Beyond Stupak: Shocking Fertility Control Provisions in Health Care Reform Legislation

This article was originally published on and is reprinted here with permission of the authors.  Gwendolyn Mink is co-author with Dorothy Roberts.

While the latest clash over health care reform has focused on
abortion funding, no attention has been paid to shocking fertility
control and family control provisions contained in current health care
legislation.  Many health care reform opponents are up in arms over
imaginary state intervention in medical care.  But the recently passed
House bill actually does authorize state intervention in a plan to monitor the childbearing decisions and family lives of low-income women.  

The House health care bill (H.R. 3962), contains a provision
affecting Medicaid recipients who are pregnant for the first time or
who have a child under two years of age.  Section 1713
allows States to use Medicaid funds for non-medical home visits by
nurses to advance certain goals affecting reproductive decisions and
family life.  The goals include: "increasing birth intervals between
pregnancies," "reducing maternal and child involvement in the criminal
justice system," "increasing economic self-sufficiency," and "reducing
dependence on public assistance." 

These goals of the home visitation program have nothing to do with
providing health care.  Instead, they are based on the false premise
that poor mothers’ childbearing is to blame for social problems.  The
proposed visitation program is eugenicist, deceptive, discriminatory
against low-income women, and utterly inappropriate to the medical work
of nurses.  

Under the program envisioned in the House bill, government-sponsored
medical professionals are charged with exhorting fertility control
among poor women, based on the mistaken premise that reproduction among
the poor leads to crime, neglect, low educational attainment, and
dependency.   Yet according to the government’s own statistics,
families receiving welfare have, on average, only 1.8 children; half
the families receiving welfare have only one child, and only one in ten
have more than three children.  

Although the data show that poverty is not correlated with family
size — and that childbearing does not cause poverty —  the U.S. House
of Representatives seeks to tell low-income women who receive medical
assistance how many children to have and when to have them.

The House health care bill codifies some of the worst stereotypes of
low-income mothers, suggesting that bad reproductive choices and
misguided family practices make their families poor.  Similarly, the
provision blames low-income mothers for raising criminals and accuses
them of maintaining unstable and neglectful home lives for their

Black mothers in particular have been subjects of deeply-embedded
stereotypes about sexual and reproductive irresponsibility that have
supported a long legacy of repressive state policies, including
sterilization and coerced birth control.  The mythical “welfare queen,”
portrayed as a black woman who deliberately becomes pregnant to
increase the amount of her monthly check, was propaganda used to
support welfare reform.  Several state legislators even proposed bills
requiring women to use birth control or undergo sterilization as a
condition of receiving welfare benefits.  Immigrant women and other
women of color have suffered similar injustices that devalue their
reproductive decision making, as well as their parental rights and
family practices.   

These statutory devices and impositions should sound familiar to
anyone aware of the 1996 welfare reform law.  It too pivoted on the
idea that regulating poor women’s reproduction would end their need for
welfare. Congress transformed welfare from a system of aid to a system
of behavior modification that attempts to control the sexual, marital,
and childbearing decisions of poor unmarried mothers by placing
conditions on the receipt of state assistance. Section 1713 interprets
literally the language of "pathology" from the welfare debate in its
plan to "cure" the putative effects of poverty by curing poor mothers’
fertility and motherhood.

We applaud the lawmakers who have banded together to take a stand
against inclusion of the Stupak amendment in the final bill. But we
urge them look beyond Stupak – to support a vision of reproductive
justice that extends beyond abortion and respects the childbearing
decisions and mothering of all women.  Health care reform must not only
ensure the right to abortion but also must protect the full spectrum of
women’s reproductive and family rights. Congress can start to promote
the well-being of all women by rejecting eugenicist provisions such as
the home visitation program. Any visiting nurse program in health care
legislation should stick to providing medical care regardless of
economic or social status.  Economically vulnerable women should not be
treated as sitting ducks for social engineers.

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  • lon-newman

    This is troubling in that the article seems to rely on unsubstantiated interpretations of the motivations of the legislators and then quickly devolves even further to hyperbole and name-calling – e.g. "eugenicist" and "fertility control." It even raises the spectres of "forced sterilization" and "welfare queens."

    The author’s point of view is understandable, but toxic. It is less than helpful in terms of analyzing the House Health Care Reform bill.  

  • juliejulie

    I understand how this legislation could be used badly, and how it could be interpreted as discriminatory. However, it is generally accepted within the feminist movement that family planning, pregnancy spacing, etc. are positive tools for women and families. Arguing against people having access to this knowledge is like arguing for abstinence only education.

    Additionally, I don’t know where the author of this article is from, but I’m from rural arkansas, and I can tell you, for sure, the “welfare queen” you mention is NOT a myth…I know some of these women myself. They ones I know do have more babies to get more check, they do refuse to let the father’s live in the home because it reduces the amount of money they can get from the government.

    Let’s all agree to be pro education and relize: people receive assistnace from the state often because they need it, and offering to come to the home, especially in rural areas, is a good thing. My own family owes much of our comfort and knowledge to the monthly visits of the county extension agent who comes out to educate on different topics. And I’m talking about three generations of family on a family farm where all the family members have college degrees. so you, know, let’s try to sometimes look at the positives to this type of education.

    julie in memphis


  • elisa

    I agree the Stupak amendment has gotten all the attention, while other troubling provisions are largely ignored. 


    I think there are two separate issues here though.  I’m not a health professional, but I do think spacing the time between pregnancies IS a health issue – for mom and her family.  (Whatever size she ultimately wants that to be.)


    TOTALLY agree nurses have no business talking about "involvement in the criminal justice system." 


    But I think we do want to support the visiting nurse program … for healthy moms and babies. 

  • crowepps

    "Bad Black Mothers" at The Nation

    I can tell you, for sure, the "welfare queen" you mention is NOT a myth…I know some of these women myself.

    I’m from Alaska, and I know a few as well, although the ones I know are all white. The thing is, though, if you look at it objectively, these are, first, women who have bought into the ‘real woman must be mother’ ideal that the ProLife advocates keep touting, and, second, are smart enough to game the system (by not letting Dad live-in), but they certainly are not the ones who CREATED the system.


    Whose bright idea was it that the family of Dad, Mom and kids with no income gets a smaller amount of support than Mom and kids alone? These women have children to raise – they would have to be dumb as stumps not to understand that tossing hubby out or staying single is the smart thing to do.


    This is a perfect example of the rule about unintended consequences: the moralists held a contemptuous stereotype of poor males and wanted to prevent any chance a husband might just sit around the house ‘drinking the welfare money’, so they passed rules to penalize him that instead made getting married for dopes. Now, of course, they keep the rule that was so disastrous and blame the women for being "immoral" – having sex while single and having babies while single (or, alternatively, immorally having an abortion so she DOESN’T have babies while single). Ain’t it wonderful how social services focuses so sternly on making sure the clientele know that everything in their life that’s horrible is THEIR OWN FAULT because they HAVE SEX WITHOUT SOCIETY’S PERMISSION?


    I cannot remember which history book I read it in, but I remember being really appalled that one of the rules in the first ‘support network’, the workhouse, was that husbands and wives had to stay in separate sections of the institution; apparently marital sex was something that was only ‘moral’ if you could support yourself 100% on your own. This prevented new pregnancies but also prevented the husband from protecting his family and enabled the staff to abuse the wife (and possibly get her pregnant). If the husband found out what was happening and dared to protest, the whole family was tossed out to starve. Sometimes I think social services hasn’t progressed much in the couple hundred years.

  • julie-watkins

    So I wouldn’t be surprised if that part of the medicad bill that applies to low-income (all of it?) could very easily have bad "unintended" consequences.

    This article reminds me of a very good Daily Kos article posted November 10th. and whereas there are countries where control-the-women is clearly evident, the anti-woman aspect of Stupak-Pitts and Hyde and lots else in US law is just part of "[explitive] the poor, … and, in the USA, access to any rights you have are what you have enough money to purchase. And the author [shanikka] gives some examples of court cases where policies that effectively discriminate on the basis of income aren’t an "equal protection" violation because there’s a "rational basis" (financial concerns).

    Her quoting Harris v. McCrae, which was the (only?) lawsuit to challenge Hyde:

    regardless of whether the freedom of a woman to choose to terminate her pregnancy for health reasons lies at the core or the periphery of the due process liberty recognized in Wade, it simply does not follow that a woman’s freedom of choice carries with it a constitutional entitlement to the financial resources to avail herself of the full range of protected choices.

    IOW, it isn’t "discrimination" if a state, deciding there’s a state interest in "encouraging childbirth", funds birth expenses but not abortion. There’s many comments about Stupak-Pitts warning about "back alley abortions", but they already have happened because of Hyde.

    Three months after the Hyde Amendment was passed, 27-year old Rosaura Jimenez became the first women to die because she could not pay for a legal abortion following the Hyde Amendment. Nobody knows how many women have died since, because it wasn’t too long after this that the government stopped requiring health care providers to keep track of such things as the number of women coming in presenting symptoms indicating that they were suffering the effects of a botched abortion procedure.

    Our ability to predict what Stupak-Pitts will brind based on the experience of Hyde is hampered because the statistics are going to be spotty or not there … .

    Even if the lanuage the above author finds suspect is, on it’s face, benign, considering the track record of USA law and the poor, I’m sure it will be used as just another tool to block access to rights that those of us with property never even think about.