The Economic Crisis: A Generation of Reproductive Health “Horror Stories”

generation has its own favorite brand of horror stories.  Its own
special set of circumstances that prick its conscience and goad it to

These words were written by
the historian David Rothman 30 years ago, in an essay called "The
State as Parent." Rothman’s argument is that  Progressives
of the early 20th century saw the social ills of that period — desperate
poverty which led to children begging on the streets and widows having
to place their children in orphanages, unregulated workplaces that were
both unsafe and exploited child laborers — as  issues that
cried out for state intervention. But progressives (with a small "p") 
in the 1970s saw too much state intervention as the problem. The horror stories for the latter were the threat to individuals’
and families’  autonomy, because of the social policies
of confining against their will those who were "different" — the
mentally ill, or the homeless — or the too quick willingness to transfer
children from parental to state custody because of dubious charges of

Rothman’s intriguing formulation leads me to ask myself, At this moment,
what are the emblematic  "horror stories" demanding action for  reproductive justice activists?  For the dismal period
of the Bush years,  the horror stories have been endless, and are well known. The glue that tied all the Bush-era reproductive
atrocities together — from the global "gag rule," to the unqualified ideologues appointed to crucial government positions, to
the provision of health care to fetuses but not to the pregnant
women carrying these fetuses — was the commitment to reward the Religious
Right fanatics that made up the President’s base.

as we enter a new era, with the end of the Bush presidency coinciding
with the worst economic crisis since the Great Depression,  I see different types of reproductive horror stories emerging. These stories
transcend the abortion divide. They speak squarely to the economic devastation
facing Americans across the political spectrum, and how this crisis
impacts people’s reproductive lives.  Three recent items
in the news serve as examples.

The first is the story of Starla
, a pregnant Ohio woman, who was informed she would soon
lose her job and her health insurance.  She rushed to a hospital,
requested a medication to induce labor, and had an emergency
Caesarean section, two days before her health insurance expired.
Not only was Darling upset about having a C-section birth — "I was
forced into something I did not want to do" — her insurance company refused
to pay for the birth.   Now this unemployed woman, two months
behind on her rent, is facing medical bills of more than $17,000.

second story, from the Wall Street Journal, concerns the increase in women seeking to donate eggs or serve as surrogate mothers, a rise
attributed to economic hard times.  "Whenever the employment
rate is down, we get more calls," said an said a spokeswoman for an
agency in Chicago, who reported a 30% rise in calls. "We’re even
getting men offering up their wives."

of the most high profile recent cases of women using their
eggs and uteruses to cope with economic difficulties came to light in
a much-discussed New York Times magazine story of a
writer who hired a middle-class woman, from a two-earner household, as a surrogate mother. The story revealed that the woman who served as a surrogate was doing
so to help pay for her daughter’s college tuition. The daughter in
turn was contributing to her college costs by selling her eggs.

These stories are particularly striking to me because in each case, the
economic crisis is driving women to do things with their
bodies that they otherwise would not do (a phenomenon, of course, that
always rises in economic hard times).  True, some women prefer
elective C-sections to vaginal birth, but Starla Darling clearly
was not one of them.  With egg selling and surrogacy, the motivations
are always a little murky — is it altruism and/or a desire for financial
compensation? — but the current spike in inquiries is making clear
that many women are now drawn to this option because of the latter,
and that seems the case with the mother-daughter pair mentioned above.

other kinds of economically driven reproductive horror stories might
we expect in the immediate future, as more people are thrown into poverty? 

The main lesson for reproductive health scholars of the Great Depression
of the 1930s was the dramatically lowered birth rate (in an era in which
both contraception and abortion were illegal).  We can speculate
that the period just ahead will similarly be one in which people will
try desperately to limit family size.  There will be more demand
for both contraception and abortion. There will very likely be a rise
in attempts at self-induced abortion, as women find that they can’t afford
to pay for the procedure, or, depending on where they live, simply can’t
afford to get to an appropriate facility. 

Sadly, some people will miss the opportunity to have the number of 
children they wish for.  Even more sadly, some will likely forego
childbearing altogether.  A higher proportion of children will
be born into families that will not have the resources to adequately
take care of them. Incidents of infant and child abandonment, even infanticide,
may well rise. 

challenge facing the new Obama presidency with respect to reproductive
justice is therefore a complex one: undoing the many limitations
on contraception and abortion put in place by the Bush administration
making it possible for the economically distressed to
have a full range of reproductive options, including having and raising
children.  Hopefully, in the early 21st century,
we will rediscover what Progressives concluded 100 years ago — that 
times of massive economic dislocation call for an activist government
which helps people have the family lives they wish for.

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  • invalid-0

    “Each generation has its own favorite brand of horror stories. Its own special set of circumstances that prick its conscience and goad it to action.” David Rothman

    Rothman’s statement is a side of a many faceted coin: As each generation becomes aware, often through the empowerment of a single group against whom prejudice was routinely exercised, that single prejudice wanes.

    Prejudice, itself, however, remains. So males may exercise prejudice against females, one primary prejudice, until females gain sufficiently to alter their status.

    Many other divisions besides male/female remain. White/Black, Gay/Straight, we seem always to find a division, Them, to diminish and a division, Us, to promote. Sociology is powerful.

    Told whom to diminish, the majority of us do. Would I, a White man, have obeyed segregation in the 30s US South? Would I take the front of the bus? Sit at a segregated lunch counter? The chances are far from slim that I would obey what the culture permitted me. Were I a White woman, the chances remain as slim. Were I a White Jew, a White Christian, same chances. Black/White decided, as male/female did- for the majority.

    But that was then, what “permissions” do I respond to now? How do I discover them? Is there a way to know?

    Harold A. Maio

  • jodi-jacobson


    This is an excellent piece, but for me also underscores a few additional points.

    The choices being made by middle (or formerly middle-class) people in response to lose of income, insurance, even homes are choices faced as a matter of course by women who live in persistent poverty and/or persistently at the margins of the lower-middle class in the United States. So we are seeing the "spread" to the middle class of conditions that always exist but are often less seen.

    Women elsewhere–take India, Peru, Uganda–have been and are using their bodies increasingly as a means of income in these same ways.  Stories about women in India acting as surrogates for women in other countries offer one example.  Women choosing to enter sex work as the only rational economic choice they can make to support their families is another example of how poverty drives and is driving women to make sexual and reproductive choices.  The U.S. has a role to play in this too, and the same Bush policies that have denied women access to sexual and reproductive health care in this country have done so with grave but less easily visible consequences elsewhere.

    I would argue that personal economic circumstances are always a factor in reproductive choices–whether or not to have children, when to have them, how many–even in the best of times.  What is different now is that women’s choices have been so purposefully and so dramatically diminished by an Administration that has had so little disregard for the lives, health, and rights of women as to be abusive.

    I hope it is the Obama Administration’s goal to ensure that *everyone* has the ability to exercise the full range of reproductive choices, including having and raising children, in good times and bad.

    This means ensuring that reproductive and sexual health are at the core of health care reform, but also that education, child care, parental leave and other conditions relevant to the "economics" of reproduction are taken as seriously as bailing out the auto and financial industries.

    Best wishes and thanks for a provocative piece.  Jodi Jacobson

  • invalid-0

    This is an interesting story angle. Yes, the lack of informed consent and overdoing of C-sections and other birth “procedures” leads to so many horror stories (over 30% of women have C-sections!), in economic and non-economic terms.

    I think the author overlooks some other major stories, though, such as the sterilization of women of color. That’s one of the biggest reproductive justice concerns of the 20th century. Also, I recently read in a Breast Cancer Action article (, that African-American women have a 36% higher breast cancer mortality rate than white women! The important question isn’t “What are the horror stories of these activist generations?”, but what “horror stories” are slipping through the cracks?

  • invalid-0

    Jodi and electric fortune–I thank-you both for your valuable comments. I agree with what both of you are saying–what we will be increasingly seeing in the U.S. are more of the events that have long occurred to women in the developing world and to poor, disprotionately women of color, in this country. Electric fortune, two great books that document the sterilization of women of color are Johanna Schoen, Choice and Coercion (about sterilization in N. Carolina) and Elena Gutierrez, “They multiply like rabbits” (thats the subtitle-i can’t remember the main title)–about the sterilization of Latinas in California. thanks again to both of you–carole

  • invalid-0

    Elena Gutierrez’s book is actually called Fertile Matters: The Politics of Mexican-Origin Women’s Reproduction