Reproductive Choice: It’s Not Always About Abortion

Pamela Merritt

That’s what choice is all about, having the ability to partner with a doctor to make decisions that are right for the individual.  That doesn’t mean those decisions would be right for someone else, but that’s the point lots of people missed.

A decade ago, I rolled over in bed one morning and felt some sort of mass in my abdomen.  I rolled onto my back and pressed my hand against it – yes, there was something real, solid and frightening in my abdomen.  I had been experiencing heavy bleeding during my periods for several months prior and had put off going to the doctor.  I was always too busy, had too much on my plate and was too willing to prioritize everything and anything over my yearly physical exam.  I lay there, anxious and afraid, unable to ignore the solid something beneath my hand.  So, I jumped up and immediately thought about where I could go to find out what this thing was and if it was cancer.  It was a Saturday and my doctor’s office was closed, so I went to my local Planned Parenthood and asked for an exam.  I was very emotional and the staff was very patient.  After the exam, I was told that I most likely had a uterine fibroid and needed to see my gynecologist for diagnosis and treatment.

I remember asking what the hell a uterine fibroid was and being told that uterine fibroids are tumors that grow within and outside of the uterus, that they pose their own health risks but aren’t cancer.

I thanked everyone at the health center.  I think I might have thanked them all twice.  Then I went home, sat down on the couch next to my dog and cried.

I was relieved but not fully, because uterine fibroids were a mystery.  Later that week my gynecologist confirmed the diagnosis of uterine fibroids and we began to work through a treatment plan.  I did a lot of research.  There were ultrasounds and blood tests and a serious discussion of diet and my general health.  What I remember most was that my doctor and I had a great dialogue about my condition and my life.  We discussed whether I planned to have children through a pregnancy.  I did not and that has not changed. I remember the options that were on the table based on the size and location of my tumors and my age and health.  In a matter of days “choice”, so often seen as only having to do with pregnancy or abortion, was suddenly a huge factor in my life.  I wasn’t pregnant, trying to get pregnant or even trying to protect my future ability to get pregnant but choice meant the world to me at that moment.

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I entered into a new world of doctor’s appointments and insurance battles.  Many of the treatment options for fibroids are classified as fertility treatments and every month my insurance company would reject my claim because they didn’t cover fertility treatments.  My doctor’s office guided me through the process of challenging the rejection, confirming that my treatment was not a fertility treatment and then resubmitting the claim.  I can’t imagine having to wage those battles without the assistance of the staff at my doctor’s office.  As it was, I found the week long back and forth debate that took place every month like clockwork emotionally exhausting.  At one point I found myself screaming at the insurance representative in my cube during work, demanding that she acknowledge there are more reasons to treat fibroids than to prepare for a pregnancy.

My debates, arguments and battles have not been limited to insurance representatives.  Over the years I’ve made a study of how friends have reacted to my treatment decisions.  I’ve had self identified pro-choice friends confront me for taking the pill to manage the heavy bleeding during my periods because they feel fibroids can be managed just fine through a special diet.  I’ve had other friends act as if they’d stop talking to me if I chose to have a hysterectomy.  When I decided to have my fibroids surgically removed after a year of treatment, a co-worker applauded my decision because it “preserved my reproductive future” while another expressed concern over the risk of my doctor having to perform a hysterectomy if there were complications.  I filtered all the advice through the understanding that their hearts were in a good place, but they always seemed to ignore the fact that I was and am an active participant in my treatment.  That’s what choice is all about, having the ability to partner with a doctor to make decisions that are right for the individual.  That doesn’t mean those decisions would be right for someone else, but that’s the point lots of people missed.  This was about my health and my uterine fibroids.

When I explained that I didn’t want to have children and that I considered hysterectomy a future option, some people dismissed my claim and others even went so far as to assure me that I’d change my mind when I got older or that I’d change my mind once I had a baby.  Suffice it to say, I was shocked.  The decision whether or not to have a child is a huge part of reproductive choice, yet here were people acting as if my choice not to have children was flimsy at best and subject to change by actually having a baby.

What stood out then and stands out now is how challenging truly supporting choice is.  Some pro-choice people struggle to respect the doctor patient relationship, too.  I’m not saying that their struggle is the same as anti-choicers who lobby to restrict a woman’s access to birth control or abortion.  Many of my friends referenced the history of black women who were given hysterectomy as the only option to treat fibroids and their words of caution were coming from a place of concern based on that history.  My situation was different.  The fact remains that, when a woman has a reproductive health issue, lots of folks jump up with lots of opinions and a lot of those opinions assume the patient hasn’t thought the situation through or is too emotional to make a sound decision.

I’ve thought a lot about the privilege of choice.  I have health insurance and I live in a city with a lot of pharmacies and health care providers.  I can consider multiple treatment options that are covered through my insurance.  I go to my pharmacy to pick up my birth control pills and rarely wonder if the pharmacist will refuse to fill my prescription because she or he assumes I’m getting them as birth control and has some moral objection they’ve decided trumps the legitimacy of my legal prescription. 

When the Missouri State Legislature considered a bill that would have protected pharmacists or pharmacies that refused to fill prescriptions because of a “moral” objection, I thought about my situation.  I imagined walking into my local pharmacy and having someone decide to refuse to fill my prescription because they assume everyone on the pill is taking it as contraception.  I had a waking dream of confronting the pharmacist with the fact that, without the pill, I bleed for an average of 14 days straight.  Prior to regulating my periods with the pill, I was dangerously anemic and suffering from exhaustion.  I could see myself demanding to know where they get off forcing me to explain the who, what, where and why behind my prescription.  It never happened.  The legislation never passed.  But I was prepared for the reality of some fellow Missourian wielding power in the name of religious freedom, trying to take away my freedom of choice.  A freedom of choice that had nothing to do with preventing pregnancy and that shouldn’t have been up for discussion even if it did.

Having uterine fibroids isn’t rare.  Since my diagnosis, I’ve met many women who have them and who have chosen different treatment paths.  But having uterine fibroids has provided me with a different view of reproductive choice and reproductive justice.  I’ve worked in partnership with my doctor to protect my right to health.  It’s been a unique journey and I am now considering the next phase, which will likely include a hysterectomy.  I know that a lot of people will have a lot of opinions and advice and I welcome the feedback as long as it is given with respect and with the understanding that the ultimate choice will be mine to make.  As a reproductive justice activist, this is what I fight for every day.  Choice should be respected as a right, not a privilege.

Commentary Economic Justice

The Gender Wage Gap Is Not Women’s Fault, and Here’s the Report That Proves It

Kathleen Geier

The fact is, in every occupation and at every level, women earn less than men doing exactly the same work.

A new report confirms what millions of women already know: that women’s choices are not to blame for the gender wage gap. Instead, researchers at the Economic Policy Institute (EPI), the progressive think tank that issued the report, say that women’s unequal pay is driven by “discrimination, social norms, and other factors beyond women’s control.”

This finding—that the gender pay gap is caused by structural factors rather than women’s occupational choices—is surprisingly controversial. Indeed, in my years as a journalist covering women’s economic issues, the subject that has been most frustrating for me to write about has been the gender gap. (Full disclosure: I’ve worked as a consultant for EPI, though not on this particular report.) No other economic topic I’ve covered has been more widely misunderstood, or has been so outrageously distorted by misrepresentations, half-truths, and lies.

That’s because, for decades, conservatives have energetically promoted the myth that the gender pay gap does not exist. They’ve done such a bang-up job of it that denying the reality of the gap, like denying the reality of global warming, has become an article of faith on the right. Conservative think tanks like the Independent Women’s Forum and the American Enterprise Institute and right-wing writers at outlets like the Wall Street Journal, Breitbart, and the Daily Caller have denounced the gender pay gap as “a lie,” “not the real story,” “a fairy tale,” “a statistical delusion,” and “the myth that won’t die.” Sadly, it is not only right-wing propagandists who are gender wage gap denialists. Far more moderate types like Slate’s Hanna Rosin and the Atlantic’s Derek Thompson have also claimed that the gender wage gap statistic is misleading and exaggerates disparities in earnings.

According to the most recent figures available from the Census Bureau, for every dollar a man makes, a woman makes only 79 cents, a statistic that has barely budged in a decade. And that’s just the gap for women overall; for most women of color, it’s considerably larger. Black women earn only 61 percent of what non-Hispanic white men make, and Latinas earn only 55 percent as much. In a recent survey, U.S. women identified the pay gap as their biggest workplace concern. Yet gender wage gap denialists of a variety of political stripes contend that gender gap statistic—which measures the difference in median annual earnings between men and women who work full-time, year-round—is inaccurate because it does not compare the pay of men and women doing the same work. They argue that when researchers control for traits like experience, type of work, education, and the like, the gender gap evaporates like breath on a window. In short, the denialists frame the gender pay gap as the product not of sexist discrimination, but of women’s freely made choices.

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The EPI study’s co-author, economist Elise Gould, said in an interview with Rewire that she and her colleagues realized the need for the new report when an earlier paper generated controversy on social media. That study had uncovered an “unadjusted”—meaning that it did not control for differences in workplace and personal characteristics—$4 an hour gender wage gap among recent college graduates. Gould said she found this pay disparity “astounding”: “You’re looking at two groups of people, men and women, with virtually the same amount of experience, and yet their wages are so different.” But critics on Twitter, she said, claimed that the wage gap simply reflected the fact that women were choosing lower-paid jobs. “So we wanted to take out this one idea of occupational choice and look at that,” Gould said.

Gould and her co-author Jessica Schieder highlight two important findings in their EPI report. One is that, even within occupations, and even after controlling for observable factors such as education and work experience, the gender wage gap remains stubbornly persistent. As Gould told me, “If you take a man and a woman sitting side by side in a cubicle, doing the same exact job with the same amount of experience and the same amount of education, on average, the man is still going to be paid more than the woman.”

The EPI report cites the work of Harvard economist Claudia Goldin, who looked at the relative weight in the overall wage gap of gender-based pay differences within occupations versus those between occupations. She found that while gender pay disparities between different occupations explain 32 percent of the gap, pay differences within the same occupation account for far more—68 percent, or more than twice as much. In other words, even if we saw equal numbers of men and women in every profession, two-thirds of the gender wage gap would still remain.

And yes, female-dominated professions pay less, but the reasons why are difficult to untangle. It’s a chicken-and-egg phenomenon, the EPI report explains, raising the question: Are women disproportionately nudged into low-status, low-wage occupations, or do these occupations pay low wages simply because it is women who are doing the work?

Historically, “women’s work” has always paid poorly. As scholars such as Paula England have shown, occupations that involve care work, for example, are associated with a wage penalty, even after controlling for other factors. But it’s not only care work that is systematically devalued. So, too, is work in other fields where women workers are a majority—even professions that were not initially dominated by women. The EPI study notes that when more women became park rangers, for example, overall pay in that occupation declined. Conversely, as computer programming became increasingly male-dominated, wages in that sector began to soar.

The second major point that Gould and Schieder emphasize is that a woman’s occupational choice does not occur in a vacuum. It is powerfully shaped by forces like discrimination and social norms. “By the time a woman earns her first dollar, her occupational choice is the culmination of years of education, guidance by mentors, parental expectations, hiring practices, and widespread norms and expectations about work/family balance,” Gould told Rewire. One study cited by Gould and Schieder found that in states where traditional attitudes about gender are more prevalent, girls tend to score higher in reading and lower in math, relative to boys. It’s one of many findings demonstrating that cultural attitudes wield a potent influence on women’s achievement. (Unfortunately, the EPI study does not address racism, xenophobia, or other types of bias that, like sexism, shape individuals’ work choices.)

Parental expectations also play a key role in shaping women’s occupational choices. Research reflected in the EPI study shows that parents are more likely to expect their sons to enter male-dominated science, technology, engineering, and math (often called STEM) fields, as opposed to their daughters. This expectation holds even when their daughters score just as well in math.

Another factor is the culture in male-dominated industries, which can be a huge turn-off to women, especially women of color. In one study of women working in science and technology, Latinas and Black women reported that they were often mistaken for janitors—something that none of the white women in the study had experienced. Another found that 52 percent of highly qualified women working in science and technology ended up leaving those fields, driven out by “hostile work environments and extreme job pressures.”

Among those pressures are excessively long hours, which make it difficult to balance careers with unpaid care work, for which women are disproportionately responsible. Goldin’s research, Gould said, shows that “in jobs that have more temporal flexibility instead of inflexibility and long hours, you do see a smaller gender wage gap.” Women pharmacists, for example, enjoy relatively high pay and a narrow wage gap, which Goldin has linked to flexible work schedules and a professional culture that enables work/life balance. By contrast, the gender pay gap is widest in highest-paying fields such as finance, which disproportionately reward those able to work brutally long hours and be on call 24/7.

Fortunately, remedies for the gender wage gap are at hand. Gould said that strong enforcement of anti-discrimination laws, greater wage transparency (which can be achieved through unions and collective bargaining), and more flexible workplace policies would all help to alleviate gender-based pay inequities. Additional solutions include raising the minimum wage, which would significantly boost the pay of the millions of women disproportionately concentrated in the low-wage sector, and enacting paid family leave, a policy that would be a boon for women struggling to combine work and family. All of these issues are looming increasingly large in our national politics.

But in order to advance these policies, it’s vital to debunk the right’s shameless, decades-long disinformation campaign about the gender gap. The fact is, in every occupation and at every level, women earn less than men doing exactly the same work. The right alleges that the official gender pay gap figure exaggerates the role of discrimination. But even statistics that adjust for occupation and other factors can, in the words of the EPI study, “radically understate the potential for gender discrimination to suppress women’s earnings.”

Contrary to conservatives’ claims, women did not choose to be paid consistently less than men for work that is every bit as valuable to society. But with the right set of policies, we can reverse the tide and bring about some measure of economic justice to the hard-working women of the United States.

News Politics

Congresswoman Pushes Intersectionality at Democratic National Convention

Christine Grimaldi

Rep. Bonnie Watson Coleman (D-NJ) charges that reproductive health-care restrictions have a disproportionate impact on the poor, the urban, the rural, and people of color.

The members of Congress who flocked to the Democratic National Convention in Philadelphia this week included a vocal advocate for the intersection of racial and reproductive justice: Rep. Bonnie Watson Coleman (D-NJ).

Watson Coleman’s longstanding work in these areas “represented the intersection of who I am,” she said during a discussion in Philadelphia sponsored by the Center for Reproductive Rights and Cosmopolitan. Reproductive health-care restrictions, she stressed, have a disproportionate effect on the poor, the urban, the rural, and people of color.

“These decisions impact these communities even more so [than others],” she told Rewire in an interview. “We don’t have the alternatives that middle-class, suburban, white women have. And we’d rather they have them.”

Watson Coleman has brought that context to her work in Congress. In less than two years on Capitol Hill, she co-founded the Congressional Caucus on Black Women and Girls and serves on the so-called Select Investigative Panel on Infant Lives, a GOP-led, $1.2 million investigation that she and her fellow Democrats have called an anti-choice “witch hunt.”

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Coleman said she’s largely found support and encouragement among her fellow lawmakers during her first term as a woman of color and outspoken advocate for reproductive rights.

“What I’ve gotten from my Republican colleagues who are so adamantly against a woman’s right to choose—I don’t think it has anything to do with my being a woman or an African American, it has to do with the issue,” she said.

House Republicans have increasingly pushed anti-choice policies in advance of the ongoing August recess and November’s presidential election. The House this month passed the Conscience Protection Act, which would give health-care providers a private right of action to seek civil damages in court, should they face supposed coercion to provide abortion care or discrimination stemming from their refusal to assist in such care.

Speaker Paul Ryan (R-WI) lauded passage of the bill and the House’s thus-far unsuccessful effort to prove that Planned Parenthood profited from fetal tissue donations—allegations based on widely discredited videos published by the Center for Medical Progress, an anti-choice front group that has worked closely with GOP legislators to attack funding for Planned Parenthood.

On the other side of the aisle, Watson Coleman joined 118 other House Democrats to co-sponsor the Equal Access to Abortion Coverage in Health Insurance Act (HR 2972). Known as the EACH Woman Act, the legislation would overturn the Hyde Amendment and ensure that every woman has access to insurance coverage of abortion care.

The Hyde Amendment’s restriction of federal funding for abortion care represents a particularly significant barrier for people with low incomes and people of color.

The Democratic Party platform, for the first time, calls for repealing the Hyde Amendment, though the process for undoing a yearly federal appropriations rider remains unclear.

For Watson Coleman, the path forward on getting rid of the Hyde Amendment is clear on at least one point: The next president can’t go it alone.

“The president will have to have a willing Congress,” she said. She called on the electorate to “recognize that this is not a personality contest” and “remove some of those people who have just been obstructionists without having the proper evidence.”

In the meantime, what does a “willing Congress” look like for legislation with anti-choice roadblocks? A majority voting bloc helps, Watson Coleman said. But that’s not everything.

“There are lots of bills that Republicans will vote for if their leadership would simply bring them up,” she said.