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Published November 23, 2009

BEYOND STUPAK - the shocking fertility control provisions in health care reform legislation

by Gwendolyn Mink and 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." 

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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.  

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.

Click here to contact your legislators )

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 children.  

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.

ACT NOW!  Click the button below to contact your Representatives to urge them to take a stand against these provisions in the final health care bill.



Gwendolyn Mink, Ph.D., an independent scholar, is co-editor of the two-volume Poverty in the United States: An Encyclopedia of History, Politics and Policy and author of Welfare's End.  She can be contacted at wendymink@gmail.com

Dorothy Roberts, J.D., the Kirkland & Ellis Professor, Northwestern University Law School, is the author of Killing the Black Body: Race, Reproduction, and the Meaning of Liberty and of Shattered Bonds: The Color of Child Welfare, and serves on the boards of directors of Black Women's Health Imperative, National Coalition for Child Protection Reform, and Generations Ahead. She can be contacted at d-roberts@law.northwestern.edu 


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Ravan said……

I don't understand why having a nurse visit first time mothers is bad. I don't understand why educating young mothers on childhood development and nutrition is bad. I don't even understand why educating women on how to gap pregnancies so that they have kids when they want them, instead of constantly or at the whim of their boyfriends, is bad. This just gives them the information that middle class women already have, due to better education, information access and family support. Are you saying that poor women don't deserve the knowledge? FYI, there are poor white women out there too.

Access to birth control, and knowledge of how to use it, is not a requirement to do so. Look at the Catholics, or the Quiverfull weirdos.

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Michelle said……

Perhaps the added difficulties associated with rearing children in poverty merit this investment. If anything, waiting to have this discussion until a woman has already had a child in poverty may be too little, too late: http://www.cato.org/testimony/ct-wc67.html

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Lonnie said……

The two previous posters are completely misrepresenting the law's provisions. There's nothing wrong with pre- or post-natal care. There is something DEADLY wrong with government monitoring, controlling, and intervening in women's reproductive choices. And there is something inherently sexist about telling women when they can and can't have babies. Rather than attacking and punishing women for having children, our government should be ending the wars and occupations and stop bailing out Wall Street and the health insurance industry and fully fund a single payer health care system and public education and creating jobs.

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Michelle said……

I made no comment about the law, which does not appear on this page and which I did not read. That said, the characterization of the law, provided on this web site, does not offer facts to support its assertions - it does not even quote the language of the bill that it finds offensive. In addition, the site's comment fails to address the well-documented and often-made assertion that being raised in poverty often hurts children, and having children in poverty often hurts women. As I understand what has been posted on this site, the proposed legislation would require only that a woman agree to receive reproductive health education information in exchange for receiving public funding for privately made reproductive choices. Any woman who chooses to turn down public funding is not required to give the government information about her personal choices, or listen to the government-provided information about the health benefits of waiting to have a second child. No funding = no exchange of information.

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Maria said……

Lonnie is right that there would be "something deadly wrong with government monitoring, controlling, and intervening in women's reproductive choices".

Thankfully health reform legislation surrounding home-visitation has NOTHING to do with these insidious and deplorable violations of human rights. Contrary to Lonnie's remarks, these provisions provide voluntarily accessed support around pregnancy and parenting young children that positively impact the lives of people who are part of the program.

I hope the authors of this site will refrain from printing inaccurate and harmful misnomers about legislative provisions that support (rather than suppress) families facing adversity in American society.

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