Why Understanding Black Women’s Beliefs About Motherhood Can Help Improve Reproductive Health Care

Chanel, now a middle-class mother of one, is just one of many women who have used abortion to end a pregnancy. “In college,” she explained, “I had two abortions and I had them not because I didn’t want to be a mother but because I wasn’t ready. I wanted to finish school and I just felt like I was too young… [M]y mother really stayed on me about not having kids and I saw what it was like for her to have kids at such a young age and to be unmarried… I never wanted to do that.” Researchers can distill Chanel’s lived experience down to the briefest of statistics: Black woman, college-educated; three pregnancies, one child. But her candid testimony sheds needed light on the complexities of personal choices about pregnancies. When I interviewed her, Chanel made it clear that her abortions were her own decision. But such decisions are always made by women in the context of external forces that constrain their options.

Decades of previous research have illuminated the significant racial and economic disparities that affect women who seek access to reproductive health services. Black women, especially, bear the brunt of socioeconomic and political factors that impede their full autonomy in making reproductive choices. Much has been made of data from the Guttmacher Institute showing that abortion rates for Black women are almost three times higher than for white women, and that unintended pregnancies are nearly twice as frequent for Black women. Meanwhile, abortions are increasingly concentrated among poor women, who accounted for nearly half of all abortions according to the latest available 2014 data.

What might create more favorable and equal conditions for Black women dealing with reproductive health issues? Studies have suggested many possible solutions – including better sexual health education for young people; expanded health insurance coverage; and increased access to reproductive care, including all forms of contraception, abortion care without stigma, and quality pre- and post-partum care for mothers and children. Many scholars are now also probing the ways in which institutional racism undercuts good health care for Black women.

Effects of Wealth, Class on Black Women’s Ideas about Motherhood

Although a focus on collecting and analyzing systematic data contributes to our overall understanding of women’s reproductive decisions and consequences, my research using in-depth interviews seeks to fill gaps left by previous studies. Discussions about abortion and contraception for Black women, I find, are often influenced by Black communities’ understandings of the centrality of motherhood in the reproductive life course. A richer understanding of the importance of motherhood to the Black community may help researchers and policymakers provide resources and programs grounded in the realities of Black women’s reproductive lives.

My conversations with research participants highlight the role of class in Black women’s definitions of motherhood and interpretations of “choice.” For poor and lower-class women, womanhood is deeply imbued with the value of motherhood. These women largely approach motherhood as destiny rather than as one choice among many. In contrast, upper- and middle-class women grapple much more with the “hows” and “whens” and “with whoms” – with the mechanics of fitting motherhood into their lives. Kim, a young working-class mother of one, explained that her own mother controlled some of her early reproductive health choices: “When I was younger my mom put me on [birth control] and said it was for my periods.” In contrast, Mia, a 33-year old middle-class women with no children, described a more deliberate decision to avoid pregnancy: “Kids are expensive… It’s cheaper to take birth control than have the kid. [laughter] so um yeah I’ll just keep taking birth control until I hit the lottery.” Both women exercised reproductive autonomy by taking birth control, but only the higher-income woman expressed the feeling that preventing pregnancy was her own choice to make.

Including Understandings of Motherhood in Reproductive Health Policy

As they make reproductive decisions, Black women struggle with expectations and obligations about motherhood. Devising policies that take account of community expectations and constraints may help reduce unintended pregnancies, increase access to reproductive healthcare services, and improve health outcomes for Black women. Exploring the meaning of choices made by Black women can reveal how variously situated women make different decisions. This, in turn, will allow more equitable provision of reproductive services.

My work begins to paint a detailed picture of Black women’s reproductive health journeys. But more research remains to be done. To combat the obstacles Black women face, we must interrogate and supplement quantitative data with qualitative explorations of personal experiences and beliefs. Data and interviews so far suggest a number of useful steps to be taken by key stakeholders ranging from policymakers to doctors:

  • Increase access to insurance to reduce the financial burden of preventing pregnancies or bearing children.

  • Foster cooperation among researchers, clinicians and educators – to improve understandings of beliefs important to the Black community, including ideas about motherhood and the meaning of womanhood. Such understandings can help providers improve the dissemination and reception of reproductive health education and services in the Black community.

  • Earmark funding for more research about the ways Black women in various social positions understand their reproductive lives. And encourage studies that encourage community participation and place a central emphasis on hearing Black women’s voices.

Black women make all sorts of reproductive choices, from using birth control to having abortions to raising babies. As their stories reveal, every choice is influenced by social class and the expectations of their families and communities. Researchers and advocates who want to improve reproductive health outcomes for Black women would do well to listen to what Black women have to say and view individuals’ choices as profoundly shaped and limited by social circumstances and cultural ideas and expectations.

Paid Maternity Leave: A Policy Imperative

Living in a country so focused on the reproductive behaviors of women, from contraception to abortion, it seems preposterous that despite the myriad policy imperatives that want to control women’s fertility, there is no federal policy that supports our decision to give birth by granting us paid maternity leave.

Maternity Leave in America: Where are we at?This policy gap is even more significant given that the USA is the only industrialized nation not to mandate paid maternity leave and is one of only a handful of countries globally that does not. The countries that are members of the Organization for Economic Cooperation and Development (OECD) average 18 weeks of paid maternity leave. Maternity leave is a social, economic and health policy that has broad and significant impacts for individuals, families, organizations and nations.

(For reasons of brevity and simplicity I am deliberately focusing on maternity leave but it is important to note that many national and organizational ‘maternity’ leave polices are subsumed within parental policies that apply to both mothers and fathers).

Family and Medical Leave

In the USA, the primary policy related to maternity leave is the Family and Medical Leave Act (FMLA) which puts various kinds of family-related leaves into one unpaid 3 month pot which includes leave for caring for a parent and leave for caring for an child. However, New Jersey, Rhode Island and California provide state-funded paid family and medical leave that includes pregnancy and childbirth. These policies are paid for by employee-paid payroll taxes and distributed through disability programs – with ‘disability’ being an unfortunate, if economically useful, way of categorizing pregnancy and birth.

If they do not work for one of the top law firms of the Vault 100 or a Fortune 500 corporation that competes for top talent and grant paid maternity leave to attract and retain employees, women are generally out of luck. If you are a woman with a ‘regular’ job, what do you do when you get pregnant or have just given birth? You have to take upaid leave at a time when your expenses have increased. Thus many women return to work within weeks of birth. Though some women try to continue to breastfeed, not many workplaces allow for convenient pumping and so women find themselves having to wean their infants because of workplace conditions in addition to their ‘early’ return to the paid workforce.

Many feminist activists do not want to ‘provoke’ a paid maternity leave policy because they think it makes women stand out as needing different (special) treatment than men. The fact is we are different from men and therefore need different policies related to our health and well-being. We incubate human beings for 9 months. We also have breasts that can be the sole nutritional source for infants for more than 6 months. This highly differentiates women’s parenting roles from that of males, regardless of how egalitarian a construct we may consider parenting to be.

Gender and Class Differences

In order for women to get the policies we want, we should acknowledge the difference, own the power in that difference, and demand what we need to take care of the next generation. The absence of child benefits, dearth of subsidized high-quality childcare, costly access to healthcare, low-performing public schools and high tuition costs for tertiary education are evidence of a government that talks about supporting families while neglecting the policies that would do so.

Not many women can afford to take unpaid leave and the women who work for companies were paid leave is a perk are more likely to be able to afford to take an extended leave without being paid while doing so. By making work incompatible with motherhood, women are forced to make hard choices between taking care of their children and being in the workforce, and men are forced to make this choice. Leaving the workforce because of motherhood not only reduces present income, it also limits lifetime income on which pensions are calculated while maintaining and expanding the income gap throughout the lifespan.

Our social welfare policies push poor women to work and yet social norms push middle class and wealthy women to stay home. Taking care of one’s own child should not be an economic luxury. Our economic and social policies recognize childcare as a ‘job’ only if someone other than a parent is taking care of a child. If a woman is taking care of her own child, her contribution to the economy and society is not ‘officially’ acknowledged by society at large.

For women who qualify for subsidized childcare, it is counterproductive and expensive to pay so much more money for a non-parent to care for a child while being unwilling to support a woman to take care of her own child. With regard to paid maternity leave and subsidized childcare, it is clearly not just about money, but it is about values.

The Wage Gap

Maternity leave is a key factor in the gender gap in wages and employment and in the ‘family gap’ in income that exists between women with children and women without children. Forty to fifty percent  of the gender gap income can be explained by the family gap differential due to marital and parental status among women.

The absence of paid maternity leave in the USA has been perceived by feminists and public health professionals as anti-woman, anti-child and anti-family because it does not provide income for woman post-childbirth nor does it support the 6-month breast-feeding recommendations of the American Pediatric Association.

Health Outcomes

There is no coincidence in having no paid maternity leave and the poor health outcomes we have for infants/children in this country. This is not to say that this is the only policy to blame as health policies are also significant contributors to poor health outcomes in mothers, infants and children. Policy ‘obsession’ with humans in utero do not continue once children are born.

There is little regard for comprehensive sexual health education for children and adolescence and too much attention paid to contraceptive choice and abortion. Once the child is born, our social welfare and health policies leave all but the poorest of mothers to fend on their own. The poorest women qualify for Medicaid and WIC (Women, Infants and Children). This is reflected in lack of affordable, high-quality childcare, poor performing public schools, juvenile justice facilities that are full to overflowing, low high school graduation rates and college costs that leave young adults mired in debt.

The Price of Motherhood

The price of motherhood should not be so financially challenging. Is possible women in developing nations will simply choose to opt out of the motherhood game altogether? Though the fact that American women continue to give birth at such high rates despite a social welfare net that has very large holes is a social policy paradox that is not easily understood. The demographic and economic challenges of low birthrates are not so easily fixed by social policy. Doing research on this topic for an economics class on gender and family, it was really hard to find a rationale for the resistance to paid maternity leave in the USA so I’m not sure why we are stuck in some sort of policy dark age along with universal access to health care.

Where Do We Go From Here?

In 2010, Ernst and Young was listed among the top 10 family friendly companies by Working Mother Research Institute, provides new mothers with 12 weeks paid leave and 10 weeks unpaid leave. Bank ofAmerica, which was also on the top 10, gives a paid leave to either gender of 12 weeks and allows them to take a total of 26 weeks. These organizations are profit-making institutions that would not be handing out benefits if they did not make economic sense. Getting good benefits lead to staff loyalty that reduces the costs of staff turnover. Furthermore, the costs of educating and training women get recouped over time when women are retained in the workforce.

For women who are joining the workforce, paid maternity leave should be a consideration when deciding on potential employers because the economic, social, health, personal and family benefits that result from such policies contribute much to our overall well-being and that of our families and society at large.

As is the norm in the USA, paid maternity leave is a social and health policy that is attached to employment and an employer. This leaves women at the whim of the workforce. Paid maternity leave should be a federal concern and not dependent on the whims of workplace or state policies.

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