Pregnancy and the Single Woman

What’s the policy shift with the most power to make children’s lives better? For decades, the answers have been variations on similar—by now very familiar—themes. Early cognitive growth is crucial, so parenting education and high-quality preschool should be priorities. Social and emotional skills are essential for success, too, so classrooms need to incorporate what now often goes by the name of character education. Since stressful environments take a toll, as recent brain and medical research has revealed more vividly than ever before, children should be raised in stable homes in safe neighborhoods. Depending on whom you talk to, that means policies to help parents find good, steady jobs, or to encourage couples to marry and then stick together. Or both.

There’s another answer, which dates back even further but doesn’t get broadcast so loudly these days: for children to thrive in all of the above ways, their best bet is to be born to mothers and fathers who didn’t just slip up but intended to have them. “Imagine a world in which every child is wanted and planned for.” In one sense, that proposal—put forward in Generation Unbound by Isabel V. Sawhill, a veteran researcher at the Brookings Institution and the president of the board of the National Campaign to Prevent Teen and Unplanned Pregnancy—sounds trite. After all, Hallmark has paid gauzy tribute to maternal devotion for nearly a century. But as the spirited feminist writer Katha Pollitt emphasizes in her new book, Pro: Reclaiming Abortion Rights, the promise of intentional motherhood has become a fraught enough goal that public rhetoric generally skirts it. “We should accept that it’s good for everyone if women have only the children they want and can raise well,” she writes, in step with Sawhill, and her should has an edge. Acceptance, and what it entails, carries a charge, because it means helping women end pregnancies they aren’t ready to continue.

For more than 40 years, the debate over family values has divided not just the left and the right but also the women’s movement, which has been criticized (fairly or not) for driving a wedge between an affluent elite, focused on abortion rights and liberating careers, and a broader socioeconomic swath of women with more-traditional views of family and female roles. By now, however, the domestic landscape has shifted. Top earners and college-degree holders bequeath their children the benefits of conventional nuclear households. Meanwhile single parenthood (which prevails in nearly a third of all families in the United States) is concentrated among lower-income, less-educated Americans, whose marriage rates have plummeted. The time may be ripe for a new rapprochement on intentional parenting. You won’t find a more rhetorically agile feminist than Pollitt or a clearer-eyed analyst of family and poverty than Sawhill to serve as guides in charting a new way forward.

Sawhill doesn’t mince words about the high price children pay for the decline of marriage, which has overtaken divorce as the main engine of single parenthood. (She doesn’t have much good to say about divorce either, citing plenty of evidence that kids generally don’t fare so well in the face of the instability that is likely to ensue.) But as she briskly acknowledges in her introduction, it’s “wishful thinking” to try to bring marriage back. Instead, she aims to boost children’s prospects by different, bracingly down-to-earth means: converting single parents from “drifters” into “planners.” Drifters slide into having children. Planners make a conscious choice. Sawhill has good reason to think this can make a real difference in sparing kids the worst effects of what researchers call “the family-go-round.” Here’s one bit of evidence from the sorry annals of family unhappiness: children who experience the death of a parent—a random event—are better off than those who weather ruptured adult relationships, which may result from “the same underlying conditions, attitudes, behaviors” that make life hard for kids.

So what distinguishes planners from drifters? All kinds of complicated, intangible factors, and one basic, concrete variable: reliance on long-acting birth control. This is Sawhill’s practical revelation. Two forms of contraception, by knocking out the need for short-term planning, have unmatched power to transform family trajectories. They are the IUD (intrauterine device, available in either progesterone-releasing or copper form) and the implant, a matchstick-size, hormone-injecting rod inserted beneath the skin of a woman’s upper arm. Once in place, both methods do the job for years. No prescription to refill, no shot to get, no device to put in or on (and little risk, with current IUDs, of pelvic infection or septic miscarriage, problems with the Dalkon Shield back in the 1970s).

Among contraceptives, IUDs and implants are uniquely “forgiving of human frailty,” Sawhill notes. As a result, they “have been found, in practice, to be about forty times more effective than condoms and twenty times more effective than the pill at reducing the incidence of unplanned pregnancies.” If you’re stunned by those statistics, so was I: I had assumed I knew the deal—that condoms aren’t as good as the pill, which is in turn not quite as good as the IUD, but that each method works most of the time. Wrong, Sawhill reveals, according to the only measurement that matters—a method’s effectiveness based on typical use over time. A chart accompanying an op‑ed she wrote for The New York Times compared outcomes over the course of 10 years, which show that more than eight out of 10 women who rely on condoms to avoid childbearing will find themselves pregnant. So will more than six out of 10 who use the pill. Only two of 100 women with a hormonal IUD, and eight of 100 with the copper version, will get pregnant. The rate is one in 100 for implants.

IUDs and implants are effective because they’re empowering. Borrowing from behavioral economics, Sawhill describes them as changing the default setting: rather than having to take action to prevent pregnancy, women have to take action to become pregnant. Put differently, long-acting contraception is a means to “help poorer and less-educated women align their behavior with their intentions.” Framed in those terms, increasing access to IUDs and implants is a way to avoid the paternalistic policing of poor women’s reproductive choices—and the abortion fight.

Plainly eager to do just that, Sawhill ducks abortion except to offer a few formulaic phrases: it’s “a difficult choice for almost anyone and morally wrong in the eyes of many,” and, paraphrasing Bill Clinton, it should be “safe, legal, and rare.” Yet by her own calculation, continued access to abortion is in fact crucial to her goals, at least until an IUD-and-implant campaign becomes a reality—and that isn’t likely to be soon (though there’s good news: the American Academy of Pediatrics recently endorsed long-acting devices as “first-line” defenses against pregnancy among teenage girls, only 4.5 percent of whom currently use them). Without abortion, Sawhill estimates, there would be nearly twice as many unplanned births as there currently are.

In Pro, Pollitt is impatient with such skittishness among liberals, and puts abortion rights front and center in the quest for reproductive justice. She, too, roots her argument in a case for parental forethought and responsibility, which she hopes will prod supporters on the left to get off the defensive and will also appeal to a wider constituency. Noting that crusaders on the right have cannily co-opted concerns about women’s safety to justify their latest push for restrictions that shut clinics, Pollitt in turn takes a pro-family stance. With abortion “arguably more stigmatized than it was when Roe was decided,” she steps forth to defend it not as a necessary evil or an inevitable source of deep sadness and shame, but as “often a deeply moral decision.” Pollitt reaches beyond a woman’s right to privacy or even autonomy to challenge those who portray abortion as anti-child and anti-motherhood. “Actually,” she argues, “abortion is part of being a mother and of caring for children, because part of caring for children is knowing when it’s not a good idea to bring them into the world”—when it’s not, in Sawhill’s terms, a good idea to just drift into parenthood.

If Pollitt’s vision of abortion sounds idealized, and risks excluding women who do feel riven with guilt or sadness, it’s also a well-timed complement to Sawhill’s evasion, which is wishful in its own way. Sawhill says that she finds the right’s conflation of abortion and birth control to be “mystifying.” It is indeed, if the goal is to reduce unintended pregnancies. But as Pollitt explains, the anti-abortion movement “is also a protest against women’s growing freedom and power, including their sexual freedom and power”—which are prerequisites to the planned childbearing that makes for “happier, healthier, better educated, and more prosperous” families. Birth control has been history-altering, and Pollitt trusts it will continue to be as women gain better access to better methods. Still, it’s “far from perfect,” she reminds us, which makes legal abortion essential to the gender-equal way of life. “Why not say that out loud?”

Even pro-life Republicans are showing signs of awareness that their extremism may be alienating a constituency they urgently need: women. Buoyed by this summer’s Hobby Lobby victory in the Supreme Court—which allowed the craft chain and businesses like it to refuse, on religious grounds, to cover certain forms of birth control (IUDs at the top of the list)—the religious right has been riding high, only to face recent pushback within conservative ranks. For the midterm elections, Republican strategy swerved, and candidates in close Senate races suddenly urged over-the-counter access to the pill. But there’s a subtext: unless they have a prescription, many women can’t claim insurance coverage for birth control, precisely what the Affordable Care Act has guaranteed without a co-pay. Conservatives will have to do better in order to compete with the vision promoted in these books, which speaks forthrightly to the left, right, and middle: “Empowering people to have children only when they themselves say they want them, and feel prepared to be parents,” Sawhill writes, “would do more than any current social program to reduce poverty and improve the life prospects of children.”