Birth Control

The children they gave away

In the decades between World War II and Roe v. Wade, 1.5 million young women were secretly sent to homes for unwed mothers and coerced into giving their babies up for adoption. Now their stories are finally being told.

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The children they gave away

“Nobody ever asked me if I wanted to keep [my] baby, or explained the options. I went to a maternity home, I was going to have the baby, they were going to take it, and I was going to go home. I was not allowed to keep the baby. I would have been disowned.”

— Joyce

It was the 1960s and Joyce was going to beauty school in Florida when she realized she was pregnant. When her mother found out, Joyce says, she was “dumped” at a Salvation Army Home for Unwed Mothers in Alabama. “It was an old, old, old house with big rooms,” she remembers now. “[And] I had no control … It was like being in a car wreck or something. Once you start skidding, that’s it. [So] I kind of skidded through it.”

Joyce is just one of more than a million and a half women who were sent to maternity homes to surrender their children for adoption in the decades between World War II and the passage of Roe v. Wade in 1973. They were college freshman working their way through school with two jobs. They were tomboys, sorority girls and valedictorians. They were mothers and they were invisible.

But now, artist and writer Ann Fessler has uncovered their hidden stories. The result of years of research and more than one hundred interviews, Fessler’s new book, “The Girls Who Went Away: The Hidden History of Women Who Surrendered Children for Adoption in the Decades Before Roe v. Wade,” is an astonishing oral history that brings to light the dark undercurrent of life in America’s postwar middle class. Denied adequate sex education, shamed by socially conformist parents and peers, and without legal access to abortion, Fessler’s subjects emerge as the victims of a double standard that labeled them promiscuous while condoning the sexual adventures of their male counterparts.

Spirited away under the pretense of an illness or a family vacation, the women — many of them teenagers — spent their pregnancies away from home and gave birth among strangers. While the maternity homes were billed as a quiet place for women to reflect on their futures, when it came time to sign adoption papers, most of the women Fessler interviewed said they felt intense pressure to relinquish their children. Persuaded by social workers who said they would never be able to provide as well for their babies as a stable couple would, ostracized by families who were shocked by their behavior, and insecure about their own strength and intelligence, most women did as they were told and tried to forget.

Decades later, though, the mothers say the repercussions of those decisions are still being felt, as they struggle with depression, fight to find their lost children, and make peace with their past. “The Girls Who Went Away” is both politically and emotionally charged. Intertwining her spare prose with the mothers’ own words, Fessler raises difficult questions about reproductive freedom, women’s rights and sex education that seem particularly relevant today as Roe v. Wade is threatened, pharmacists refuse to fill contraception prescriptions, and a conservative administration promotes an abstinence only agenda in America’s schools.

Salon spoke with Fessler from her home in Rhode Island about the meaning of choice, the long-term effects of living a lie, and myths about unwed mothers.

You’ve been working on the subject of adoption for years, first as a visual artist and now as a writer. Was it your own experience as an adoptee that inspired you to reach out to birth mothers?

It really all began in 1989, when a woman approached me at a gallery opening and said that she thought I was the daughter she had given up for adoption decades before. I wasn’t, but it was an amazing experience because at that point, I really hadn’t thought too much about trying to find my own mother.

The woman told me a little about her story as a surrendering mother. She was sent to a maternity home and said she never felt like she made the decision to surrender her child, but that it was made for her. She asked if I had tried to contact my mother and when I told her that I hadn’t, because I didn’t want to bother her after all those years, the woman said, “She probably worries every single day about what’s happened to you and whether you’ve had a good life.” And that thought had just never occurred to me.

That was the moment I decided that I wanted to start reflecting on my experiences as an adoptee. Through the years, in each of my projects — whether films or art installations — I tried to set up areas where other people could contribute their stories. I was trying to be inclusive and to raise awareness of what adoption is like from all different viewpoints. And each time, I was really impressed by the stories I heard — they started to give me an idea of the complexity of the situation. But what floored me were the stories from the surrendering moms, mostly because I kept hearing the same things again and again — that the mothers didn’t feel like they had a choice. And I just kept thinking, why have I not heard these stories before?

You obviously tried to collect interviews from a range of women, but it does seem like because they were not cheap, the maternity homes serviced a particularly white, middle-class clientele. Did you discover different kinds of stories when speaking with women of different races and classes?

The African-American women I interviewed, of course, were women who had surrendered their children; I didn’t interview people who kept them. So they actually had the same kind of experience as most of the white women I spoke with, in that their families had high hopes and aspirations for them and felt that given the time period, if they had a child it would be the end of their education and everything else. Their parents were well-intentioned, but they didn’t anticipate the long-term effects — though it’s hard to imagine how anyone who’s had a child could not anticipate that surrendering a child would have a lifelong impact.

You say again and again that these stories need to be understood within the context of their time. What was it about the postwar years that made it such a difficult time for young women?

There was a lot of social pressure in the 1950s and 1960s — the time period I focus on — and that pressure was partly due to the tremendous rise in economic and social stability in many families after the war. The U.S had a booming economy, so families that had previously been thought of as working-class poor had moved up into the middle class and they didn’t want to go back. Having a daughter who was pregnant and not married was — and sometimes still is — seen as a reflection of parenting skills, and someone who had a daughter who was pregnant was considered low-class. It was just thought that didn’t happen in “good” families, though of course that was because the “good” families were the ones who could afford to cover it up by sending their daughters out of town.

Many of the women I spoke with talked about feeling betrayed because their mothers seemed more concerned about what the neighbors thought than about how they were coping, or what was going to happen to their grandchild.

I was surprised, reading the women’s stories, how often it was the mothers who were hardest on the daughters, and it was the fathers who visited them and cared for them when they were sent away.

Isn’t that interesting? I think that partly that was because at the time, raising children was really seen as the mother’s role, and the father’s influence was not considered as central. The idea was that if you were a solid middle-class family, the mom stayed home and spent her whole life with the kids, raising them and shaping them — so if something went wrong, it was her failure.

You write that the historical silence about maternity homes has helped perpetrate myths about what the mothers were like and what they wanted. What are those myths?

The biggest one is that any baby surrendered for adoption was willingly and perhaps even eagerly given up by the mother. And so the implication is that the women considered all their options — that they had options — and made a decision. When, in fact, most of the women I interviewed felt they didn’t really make the decision at all. If they were high school age, their parents made the arrangements and said this is what is going to happen, we’ll help you through this, but this is the only way.

A few of the older, college-age women did choose to go to the maternity homes, because they were supposed to be places that would shelter you and give you time to think about your decision. But the statistics reveal the truth: If women went into a home, 80 percent would surrender their baby, because once they were there, the pressure to do so was tremendous. The women were told, “This is absolutely the best option. If you love your baby, you will give it up for adoption, so it can have two parents.”

There was just no room for imagining other solutions at the time, at least in the middle class. I’m the same age as many of the women in the book — I came of age in the late ’50s and early ’60s — and I can tell you that growing up, I didn’t even know anyone who was divorced. It was just such a homogeneous world if you were white and middle-class that you didn’t have any other examples to follow as a parent. So the first myth would be that the women made a choice, which implies having options — when, in fact, the women I interviewed saw no alternatives at all. If their parents weren’t going to help them — which was really the only way that any girls made it — then they didn’t have a choice.

The second myth was that during the time period the book covers, anyone who got pregnant and sent away was considered a slut. It was an extremely hypocritical time sexually, because by the end of the 1960s something like 68 percent of women were having sex before age 20, but everybody lied about it. So all the girls who were having sex but didn’t get caught could claim they were virgins, but the ones who got pregnant couldn’t deny what they had done. So it was assumed they were either promiscuous or more sexually advanced than their peers, when most weren’t. It turns out, actually, that among the women I interviewed, most became pregnant with their first sexual partner, some with their very first sexual experience, and many within only five sexual experiences. So most likely they got pregnant not because they were promiscuous, but because they were naive. They didn’t know anything about sex; some didn’t even know how babies were born. People just didn’t talk about sex during the era; there was no sexual education, and in some families it simply never came up.

The third myth is that a woman who surrenders her child doesn’t suffer a loss. The families and the people who ran the maternity homes told the women that they’d go to the hospital and have the baby and the baby would be taken away and life would go back to normal — as though they just had their appendix removed. The idea was that they could make up a lie about where they’d been for the past four months and no one in the community would be the wiser — it would be like it never happened.

But you do write that maternity homes weren’t always so adamant about making mothers surrender, and that their ideology shifted dramatically after the war. How did they go from being places that may not have been ideal, but were at least supportive, to ones that were focused entirely on adoption?

The difference was that after the war thousands of adoptive families were clamoring for children. The numbers were staggering; at the time, for every child that was placed, there were 10 families still waiting for a baby. So all these lovely, established young couples were coming to maternity-home social workers hoping to adopt and that put the workers in a complicated position. On the one hand, they had a 17-year-old in front of them, who was sort of in a daze, and her baby’s not even real to her yet. She’s pregnant, but to her, pregnancy is a problem. Everyone is telling her she’s bad and that she’s shamed her family.

And so you find that more often than not, the social worker ends up agreeing with the girl’s family that the best-case scenario would be to get her baby placed with one of the many fine families waiting to adopt. And I don’t want to make it sound like I’m down on adoptive families, because, in fact, they were told they were adopting children who were unwanted. The problem was that all the parties were kept apart from one another, and it was a paternalistic system that told these women, “We know what’s best for you.”

Was there an element of social engineering at work? Were the women seen as less capable of parenting because they had already disgraced their families?

Definitely. The message from social workers was that the baby would be so much better off with an adoptive family than with the surrendering mother because she was already a screw-up — she’d gotten pregnant, she wasn’t married, so how good a mother could she be?

She was seen as unfit because she was unmarried, though, of course, at the time, loads and loads of women got pregnant and then got married so they could give birth six or seven months after the wedding. In those cases, all was forgiven.

Did you talk to any women who, upon giving birth, wanted to change their minds and keep their baby?

I heard again and again from women that once their baby was born, everything changed. They finally realized that what they were dealing with wasn’t an amorphous problem, it was their child. Once that happened, quite a few women told me they tried to change their minds, to convince their parents to give them more time to find another solution. The terrible thing was that in some cases they were simply told it was too late. But legally that wasn’t true; there was a window of time in which mothers were allowed to change their minds.

So they were lied to?

Yes. Social workers were just so convinced that they were doing the right thing.

Did any of the women you spoke with try to get abortions?

Remember, this was before abortion was legalized, which doesn’t mean that there weren’t abortions happening, but there were lots and lots of botched ones. And most girls didn’t even know who to ask about it, or where to find one. So certainly, some women might haven chosen to terminate their pregnancies, but many of the women I interviewed were actually not pro-choice.

For example, one woman told me about growing up in a very strict Catholic family and, like many of the mothers, she had been in denial for several months, just thinking the problem would go away. Her waistline was expanding, but she just thought, This is not real, it can’t be real. For many women, by the time their parents found out it was too late to take them to a secret doctor for an abortion. In this particular case, though, the woman’s father, who was extremely religious, to the point that he didn’t use birth control, came to her room and actually said to her, “Is it too late for us to do anything about this?” And it was the daughter who said no, that she wasn’t willing to go through with an abortion.

You write that the National Mental Health Association recommends that people dealing with grief seek out people who understand their loss. But most of the women you spoke with did exactly the opposite — in fact, the insistence on secrecy seems like it made that kind of healing impossible.

Yes, secrecy was imperative. There was no reason to send a woman away and give up a child if you weren’t going to keep it quiet; the idea was that no one would ever know. That was what the families wanted and in some cases the women too — they knew what the social stigma was like, and they just felt like they could not deal with it. They knew what the image of an unwed mother was, and it wasn’t them.

One of your recurring themes is how damaging the burden of maintaining a lie can be on a life.

Absolutely. First of all, the women suffer tremendously from an ongoing sense of worry about their children — a feeling that some studies have equated with having a loved one who is missing in action. It’s this idea that your child is alive, is out there in the world, so are you going to run into her on the street one day?

The women were told by every authority figure in their lives don’t ever tell anyone because people will think less of you, no man will ever want to marry you if he knows you were such a bad, slutty girl — they heard that over and over. And that perpetuated the secrecy.

Also, many, many women realized only later, when the world started changing around them, that they had been duped. They were told that they had no choice, that the world wouldn’t accept them, but then within a few years the world and the culture had changed, and they saw that maybe other options might have been possible. One woman told me that when she was pregnant as a teen she had to drop out of school, but then in the 1970s Title IV made it a law that you could not discriminate against a woman and make her drop out of school just because she was pregnant.

There were also some organizations that started up in the 1970s of women who began coming out of the closet to talk about their experiences as unwed mothers who had been forced to give up their children in maternity homes. But, in general, most of the women still didn’t talk about it

So not only were they not talking to their husbands and friends, they weren’t talking to each other?

Exactly. Remember, the mothers were all told that they would just move on, so many felt that something was wrong with them when they couldn’t forget their children. And not having anyone to talk to, they couldn’t compare notes.

They told me how the shame and secrecy affected their self-esteem, how they couldn’t relax and were always afraid of being found out — and I actually began to think it had some parallels to the gay community, to the idea of being closeted. The mothers found themselves driven to incredibly destructive behavior. And like in the homosexual community, things didn’t really begin to change until people came out and started speaking up, saying, “I’m queer and I’m proud,” the same was true for surrendering mothers. More and more women started speaking up, saying, “I’m a birth mother and this is nothing to be ashamed of.” And so gradually women became more aware that they weren’t alone. But there are still many, many women who are very distraught and lonely.

In my book, I reproduce a note that was left for me in one of the comments boxes at an exhibition. It was from a woman who had snuck away for the day to come to the show, and she said, “This is the way I live my life, I couldn’t tell anyone I came here because my sons don’t know they have a half brother.” And I think she ended it by simply saying, “I live in hiding.”

You say that a lot of pain could have been prevented if parents in the ’50s and ’60s had been more realistic about the likelihood of young people having sex and had provided them with adequate sex education and contraception. Given the focus on abstinence only sex-ed in the U.S. today, are you worried for the future?

It’s scary to see such regression. A lot of things will never change for the women in my book; their lives are set. But one thing their stories can offer is a window onto a time period. And what they show us are the consequences of a sexually repressive, paternalistic, conservative society. And there are many people in the country right now who would like to go back there.

Abstinence-only sex education doesn’t allow for even a mention of birth control — the line is that the only way not to get pregnant is not to have sex. And certainly, that’s true and abstinence should be taught. But to focus solely on that is to also be willfully blind to the realities of human behavior. Sex education is incredibly important — especially realistic, age-appropriate sex education that starts early on — and it should be coupled with frank talk about relationships and respecting others. Because what scares social conservatives are stories about teen boys keeping lists of all the virgins they have scored. But while that shouldn’t be excused, that’s really not about sex, it’s about conquest. It’s a lack of respect for other people.

You say that the voices of the women in your book need to be heard as part of the current national debate over reproductive freedom because the “double standard” is still very much a part of our cultural psyche. Can you explain what you mean by that?

Women and men are both sexual beings, and the onus should not always be on the women to stop the sexual advances of the man. It’s a couple having sexual relations. But I think we still have this caveman notion that a man can go around spreading his seed, making conquests, and the woman is supposed to be the one with restraint who holds him back. And if you look at the world in general, outside the U.S., it’s quite clear that both sexually and politically women still do not have equal say or power. Look at the Supreme Court right now. We don’t know yet what effect their decisions will have on the country, but just the imbalance of representation indicates that on some level we still value men’s opinions more, or believe that men can make more rational decisions. So if nothing else, I hope that by uncovering this hidden little part of women’s history, I can help build a bridge between two generations, and to show young people today the importance of having a voice, of being participants in their own lives.

Sarah Karnasiewicz is a freelance writer and photographer based in Brooklyn, N.Y. Until recently, she was senior editor at Saveur magazine; prior to that she was deputy Life editor at Salon. She has contributed to the New York Times, the New York Observer and Rolling Stone, among other publications. For more of her work, visit thefastertimes.com/streetfood and Signs and Wonders.

The battle to ban birth control

Using bogus health facts to scare women about the "dangers" of contraception, a fledgling movement fights for a culture in which sex = procreation.

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The battle to ban birth control

Ever since she was in her early teens, Mary Worthington has been vehemently opposed to contraception, which she regards as immoral and dangerous. To spread her anti-birth-control gospel, this month she launched No Room for Contraception, a clearinghouse for arguments and personal testimonials on this subject. NRFC joins other anti-contraception Web sites like Quiverfull and One More Soul.

Worthington, who wouldn’t reveal where she lives and works, or her exact age, is a recent graduate of Franciscan University of Steubenville, in Ohio, where she earned a B.A. in theology and a minor in human life studies. She is also opposed to abortion. But NRFC doesn’t even address abortion; its sole purpose is to “prove” that the pill and the IUD cause health problems and destroy women’s fertility, that condoms lead to the spread of sexually transmitted diseases by making people believe that sex can be completely safe, that contraception destroys marriages by rendering sex an act of pleasure rather than one of procreation. Emboldened by the fact that the president and the two most recent Supreme Court nominees are anti-choice, a recent antiabortion victory in South Dakota, and legislative success restricting access to emergency contraception, groups like NRFC are shifting their focus and resources away from abortion and putting their energy into restricting birth control.

On the face of it, their fight seems doomed. The vast majority of Americans support access to birth control: According to a National Family Planning and Reproductive Health Association poll last year, even 80 percent of anti-choice Americans support women’s access to contraception. And with the exception of a dwindling number of devout Catholics, a large majority of American women have used or regularly use some form of contraception. Perhaps most telling of all, no mainstream antiabortion organization has yet come out against contraception, a sign that they know it would be a political disaster.

Still, the anti-birth-control movement’s efforts are making a significant political impact: Supporters have pressured insurance companies to refuse coverage of contraception, lobbied for “conscience clause” laws to protect pharmacists from having to dispense birth control, and are redefining the very meaning of pregnancy to classify certain contraceptive methods as abortion. In increasing numbers, women and men opposed to contraception are marshaling health facts and figures to bolster their convictions that sex for anything but procreation is morally wrong and potentially deadly. Although its medical arguments are really just thinly veiled moral and religious arguments, using findings that are biased and unfounded, the rising anti-contraception movement, echoed by the Catholic Church, is making significant inroads. Leaders of the pro-choice movement know it, are worried about it, and realize they can’t take it lightly, as they mount their own strategies to battle it.

“It is very hard to awaken people to the threat,” says Gloria Feldt, the former president of Planned Parenthood, “because who can believe that something so accessible can be at risk? But that’s what [people] said when they started attacking Roe, and now look at how close we are to losing Roe.”

Nor is the fight against birth control only the province of a few zealots. While sites like Worthington’s may be new, many antiabortion activists have always been bitterly opposed to contraception. “After Roe v. Wade was decided,” says Feldt, “the debate focused on abortion instead of birth control. But [for anti-choicers] they are not separate issues.” She points out that what we’re seeing today is more of a revival of an old movement than a shift to something new. “It’s been there from the beginning. If you go back and look at the rhetoric against birth control from 1916, it’s exactly the same as the rhetoric now.”

And when you look closely, there is evidence to suggest that even the mainstream anti-choice groups are ready to make the battle against contraception part of their agendas. Many of the National Right to Life Committee state affiliates have opposed legislation that would provide insurance coverage for contraception. Iowa Right to Life even lists a host of birth control methods — including the pill, the IUD, Norplant and Depo-Provera — as abortifacients. And NRLC itself parses its language very carefully when it comes to contraception. A call to the organization resulted in an e-mailed statement on the group’s position that read in part, “NRLC takes no position on the prevention of the uniting of sperm and egg. Once fertilization, i.e., the uniting of sperm and egg, has occurred, a new life has begun and NRLC is opposed to the destruction of that new human life.” Such a position leaves the group plenty of wiggle room to argue, when it is ready to do so, that contraceptives prevent the implantation of a fertilized egg and are thus a form of abortion. (NRLC wouldn’t comment further, because, according to a media relations assistant, contraception lies outside of its purview. For the same reason, Feminists for Life refused interview requests. And at Concerned Women for America, a group that has been openly anti-contraception, a spokesperson told Salon twice that none of its experts were available for interviews.)

“The brilliance of the other side is that it’s such a wholesale attack, that it’s hard to find an entry point,” says Cristina Page, vice president of the Institute for Reproductive Health Access at NARAL Pro-Choice New York, and the author of “How the Pro-Choice Movement Saved America: Freedom, Politics, and the War on Sex.” While pro-choicers are busy trying to save Roe v. Wade, the anti-choice movement is “laying down their game plan for this next wave.” And, she adds, “On every single front, whether it be educational, whether it’s a matter of direct access, or whether it’s about funding, their campaign is on, and it’s effective.”

For those who are pro-choice, the idea of fighting to ban both abortion and contraception seems contradictory: Contraception, after all, lessens the number of abortions. But once one understands what the true social and moral agenda of activists like Worthington is, and their attitude toward sexuality, the contradictions vanish. For them, sex should always be about procreation; since contraception prevents conception, it is immoral. At a deeper level, they believe that women’s biological destiny is to be mothers.

Feldt says, “When you peel back the layers of the anti-choice motivation, it always comes back to two things: What is the nature and purpose of human sexuality? And second, what is the role of women in the world?” Sex and the role of women are inextricably linked, because “if you can separate sex from procreation, you have given women the ability to participate in society on an equal basis with men.”

The anti-birth-control movement has seized recent headlines about emergency contraception — and the fact that many people are unfamiliar with how it works — to put forth its view that E.C. is tantamount to abortion. Page sees the anti-choice movement using the “same exact arguments that they make for abortion for contraception,” which includes “reclassifying contraception to be abortion. As abortion becomes more constricted,” Page says, “these campaigns will begin to intensify, as we’re already seeing with E.C.”

Indeed, the anti-choice push to keep emergency contraception (such as Plan B) from being available over the counter, and to protect pharmacists who refuse to fill prescriptions for it, has centered on the argument that E.C. is an abortifacient. “Confusion is one of their strategies,” Page says, pointing out that anti-choice activists don’t bother to distinguish between RU-486, the “abortion pill,” which terminates an early pregnancy, and emergency contraception, which is simply a higher dose of the standard birth control pill and helps prevent pregnancy. “How many people hold the misunderstanding that E.C. is a method of abortion shows how effective this movement is,” she says. Indeed, in a 2003 survey of women in California, only one in four knew the difference between RU-486 and E.C.

“The emergency contraception debate has been in the news a lot lately,” notes Worthington, and “it got me thinking of the need for more resources like [NRFC].” Worthington, who also maintains an anti-contraception blog called the Revolution, says that she hopes to educate young people on the detrimental effects of contraception, and also give older women who have used birth control a forum to talk about how it harmed their marriages. (A section on the site, “Testimonies,” so far offers two personal stories, reprinted from the Priests for Life Web site. In both, the writers tell of the grief they felt when they discovered the “truth” about how the birth-control pills they were taking caused abortions.)

Worthington and other anti-choice activists simply don’t distinguish between E.C. and abortion. “Contraception is an abortifacient,” she says. “Look at the package insert for Plan B. It says it can act to alter the endometrial lining and prevent implantation. It’s not technically an abortion, because pregnancy has been redefined to mean ‘after implantation,’ but it’s still taking the life of a human.” But there is no proof that Plan B prevents a fertilized egg from implanting in the uterus; in fact, it’s scientifically unknowable, because it’s scientifically unknowable if an egg is even fertilized until it implants in the uterus. The American Medical Association defines pregnancy as the moment when implantation occurs; even if Plan B did prevent implantation, it still wouldn’t be ending a medically defined pregnancy.

“The anti-choice movement,” says Feldt, “completely ignoring scientific fact, is attempting to redefine pregnancy as the moment of conception, the moment when sperm and egg meet. At the root of that is the attempt to get the fertilized egg more status than a woman.”

And as Page points out, once a fertilized egg is considered a human life, it’s just a hop from there to concluding that the standard birth-control pill is an abortifacient, too. “Basically, it’s the same pharmacology,” she says, “so if you’re against emergency contraception and you’re lending validity to the argument that it’s abortion, you’re saying exactly the same thing about the birth-control pill. If somebody out there thinks Plan B is abortion, they think the birth-control pill is abortion.” And there’s proof that this argument is working: Some pharmacists and even physicians are not just denying patients E.C., they’re also refusing to dispense the pill.

Page also notes that the anti-choice movement has succeeded in pushing legislation that, though seemingly unrelated to contraception, helps support its cause. According to the National Conference of State Legislatures, at least 15 states have fetal homicide laws that apply to “‘any state of gestation,’ ‘conception,’ ‘fertilization’ or post-fertilization” — meaning that one can be convicted of manslaughter or murder for destroying a fertilized egg, even if it hasn’t implanted itself in a woman’s uterus.

Another successful campaign has centered on condoms. In 2000, at the behest of then-Rep. and anti-choice ally Tom Coburn, R-Okla., the National Institutes of Health convened a panel of experts to evaluate the condom’s effectiveness at preventing the spread of sexually transmitted diseases. The panel concluded that correct condom use definitively protected against the spread of HIV and gonorrhea, and that there was “a strong probability of condom effectiveness” for other STDs, including human papillomavirus (HPV). Coburn used the findings to declare that condoms don’t protect against HPV — a wild misappropriation of fact that has nonetheless become a big part of the anti-choice argument against the condom’s efficacy. Under pressure from Coburn and other anti-choice activists, the Centers for Disease Control was forced to revise its Web site fact sheet on condoms. There is now a box in the center of the page that reads, in part, “While the effect of condoms in preventing human papillomavirus (HPV) infection is unknown, condom use has been associated with a lower rate of cervical cancer, an HPV-associated disease” — not quite the same as saying, as the CDC previously did, that condoms protect against HPV.

Such subtle shifts in language have helped anti-choice activists to argue that condoms actually help spread STDs such as HPV by giving users a false sense of security. “When condoms are distributed to youth, they are more likely to engage in the activity,” says Worthington. And that’s why, she says, they’re at risk for everything from AIDS to unintended pregnancy. “In the real world, everyone knows that condom use is never 100 percent correct,” she says matter-of-factly.

While no one is suggesting that activists like Worthington will ever succeed in outlawing condoms or the pill, they are making incremental progress in passing laws that are making access to birth control more difficult. Of the 23 states that mandate employers to provide insured coverage for prescription contraceptives to their employees, 14 have exemptions for religious employers, and Missouri allows any employer, religious or secular, to deny coverage for any kind of contraception. During the 2005 legislative session, more that 80 bills in 36 states were introduced that would restrict minors’ access to birth control. On the federal level, the Health Insurance Marketplace Modernization and Affordability Act, currently being considered in Congress, would allow insurers to ignore state laws mandating contraceptive coverage. And then there is the matter of pharmacists and “conscience clause” laws. South Dakota, Arkansas, Georgia and Mississippi already allow pharmacists to refuse to fill contraceptive prescriptions. And at least 15 states have legislation pending that would allow not just pharmacists to refuse to dispense prescriptions, but would also protect cashiers who refused to ring them up.

“There are more laws on the books and proposals to welcome pharmacists to obstruct women’s access to birth control than there are pharmacists willing to do it,” says Page. “99.9 percent of pharmacists know their role is to fill prescriptions and not to make moral judgments.”

That doesn’t mean that a law on the books wouldn’t have a practical effect. “Once you have it as a law,” says Chip Berlet of Political Research Associates, a progressive think tank that tracks campaigns meant to curb human rights, “you organize more and more pharmacists to refuse dispensing pills.”

One reason for the new push to restrict birth control may have to do with changes in the Catholic Church — although this is hard to prove, because like many anti-contraception campaigners, Worthington insists that her site has nothing to do with Catholicism, even though she identifies herself as a Catholic and NRFC is filled with discussions of Catholic texts, like the “Humanae Vitae” and the Bible-study document “The Truth and Meaning of Human Sexuality.” Still, Berlet sees a connection to the appointment of Cardinal Ratzinger as pope — an appointment that radically conservative groups like Human Life International have enthusiastically supported. “I think they see in the Vatican some room to push this issue further to the right,” says Berlet.

Like the Catholic Church, NRFC opposes the use of contraception even within marriage. The “About Us” page on the site claims that “the constant promotion of and use of contraception leads to promiscuity, and a general lowering of morality and furthers the idea the sex has nothing to do with childbearing or commitment. When this attitude is brought into marriage, it can taint the relationship from the beginning.”

NRFC sees the availability of contraception as the root cause of the need for abortion. The “About Us” page also quotes a passage from the U.S. Supreme Court decision on Planned Parenthood v. Casey to argue that “In law and in practice, [contraception] led to the necessity of abortion because contraception proved not to be failsafe”: “[F]or two decades of economic and social developments, people have organized intimate relationships and made choices that define their views of themselves and their places in society, in reliance on the availability of abortion in the event that contraception should fail.”

In order to support the idea that contraception is dangerous, Worthington publishes articles on the site that take qualified language from scientific studies and distort their conclusions. One of them, “Oral Contraceptives declared carcinogenic by World Health Organization,” takes the news that the WHO found that estrogen-progestogen-based contraceptives increased a woman’s risk for breast, cervix and liver cancer while decreasing the risk for endometrial and ovarian cancers, and concludes: “It does not seem logical that any woman would place her body at risk for these deadly cancers, even if for the sake of reducing the risk of other cancers. Meanwhile, in the process a woman on The Pill is destroying her fertility. Medical doctors and researchers agree that one of the best ways to prevent some common cancers (such as breast cancer) in women is to conceive and bear a child and to breastfeed naturally. This is the body’s natural means of protecting itself from cancer.”

Worthington doesn’t mention that the WHO concluded, “Because use of combined estrogen-progestogen contraceptives increases some cancer risks and decreases risk of some other forms of cancer, it is possible that the overall net public health outcome may be beneficial.” Nor does she qualify her assertions with the fact that the WHO reviewed only previously published data, much of it gathered under studies conducted at a time when birth-control pills contained much higher levels of hormones than they do now. And her citation on breast-feeding comes from the anti-abortion group the Coalition on Abortion/Breast Cancer.

Finding these inconsistencies requires digging below the surface of the site — on the face of it, Worthington presents her cases persuasively, and couches her arguments in the rhetoric of women’s empowerment rather than that of morality. In another piece, titled “Chemical contraceptives kill her sex drive,” she takes as her starting point a January 2006 study in the Journal of Sexual Medicine about the relationship between the birth-control pill and sexual desire. Worthington notes that “the conclusion of the study states that while there is a link between chemical contraceptives and a decreased sex drive, more evidence is needed for an accurate correlation to be seen.” But then she blithely continues: “If The Pill is causing such trauma and stress in the lives of women, why is it promoted as the be-all, end-all for worry-free sexual relations?”

Worthington goes on to conclude: “Because of the use of hormonal contraceptives, men are equipped with the means to abuse women.”

When asked to clarify that statement, she replied, “Chemical contraceptives are promoted as a means by which a couple can have sex all the time with no worries, but how can you expect a woman to have sex if the man is making her take a pill that decreases her sex drive?”

Chip Berlet calls this kind of explanation “faux feminist rhetoric”: “It … changes the appearance of what side you’re on.” Indeed, if you ignore their ultimate conclusion that birth control should be eradicated altogether, many of Worthington’s arguments look a lot like feminist arguments. Concerns about the correlation between sex drive and the pill have been raised by pro-choicers, too, and on Worthington’s blog is a startling post railing about how unfair it is that a male birth-control pill will probably never exist because men don’t want to risk impotence, and women are expected to handle their side effects in stride. Take out the phrase “morally offensive” in relation to contraception in general, and there’s not much in the argument for a pro-choice feminist to disagree with.

Frances Kissling, president of Catholics for a Free Choice, points out that there is a conscious effort to appeal to that “segment of the women’s health movement who are suspicious of chemicals and IUDs and want to lead a natural life. There is that part of the [anti-choice] movement, and people who make Web sites like these see themselves as in alliance with women concerned with those issues.” Kissling says that this too is part of the Catholic movement against contraception. “This anti-birth-control stuff is part of two things: One, a conservative Catholic, mostly lay, movement to try to cast sexuality in attractive, natural terms,” meaning that “sex is beautiful, sacred, wonderful in the context of your body as a temple, only in marriage, and contraception is unnatural, chemical, dangerous.” Secondly, it’s an “attempt to promote natural family planning.”

Natural family planning is, in a nutshell, a more advanced, scientifically updated version of the rhythm method. Worthington says that NRFC doesn’t explicitly promote natural family planning, although it’s a “practical application” of her message against contraceptives. NFP is mentioned frequently on her site, and she is careful to correct any suggestion that NFP is a type of contraceptive practice: “Contraception destroys fertility while NFP works with fertility,” she says. It is “a scientific understanding of a woman’s body — recognizing when would be a good time to abstain, and when would be a good time to have a child”; she adds that it “requires self control and maturity.”

Kissling agrees that “the science has advanced as to knowing when ovulation occurs, which makes it reasonably reliable.” Just as we know when a couple trying to conceive should have sex, we know when one trying not to should abstain. “The problem,” she says, “is with ‘periodic abstinence,’ abstaining during ovulation with safety window on either side — the problem is abstaining from sex.” Realistically, very few couples are going to be able to follow a strict schedule of abstinence for very long, even if they sincerely want to try.

Still, says Kissling, because it doesn’t require hormones, and because proponents claim that NFP means that men have to be more in tune with a woman’s ovulation cycle, “there is a belief among Catholics that they could seduce feminists into using natural family planning.”

Yet, all evidence points to the overwhelming unpopularity of NFP. “The incidence of Catholic use of this method is no more than 5 percent [according to the 2002 National Survey of Family Growth],” says Kissling. “Catholics don’t want to use it, don’t accept this theology of the body. Very few people are buying what’s on these Web sites, but they have the same kind of appeal to young people as chastity pledges, or the Silver Ring Thing.” Basically, she says, it’s about the church finding “new ways to sell an unpopular contraceptive method.”

Further, NFP relies on the assumption that there is a period in a woman’s cycle when she’s not at risk for becoming pregnant, an assumption that may be false. Cristina Page points to a study that shows 40 percent of women may develop pre-ovulatory follicles as many as two to three times during one cycle, and thus it may be impossible to know exactly when they are ovulating. This helps explain why NFP has a whopping 25 percent failure rate.

Despite the unpopularity of NFP, the insistence on it and the taboo against birth control among some very strict Catholics — and evangelicals, an increasing number of whom oppose birth control at least outside of marriage — don’t seem to be preventing abortions. In a paper titled “From Patterns in the Socioeconomic Characteristics of Women Obtaining Abortions in 2000-2001,” researchers Rachel K. Jones, Jacqueline E. Darroch and Stanley K. Henshaw found that 40 percent of women in that year who had abortions identified themselves as either Catholic or evangelical.

“We know that birth control is 85 percent effective in reducing abortion,” says Cristina Page. “If it’s not [100 percent] effective even while legal, we’re moving onto a campaign that will exponentially increase the need for abortion.”

For those on the pro-choice side of the question, restricted access to birth control doesn’t just mean an increase in the number of abortions; it means the loss of other benefits as well. Contraception has given women the freedom to put off marriage, to go to college in greater numbers, to bring more wanted children into the world, and to find good jobs and thus bring more wealth into their families. Asked how he responded to the charge that banning contraception would turn back the clock on these advances, Ruben Obregon, Worthington’s co-founder in NRFC, responded: “Do you think a woman who has had an abortion feels that killing her unwanted child is an advance? My friends who have had abortions don’t exactly feel this way.” Obregon added, “It’s interesting how you fail to mention the high divorce rate, children of broken families, the spread of HIV and other STDs, all of which could arguably be linked [to] the impact of contraception on society.”

Obregon, who would only respond to questions via e-mail, and who refused to divulge his age, religion, location or line of work “out of respect for my family and my next of kin,” and because “it just opens things to ad hominem attacks,” also added, “And then there is the potential problem of not having enough gainfully employed workers to support those on social security.” Asked to clarify whether he meant that Americans needed to procreate more to create more workers, he replied, “No, you are saying that. Nice attempt to put words into my mouth.”

Any attempt to clarify Worthington or Obregon’s position, or to get them to back up their claims, led to more misdirection, fuzzy arguments, or, at best, questionable and clearly biased studies. To the suggestion that the problem with condom failure rates had to do with a lack of sex education, that distributing condoms without education was like throwing someone a deflated life jacket and not teaching them how to inflate it, Worthington responded, “What we’re talking about here is the difference between something that is morally wrong and something that is morally indifferent. What is morally wrong is having sex before marriage.”

Ultimately, Worthington and Obregon’s fight isn’t about birth control or abortion then, but about changing the way people live. Worthington admitted that she thought “sexuality is a gift from god,” and that she believes in “abstinence until marriage”; asked why she didn’t state that explicitly on the site, she hesitated before replying that it was “something we didn’t feel was important to mention, because what we felt was important to point out was the dangers of contraceptive use.”

According to Page, there’s no way to distinguish the anti-choice and religious arguments anymore. “The anti-choice movement has become a religious movement, and because of that, their interest isn’t in reducing abortion. In fact, reducing abortion has become problematic for them, because they want to strip Americans of using birth control, in effect to change the entire family structure.”

Page says she has noticed, too, that some anti-choice groups tend not only to oppose birth control, they also oppose child care. In her book she points to some troubling statistics and anecdotes: Ninety percent of senators who opposed the 1993 Family and Medical Leave Act are anti-choice; in the 2004 Children’s Defense Fund ranking of the legislators best and worst for children, the 113 worst senators and Congress members are all anti-choice; Web sites like Lifesite and that of the Illinois Right to Life Committee post reports linking child care and aggression; Focus on the Family, the Family Research Council and Concerned Women for America stress the damage that day care can have on a child. (Most of their information comes from the National Institute of Child Health and Human Development’s Early Child Care Report, which has been debunked again and again and again.) “The trifecta is ban contraception, ban abortion, make child care impossible,” says Page.

Frances Kissling agrees that the ultimate message is that “mommy should stay home and take care of the kiddies. This is bound up in this notion of men at the head of a family, of women’s identity as linked to their biological capacity, that men and women are complementary and different, that a woman’s primary function is motherhood.”

The site’s inconsistencies and seemingly pro-feminist viewpoint support that view. “If this was 1885, people reading this site would see it as very internally consistent,” says Chip Berlet. “It’s implicitly patriarchical, but it’s the Victorian patriarchical position — it’s not just pre-Vatican II, it’s pre- the last century: Put women on a pedestal; protect them from the dangers of the outside world.”

So why does it still resonate with some people? “For a lot of people it hasn’t been real good here in the post-Enlightenment — people have lost a connection to family and community, and they’re confused,” says Berlet. “The mythical reconstruction of the past where men were men and women were protected by the men is a cozy idea.”

But if the post-Enlightenment comes with its collateral damage, there’s collateral damage to pushing the ideals of traditional marriage as well. Martha Kempner, director for public information at the Sexuality Information and Education Council of the United States (SIECUS), points out that “for many young people, this completely ignores the reality they’re living in now. There’s no [room for an] alternative family structure. Say if your grandparents are raising you: You’re not as good, your family is not as good.”

Kempner thinks that, in the face of the anti-birth-control movement and Web sites like NRFC, the pro-choice side has to have “as many, if not more, places where [people] can get real information. And we have to teach critical thinking skills — one of the most important things a comprehensive sexuality education can do is teach you how to look at information and understand what makes it scientific, what makes it biased, and what makes it opinion.”

Kempner also thinks that, often, pro-choicers may be too quick to dismiss the importance of seemingly absurd claims. She points to a quote from Wendy Wright, president of Concerned Women for America, criticizing a study that correlated the increased availability of birth control with the decrease in abortion rate: “An ‘unintended pregnancy’ could be a wonderful surprise, not planned but welcome. Why should the government be in the business of ‘preventing’ a surprising but welcome pregnancy?” “Sometimes we look at statements like that and see them as completely ridiculous,” says Kempner, “and possibly wrongly assume that other people will see how ridiculous they are.”

Gloria Feldt says that the pro-choice movement needs to go even further. “Merely responding to attacks or even fighting back won’t do; in fact, it will make things even worse,” she wrote in an e-mail. Indeed, Feldt believes that even with its sly rhetoric and legislative victories, the anti-choice movement may finally have crossed the line, and given pro-choicers something to rally around. The pro-choice movement, she says, “must come roaring forward with a strong message, stirring policy agenda, and bold expansion of direct services. Motherhood in freedom is an ideal that is steeped in our highest values as a society. We own that ground, and if we claim it, it will not erode.”

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Priya Jain is a freelance writer in New York.

Think your birth control will always be covered? Think again

The Senate discusses a bill that would wreak havoc on women's insurance coverage.

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Hot off the Money Is More Important Than Women wire, this just in from Planned Parenthood:

“Today the United States Senate is considering a bill that would have a serious and damaging impact on health coverage for women across the United States. The Health Insurance Marketplace Modernization and Affordability Act (HIMMAA), introduced by Sen. Mike Enzi (R-WY), would allow insurance companies to ignore nearly all state laws that require insurance coverage for certain treatments or conditions, such as laws that require them to include contraceptives in their prescription plans. [Emphasis added by irate Broadsheet poster.]

“This federal legislation would raze hundreds of state laws that ensure patients can get the medical care they need and would

“– not allow women to designate their ob/gyns as primary care providers

“– not allow women to seek care directly from their ob/gyns, but would force them to be screened by their primary care doctors first

“– dismantle coverage for contraception

“– dismantle coverage for annual cervical cancer exams

“– not allow women to stay with the same doctor throughout a pregnancy, if that doctor was dropped from the insurance provider.”

In short: “Under HIMMAA women will lose contraceptive-equity protections currently guaranteed by state law.”

Broadsheet is already hearing from women whose co-pays for “insured” contraception have suddenly, mysteriously, spiked. Let your legislators hear from you.

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Award-winning journalist Lynn Harris is author of the comic novel "Death by Chick Lit" and co-creator of BreakupGirl.net. She also writes for the New York Times, Glamour, and many others.

Repeat after me: Plan B is not abortion

Plan B is not abortion, Plan B is not abortion ...

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Feministe points us to a well-meaning and useful — yet somewhat naive — editorial in the St. Louis Post-Dispatch about why it’s medically inappropriate to confuse emergency contraception with abortion and, ergo, why certain pharmacists and others who oppose it haven’t got a leg to stand on. In the piece, Philip G. Peters Jr., a professor of health law at the University of Missouri-Columbia, cites two recent studies that show pretty clearly that E.C. works by inhibiting ovulation, not — as previous studies have suggested may also occur — by preventing implantation of a fertilized egg.

Eureka!

Not!

Peters calls these studies “remarkably good news.” Now that we’re so sure that E.C. prevents ovulation — that is, intervenes before “life” begins — “neither pharmacists nor lawmakers must choose between reproductive freedom and freedom of conscience, a choice that previously seemed inescapable,” he exults. Right! That silence you hear? It’s the sound of militant pharmacists and sellout legislators taking it all back. They’re not about to budge on this one, sorry. Even if they know better, which many don’t. Especially those who oppose abortion and birth control (i.e. those who oppose rain and umbrellas). While professor Peters’ optimism is refreshing, it seems that in his world, all laws are based on common sense, all leaders have integrity, and Dolly won the Oscar for best song.

That said, given the extent and effectiveness of E.C. = abortion/Plan B = RU-486 [sic/sic] mind control — even my supergenius megaliberal former roommate fell for it not too long ago — we can’t afford not to see editorials like this, over and over again. This “news” about ovulation vs. implantation won’t change the minds of the hard-liners, but it could help free some reasonable people who are under their spell. (Meanwhile, stay tuned: How long before we hear from the “Life Begins at Ovulation” brigade?)

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Award-winning journalist Lynn Harris is author of the comic novel "Death by Chick Lit" and co-creator of BreakupGirl.net. She also writes for the New York Times, Glamour, and many others.

In Michigan, birth control for all

The state will allot $183 million from Medicaid to provide family planning services to the uninsured.

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And now, for some good news: Michigan will extend family planning services to 200,000 uninsured women, a plan expected to save millions of dollars. The Detroit News reported yesterday that “the plan will use $183 million from Medicaid to provide birth control to women ages 19-44 who cannot afford it.” The plan, which should go into effect by June, will, in addition to granting uninsured women contraception, also provide education and prenatal and postnatal counseling.

“We believe extending these services to low-income women across our state greatly increases the chance that every pregnancy in Michigan is a wanted one,” Democratic Gov. Jennifer Granholm told the Detroit News. “If all pregnancies were intended, the state would see significant reductions in infant mortality, child abuse, child neglect and abortion.”

At first glance the plan appears to be one of the most progressive allotments of federal funding for family planning since President Bush came into office. But as Renee Chelian, executive director of Northland Family Planning Centers, points out, “Most health departments have cut family planning services and with the exception of a couple of agencies that offer low-cost birth control, there are no places for women to go.” In other words, the allotment of funds will make up for the money that would normally be coming from departments of health. Despite the plan’s aim to decrease the number of unintended pregnancies, such pregnancies will undoubtedly continue, and for those uninsured women, the plan does not cover abortion services. Still, this is a welcome change from the usual abstinence-only and faith-based family planning funding that is one of the most frustrating uses of taxpayer dollars.

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Sarah Goldstein is an editorial fellow at Salon.

Should you IUD?

The once-controversial contraceptive deserves a second look.

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A flood of reader letters in response to yesterday’s Broadsheet post about women’s growing dissatisfaction with birth control pills has got us thinking seriously about IUDs (intrauterine devices) — those highly effective, but largely misunderstood, contraceptive devices that offer women long-term protection against pregnancy without hormonal side effects like weight gain, loss of libido and blood clots.

IUDs, while extremely popular globally (with more than 85 million women using them worldwide) have yet to be embraced by American women, in part because of lingering fears concerning their safety. (In 1976, a common IUD known as the Dalkin Shield was recalled after it was linked to uterine infections in thousands of women and dozens of fatalities.) But in the three decades since then, huge strides have been made in the development of harmless, reliable IUDs — which makes us think more women should be giving them a second look.

The two most popular options on the market right now are the ParaGard, a copper IUD that can be left in place for up to 12 years and is completely nonhormonal, and the Mirena, which is made of plastic, contains a small amount of the hormone progestin and is effective for five years at a time. According to Planned Parenthood, “both kinds of IUDs work by preventing sperm from joining with an egg by affecting the way they move. The hormone in Mirena increases effectiveness. It thickens cervical mucus, which provides a barrier that prevents sperm from entering the uterus. It also prevents some women’s ovaries from releasing eggs (ovulation).”

As with oral contraceptives, IUDs do not protect against sexually transmitted diseases, so should be used in conjunction with a condom or only by those involved in monogamous, committed relationships. Side effects may include a change in menstrual bleeding and cramping, and in rare instances IUDs may tear or be expelled from the uterus, according to Planned Parenthood.

So, are the new IUDs worth a try? If anecdotal testimony is any evidence, the answer is a resounding “Yes!” Among Broadsheet’s friends in women’s health — doctors, nurses and midwives — IUDs are the contraception of choice. Salon reader and letter writer “hollerhither” writes, “I stopped using the Pill for exactly the reasons [Traister] cited (depression, weight gain, etc.), and after consultation with my doctor decided to go with the Mirena IUD. It offers a localized, low dose of hormones but so far none of the side effects I dealt with when on the Pill. Extremely light periods, high effectiveness rate, and it’s good for five years (but can be removed at any time). The procedure was a regular $25 insurance copay plus $25 for the device itself — a bargain. [And] the Mirena is the #1 form of birth control used by the women in my gynecologist’s office — both doctors and nurses. That alone speaks volumes.”

So, tell us, ladies — do you IUD? What kind of experiences have you had with them? And what should we be asking our doctors? Let the birth control revolution begin!

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Sarah Karnasiewicz is a freelance writer and photographer based in Brooklyn, N.Y. Until recently, she was senior editor at Saveur magazine; prior to that she was deputy Life editor at Salon. She has contributed to the New York Times, the New York Observer and Rolling Stone, among other publications. For more of her work, visit thefastertimes.com/streetfood and Signs and Wonders.

Page 19 of 23 in Birth Control