Crib Sheet: Beyond Choice

A reproductive health vision for a post-Roe generation.

By Dana Goldstein

Americans have abortion fatigue. According to a July poll conducted by the Pew Research Center for the People and the Press, 66 percent of adults believe the country should find a middle ground on this divisive issue, instead of endlessly rehashing the same clichéd arguments about the rights of women versus the rights of fetuses. As we approach the November mid-term elections, arguments over abortion and gay rights have been superseded in most districts by debates about the war in Iraq, immigration, and job security. For many, this is a step in the right direction: Why should the designations “pro-choice” and “pro-life” serve as a political litmus test when Americans are facing such a complex set of challenges?

But as progressive reproductive health activists can attest, although Americans continue to broadly support access to abortion and birth control, a well-organized minority of activists—many motivated by conservative religious beliefs—continues to push an anti-abortion, anti-birth control agenda in schools, state legislatures, the courts, and at the federal level. In South Dakota, women’s groups are fighting tooth and nail in support of a ballot initiative that would overturn the state legislature’s ban on almost all abortions, including in cases of rape and incest. And with new justices on the Supreme Court, anti-abortion rights activists are expected to push for further challenges to Roe v. Wade.

It is against this backdrop that the Center for American Progress has released its report, “More Than a Choice: A Progressive Vision for Reproductive Health and Rights,” by Jessica Arons. The report seeks to expand the discussion of reproductive and sexual rights beyond the narrow focus on abortion. It argues that a proactive policy approach on reproductive health is in keeping with broader progressive commitments to human rights, support for American families, and fighting discrimination. At a minimum, such an agenda must include support for the ability to become a parent and parent with dignity, to determine whether or not to have children, to have a healthy pregnancy, and to have healthy and safe families and relationships.

The report urges progressives to consider both the negative and positive roles of government in protecting reproductive health. The “pro-choice” rhetoric of the Roe v. Wade generation of reproductive rights activists is limited because it articulates only a negative responsibility—the federal government’s obligation not to invade the privacy of women making childbearing decisions. But as abortion becomes less and less accessibleacross the United States, especially for low income and young women, it becomes increasingly important for reproductive health activists to articulate the government’s responsibility to actively support all women and their partners in making and implementing sexual decisions—to make sure that all women have access to reproductive health resources, not just theoretical “choices” that only privileged women can exercise.

Comprehensive sexual health education is a clear starting-point for efforts to improve sexual health and decrease the need for abortions. Unfortunately, only fivepercent of American teenagers receive comprehensive sex-education. Federally-funded abstinence-only programs exclude practical information on how to choose, access, and use contraceptives. As Emily Amick reported for Campus Progress in July, over 80 percent of these programs contain misleading or false medical information—claims that condoms are ineffective in preventing pregnancy, that touching a person’s genitals can lead to pregnancy, and that half of gay male teenagers have AIDS. The federal government should be supporting curricula based on scientific fact, not politically motivated propaganda meant to scare young people. The average American under the age of 25 first had sex at age 16. Two-thirds of Americans have had sex by the time they graduate high school. The reality of pre-marital sex among young people necessitates reality-based, comprehensive sexuality education.

When unintended pregnancies do occur, women should be able to choose whether or not to carry to term without fearing inadequate healthcare in either scenario. Medical research shows that the strongest predictor of an infant’s health is its mother’s health before, during, and after pregnancy. Yet over 15 percent of Americans do not have health insurance. Recent immigrants are ineligible for Medicaid until they have been in the United States for five years. Given these limitations on quality prenatal care and basic health care, as well as overall economic and social instability and lack of access to contraceptives, it’s no surprise that low-income women are four times as likely as the most affluent women to have an abortion, even though the procedure can be expensive and, for some women, requires hours or days of travel to an abortion provider.

It is also crucial to place the decision to seek an abortion in the context of an individual woman’s lifetime of decisions on when and how to have children. Sixty percent of women who have an abortion are already mothers, and more than half of women who have an abortion intend to one day become mothers or have additional children. In order to flourish as individuals, women and men must be free to choose how to start and grow their families, and they must know they have access to the necessary healthcare resources.

Similarly, all Americans should have the right to pursue parenthood when they choose to do so, regardless of their sexual orientation or gender expression. Laws limiting the rights of LGBT individuals to marry and adopt children are discriminatory and deprive many loving Americans of the opportunity to build families. Supporting families means accepting the diverse range of households that already exist in the United States—less than one quarter of Americans now live in a traditional heterosexual nuclear family, and at least 1 million children in the U.S. are already being raised by gay parents.

This progressive vision of reproductive health and freedom shifts the discourse away from the obsession over sexual morality and toward shared policy goals based on the real lives of Americans.

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