Beyond the Birth Wars

The Grieving Parents by Kathe Kollwitz

Since writing two essays which address the natural childbirth movement (first in 2011, then again last week) I feel a bit as if I've been sucked into the tunnel vision of the Birth Wars. 

Taking a step back, I see it all as a paltry debate among those of us who are lucky enough to have quality and choices when it comes to our health care.

Don't read me wrong; it's clear that there is a whole lot of natural childbirth woo out there that is distinctly anti-science, anti-medical establishment, and anti-feminist. It is clear that lay midwives attending high-risk births in homes instead of hospitals has resulted in the preventable deaths of babies and women. 

It's just that in reading about the broader picture of birth in both America and across the world, I see a much greater concentration of death and harm among the economically disadvantaged, and especially women of color. I feel compelled to check my priorities. It's not that every woman and baby doesn't matter. It's that every woman and baby does matter.    

The Widow II by Kathe Kollwitz

For many pregnant women and their newborn babies, the difference between rich and poor is the difference between life and death. For instance, according to Save the Children's State of the World's Mothers 2013, in Cambodia, babies born to the poorest 20% of parents have a 144% elevated risk of death compared to babies born to the richest 20%. More than a quarter million women die every year because of complications from childbirth.The dead babies (and consequentially the grieving mothers, many of whom must endure their grief without sufficient social or mental health support) number over a million every year. Without question, most of these deaths are preventable, connected to, and exacerbated by the conditions of poverty.   

America's GDP doesn't make Americans immune to the deadly disadvantages of poverty. In 2011 the World Health Organization reported that the USA had a higher newborn mortality rate than 40 other nations. And a 2010 publication by Amnesty International reported about the high rates of maternal deaths and complications associated with pregnancy and birth for American women. 

In addressing these issues, natural childbirth advocates cry out about overused medical interventions and unnecessary c-sections. But it seems apparent to me that the problems for women and babies at higher risk begin long before a woman becomes pregnant. Food insecurity, poor nutrition, unsafe and/or highly stressful living conditions, and inconsistent access to preventative health care set women up with issues such as high blood pressure, diabetes, and obesity, all of which can easily lead to complications in pregnancy, which then may very well require all those interventions and c-sections. 

Then there's the elephant in the room that nobody wants to talk about, and often if anyone does, they are shut down: racism. Race is the strongest predictor of outcomes for birth in America (with black women and babies suffering the worst outcomes), and yet when these huge disparities are reported and discussed, the focus tends to stick exclusively to economic disadvantages and ignore the *gasp* possibility that black women are treated differently by doctors, nurses, and other health care workers (not to mention employers, teachers, social workers, or anyone else they encounter and who might impact their lives.) But is it so hard to imagine that pervasive and damning stereotypes of pregnant black women, especially poor, young, pregnant black women, could have at least a subtle impact on the way they are handled and advised by medical professionals during prenatal care, birth, and postpardum care? 

Authors of the 2010 article Closing the Black-White Gap in Birth Outcomes: A Life-Course Approach, outline a 12 point plan which includes suggestions which seem indirectly connected to pregnancy and birth, such as "Invest in community building and urban renewal", and "Reduce poverty among African American families." People who enjoy strong communities and financial security often take their huge benefits for granted and fail to see how they dramatically impact a person's overall health, behavior, and choices. 

Of course the broad suggestions in this 12 point plan need to be refined into specific programs, many uniquely tailored for particular communities, but the overall point is sound. 

The issues that result in dead or injured women and babies at birth can't be solved by either warm and fuzzy homebirth midwives or even a well-trained OB with a scalpel. The physical, emotional, and social needs of impoverished women not being met are far too great. 

Harming Young Mothers with Stereotypes

Hypothetically, imagine a single woman who becomes unexpectedly pregnant. 

The father is a man she has been dating, but not for long, and she can't tell yet if they're suited for marriage. He has a job, but lives paycheck to paycheck. He sometimes mentions more lucrative career aspirations, but she doesn't know him well enough to know how serious and capable he is to achieve them. 

She has a full time job, but also lives paycheck to paycheck, so she's also attending college part time, and aspires toward a degree that will help her get a job that pays better. 

She decides to keep the baby. Not because of any moral or religious pressure - she is politically pro-choice. She knows being a mother will introduce many challenges, and that she will need to depend on family, friends, and possibly social services for assistance. But she has family and friends, there are programs for food, medical care, and early childhood education (WIC, SNAP, CHIP, Medicaid, and Head Start) if she needs them. Most importantly, now that the potential for a child of her own is growing inside her, she feels strongly that she is ready to be a mother. 

This hypothetical includes a lot of information about the mother-to-be. One thing it doesn't include is her age. Assuming that every other factor remains the same, what different challenges will she face if she is 20, 30, or 40? 

Another detail left out is how her family and friends react to her decision. If this were your friend or relative, would her age make a big difference in your response? Would you be more supportive and less likely to try to talk her out of keeping the baby based purely on her age? 

Over the years, I've slowly realized that I've picked up unfairly prejudicial attitudes toward young mothers (think between 18-25 years old.) These attitudes include that young mothers are short-changing themselves in terms of earning potential, career development, and long-term personal fulfillment. That they are, in their immaturity, acting on foolish and romantic notions, not considering the full ramifications of their choices, and likely to have regrets. 

Such attitudes about young mothers are common among middle class, educated liberals (such as myself.) We rationalize our prejudices two ways: first with statistics, and second as a way to position ourselves in opposition to religious conservatives. 

Statistics

The evidence firmly reveals that young mothers across the spectrum are at an economic disadvantage. But why are younger mothers so disadvantaged? 

Stephanie Coontz points out that all mothers have decreased earning potential. 

Much of the progress that women have made in income parity has gone to childless women. Motherhood, writes the sociologist Joya Misra, is now a greater predictor of wage inequality than gender in the United States. According to her research, conducted with Michelle Budig at the University of Massachusetts, Amherst, motherhood imposes about twice the earning penalty in the United States compared with what women face in countries that have expansive publicly financed child care systems.

Coontz goes on to cite evidence that mothers are discriminated against by employers when it comes to hiring, hours, and promotions. This means that women who choose to have their first child young start out their careers facing discrimination. 

The problem is a system failing mothers, especially young mothers, not of women messing up the timing. 

Advising young women to put off those aspirations toward motherhood - regardless of what they want - because they will face discrimination is like advising a woman not to go into a career field known for its sexism. When we advise people to give up perfectly valid aspirations because we fear the system will treat them unfairly, we are supporting that status quo instead of demanding that it  change to fit peoples' needs. 

Opposing Religious Conservatives

Young motherhood is often associated with anti-feminist, religious values; the Bible instructing women to obey their husbands, the Quiverfull movement, high divorce rates among young couples in the Bible Belt, and even child brides forced into marriage. 

All of that is scary, harmful, and needs to be firmly countered by modern humanist values. But what does the Religious Right have to do with a single, young, and independent woman who happens to have an unplanned pregnancy and wants to raise the child? What does the Religious Right have to do with recently graduated high school sweethearts who are ready to get married and begin their family? 

I often hear people say that women should wait so that they can finish their education. But 43% of Americans obtain no formal education beyond high school, and only 30% will get a Bachelor's Degree or higher. (source.) A majority of jobs are done by workers without any higher education, including occupations in management, administration, and sales. 

Again, the problem is the economy, not religion. It is that most young, full-time working Americans cannot earn enough to even modestly support a family. This sinks so many single mothers into poverty, and puts tremendous strain and hardship onto young married couples with children. 

Stereotypes Hurt

Prejudiced attitudes from liberals against young women who choose motherhood adds shame to the list of challenges they must face. 

According to a survey reported on Parenting.com, young mothers often do feel that they are being shamed for their decision. 

Thirty-six percent of younger moms (and a whopping 54 percent of moms 24 years old or younger) say that an older mom has tried to make them feel like they're too immature or inexperienced to care for a baby.
...
13 percent of the younger ones cite "the disapproval of others" as one of the main drawbacks to having kids when they did. 

The Stacked Deck 

Wage stagnation prevents too many single mothers (of any age) from being able to support themselves, and prevents too many husbands (especially the young ones) from being able to support their stay-at-home-wives and children. One need only look at stats on household income to see that most working Americans are being asked to do more with less. Liberals giving all young women the impression that having a kid young leads to poverty is just as bad as conservatives telling women they just need to find a good husband to depend on. 

The reality is that many young women, both married and unmarried, are ready for motherhood. It's not their fault that the deck is stacked against them. The deck is stacked against a lot of people in our society, some because of their race, ethnicity, or socioeconomic background, and some because of perfectly legitimate, personal decisions, such as to start a small business, become an artist, or raise children. 

If we as a society decided that the hardships of the poor and working class - food insecurity, inadequate health care, unsafe neighborhoods, under-performing public schools, un-affordable day care - were unacceptable, if we were to prioritize alleviating those hardships, then all people would be free to make the educational, career, and family choices that best suit them, without fear, and without shame. 

Day Care Should Be Free

In honor of Labor Day, I've decided to write about an issue that has bothered me since the birth of my daughter two years ago. Although it should have bothered me long before that. The only reason it didn't is because, until I had my own child, it never occurred to me.

We should have free, public day care in the United States. Just as we have public schools and public libraries, the services of firefighters and police, day care should be free to the public and funded by tax dollars. And we should have this because it is fair and in the interest of not only parents, but our society at large.

Consider these facts:

According to the National Association of Child Care Resource and Referral Agencies, the average cost of day care for a single child over one year is $11,666.

According to the 2008 Census, average household income is around $52,000. Single custodial parents (who care for 26% of America's children) are obviously earning less than that, although the majority of them still do not qualify for or take advantage of social services such as food stamps, rent subsidy, or Medicaid.

According to analysis of 2008 data by Emmanual Saez at the University of California-Berkley, the bottom 90% of American household's average income is just over $31,000.

According to the Bureau of Labor Statistics, child care workers average around $20,000 annually, with the highest paid still barely reaching $30,000. (So basically, those workers - mostly women - can't afford to send even one of their own kids to the very facility they work at caring for other peoples' kids.)

As of 2006 the average full time Walmart employee (working about 34 hours per week at just over $10. per hour) earns $17,874 per year.

The typical working parents of young children are just barely getting by financially, many in the gap where they aren't quite poor enough to qualify for aid, but also aren't earning enough to save for emergencies, retirement, or their children's college funds, much less for well-deserved and psychologically-needed vacations. They are literally on the edge of poverty, and face rapidly rising costs of medical care and insurance, food, gas, and higher education, while wages stagnate.

Obviously huge numbers of Americans simply can't afford professional child care. Even the crappy little one-room day cares loaded with crying infants, where the TV is blaring all day long, and exhausted caretakers are overworked and underpaid are too expensive for most American households. A single mother working a job making $30,000 a year simply cannot afford full time professional day care, but she must work in order to provide housing, food, and medical insurance for her family. So who exactly is taking care of the kids?

Retired and unemployed relatives and friends is one answer. And is that a good solution? I question the quality of care children receive by people who might be alone with them for 40+ hours a week, and whose only qualification may be that they happen to be around and have been pressured into it by a sense of family or friendly obligation. I also question how fair it is to older relatives, usually grandparents, who may not be in the best health, and after earning their retirement now have to go back to work full time doing the highly stressful job of caring for babies and toddlers.  

Then there are the parents who sacrifice earnings and career to care for kids. Many highly educated, productive working mothers (and some fathers) are leaving their careers or at least cutting back heavily on work to raise children, and then finding themselves at a huge disadvantage when they return to their career. Women are especially at a disadvantage if their marriage ends in divorce. Society is losing out on the benefits of these peoples' work.

There is obviously a problem here.

But if I bring this issue up to my middle class, liberal friends, they mostly just sort of shrug their shoulders and say something like, "Well, yeah, it probably should be made a little more affordable for some people."

Bullshit, I say. This is outrageous! The cost of just about everything is outpacing wages too quickly. Children are not a luxury or accessory. They are members of our society who need to be cared for until they mature, and we as a society have a responsibility to them and to the parents and guardians who raise them. Day care should be a free, public service. And it should be as simple and easy as enrolling a kid in public school.

Happy Labor Day, folks.