What factors constrain the choice of if, when, and how to birth or parent a child?
Deciding when and how to grow a family can be a deeply personal choice for those with the capacity for pregnancy. This decision is also influenced by a myriad of factors, including policies and systems in the U.S. that shape the circumstances under which individuals elect to parent a child or children. Though, the notion that family planning is always a “choice” oversimplifies the realities many people face. This is the first in a series of blogs addressing family planning in the U.S. and we will be diving deeper into these issues in the upcoming months. On this Mother’s Day, we delve into several key areas to begin to understand the complexities of these decisions.
Healthcare Access is Essential
Access to healthcare is a significant factor in family planning decisions. Many individuals face systemic barriers that limit their access to reproductive health services. For instance, “Health care resources, services, and providers are not distributed equitably across the country, and this is particularly true of reproductive health care. Health care access and affordability concerns are particularly acute for women of color—in particular, Black and Hispanic women—as well as low-income, uninsured and underinsured women, and disabled women; LGBTQIA+ people; immigrant and undocumented women; and other historically marginalized groups.” (The Center for American Progress) Pregnancy and birth are not without risk and these risks increase significantly without access to quality reproductive health services.
Traveling for healthcare is costly and not an option available to everyone living in the U.S. “An estimated 19 million women of reproductive age live in contraceptive deserts—areas with limited access to the full range of FDA-approved contraceptive methods. Women in these contraceptive deserts experience systemic and structural barriers to birth control, such as limited transportation, difficulty affording birth control, and lack of available child care options when accessing reproductive health and family planning services.” (The Center for American Progress) Lack of access to contraception and other reproductive healthcare makes family planning more difficult and can result in delays in care, which limit folks’ decisions.
Access to Contraception is Crucial
Access to contraception is a cornerstone of family planning. It has enabled people with the capacity for pregnancy to make informed decisions about their reproductive health, leading to improved health outcomes and economic benefits. “For more than 60 years, access to birth control has given many women greater reproductive and bodily autonomy. Contraception also gave women the ability to meet their family planning goals by deciding whether, when, and how to have children. This advancement in contraception and family planning services helped reduce unwanted pregnancies and improve the health outcomes of women and children. These factors, in turn, contributed to improved women’s labor force participation, increased college attainment and educational outcomes, helped narrow the gender pay gap, and improved professional career growth among women.” (The Center for American Progress) Increased options for education, employment, and economic opportunity, often allow parents to provide for the children they already have or may one day have and empower them to have choices that are best for their families.
Investing in contraception is not only beneficial for individuals but also cost-effective. Our analysis found that, on average, providing contraceptive care for one person for five years costs $1200 in public funds. In comparison, Medicaid-funded births (including prenatal care, delivery, postpartum care, and infant and child medical care) cost more than $75,000 for five years. These costs reveal that publicly funded birth is 60 times more expensive than paying for contraceptive care for folks who cannot afford it. Publicly supported providers generate significant savings by preventing unwanted pregnancies and reducing the need for medical care associated with pregnancy, birth, and post-partem. While these numbers address the significant financial costs, that is only part of the picture. There are also physical and emotional costs associated with pregnancy and birth, particularly for those marginalized by the healthcare system.
Economic Circumstances & Employment Policies
Economic status and employment opportunities have significant impacts on if, when, and how folks grow their families. While this is not always the case, many folks who become pregnant feel constrained by their financial circumstances. Those without access or control of their financial resources may not feel they have the capacity to birth and/or parent a child. A pregnant person without the support of others may not want to, or have the capacity to, continue their pregnancy unsupported. Parental leave in the U.S. is not guaranteed and can be limited or not an option at all. Only “certain employees” can take up to 12 weeks of unpaid parental leave per year. And time taken off work due to pregnancy complications can be counted against the 12 weeks. (U.S. Department of Labor) There are many circumstances in which folks cannot afford to take time off for pregnancy, birth, or complications and the individual circumstances of securing paid employment can constrain choices regarding pregnancy and parenting.
The Myth of Adoption as an Alternative to Abortion
We are hearing more and more the false narrative that adoption is a suitable alternative to abortion. Right-wing judges and politicians, including in the Dobbs decision, are pushing that abortion access isn’t critical so long as we have a system of adoption. This argument overlooks the essential fact that abortion addresses the choice of whether to remain pregnant while adoption addresses the choice of whether to parent. Additionally, abortion access is healthcare and this false narrative ignores the complex realities of pregnancy decisions and the historical context of adoption practices in the U.S. As Sisson writes, “But the justices’ arguments that adoption is a meaningful alternative to abortion, that the availability of suitable homes is of consoling relevance to those denied abortion, or that the state has a vested interest in ensuring the availability of children for adoption all ignore not just how pregnancy decisions are made, but how a long trajectory of oppressive and traumatic American history has shaped the practice of adoption today.”
The reversal of Roe v Wade has significant implications for many folks in the U.S. With abortion access restricted, many individuals are finding themselves with limited options of whether or not to continue a pregnancy. Data that shows Americans making different “choices” are not so much about shifting “trends” but are due to a lack of access and viable alternatives. As Gretchen Sisson writes in her book “Relinquished: The Politics of Adoption and the Privilege of American Motherhood”, “The reversal of Roe v Wade will deny some Americans access to abortions that they would otherwise choose to have, potentially dramatically increasing the number of domestic adoptions. This increase will not be because women frequently decide between abortion and adoption–as this book will explore, they do not–but because as people’s options are constrained, as abortion is unavailable and parenting is untenable, adoption becomes the only path forward.” With limited access to abortion, medical “choices” become very constrained for both patients and providers. We have seen, even in states where abortion is legal, many doctors have become afraid to perform life-saving procedures for fear of legal action being taken against them by the state.
Not to mention, many individuals seeking abortion are fundamentally uninterested in adoption, as evidenced by surveys where 99 percent of participants stated they did not want to put their baby up for adoption instead of having an abortion. Adoption is a rare choice among American women, with less than 1% relinquishing an infant for private adoption. Despite this, adoption plays an exaggerated role in cultural narratives about pregnancy and motherhood. These narratives often overlook the lived experiences of individuals whose choices are constrained or who face significant systemic challenges while making family planning decisions. Sisson writes, “After the Dobbs decision came down, I spoke with many reporters who asked variations of the same question: Why aren’t women who are denied abortion more interested in adoption? I would respond that women are generally not interested in giving away their children. Can you explain more? They would ask. I would try, but there comes a point at which I, as a researcher, cannot explain more. As a mother, though, I always wanted to ask them: Under what circumstances would you give up your children?” Most people seeking abortion are fundamentally uninterested in adoption. Surveys indicate that adoption is often ruled out because it does not align with their personal circumstances or beliefs. Folks denied abortions may consider adoption only when parenting feels impossible, highlighting that this is not so much a “choice” as an issue of limited access constraining options.
On Their Own Terms
Family planning decisions are influenced by a complex interplay of healthcare access, educational opportunities, economic status, contraception availability, and many more factors. Understanding these influences is crucial for creating policies that support individuals in making informed and autonomous decisions about their reproductive health. An ecosystem of care provides support for individuals and empowers their decision-making. By addressing systemic barriers and inequities, and increasing access to healthcare for those with the capacity for pregnancy, we can help ensure that everyone has the opportunity to make the best choices for themselves and their families. It is essential work to understand and support people in having the families they want, in their own time and on their own terms.
We highly recommend Gretchen Sisson’s book for further reading:
Relinquished: The Politics of Adoption and the Privilege of American Motherhood