Who Can Afford to Have Kids, Anyway?

Class and Reproductive Justice

By Débora Nunes | November/December 2022

The U.S. Supreme Court’s recent decision regarding people’s uteruses —namely that state legislatures should have full authority over them —was quickly followed by an avalanche of individuals, politicians, and CEOs rightfully arguing that access to a safe abortion is a human right without which women are denied privacy, health, bodily autonomy, and the possibility of a decent life. Large companies promptly announced abortion access for their workers as a new employee perk, and some “blue ” states pledged they would keep their borders open for out-of-state individuals in need of safe abortions. Those urgent measures are certainly important to facilitate abortion access for some women in the short run, but how do they change the relationship between reproductive justice, the state, and for-profit companies over time? The answer to this question is not straightforward. Within economic research and policy circles, feminist economists have been building an understanding of the relationship among individuals, state governments, and corporations and urging us to pay attention. The fact that businesses profit from workers postponing parenthood, so that they have prime access to people ’s most productive years, might create a serious problem for workers who find themselves pregnant and can only rely on their company-provided health care to access an abortion. On the other hand, governments and businesses themselves also need a next generation of healthy workers to guarantee a thriving society, capable of providing for their offspring and for an older, retired generation. But which companies are willing to pay the up-front “cost ” of ensuring a next generation, and which workers do they think are worth the expense?

If we agree that reproductive rights are about allowing people to take control of their own lives and act according to their own purposes, reproductive justice becomes not only an issue of guaranteeing the right to not have kids if someone doesn ’t want to, but also the right to have children if one does so wish, with the ability to socialize them, teach them, care for them, and raise them to the best of their ability. The Supreme Court ’s decision to overturn Roe v. Wade stole the right to decide the best time to reproduce from thousands of women in the United States, but working-class women and ethnic minorities have already had that right stolen through several other channels throughout U.S. history, sometimes very explicitly (for example, through forced sterilization policies and unethical birth control pill testing in Puerto Rico, see sidebars), and often through indirect mechanisms that make raising a kid virtually impossible for lower- and middle-class parents (real wage stagnation, austerity policies that dismantle public education and public care services, lack of health care, and the increasing cost of living, to name just a few such mechanisms). Maybe it ’s worth interrupting the round of applause for big corporations that announced their new abortion access benefits to ask: Can this move by for-profit companies advance the reproductive justice agenda, or will it just end up deepening the distance between upper-class and lower- and middle-class women when it comes to reproductive justice?

The 1956 Puerto Rican Birth Control Trials

By the 1950s, nurse and activist Margaret Sanger, who opened the first birth control clinic in the United States in 1916, decided to contact biologist Gregory Pincus, asking him to develop an effective and cheap birth control pill. Together with obstetrician John Rock, they developed a pill and conducted several successful tests on rabbits and rats, before deciding it was time to start a human clinical trial. The heated debate about contraception in the continental United States—and the restrictive legislation around it in some states—were serious barriers for the research trial, but that was not a problem in Puerto Rico.

Pincus, who visited the island during the summer of 1955, argued that if even the poor and uneducated Puerto Ricans could understand how to take the pill, then any woman in the United States would be able to understand it, too. Pincus ’s very nonscientific (and racist) argument to hold such a large and risky clinical trial called the attention of notorious eugenics supporter Clarence Gamble (see sidebar, “Eugenics in the United States, ”), who agreed to finance the endeavor. Since Puerto Rico was marked by high poverty and fertility rates, the project won the sympathy of medical and research authorities, which gave the trial a green light after seeing the promising nonhuman clinical trials results.

So, in 1956, women living in a recently built government housing project located in one of the poorest areas of Puerto Rico started taking birth control pills that were around 20 times stronger than the ones available today, without receiving any compensation nor information about what they were taking and the possible side effects. They were just told that the medication would prevent pregnancy. The women experienced severe side effects during the trial, including blood clots, depression, and nausea, and three women died.

Pincus and Rock decided to ignore the side effects and never assessed their root causes. They also ignored the deaths—no autopsies were requested by the researchers, and the cause of death was never investigated for any of the women who died. The trial was considered a success, and a similar unsafe and unethical experiment was funded by Gamble in a mental asylum in the United States shortly after the trial in Puerto Rico. In 1957, the pill was finally approved by the Food and Drug Administration for no more than two years at a time, and the pill received approval for unlimited use in 1960. However, some side effects of birth control pills—like depression—are still not fully understood, more than 40 years later. A couple of years ago, a birth control pill for men was found to have excessive side effects and failed the clinical trial; those side effects were very similar to those currently associated with female hormonal contraception.

Sources: Annalisa Merelli, “Vasectomy rates suggest it ’s not likely that men would take a birth control pill, ” Quartz, March 30, 2022 (qz.com); Rane Roste, “1956 Puerto Rican Birth Control Trials, ” YouTube, March 25, 2020 (youtube.com); Erin Blakemore, “The First Birth Control Pill Used Puerto Rican Women as Guinea Pigs, ” HISTORY, March 11, 2019 (history.com); PBS, The American Experience, “The Puerto Rico Pill Trials ” (pbs.org).

Who Had Access to Abortion Before the End of Roe v. Wade?

Even before the Supreme Court overturned Roe v. Wade, whether or not someone had access to a safe abortion was already constrained by their income and place of residence. According to a study conducted by Caitlin Knowles Myers in 2021, when states require two in-person visits for an individual to access abortion instead of only one (the Supreme Court considered this measure a “small cost to impose ” on women, and it was enforced in 26 states as of 2021), second-trimester abortions increase by 19.1%, which means that the procedures are riskier, more expensive, and more likely to cause physical harm (at this point in pregnancy, the fetus ’s mass is too large to be broken up by suction, requiring a more invasive procedure). The two-visit requirement was estimated to reduce abortions by 9% and increase births by 1.5%; that effect is 2.5 times larger for non-Hispanic Black women than for non-Hispanic white women, and the largest increase in births occurs in counties with high poverty and high unemployment rates.

Also, according to Myers, abortion-restrictive laws that end up increasing the travel time to abortion facilities —such as the one approved in Texas in 2013, which closed half of the abortion facilities in that state —are particularly harmful for people of color. An increase in travel distance by up to 100 miles is estimated to reduce abortions by 20.5% and increase births by 2.4%, while the next 100 miles of travel distance (from 100 to 200 miles) is estimated to reduce abortions by an additional 12.7% and increase births by an additional 1.6%. All age and ethnic groups are affected by increased travel distances, but the effects on births are particularly pronounced for young women and non-Hispanic Black women —communities also characterized by being low-income and having limited access to employment benefits. Further, according to a Guttmacher Institute report published in 2019, about 18% of pregnant women sought abortions in 2017: 59% of them had previously given birth, 75% were low income, and 55% reported a recent disruptive life event, including the death of a close friend or family member, losing a job, breaking up with a partner, or falling behind on their rent or mortgage. In this scenario, any abortion-restrictive law tends to disproportionally impact underprivileged women.

The Choice of Not Aborting: Who Can Afford to Raise a Healthy Kid?

If the right to an abortion is constrained by someone ’s income, race/ethnicity, and place of residence, the right to have a healthy, well-educated, and well-fed kid if one so wishes seems to increasingly be a luxury attainable only for upper-class women. During the past 20 years, the percentage of women between 24 and 54 years old who participate in the labor force has been consistently decreasing in the United States, making it the only country in the Organization for Economic Cooperation and Development (OECD) —essentially the rich countries ’ club —experiencing that trend. According to the Current Population Survey, a monthly survey of households conducted by the Census Bureau for the Bureau of Labor Statistics, 60% of those prime-age women who are not working or looking for a job have foresworn paid employment because they are taking care of their home and families. One would expect that, since more women are dropping out of the labor force in the United States, fertility rates should be increasing and should be higher than in other OECD countries, but that ’s not the case: The number of children per woman in the United States decreased in the last two decades, staying below the replacement rate of 2.1 (the rate at which the population would stay constant) since 2009. While the OECD average fluctuated between 1.7 and 1.8 children per woman since 2010, the United States showed a decreasing trend in that indicator for the same period, matching the OECD average in 2018 and staying the same ever since. When compared to Sweden, for example —an OECD country known for its strong legislation to guarantee reproductive justice, such as access to abortions, paid family leave, universal health care, and high minimum wages —the United States simultaneously exhibited lower fertility rates during the past decade (around 0.1 points smaller every year for the period) and a smaller female labor force participation rate (56.1% in the United States versus 61.7% in Sweden, based on 2021 data).

This phenomenon is particularly interesting when we consider the decreasing purchasing power of wage earners over the last decade: The value of the federal minimum wage has decreased 21% since 2009 (when it was last raised) and reached its lowest point in 66 years in 2022, according to an Economic Policy Institute analysis of recently released Consumer Price Index data. This suggests that women are quitting the labor force not because their partners make enough money for the entire family, but because their earnings are so low —and care services are so outrageously expensive —that families are better off decreasing the amount of cash that enters the household and providing full-time, unpaid care themselves.

This hypothesis seems even more likely when looking at the childcare sector in the United States. According to a recent study published by the OECD, the United States has the highest net childcare costs among a panel of 40 middle- and high-income countries. For households with a single parent of two children aged three or younger making 67% of the average national wage, the OECD study estimates that 35% of the household income would be spent on childcare. For countries like Canada, that same statistic is shockingly different: a negative percentage of the household income would be spent on childcare, since the benefits to reduce the childcare fees that parents pay are so high that they actually end up surpassing the cost of the service.

A 2020 report on childcare produced by the Joint Economic Committee chaired by Democratic Rep. Don Bayer states that, before Covid-19, 83% of parents of young children reported that finding quality, affordable childcare was a serious problem. Since 2000, the cost of childcare has increased almost twice as fast as inflation. The average family that uses childcare in the United States spends about one-fourth of their income to pay for it. In some states, a single-earner family making the median income would need to spend more than half of their earnings to care for a single infant. In 30 states and Washington, D.C., the average cost of center-based infant care is more than the average in-state college tuition. Such high out-of-pocket costs for families might be a direct impact of the low government investment in the childcare sector: The U.S. federal government spends less than half as much on childcare as a share of its GDP when compared to the OECD average.

Eugenics in the United States

“Eugenics ” was a term coined by Francis Galton in 1883 to name his ambitious political plan: The government should promote marriages among what he believed were the fittest individuals, and prevent inferior humans (such as people with physical or mental disabilities, no education, poor families, or criminal backgrounds) from reproducing. He believed that traits like intelligence and poverty were genetically hereditary, so selective breeding programs would pave the way to a highly gifted, super-race of humans.

Such ideas soon became popular among scientists and started attracting the attention of prestigious institutions. The first International Eugenics Congress, hosted by the University of London in 1912, was led by Leonard Darwin (Charles Darwin ’s son) and had a list of high-caliber attendees, such as Winston Churchill. With the increasing popularity of the movement in the United States, the second International Eugenics Congress was hosted at the American Museum of Natural History in New York City in 1921, and the museum ’s president, Henry F. Osborn, delivered the opening speech. The speech, which included blatantly racist and nonscientific passages defending “the right of the state to safeguard the character and integrity of the race or races on which its future depends, ” was the featured piece in the journal Science in October of that year.

But scientists were not the only ones seduced by eugenics arguments; politicians and some prominent economists, such as John Maynard Keynes, saw in eugenics ’ ideas the key to reducing welfare rolls and the financial burden associated with them. In 1907, Indiana became the first U.S. state to make forced sterilization mandatory for “criminals, idiots, rapists, and imbeciles in state custody. ” In 1910, Charles Davenport and Harry Laughlin created the Eugenics Record Office in Long Island, New York, which collected data on families ’ pedigrees and promoted eugenics ideas for three decades. Their initiative inspired several other eugenics clubs, which started opening around the country to promote competitions for the “fitter family ” and the “better baby, ” and to work on approving forced sterilization laws for individuals that were considered inferior. By 1931, 30 American states had forced sterilization laws in place, which allowed the forced sterilization of nearly 70,000 people—most of them Black, Latina, and Native American women, despite the significant lower cost of the procedure for men. In North Carolina alone, Clarence Gamble ’s Human Betterment League was so successful in pushing the eugenics agenda that 7,600 people were sterilized against their will; 99% of them were women, and 65% were Black women. Out of the 30 states that adopted forced sterilization laws, North Carolina is the only one so far that eventually provided compensation for the victims.

Such sterilization programs attracted the attention of a famous German eugenics fan: Adolf Hitler. In Mein Kampf, published in 1925, he wrote that “There is today one state in which at least weak beginnings toward a better conception [of citizenship] are noticeable. Of course, it is not our model German Republic, but the United States. ” Hitler ’s Reich deployed its own sterilization laws, nearly identical to those in the United States, within six months of the Nazis taking power in 1933.

Some people claim that the atrocities of Nazi Germany were responsible for making eugenics ideas less popular in the United States in the post-World War II era, but we can still see the influence of eugenics in some contemporary institutions, particularly in prisons and the justice system. In 2009, a 21-year-old woman in West Virginia who was convicted of marijuana possession underwent sterilization as part of her probation. In 2017, a judge in Tennessee offered to reduce the jail sentences for inmates who “volunteered ” to undergo sterilization. In 2018, an Oklahoma woman convicted of cashing a counterfeit check received a reduced sentence after undergoing sterilization at the suggestion of the judge. And in 2020, a nurse at the Irwin County Detention Center in Georgia spoke out against the sterilization surgeries that were being performed on immigrant women by Immigration and Customs Enforcement (ICE) without their full knowledge of what the procedure was.

Sources: Lori Jane Gliha, “Virginia Eugenics, ” 2016 (vimeo.com);Teryn Bouche and Laura Rivard, “America ’s Hidden History: The Eugenics Movement, ” Nature, Sept. 18, 2014 (nature.com); Fresh Air, “The Supreme Court Ruling That Led To 70,000 Forced Sterilizations,” NPR, March 7, 2016 (npr.org); Mark G. Bold, “It ’s time for California to compensate its forced-sterilization victims, ” Los Angeles Times, March 5, 2015 (latimes.com); Sanjana Manjeshwar, “America ’s Forgotten History of Forced Sterilization, ” Berkeley Political Review, Nov. 4, 2020 (bp.berkeley.edu); Steven A. Farber, “U.S. Scientists ’ Role in the Eugenics Movement (1907–1939): A Contemporary Biologist ’s Perspective, ” Zebrafish, Dec. 2008 (ncbi.nlm.nih.gov); José Olivares and John Washington, “ ‘A Silent Pandemic ’: Nurse at ICE Facility Blows the Whistle on Coronavirus Dangers, ” The Intercept, Sept. 14, 2020 (theintercept.com).

Such American exceptionalism when it comes to family protection unfortunately doesn ’t stop with childcare costs; the United States is also the only OECD nation —and one of only six countries in the world —without national paid parental leave. The Family and Medical Leave Act (FMLA), which is the only piece of federal legislation about parental and caretaker leave, only guarantees up to 12 weeks of unpaid leave for individuals who meet three specific criteria: they have worked for the same company during the past year; during this time they have worked at least 1,250 hours; and the company has more than 50 employees. As a result, only 56% of employees in the United States were eligible for unpaid leave through the FMLA according to a 2020 report, and only 38% of low-wage workers were eligible. After the pandemic, those numbers are estimated to be significantly smaller. And, because it is unpaid and most families can ’t afford to take time off from work without pay, the household member with the higher income —typically the man —ends up not taking the unpaid leave, or just using a couple of days off, while women drop out of the labor market altogether or assume a part-time, flexible, or lower-paid position. That helps explain why the gender pay gap is so persistent in the United States: Women made, on average, $0.83 for every $1 earned by men in 2020, and progress with closing the wage gap has stalled over the past 15 years.

Only eight states (plus Washington, D.C.) currently guarantee paid parental leave. Several other states are in the process of introducing paid parental leave —such as Connecticut, in which paid-leave benefits became effective in 2022; Oregon, which will start providing benefits in 2023; and Colorado, where the state ’s paid leave law goes into effect in 2024. The increasing popularity of paid leave when the question is put to voters on the ballot might indicate that the right to have kids is also a reproductive justice issue that has momentum and popular appeal, and, above all, constitutes a human right that is currently heavily limited by one ’s class. According to the U.S. Bureau of Labor statistics, among the poorest 10% of wage earners in the United States, only 6% had paid family leave coverage in 2021, while among the richest 10% of wage earners, 46% had paid family leave during the same year. Firms with many high-wage workers (where at least 35% of employees made $63,000 a year or more, meaning that those workers belonged to the top 25% of income earners in the United States in 2019) are more likely to offer paid family leave than firms with many low-wage workers (where at least 35% of employees made $25,000 a year or less), according to a 2019 Employer Health Benefits Survey from the Kaiser Family Foundation.

The Post-Covid, Post-Roe Era: Not a Promising Picture

If access to reproductive rights was already severely constrained for working-class women during the past two decades, the post-Covid, post-Roe era looks like it will be even worse. Regarding the right to an abortion, Myers estimates that 39% of women between 15 and 44 years old will see an increase in the distance they will have to travel to access an abortion facility in 2023. She also predicts that more than 100,000 women will not be able to access abortion care in 2023, decreasing the number of abortion procedures by 32.8%. Both of these developments will increase undesired pregnancies and unsafe, self-managed abortions, particularly among women of color and residents in poor, high-unemployment communities. To believe that such demand for abortions will be partially remedied by big corporations that offer abortion access as an employee perk seems naive. Considering the data about paid parental leave presented above —and the characteristics of the women who struggled to access a safe abortion even before Roe v. Wade was overturned —it seems that the same working-class women who don ’t have access to good jobs that provide much-needed paid time off during pregnancy and postpartum now won ’t have access to a safe abortion, either.

Alternatively, we can hypothesize that a company might provide abortion access to all employees but might only provide paid parental leave and other benefits associated with the right to have a kid to highly specialized, hard-to-replace workers. Indeed, that seems to be a profit- maximizing strategy, considering the short- and long-term impacts of welcoming a child into a given family —which requires considerable leave time —when compared to the impacts of an abortion, even if it requires travel and time off. The best possible scenario for companies is to have their own employees present and productive, while the next generation of workers is produced elsewhere, so that other firms (or the state) bear the costs. It ’s hard to claim that such an approach, which smacks of eugenics (see sidebar), increases people ’s reproductive rights. One could even allege that when your employer-provided health care benefits include abortion coverage but provide no support or subpar support to carry the pregnancy to term and raise an infant, that high incentive constitutes a form of coercion.

In August of 2020, more than four-fifths of childcare facilities reported that if they didn ’t receive additional public assistance, they expected to permanently close. The small and pricey supply of childcare services forced 13% of parents to reduce hours or quit their jobs in that same year, on average losing a full day of work a week, according to the Joint Economic Committee report mentioned above. Needless to say, the vast majority of those workers are women. Coupled with market pressures against the U.S. government to lower inflation and decrease public investment —after record- breaking federal spending to fight the health and economic impacts of the Covid-19 pandemic —and adding the likely increased birth rate among low-income women, the insufficient and expensive childcare services that we observed pre-Covid will become even more exclusive in a post-Covid, post-Roe era.

Where to Run?

In the current context of decreasing reproductive rights —both in terms of the right to abort an undesired pregnancy and the right to have kids if one so whishes —the importance of an intersectional analysis becomes evident. Despite the difficulty of reconciling a professional career with a family life, for female CEOs reproductive justice is easily attainable. As a top executive, Anne-Marie Slaughter declared in an interview with Fortune magazine, by the time she was 43 years old she had never faced a family issue that she couldn ’t just push through or pay someone to solve for her; however, she claims that by the time she was 53 years old, she decided to turn down her dream job to spend more time with her kid. For working-class women, such a choice is not a reality: the increasing cost of abortion, coupled with the increasing cost of raising healthy and happy children to the best of their ability, puts these women in double jeopardy. For Slaughter and other CEOs, offering benefits for low-paid employees to increase their right to have kids is not a profit-maximizing strategy; for CEOs in general, and particularly for the ones in the health and care services sectors, government-provided care services are a threat to their business. Women from different economic classes have different levels of access and divergent interests when it comes to reproductive justice. If we agree that access to abortion and to the ability to reproduce are human rights, we can ’t just leave it to for-profit companies to decide who can access what and when.

On a positive note, the post-Covid and post-Roe era brought the discussion about the care crisis and reproductive rights to the center stage of public debate. There are efforts at the federal and state level to advance care-providing policies, and the current political environment allows for such historic demands to gain momentum —examples of that include a recent piece in the New York Times featuring the effectiveness of government programs to drastically reduce child poverty in the United States during the past three decades; the approval of President Joe Biden ’s Inflation Reduction Act, which will spend $400 billion on clean energy and health care provisions; and the president ’s $400 billion plan to support families ’ long-term health needs. Instead of applauding corporations ’ decision to now offer abortion access as an employee perk —which tends to fuel the discrepancies in reproductive rights access among women of different economic classes, race/ethnicities, and geographical locations —our efforts should instead go toward pushing the reproductive justice agenda as a whole, and defending the individual freedom to choose whether, when, and how to reproduce.

is a graduate teaching instructor and Ph.D. student at Colorado State University, and a research fellow for the journal Feminist Economics. She received a bachelor ’s degree and a master ’s degree in economics from the Federal University of Rio Grande do Sul (UFRGS), Brazil.

David Cooper, Sebastian Martinez Hickey, and Ben Zipperer, “The value of the federal minimum wage is at its lowest point in 66 years, ” Economic Policy Institute, July 14, 2022 (epi.org); KFF, “2019 Employer Health Benefits Survey, ” Sept. 25, 2019 (kff.org); Caitlin Myers, Rachel K. Jones, and Ushma D. Upadhyay, “Predicted changes in abortion access and incidence in a post-Roe world, ” Contraception, August 1, 2019 (contraceptionjournal.org); Caitlin Myers, “Measuring the Burden: The Effect of Travel Distance on Abortions and Births, ” IZA Institute of Labor Economics, Discussion Paper Series, July 2021 (iza.org); Joint Economic Committee, “We Need to Save Child Care Before It ’s Too Late, ” Sept. 23, 2020 (jec.senate.gov); David Leonhardt, “Poverty, Plunging, ” New York Times, Sept. 14, 2022 (nytimes.com).

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