children, how many to have, and when to have them is core to our personal freedoms. But because abortion isn’t a subject most people talk about in groups, and because these stories are so rarely shared in public, there are a lot of misconceptions about what’s really going on with women on this issue.

To start, I have yet to meet any person who didn’t take reproductive choice and the responsibility of making that type of choice seriously. It’s not just me who thinks this. The data shows it’s true. In fact, the reasons patients most frequently have the procedure underscores a deep understanding of the economic responsibilities of parenthood. The three most common reasons given for this procedure are a concern for or responsibility to other individuals, the inability to afford raising a child, and the belief that having a baby would significantly interfere with work, school, or care for other dependents.⁴ One mom said, “Twenty months after my first child was born, my birth control failed. I found out that I was accidentally pregnant. I’d just taken a new job to help put food on the table, and we didn’t have the financial or emotional resources for another child at that time. So together, my husband and I decided to terminate the pregnancy.” With the average cost of raising a child from birth to age eighteen now at $200,000 (not including college), she simply couldn’t afford to have another child at that time.⁵ Most women who have an abortion already have children and choose not to have another child for the well-being of their existing family, just like this mother. Access to birth control, family planning, and reproductive health care is a critical part of economic security for women and families.

My Body, My Choice

The right to control and make decisions about our own bodies is fundamental to women’s freedom. Seems simple, right? Logically, “My body, my choice” should be met with “Her body, her choice.” But far too often it’s not. Instead, “My body, my choice” is often met with a resounding wall of “Not really your body, not really your choice.” And, yes this makes steam come out of my ears. My ears that are in my body, by the way. There’s a good reason for this steam: A woman’s right to access birth control, abortion, and reproductive health care has all been increasingly under attack in the past several years.

In 2017, as the Affordable Care Act and Medicaid came under attack, so too did a woman’s right to choose and to reproductive health care. That year we saw our conservative government leadership further limit access to affordable birth control and reproductive health care—as well as reduce funding for programs that help families. These actions are a catch-22 of epic proportions that affect women and children, largely advanced by men in leadership positions who are working hard to move women’s rights back in time. As Cecile Richards, president of Planned Parenthood, has said in Glamour,⁶ “No mother in the world wants her daughter to have fewer rights than she did.”

Many conservative politicians also have been part of relentless attacks on Planned Parenthood, one of the main sources of reproductive care in our nation. Over 2 million people would lose access to health care if Planned Parenthood was defunded and their health centers were closed as was proposed. This would be a critical loss to our medical infrastructure. In more than 20 percent of the counties where Planned Parenthood health centers operate, there are no other health care providers who serve the patients who rely on safety net programs like Medicaid. In fact, two-thirds of states report having trouble ensuring enough providers, including ob-gyns, who will take Medicaid as Planned Parenthood does. This is a big deal because millions of women get their birth control from Planned Parenthood, not to mention other services such as 320,000 breast exams and nearly 295,000 Pap tests per year.⁷

Eviscerating funding for reproductive health care as has been proposed at the federal level is a very bad idea. What’s happened in the states that have imposed massive funding cuts for women’s health illustrates what we can expect in the future if we don’t stand up for our rights. For instance, pregnancy-related deaths doubled in Texas after the state stopped reimbursing Planned Parenthood and making other funding cuts to women’s health care services.⁸

This has been no small assault on women’s rights. The Guttmacher Institute found that “As of January 1, 2017, at least half of the states have imposed at least one of five major abortion restrictions: Unnecessary regulations on abortion clinics, mandated counseling designed to dissuade a woman from obtaining an abortion, a mandated waiting period before an abortion, a requirement of parental involvement before a minor obtains an abortion or prohibition on the use of state Medicaid funds to pay for medically necessary abortions.”⁹

As I type these words, 90 percent of all counties in the United States now lack a facility that provides abortions, which accounts for 30 percent of all women of childbearing age without access.¹⁰ While abortion rates are the lowest they’ve ever been, there’s no link between the drop in rates and increased restrictions. Instead, studies show that abortion rates are falling because of increased access to affordable, high-quality birth control, which has happened through the ACA because it made birth control largely free. The Guttmacher Institute shares the details: “Of the 28 states and the District of Columbia that did not have major new restrictions in effect, 10 states had larger-than-average declines [in abortions]. In addition, four of the 22 states with new restrictions actually saw increases in their abortion rates, compared with two states and DC in the group without new restrictions.”¹¹ The facts are solid: If reducing abortions is the goal, then the way to do that is by increasing access to birth control and to reproductive health care for women, not by restricting it. A woman’s right to get reproductive health care and make decisions with her doctor in a facility that can safely provide her the care she needs is essential on more than one level.

It’s also deeply troubling that in areas where abortion is restricted, data shows that there are now more Google searches on how to do abortions on your own. This is a dangerous practice that history has shown costs women their lives. In a 2017 Vox interview, Seth Stephens-Davidowitz, an author and former Google data scientist, stated: “I’m pretty convinced that the United States has a self-induced abortion crisis right now based on the volume of search inquiries. I was blown away by how frequently people are searching for ways to do abortions themselves now. These searches are concentrated in parts of the country where it’s hard to get an abortion and rose substantially when it became harder to get an abortion.”¹² This is flat-out dangerous.

How to Prevent Abortions

Studies show what common sense knows: Access to affordable birth control lowers the abortion rate. After the implementation of the Affordable Care Act in 2010, which covered free birth control without a co-pay, the abortion rate was at a historic low.¹³,¹⁴ Because birth control was seen as a vital part of women’s health care, it was covered by health plans without co-pays or deductibles. But in 2017 President Trump overturned that birth control access rule, undermining this critical policy. This reversal of the free birth control access rule hurts low-income women the most. Low-income women who are among the least likely to be able to afford birth control have the highest abortion rates: 75 percent of abortion patients in 2014 were poor or low-income.¹⁵ So when elected leaders are talking about rolling back access, they’re really talking about rolling access back the most for women who are already dealing with disproportionate levels of discrimination, including wage and opportunity gaps. Unbelievably, the very same conservative leaders who oppose access to reproductive health care and birth control also often oppose policies that open the door for women to be able to work and be self-reliant while having children such as paid family/medical leave, affordable childcare, and health care. This is not okay.

Being able to determine how many children to have and when to have them is a key part of women’s freedom and economic prosperity. Providing the basics for a child requires a lot of money. Just a year of childcare now costs more than college in most states. In fact, in 2010 it cost $226,920¹⁶ on average for a middle-income, two-parent family to raise a child from birth to eighteen years old. That’s not including college. This is the reality that women face today when determining if and when it is the right time to start or expand a family.

Fighting for Generations

Sometimes I’ve had to call my 101-year-old grandma for a reality check—and a pep talk. At 101 my grandma still vividly recalled when anti–birth control activists would protest at her house in the early 1900s. Her mom (my great-grandmother) was working as the president of the Rochester, New York, chapter of Planned Parenthood to increase access to birth control for women. My grandmother remembers small crowds protesting outside their home, with people banging on their front door, hoping my great-grandmother would open it so they could yell at her for educating women about birth control. The protests that my grandmother described happening in the early 1900s aren’t all that different than the anti-choice protests that are happening today.

There are times when I have to remind myself that this assault on birth control and choice is happening now, not in 1917. In those times, my grandmother reminds me, the women who came before us didn’t back down, so neither should we. Today’s generations of women stand on the shoulders of many giants who came before us in this fight, who were able to open doors and who rely on us not only to keep those doors open but also to build entire new houses of freedoms for our daughters.

The truth of the matter is that many Republican leaders and a few Democratic leaders, too, have been—and still are, at the writing of this book—putting forward legislation that limits women’s freedoms. These laws often not only block women’s access to abortion but also regularly fund abstinence-only education (which studies show causes unintended pregnancies to rise),¹⁷ cut access to affordable birth control, halt reproductive health care, and end funding to Planned Parenthood, which today helps limit the number of women who get unintentionally pregnant and thus limits abortions. It simply defies logic that many conservative elected leaders would want to put women’s health and freedoms at risk in this way.

Logic-defying leaps are common in this policy area, and so are myths. For example, some people think the reproductive choice and birth control debates don’t impact that many people. Think again. A full 99 percent of women, including moms, use birth control at some point in their lives.¹⁸ There’s also a ridiculous rumor that women are using abortion as a method of birth control. Not so. Most patients were using a contraceptive method when they got pregnant, most commonly condoms or a hormonal method.¹⁹

Last but not least, let’s set the record straight when it comes to teenagers, who, despite what some ads might claim, don’t seek abortions at high rates. Only 12 percent of abortion patients are teens. Sixty percent are in their twenties, and 25 percent are in their thirties. Further belying the myth of the promiscuous teenage girl, teen pregnancy rates are at historic lows.²⁰ In fact, studies show that more than half of women who get an abortion (59 percent) are already the mother of at least one child.²¹,²²

Finally, as the statistics in this book show, the fight for access to affordable birth control and reproductive choice is not just a bunch of hot air being blasted by politicians with little consequence. Nothing could be further from the truth. Reliable birth control and reproductive choices that permit women to manage how many children we want and when we want them is nothing short of revolutionary—not just for women and mothers, but for our country as a whole. It has helped to narrow the gender pay gap, improved the health of women and their families, and led women toward access to economic and political power. This is no small improvement. According to an article in the American Economic Journal, “Estimates imply that the Pill can account for 10 percent of the convergence of the gender gap in the 1980s and 30 percent in the 1990s.”²³

Ilyse Hogue has said that “The right to access a safe and legal abortion is now a proxy for a portion of our society telling women that we can’t have sovereign rights to our own bodies and lives, without which we can never be equal citizens.… Anytime we see a shift to a more authoritarian culture, women suffer. It’s not surprising because men who buy into that frame know that the best way to control women is through their fertility. Once you have children everything changes. So unless we do it on our own terms, then all of our other rights and freedoms become tenuous. Now is the time to say this is an inalienable right and we can’t afford one other dent in the armor.”

So we need to pay attention. We need to watch for rights being slowly taken away from us over time. And we need to watch closely. It’s similar to the parable of the boiling frog where a frog gets into a pot of cold water and doesn’t realize its body has been slowly warming up until it’s pretty much cooked. That’s what’s happening in regard to access to birth control and reproductive choice. Our freedoms are coming under increasing fire in a big way and at a constant rate. This problem is bigger than any one president and started long ago. The Guttmacher Institute reports: “In the 43 years since the U.S. Supreme Court handed down Roe v. Wade, states have enacted 1,074 abortion restrictions. Of these, 288 (27%) have been enacted just since 2010. This gives the last five years the dubious distinction of accounting for more abortion restrictions than any other single five-year period since Roe.”²⁴

Birth control is and should be a vital part of women’s health care, women’s economic security, and of both women’s and men’s freedom. Birth control is as necessary as any preventative care and, as a result, absolutely should be covered by health plans without co-pays or deductibles, allowing a woman and her doctor—not extremist politicians in Washington, DC—to decide what’s best.

No matter where you stand on the pro- or anti-choice spectrum, access to birth control is a good thing. I want to reiterate that at the beginning of 2017, after the implementation of the Affordable Care Act in 2010, which covered birth control without a co-pay, the abortion rate in our nation was at a historic low.²⁵ Again, it’s common sense: More birth control equals fewer abortions. And the data backs up common sense.²⁶

It’s time to get fired up, to make some calls, to demand access to the full suite of reproductive health care for everyone—and to keep the march going so every single woman in our nation, in every single state, gets to choose what’s best for her, her body, and her life. Access to birth control and reproductive choice was, and still is, revolutionary. We can’t let any of those doors close. Together we won’t only keep doors open, we’ll open whole worlds of freedoms for those who come after us.