Women and Welfare: Revisiting Reform in the Wake of Economic Crisis

Susan Wefald

Coverage of the economic crisis focuses on the fate of the newly poor middle class. But stories about those who were already poor in the “best of times” have been few and far between.

This article was originally published by the Ms. Foundation for Women.

While there’s been plenty of talk throughout this global economic crisis about the fate of the newly jobless, newly poor, middle class, stories about how the tanking of the economy has affected those who were already poor in the “best of times” have been few and far between. In this week’s issue of The Nation, however, Katha Pollitt asks some long overdue questions about the current plight of Americans who entered this recession in poverty — particularly the women among them.

Framing her piece around “welfare mothers,” and the impact that the passage of 1996’s Personal Responsibility and Work Opportunity Reconciliation Act (or PRWORA) has had on their lives, Pollitt notes that despite the tendency of pundits and analysts to label these welfare reforms a “success,” in fact, even in the economically prosperous 1990s, the families most affected by said reforms remained solidly poor. PRWORA may have pushed poor women off the welfare rolls and forced them to find jobs (which conservatives cast as a return to the great American ethic of “hard work”) — but those jobs tended to pay them much less than it actually took to survive, usually earning them salaries well below the annual poverty line. (Hard to see the “success” in all that.)

So how are these women and families managing nearly 15 years after the passage of the PRWORA and in the worst economic climate in recent memory? The hidden truth may be that they aren’t managing at all; they’re simply subsisting. Homeless shelters have seen the impact: according to the Center on Budget and Policy Priorities, from July to November 2008 the number of families entering New York City homeless shelters increased 40 percent over the same period in 2007. And as Pollitt points out, while the use of food stamps nationwide has also risen 40% over the last 2 years, there’s been little jump in welfare rates over the same period — meaning, most likely, that the process for accessing the latter type of aid has become so complicated as to “weed out” those who most need it. It’s therefore safe to assume, according to one of Pollitt’s sources, that most of these women and families are now living in a state of “constant suffering and inequality,” vulnerable not just to poverty itself, but to all of its attendant, ugly bedfellows, including increased rates of domestic violence.

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There are, of course, solutions to be had to problems of this nature, and, among other things, they involve crafting and pushing for the adoption of policies that put the needs and experiences of women and families at their center — just as Ms. Foundation grantees the Mississippi Low-Income Child Care Initiative and the Georgia Citizen’s Coalition on Hunger do every day.

With TANF (Temporary Aid for Needy Families – a provision of PRWORA that replaced AFDC) up for recertification this year, Congress now has an opportunity to, in the words of grantee Legal Momentum, finally “make [welfare programs] responsive to the mothers and children [they are] intended to serve.” To do that, though, they’ll need to start listening to the women living on the front lines of extended poverty and including their perspectives in the decision-making process — an approach that’s clearly long overdue.

Commentary Contraception

The Promotion of Long-Acting Contraceptives Must Confront History and Center Patient Autonomy

Jamila Taylor

While some long-acting reversible contraceptive methods were used to undermine women of color's reproductive freedom, those methods still hold the promise of reducing unintended pregnancy among those most at risk.

Since long-acting reversible contraceptives (LARCs), including intrauterine devices and hormonal contraceptive implants, are among the most effective means of pregnancy prevention, many family planning and reproductive health providers are increasingly promoting them, especially among low-income populations.

But the promotion of LARCs must come with an acknowledgment of historical discriminatory practices and public policy related to birth control. To improve contraceptive access for low-income women and girls of color—who bear the disproportionate effects of unplanned pregnancy—providers and advocates must work to ensure that the reproductive autonomy of this population is respected now, precisely because it hasn’t been in the past.

For Black women particularly, the reproductive coercion that began during slavery took a different form with the development of modern contraceptive methods. According to Dorothy Roberts, author of Killing the Black Body, “The movement to expand women’s reproductive options was marked with racism from its very inception in the early part of [the 20th] century.” Decades later, government-funded family planning programs encouraged Black women to use birth control; in some cases, Black women were coerced into being sterilized.

In the 1990s, the contraceptive implant Norplant was marketed specifically to low-income women, especially Black adults and teenage girls. After a series of public statements about the benefits of Norplant in reducing pregnancy among this population, policy proposals soon focused on ensuring usage of the contraceptive method. Federal and state governments began paying for Norplant and incentivizing its use among low-income women while budgets for social support programs were cut. Without assistance, Norplant was not an affordable option, with the capsules costing more than $300 and separate, expensive costs for implantation and removal.

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Soon, Norplant was available through the Medicaid program. Some states introduced (ultimately unsuccessful) bills that would give cash rewards to entice low-income women on public assistance into using it; a few, such as Tennessee and Washington state, required that women receiving various forms of public assistance get information about Norplant. After proposing a bill to promote the use of Norplant in his state in 1994, a Connecticut legislator made the comment, “It’s far cheaper to give you money not to have kids than to give you money to have kids.” By that year, as Roberts writes, states had spent $34 million on Norplant-related care, much of it for women on Medicaid. Policymakers thought it was completely legitimate and cost-effective to control the reproduction of low-income women.

However, promoting this method among low-income Black women and adolescents was problematic. Racist, classist ideology dictating that this particular population of women shouldn’t have children became the basis for public policy. Even though coercive practices in reproductive health were later condemned, these practices still went on to shape cultural norms around race and gender, as well as medical practice.

This history has made it difficult to move beyond negative perceptions, and even fear, of LARCs, health care, and the medical establishment among some women of color. And that’s why it’s so important to ensure informed consent when advocating for effective contraceptive methods, with choice always at the center.

But how can policies and health-care facilities promote reproductive autonomy?

Health-care providers must deal head on with the fact that many contemporary women have concerns about LARCs being recommended specifically to low-income women and women of color. And while this is part of the broader effort to make LARCs more affordable and increasingly available to communities that don’t have access to them, mechanisms should be put in place to address this underlying issue. Requiring cultural competency training that includes information on the history of coercive practices affecting women of color could help family planning providers understand this concern for their patients.

Then, providers and health systems must address other barriers that make it difficult for women to access LARCs in particular. LARCs can be expensive in the short term, and complicated billing and reimbursement practices in both public and private insurance confuse women and providers. Also, the full cost associated with LARC usage isn’t always covered by insurance.

But the process shouldn’t end at eliminating barriers. Low-income Black women and teens must receive comprehensive counseling for contraception to ensure informed choice—meaning they should be given information on the full array of methods. This will help them choose the method that best meets their needs, while also promoting reproductive autonomy—not a specific contraceptive method.

Clinical guidelines for contraception must include detailed information on informed consent, and choice and reproductive autonomy should be clearly outlined when family planning providers are trained.

It’s crucial we implement these changes now because recent investments and advocacy are expanding access to LARCs. States are thinking creatively about how to reduce unintended pregnancy and in turn reduce Medicaid costs through use of LARCs. The Colorado Family Planning Initiative has been heralded as one of the most effective in helping women access LARCs. Since 2008, more than 30,000 women in Colorado have chosen LARCs as the result of the program. Provider education, training, and contraceptive counseling have also been increased, and women can access LARCs at reduced costs.

The commitment to LARCs has apparently yielded major returns for Colorado. Between 2009 and 2013, the abortion rate among teenagers older than 15 in Colorado dropped by 42 percent. Additionally, the birth rate for young women eligible for Medicaid dropped—resulting in cost savings of up to an estimated $111 million in Medicaid-covered births. LARCs have been critical to these successes. Public-private partnerships have helped keep the program going since 2015, and states including Delaware and Iowa have followed suit in efforts to experience the same outcomes.

Recognizing that prevention is a key component to any strategy addressing a public health concern, those strategies must be rooted in ensuring access to education and comprehensive counseling so that women and teens can make the informed choices that are best for them. When women and girls are given the tools to empower themselves in decision making, the results are positive—not just for what the government spends or does not spend on social programs, but also for the greater good of all of us.

The history of coercion undermining reproductive freedom among women and girls of color in this country is an ugly one. But this certainly doesn’t have to dictate how we move forward.

Commentary Politics

The Loss of Our Sons and Daughters Is More Than a Political Moment

Toni Bond Leonard

We must bear witness to support the Black mothers who shared their stories of losing children to state and racial violence at the Democratic National Convention. But bearing witness means demanding justice and policy change.

When I watched the Mothers of the Movement—a group of Black mothers of slain children—take center stage at the Democratic National Convention (DNC) last week, I saw Black women “making a way out of no way.” We turn our suffering and righteous indignation into agency.

Sybrina Fulton, Trayvon Martin’s mother, talked about being thrust into the spotlight while grappling with her teenage son’s killing. Geneva Reed-Veal, the mother of Sandra Bland, began her remarks by acknowledging God’s greatness and how the mothers’ presence at the DNC was itself proof of that greatness. She then related the horrific details of her 28-year-old daughter being found hanging in a Texas jail cell after a possibly unlawful traffic stop in 2015. She called it the worst nightmare anyone could imagine.

But as eloquent and moving as the Mothers of the Movement were, their narratives were treated as a political moment that demonstrated mostly that Hillary Clinton had successfully campaigned to garner the backing of these mothers who are surviving reproductive loss. As I watched Reed-Veal fight back tears, I wondered what type of strength it takes to find peace with such a loss.

The lives of women such as Fulton and Reed-Veal—and those of their deceased children and their remaining families—matter more than a fleeting appearance in Philadelphia. While Clinton is apparently able to imagine what it means to lose a child and talk about that on the campaign trail, it is different to live with the immeasurable weight of losing a loved one, especially when it was due to systemic racism.

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In the Christian tradition, we remember Jesus’ suffering on the cross. And the mothers’ words call us to bear witness to police violence and the women who suffer irreparable reproductive loss. But bearing witness requires us to do more than see and hear about atrocities. We must also demand justice.

Reproductive justice theory holds that women have the human rights to bear children (or not), and to parent with the necessary social and economic supports so that their children not only survive, but thrive. Thriving means access to safe affordable housing, quality education, a living wage, healthy foods, and health care that is grounded in prevention and healing. It means living without fear of violence, especially from the very state authorities entrusted with protecting us.

In Sisters in the Wilderness: The Challenge of Womanist God-Talk, womanist theologian Delores Williams discusses Black women and a particular type of “surrogacy.” She uses the biblical story of Egyptian slave Hagar, who became Abraham’s concubine to bear him the son that his wife, Sarah, had not. Hagar’s body—and her child—were not her own. Williams argues that Black women have long been forced to step into others’ roles—raising white women’s children during and after slavery, for one—and that surrogacy has been exploitative.

We stand now in a moment where Black women are still surrogates. Their children are not their own, used as human targets by law enforcement and racists to act out their hatred of Black people. And even as the Mothers of the Movement struggle to grieve, their pain plays out in public.

To honor and address their pain, we must listen compassionately to Black people who say “Black Lives Matter.” The shootings of police officers cannot be used to scapegoat the legitimate concerns and demands of Black Lives Matter, which push us to confront historical and ongoing violence against Black Americans. Those urgent cries must fall on ears ready to understand the long history of our lives not mattering in this country. Those cries come from the collective memory of enslaved Black bodies, especially Black mothers forced to bear children to gratify economic greed, and firsthand contemporary experience.

Political candidates must also do more than just listen to the heartrending stories. They must also put forth concrete legislation to address the structural inequality behind racial profiling and the murders of Black people.

While Clinton’s platform includes ending gun violence and building trust between communities and police, what we did not hear at the DNC was how she would advance policies that would prevent the tragic reproductive loss that the Mothers of the Movement now know.

Her platform sounds progressive, but I cannot help but remember her racially coded comments in support of the 1994 Violent Crime Control Act: that youth in gangs “are often the kinds of kids that are called ‘super-predators.’ No conscience, no empathy. We can talk about why they ended up that way, but first we have to bring them to heel.”

Typically, dogs are brought to heel so that they walk close to or follow their owners. An unconscious, unfortunate choice of wording, perhaps? Still, the anti-poor legislation passed during her husband’s administration, and which she supported, has created and worsened conditions that shove poor families, disproportionately families of color, further into poverty.

In this watershed moment, radical accountability is needed if we’re to stem the use of deadly force against Black people.

Our elected leaders can model accountability by admitting that their own policies or statements have fed the police and not hungry people. Quite frankly, Clinton’s support of the crime bill and of the federal welfare reform requires some meaningful and public repentance.

And that repentance has to be more than a moment at the DNC or any future political gathering, but a sincere strategy to correct the injustices that claimed the Mothers of the Movement’s children. This is what it means to bear witness.

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