Saturday, April 09, 2011

The Perils of Planned Parenthood

I spent most of yesterday at my desk at work, worried about the impending government shutdown. Frustrated, but doing my job, and, in an open window on my computer, letting the Washington Post comment stream float by in live update mode as 2-3 new comments were posted every 5-10 seconds. That is not an exaggeration.

Once again, Planned Parenthood and abortion services were under attack--a familiar theme in our national discourse. Both sides had reached an impasse, not truly on budget cut numbers, but on whether to continue federal funding for Planned Parenthood. At stake, the weary battle over abortion in all its ugliness and misrepresentation. The Post comment stream reflected this: a profound ignorance of the fact that while federal funds do go to Planned Parenthood (1/3 of its revenues), those funds may not (and aren't) used for abortion services. And abortion services make up only 3% of its services (contraception, for example, represents 35%). Private donations (something that, honestly, should be sacrosanct in this country) fund abortions. Federal funds pay for women's health services, varieties of counseling, and, yes, contraception.

So the animus on the Republican side was, sorry for my readers who lean right, simply wrong. And, I would argue, mean-spirited. Planned Parenthood receives government funding to perform essential healthcare services for women, and it is an excellent model of a public/private non-profit organization that uses donations to supplement work that the federal and state governments are not always able to do. Planned Parenthood raises 37% of its operating budget from health center income and another 28% from private contributions. (All of these data are from their most recent annual report.)

All that said, I had the same struggle with my knot of emotions about Planned Parenthood and NARAL that I always do. I am keenly aware that many people in this country think that if my child could have been aborted, he should have been aborted (and this attitude crosses the political aisle). Parents of disabled children represent the full spectrum of American politics--that's what makes us, truly, representative of America in a way no other subpopulation or interest group is. Because disability strikes the rich and the poor, all races and all ethnicities with ruthlessly random efficiency. One of my cousins who parents a disabled child thinks that Sarah Palin rocks. The other would probably rather spit in Sarah Palin's eye. And, of course, Palin herself is the parent of a child with disabilities.

I have little interest in Sarah Palin, but it does get under my skin when people suggest she uses Trig for political gain or, even, that she shouldn't think about having a career while her son has special needs (among other nasty things that have said about her child and her caring for that child). Because when people judge her decisions and her attempt to exercise a right to self-determination, I know for sure there are people out there judging mine.

I am a progressive voter who will probably never vote Republican, and, yet, feel increasingly alienated from the Democratic Party. When the budget negotiations came down to the issue of Planned Parenthood (and the fake issue of abortion), I felt as conflicted as I had been when the passage of the healthcare legislation came down to Planned Parenthood, NARAL, and abortion funding--about a year ago.

I was already aware that millions of dollars in Medicaid cuts for children's healthcare had been proposed by the President himself. And the Democrats were going along with it. Republicans wanted to cut the budget for school lunches for poor children by refusing to fund fruits and vegetables. For all I know, that passed. Services for the disabled were taking cuts.

And yet, Planned Parenthood, an organization that arguably does a lot of good, was once again a sacred cow. And this is because that's the way lobbying works in the vast advocacy apparatus that encompasses DC politics. Planned Parenthood has a separate lobbying arm that has worked hard to elect Democratic politicians. Abortions and women's healthcare rights have been, solely, a Democratic issue. Thus, elected politicians are beholden to them, and to NARAL and to Emily's List. None of these organizations lobbies for the rights of children, the apparent detritus of our everlasting war about 'choice' and 'life.'

Don't get me wrong. When Harry Reid said that the healthcare rights of women were extremely important, I felt good about the fact that finally, finally, politicians were really willing to stand up for the rights of women. I felt good about the political power that women have been able to achieve. I feel proud that Debbie Wasserman-Schultz will be the new head of the DNC. I still like Nancy Pelosi.

But here's the thing. My husband, who scans the voluminous copy of news reports and political websites and political blogs, tells me that, in order to save $300 million in funding for Planned Parenthood, the Democrats gave up at least another $1 billion in cuts. And while I don't know exactly what those cuts are, I can imagine that, given the tenor of this national conversation, many, many of those cuts will negatively effect the medical needs of children, including disabled children, and the care of children--from how they are nourished to whether there's a roof over their heads.

To me, this is something of a Pyrrhic victory.

Yes, I know that Planned Parenthood is a non-profit organization and that, in order to maintain its non-profit status, it must define its mission in a clear and delimited way. And that mission does not include the health needs of children--perhaps not out of callousness, but of practical necessity. This is the first paragraph of Planned Parenthood's mission:

Planned Parenthood believes in the fundamental right of each individual, throughout the world, to manage his or her fertility, regardless of the individual's income, marital status, race, ethnicity, sexual orientation, age, national origin, or residence. We believe that respect and value for diversity in all aspects of our organization are essential to our well-being. We believe that reproductive self-determination must be voluntary and preserve the individual's right to privacy. We further believe that such self-determination will contribute to an enhancement of the quality of life and strong family relationships.

In posts over the years on this blog, I've struggled with my relationship to the word "choice" and the way its referent valence to reproductive rights has been absorbed into the American lexicon. I've argued that "choice" has been co-opted from the abortion debate, in which it represents the value of reproductive self-determination, to a colloquial referent that is used to judge women negatively who have children and are still convinced they have some right to self-determination. The term was once turned on me by a friend who was a Buddhist nun. When I articulated some of the hardships involved in raising Robert, she gently chided me by saying, but you chose to have Robert. And that was mild compared to the ranting that goes on in comment streams that involve women and children.

I've also argued that "choice" has become an intra-femina moral marker to categorically exclude women who've experienced negative outcomes with their offspring, whether those outcomes were situational or medical. This is most apparent to me when women who face few life constraints wax on about how carefully they planned their pregnancies and how well those pregnancies and children and their lives turned out as a result of those women's appropriate decision making processes. This is moral talk: I'm a good person because I chose well. You're perhaps not a bad person, but clearly you choose poorly in some way you neglected to anticipate, so you are, at least, an inferior person.

Ah, American Calvinism--The Protestant Ethic and the Spirit of Capitalism. The elect are made manifest by God's material blessings, while the rest of you bear the signs of God's just and rightful abandonment.

The word "choice" does not make much of an appearance on Planned Parenthood's website. But an insistence on "self-determination" is repeated. This statement is from the introduction to the annual report:

For more than 90 years, Planned Parenthood has been a change agent — fighting for a world where every child is wanted, loved, and treated fairly; a world where women’s health is a paramount concern and access to health care is not only a right but a reality; a world where women are in charge of their own destinies.
You can see the obvious irony in that last sentence for women like me, and my friend Elizabeth, and my friend Erika. We have, each of us, in public, come to variously angry, tearful and sarcastic terms with the big, broad, concrete wall fact of our inability to be "in charge of [our] own destinies." Because we gave birth to children with profound disabilities. Vicki, too, struggled with this while her son was alive--and her memoir, This Lovely Life, is a book that is refreshing because it, indeed, acknowledges that anger at societal constraints (not at our children) is a valid response to what happened. None of us are angry or resentful of our children. We're pissed off at the society that makes our lives a living hell at times because it assigns our kids zero value, both in economic and social terms.

Which brings me (I can only speak for myself) back to Planned Parenthood. Reproductive rights are important, and I would never interfere with any woman's decision to have an abortion, but this message about "self-determination" represents a false dichotomy. In the culture in which we currently live, reproductive rights only offer unfettered self-determination if a woman chooses not to have children. Therefore, this is an awfully gauzy premise that our feminist groups try to float toward us. That you have the power to plan the full details of your reproductive destiny is kind of a big, fat lie. 

Just in terms of childbirth, any honest OB/GYN will stop you dead in your tracks when you start talking about how you've planned your baby's birth down to the last details. When I asked just whether I could wear a favorite night shirt, my OB said, sure, if you're OK with the possibility that we might have to cut it off you in an emergency. Genetic problems are not caught by every prenatal test, babies suffer oxygen deprivation when they're tangled in umbilical cords during birth, genetic and metabolic conditions present themselves years after birth, and, of course, there are accidents. These can happen to anyone, regardless of all your careful planning.

We deserve better than this gauzy false promise. Planned Parenthood's mission is limited, and its commitment to the rights of women stops when a child is born. After that, we're on our own, ladies. Having made our 'choice.' How is this different from the world my grandmother was born into? I mean, sure, if I don't have kids, my economic and career prospects are at near parity with those of men, but if I do--let alone if my kid is disabled--  

Sorry for the undercurrent of resentment. Can't be helped.

Going back to the money and the budget issues: what bothers me most is that neither side, Republicans nor Democrats, is currently committed to the healthcare and nutritional needs of children, let alone the programs that fund support services for children with disabilities, which is what articulates a space for some self-determination for their mothers and families. Arizona, California, Texas, and Florida, among others, have all made draconian cuts to Medicaid for children and community support resources for children with disabilities. Medicaid reimbursements are becoming so low that some children cannot find a specialist who will take them as a patient to treat their health problems. I'm lucky to live in Maryland where I haven't yet faced those--but Robert's been on a Medicaid waiver waiting list for years to help us with the costs of his medical care. And if Representative Paul Ryan has his way, when Robert turns 18, Medicare is going to hand him a voucher and say, hey, kid, here's a few bucks to see if you can buy an insurance policy on the private market--too bad you're tube-fed, confined to a wheelchair, ataxic, and non-verbal--I guess it's going to be expensive for you.

To bring this, to try to bring this post to a close: if we're willing to throw $1 billion in domestic cuts overboard, many of which benefit children, the disabled, and the poor, so that we can preserve $300 million for Planned Parenthood, an organization that is 2/3 self-funded and that has an aggressive donor base, are we as Democrats or persons leaning left approaching moral equivalency with Republicans? That it's all well and good to support "life" or "choices" while they're in the womb, but we have no responsibility to the well-being of children once they're born? That, at any rate, has long been the accusation Democrats have leveled at pro-life Republicans.

I mean, jeez, an abortion costs $500 to $1,000 dollars. Birth control is $30 to $50 per month. The cost of treating a child with autism runs into the tens of thousands of dollars per year. Robert's orthotic braces, which he outgrows periodically, cost $1,800. The biotin that keeps him alive costs $3,000 per year, and the generic form of Prevacid that keeps him from aspiration pneumonia costs $4,000 per year. New epileptic drugs are being produced all the time, but they range from $300 to $700 per month. Wheelchairs for kids are $10,000. And the cost of respite care, if your child needs skilled nursing care, is $20 to $30 per hour

At what point in time are we going to align ethical priorities with our politics? At what point in time are we going to realize that women's self-determination is about a lot more than the threshold decision to have or not to have a child? When is there going to be a powerful women's lobby that advocates for all women equally?


Elizabeth said...

I'd like to come and worship you.

GB's Mom said...


erika said...

You chose to have Robert, I chose to have Izzy, lots of people choose to get on airplanes even though planes crash, even more people choose to drive a car, 38,292,687 people choose to live in earthquake-prone, wild-fire ridden California, the casualties of the Japanese monster quake and tsunami chose to live in Northeast Japan... So? I meticulously planned out everything I could concerning Izzy's arrival. I scrutinized everything I ate, I stopped using certain cosmetic products, I gave up coffee, I worked out, gained the recommended weight, I was in excellent health and shape, had lots of prenatal tests, read all the pregnancy, childbirth and parenting books, etc. etc. and then Izzy was born and it all went out the window. This whole choice-talk is nonsensical and very naive. Your writing on the other hand is excellent. I posted it on my Facebook page.

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