My friend Amy found out she was pregnant only after months of going through what she thought were early symptoms of menopause. Her husband was a successful lawyer amidst a lucrative twenty-year career. She herself had worked as a lawyer before transitioning into a stay-at-home mom of two kids. From the outside, they had it all: education, career, money, a safe living space, good schools, and an idyllic family life.
Amy and her husband had moved numerous times over twenty years to pursue better job opportunities. This nomadic lifestyle gave them the opportunity to see the world in a way that others could only dream of. Her kids took pictures in front of the Egyptian pyramids, Stonehenge, and the temples in Kyoto. International travel was the norm for family vacations.
Amy’s first two pregnancies had gone smoothly. But the third one did not.
She tried to weather out morning sickness on the couch while her kids were at school, but the symptoms never alleviated. As Amy passed her days in front of the television, she realized her symptoms weren’t just physical. By the time she wrapped her head around how radically her lifestyle had diminished, she couldn’t fathom what to do. Since she was new to town, she had very few friends close enough to come knocking on her door. Her mother was disabled, and lived too far away to offer support. Amy searched for doulas, leaving four messages and two emails, but most could not take on new clients. When she did not get any other responses for a full 24 hours, she stopped checking her emails all together.
As feelings of hopelessness set in, she began considering abortion.
I met Amy years later. I also met her child. She had decided to keep the baby, but was still traumatized by the unexpected difficulty that her third pregnancy had presented.
Amy’s story illustrates how financial stability alone does not ensure that a woman can find adequate social support during pregnancy. As with so many other health and emotional problems, the people who need help the most often find it the most difficult to access. Having tens of thousands in savings or a credit card with a high limit will not induce anyone to come knocking on your door just to check in on you. Abortion is not just a poor woman’s problem.
Conversations about abortion frequently focus on financial concerns and access to contraception and abortion services. Abortion is seen as a poor woman’s issue. Half of all women seeking abortion live below the federal poverty line, and about 75% of woman seeking abortion struggle with food, housing, and transportation. However, using data from the National Survey of Family Growth, the Brookings Institute showed that single, wealthy, pregnant women have a higher abortion rate than single, poor, pregnant women. Of women who were pregnant in the year prior to the survey, more than 30% of women at or above 400% of the federal poverty line aborted their last pregnancy while less than 9% of women below the federal poverty line made that same choice.
The numbers above tell a story: It is not uncommon for wealthier women to choose abortion.
While both affluent and impoverished women sometimes choose abortion, society views them differently. While poor women are seen as desperate, wealthy women who seek abortions are often branded as selfish. Poor women experience “crisis” pregnancies, and are rightly viewed with empathy. But we assume that wealthy women could easily raise a child and are simply choosing not to.
That assumption is wrong.
Indeed, ensuring that basic needs can be met – including prenatal care, nutrition, and safe housing – is absolutely necessary. For many expectant parents, these problems dominate. Morning sickness can keep a woman from work, cutting her pay at the exact time when the family is trying to save for the increased expenses associated with an extra family member. A car seat can cost as much as $300. For parents working minimum wage jobs, these expenses can be overwhelming. For parents trying to take on more hours of work, even finding the time to shop around for the best deal can be prohibitively difficult, especially considering that a car seat is just one of many new acquisitions the family will need to make. The financial strain new parents feel cannot be understated. However miniscule they may seem in theory, they can be the deciding factor to a family faced with a choice between continuing a pregnancy or aborting.
“Financial stability alone does not ensure that a woman can find adequate social support during pregnancy. As with so many other health and emotional problems, the people who need help the most often find it the most difficult to access any.”
Still, the challenges pregnant women face are not fully addressed by good finances or even access to healthcare. Financial stability is necessary but not sufficient for the health and wellbeing of moms and babies. The reality is that many affluent women choose abortion because they do not have the social support they need to choose life.
This should be obvious: Pregnancy is the process by which a new member of the human family is welcomed by the community. For this to happen, there needs to be a community of other human beings. A sterile clinic in which to give birth may be necessary for many woman to birth safely, but it cannot substitute for a matriarch of the community providing personal encouragement and advice. A credit card with a high credit limit may enable a woman to have any material need delivered to her door, but even this convenience does not come close to replicating community support. Having money in the bank account and a high level of education does not ensure that a woman will have a neighbors, health visitors, or other community members checking in just to see how things are going.
I have seen these principles in action. When I got pregnant with my first child, my husband and I were studying in the UK. Midwives visited me at home. They not only checked up on me physically but emotionally as well. There is a stereotype that midwives in the UK make tea for new moms and moms-to-be. They did this for me! They walked into my kitchen and put on a kettle of hot water. Throughout their home visits, the midwives left the impression that they genuinely cared about me and my family.
As it happened, I went into labor prematurely, and my baby had a lengthy stay at the NICU. It turned out that my baby could not breastfeed, and I did not have the first clue how to find breastfeeding support. But before I had the chance to panic, a breastfeeding consultant showed up at my door. When my baby finally came home, a home health visitor came to my house regularly to weigh the baby and ask me how things were going. As a result of these regular visits, the anxiety that came with being the new mother of a premature baby was relieved.
The services that I have been describing may sound luxurious, but they not. Because we were in the UK, they were standard procedure.
The disconnect between my experiences giving birth in the UK and later the United States helped me the critical element missing in our country. There is a mismatch between what pregnant women need and what American society offers. Social support is critical, but we generally aren’t addressing it.
Rather than thinking of this kind of support as an optional extra, it would be better to think of it as preventative care that should be administered as a matter of course. We are already doing something like this in other areas of the medical field. For example, consider the administration of Oxytocin during childbirth. The Association of Women’s Health, Obstetric and Neonatal Nurses recommends the administration of this drug for the management of third stage labor for all women to prevent postpartum hemorrhage, which affects 2.9% of births in the US.
Home health visitors, or something similar, should be considered as preventative health care in a sense similar to Oxytocin. They would be especially helpful in handling one of the pitfalls that often comes with pregnancy: depression. Up to 70% of women experience “baby blues,” and 10-20% experience postpartum depression. These symptoms are often unavoidable, but according to the Reproductive Psychiatry Resource and Information Center, a woman’s social network can play a significant role in softening the blow. Such programs can be structured differently in different places based on the needs of local communities, but intentional outreach and offers of support (perhaps volunteers with some training in basic pregnancy and postpartum support, or nurses who call once a week or once a month, or emotional support doulas, or simply coordinators that do extensive outreach so that every pregnant woman within the community knows how and where to get help) should be the standard procedure.
Inevitably, some women would “opt out” of such services, finding them intrusive. That is to be expected. But a healthy woman annoyed by a phone call or knock on the door is in a better place than a struggling woman who suffers alone for months without knowing how to get help.
And communities seem to be waking up to this reality. One movement called “Doulas for All,” an initiative of the New York Coalition for Doula Access, is campaigning to reform Medicaid policy to ensure that all women, regardless of income, have access to quality doula care during birth. Other states, like Maryland, are developing home visiting programs.
“Intentional outreach and offers of support (perhaps volunteers with some training in basic pregnancy and postpartum support, or nurses who call once a week or once a month, or emotional support doulas, or simply coordinators that do extensive outreach so that every pregnant woman within the community knows how and where to get help) should be the standard procedure.”
But these movements are more ideal than reality.
Because doulas are scarce, finding one is a challenge in itself. Similarly, Maryland’s home visiting program is confusing and difficult to navigate. The website is unclear about what services are available to pregnant women, and a person calling the information line is subjected to several lengthy recordings before discovering that the offices are closed due to Coronavirus.
Such accessibility issues are the norm, not the exception. You have to figure out who to call, what website to visit. You interact with recordings, or robots. You leave messages that will never be returned. The rosy ideal is undercut by the ineffectual reality.
But it doesn’t have to be this way.
The best and most responsive support will come from structures devised by local communities. In PG County Maryland where I currently live, an organization called PG County Aid was created in response to the Coronavirus pandemic. They had active outreach, putting flyers in stores, in parks, and along trails as well as on social media. People were encouraged to call if they were experiencing almost any problem associated with pandemic including food insecurity, financial problems, social problems, and loneliness. Volunteers spoke many languages, and when individuals called for support, they were greeted by the friendly voice of a neighbor from the same community.
Although PG County Aid distributed food and baby supplies, they did not, themselves, solve most problems people called about. Instead they were a network of community members who were willing to accompany people in trouble shooting their problems. Volunteers did research, made phone calls, and sought creative solutions to the problems with which community members would call in. And beyond the concrete assistance volunteers provided, they simply helped people not to feel alone.
Although PG County Aid has been disbanded now that the pandemic is subsiding, it stands as an example of a successful, locally controlled and structured outreach and support program. It could realistically be a model for similar programs of community based social support for expectant mothers and new parents.
That includes people like Amy. After watching her suffer in isolation, and unable to help, her husband suggested an abortion. Amidst a devastating crisis, they lacked the critical social resources that they needed. And although she carried the child to term and now has a happy and healthy son, memories of that time haunt her because she felt so alone.
Amy’s experience exemplifies what millions of women – even affluent women – experience each year. But her suffering is not inevitable. When communities invest in social supports for the mothers in their midst, it becomes so much easier to choose life.
Laura Evans Serna is a philosophy graduate student with a background in mathematical modeling. As a military spouse she has lived and worked in three states as well as the UK and Japan. She currently lives in DC with her husband and four beautiful daughters. She blogs at laura-evans-serna.com.