Women¡¯s Reproductive Rights and the TItle X Family Planning Program

Veronica Mollere

Abstract

This article explores the effect of Title X funding on the lack of equitable access to reproductive healthcare for economically disadvantaged women of color, particularly in light of the 2011 threats made by Congress to eliminate the program altogether. By examining the history and current state of women¡¯s reproductive rights in the United States through a gender lens, it is argued that working-class women of color face disproportionate disadvantages in accessing reproductive healthcare and exercising freedom of reproductive choice. In the context of recent policy indecision about the future of federal funding for these issues, this article demonstrates how the United States has the opportunity to redefine the choice a woman¡ªregardless of class or color¡ªcan exercise over her body as a right and not a privilege. The relationship between historical patriarchy and current issues with reproductive rights is analyzed, and suggestions for policy and direct practice and are given.

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While the United States is touted as a nation of freedom and equal rights, women have not yet achieved a social status equal to men. This manifests in many aspects of women¡¯s lives: in the workplace and with wages, educational opportunities, societal expectations for gender roles, and importantly, reproductive rights. Progress has been made in some of these areas but equality has not been actualized. In fact, many of the achievements made on behalf of women were due to feminist political activity of white middle-class women. The results, while sometimes momentous, often disregarded women of color and lower socioeconomic status. Women of color in America face a disproportionate amount of discrimination in these spheres of inequality because of this, even discrimination by white women.

One issue that perpetuates this double standard of inequality is women¡¯s reproductive rights. For women of all colors and classes this continues to be a difficult topic, with historical perspectives framing an unrealistic depiction of the ideal woman: white, married to a man who earns a middle-class income that supports her staying home as a wife and mother to at least two children. Throughout history and even today, reinforcement of this patriarchal ideal has rendered women inferior to and dependent upon their male counterparts, which in turn has framed the treatment of women and their bodies. This ideal has severely inhibited poor women of color from ever meeting standards that would propel them towards equitable treatment. With regard to reproductive rights and sexual health, current policies that govern American women are racist and classist in nature and ultimately, as Roberts (1997) iterates, ¡°work together to achieve a common end that is against the interests of black women¡± (p. 235).

A prime example of this matter is the Title X Family Planning Program, which since its inception has negatively affected black women¡¯s access to reproductive healthcare and information. This claim of discrimination can be framed in an examination of both Title X and restrictions to Medicaid eligibility that target gender, class, and race. Taking a gender lens and examining societal barriers that prevent poor, black women from accessing quality reproductive care and unbiased choice, as regulated by Title X federal funding and Medicaid restrictions, paints a picture of gross inequality, structural racism and sexism.

Historical Context

America was founded on the notions of heterosexual marriage and family. These values continue to influence policies that govern society even today. The United States¡¯ history is rich with societal preference for women to be in the home, as wives and mothers. In the earliest colonial times, preference for settlement and societal aid was given to white women who arrived with intention of marrying and starting a family. With this foundation, America enforced early on what Abramovitz (1996) referred to as its ¡°patriarchal ideals about the proper role of women,¡± which are rooted as far back as colonial society¡¯s expectation of women to be subordinate to both men and the Judeo-Christian God (p. 52). While it seems obvious that these ideals influenced the allocation of relief in the colonial era given the background of the settlers, policies in place today still reflect these outdated axioms.

Historical repression of women in America should be noted not only as an issue of gender but also of race. In early settlements, women of color were denied the opportunity to situate themselves in this sphere of subordination because ¡°white colonial society simply denied the ¡®rights of womanhood¡¯ to female black slaves¡± (Abramovitz, 1996, p. 60). Similarly, the stigma against poor women whose circumstances prevented them from adhering to the feminine ideal proved that prejudice was ¡°embedded in the institutions of public welfare¡± (p. 66). During that time, these two categories of women, which often overlapped, were most often deemed ¡°undeserving¡± of aid ¡°based on their compliance with the family ethic¡±, and by that very definition the ¡°system had virtually nothing to offer [these] women¡± (p. 99) These regulations set the precedent for the continuation of biased United States social policies that continue to place the most burden on these groups.

With the rise of America as an industrial nation, white women¡¯s role in the home became institutionalized at a fundamental level. As a result of these revised gender norms, women were completely separated from the economic realm in which men existed. They were stripped of their ability to hold any meaningful roles outside of ¡°marriage, motherhood, homemaking, and the overseeing of family life¡± (Abramovitz, 1996, p. 110). In addition, they were denied acknowledgement of their sexual needs aside from a ¡°moral responsibility¡± to reproduce. At the same time, women of color and poor women were denied the few rights allowed to white women. They were seen in contradiction of the new, industrial family ethic because of their financial need to participate in economic production, even if they were married. Abramovitz (1996) argues that the nation¡¯s ethics at this time reinforced the ¡°devaluation of women… [to] restore patriarchal power¡± (p. 127). This same patriarchal power supported the role that women were expected to play in industrial America, which was nearly impossible for blacks and immigrants to attain. Herein lies the foundation for women¡¯s continued sexual repression under laws and policies, most notably directed at those who cannot not assume the imposed ¡°proper¡± gender role, which has historically implied whiteness.

Government Regulation

Since its earliest days United States government has held power to regulate the gender system in ways that placed the rights of men over women, and also those of white, middle or upper class women over women of color and those of a lower socioeconomic status. This social regulation of gender illustrates an attempt to control women¡¯s bodies, which has long been a cause of policy debate. Until politics in America can shift toward an unprejudiced approach to regulating society, women will continue to face disproportionate amount of discrimination over their right to choose with regard to reproductive health. A movement toward political acceptance of reproductive freedom for all, as a matter of human rights in the United States could increase the likelihood of truly protecting a person¡¯s basic dignity and autonomy, as well as the right to choice and privacy, regardless of gender, color, or any other socially implied stratifications.

At the heart of equal and unbiased family planning and reproductive health are a number of issues that contain varying levels of stigma situated in the patriarchal and religious ideals of America. Women of all backgrounds face numerous barriers to reproductive care, including: limited access to contraceptives and emergency contraception; education about family planning and sexually transmitted infections; adequate prenatal care for both mother and child; and the very politically and ¡°morally¡± reprehensible issue of abortion. What¡¯s more, marginalized, low-income women and women of color face policy and societal conditions that must first be meet in order to even be faced with the barriers listed above¡ª let alone to overcome them. Roberts (1997) argues that there is a ¡°systematic, institutionalized denial of reproductive freedom [that] has uniquely marked black women¡¯s history in America,¡± running as an undercurrent of discrimination and dehumanization since the time of slavery (p. 4). With so many modern-day stipulations and obstacles to comprehensive and unbiased healthcare, a demand for change in social policy and ultimately in the definitions of women¡¯s rights is needed. Unfortunately, current lawmakers are regressing reproductive rights by proposing legislative budget cuts to severely or totally diminish the minimal funding that enables reproductive choice. This, in turn, disproportionately negatively affects women of color because of their systemically imposed reliance on such federal funds.

Title X Family Planning Program

The most significant federal policy to address the issue of reproductive health is the Title X Family Planning Program (“Population Research and Voluntary Family Planning Programs” Public Law 91-572), enacted in 1970 under President Richard Nixon. Title X provides sliding scale, affordable reproductive healthcare that can theoretically be given at any clinic providing family planning services such as ¡°breast and pelvic exams, Pap smears and other cancer screenings, HIV testing, pregnancy testing and counseling, and affordable birth control¡± (Bassett, 2011, p.1).

The most recent Title X ¡°2011 Program Priorities¡± state that the program aims to specifically target ¡°hard-to-reach and/or vulnerable populations¡± (HHS, 2011). Embedded in those same priorities are stipulations about the kinds of educational materials available to those at-risk populations, emphasizing abstinence education and eliminating the possibility of discussing the option of abortion (HHS, 2011). This policy claims to place emphasis on reaching vulnerable individuals, which in America are typically single, black women, who are ¡°more likely to be the victims of ¡®reshuffled poverty,¡¯ caused by the dissolution of an [already] poor household¡± (Roberts, 1997, p.224). At the same time, it isolates these women by giving them incomplete care that keeps them impoverished. Roberts (1997) provides evidence that ¡°while about half of poor white single mothers became poor at the time they established a single-mother household, only a quarter of black women did… [they] were poor already¡± (p. 224). Title X¡¯s inherent preferences in targeting these women with stipulations on the type of care provided is unrealistic for this population and reinforce a conservative, patriarchal ideal that women should not be allowed full reproductive choice.

According to the U.S. Department of Health and Human Services Office of Population Affairs [HHS], in ¡°2010, 90 Title X grantees provided family planning services to more than five million women and men through a network of more than 4,500 community-based clinics¡± (HHS, 2010). These public clinics are often the most convenient and affordable locations for black women to receive reproductive healthcare ¡°because they are less likely to have private health insurance¡± (Roberts, 1997, p. 233). Planned Parenthood [PP], whose history far precedes Title X funding, is one of the most prominent and far- reaching of these clinics. Despite documented use of federal funding that is well within the guidelines, this organization and others have come under scrutiny because of their perceived failure to promote an outdated patriarchal ideal.

Planned Parenthood

Planned Parenthood is America¡¯s ¡°leading sexual and reproductive healthcare provider and advocate¡± offering medical care, educational information, and political advocacy since 1916 (Planned Parenthood, 2011). Planned Parenthood was already making huge strides in reproductive healthcare far prior to the passage of Title X legislation in 1970. In 1968, the Guttmacher Institute of Planned Parenthood disseminated the first publication to highlight the importance of birth control availability for adolescents. During Reagan¡¯s presidency the nation regressed into a society focused on chastity for teens. Such changes indicate the ebb and flow of politics that has long affected Planned Parenthood and family planning initiatives. While the initial positive power of Title X lasted, however, there was bipartisan support for family planning and availability of birth control for the lower class regardless of age, which included black women (PP, 2011). This positive approach to reproductive choice did not last. Today heavy conservative opposition to family planning, abortions, and also to Planned Parenthood exists.

As a longstanding provider of comprehensive community reproductive healthcare, Planned Parenthood assists more than five million individuals each year in more than 800 local health centers despite political obstacles (PP, 2011). The organization is based upon a belief in the ¡°right of each individual…to manage his or her fertility, regardless of the individual¡¯s income, marital status, race, ethnicity, sexual orientation, age, national origin or residence¡± (PP, 2011). In the context of the current society that promotes reproductive ideals nearly opposite to its mission, Planned Parenthood has recently been the subject of serious moral and monetary debates in Congress as well as a topic of heated debate in the 2012 Election.

Recent Controversy

With an operating budget of approximately 320 million dollars as of 2010, Title X claims to ¡°provide individuals with comprehensive family planning and related preventive health services [including] access to contraceptive services, supplies, and information to all who want and need them. By law, priority is given to persons from low-income families¡± (HHS, 2011). In actuality, the stigma that arose out of the reproductive duties of colonial and industrial era ethics still run through this policy, as evidenced by the fact that ¡°by law, Title X funds may not be used in programs where abortion is a method of family planning¡± (HHS, 2011). That stipulation alone reinforces notions that funding and policy still heavily regulate a woman¡¯s body. A woman¡¯s right to choose remains an ongoing struggle on both state and national levels. This is evident in recent budget debates around this policy that threatened to eliminate Title X funding entirely.

The 2011 debates about the future of Title X funding, which was ultimately a 6% cut, centered on abortion (Williams, 2011, p.1). Early in the budget debates, Indiana representative Mike Pence introduced a bill that would prevent any organization that performs abortions from receiving Title X funding, which could cut as much as a third of Planned Parenthood funding, when in fact only 3% of the services they provided in the past year were abortions (Kliff, 2011, p. 1). Kliff (2011) reported that while Title X funds cannot be used for abortions, there was no contention as to whether Planned Parenthood used their federal funding to practice them ¨C they did not. In fact, the rationalization seems to be far-fetched, as ¡°conservatives argue that the money it receives from Title X frees up other money that can indirectly be used for abortions¡± (Bassett, 2011, p. 2). Embedded in Pence¡¯s ideologically backwards push for defunding are values rooted in the patriarchal ideal and ultimately a stripping of healthcare recipients¡¯ constitutional rights.

Pence¡¯s bill was defeated in the Senate in mid 2011, but with ongoing budget negotiations, legislators continue to consider family planning funding as expendable. In fact, even amidst the strides that were made through the passage of the Affordable Care Act: increased equitable insurance and access to preventive and reproductive care options for families, progress is in jeopardy because of conservative views on birth control and abortion. The reformed healthcare law includes a stipulation for businesses to provide birth control coverage as part of insurance plans offered to employees. That provision has became a topic of heated debate in the Senate, when a measure nearly passed at 48-51 votes in March of 2012 that ¡°would have allowed employers and insurers to opt out of portions of the…law they found morally objectionable… [like the] requirement to cover the cost of birth control¡± (Kellman, 2012, p.1). Also, the Nelson abortion provision of the health care reform states that should a health plan opt to provide coverage for abortion, it must ¡°collect two payments from all enrollees, one for abortion coverage and one for all other coverage¡± effectively ensuring that abortions are only funded by the separate private accounts (PP, 2012, p. 2). In these instances, patriarchal, Protestant ideals continue to leave women vulnerable to a government that does not protect the basic right to choose how to best care for their own bodies.

Similar federal legislation that poses a risk to women¡¯s equitable access to healthcare is the No Taxpayer Funding for Abortion Act, or the Smith bill which has passed the House of Representative vote and is on the way to Senate, would ¡°ban private health insurance coverage for abortion for millions of women who are currently covered¡± (PP, 2012, p. 1). Those women currently offered private insurance that includes abortion will either be forced to drop that portion of their coverage or pay higher taxes individually, while small businesses offering the comprehensive care will also be subject to tax penalties (PP, 2012). Essentially, through both the Nelson provision and the Smith bill, it currently stands that women could legally be penalized financially for exerting reproductive choice and opting into coverage that includes abortion as a provision.

Abortion

A landmark decision by federal courts in the 1973 case, Roe v. Wade, determined a woman¡¯s right to have an abortion is protected by the constitutional right to privacy (PP, 2011). Since then, regulation of this legislation has jeopardized women¡¯s health inadvertently through the withholding of financial support as well as educational information that would constitute comprehensive prenatal options counseling. Despite the many roadblocks and close calls that stood to overturned the decision entirely, it remains in place nationally. What has never actualized, however, is total state and national government support for unbiased reproductive healthcare. Roberts (1997) points out that less than five years after the monumental legislature passed in the Supreme Court, the decision had to be made ¡°whether the Constitution also required the government to pay for the cost of abortions to poor women¡± (p. 230). The answer was no, despite the unconstitutional conditions this ruling promotes. For only a short time was this federal right to abortion, and therefore women¡¯s bodies, unregulated.

The main inhibitor to federal involvement in subsidizing abortions came in 1976 with the passage of the Hyde Amendment. This rider to Medicaid initially ¡°prohibited federal reimbursement…even for the most therapeutic abortions¡± but currently ¡°pays…only when the woman¡¯s life is endangered¡± (Roberts, 1997, p. 231). The No Taxpayer Funding for Abortion Act sparked extreme controversy in February of 2011, ruling out ¡°federal assistance for abortion in many rape cases,¡± overturning existing provisions for such instances through the Hyde Amendment (Mahanta, 2011, p. 1). The wording of the new act has since been changed due to public and even political outcry, a beacon of hope for the advocates of women¡¯s reproductive rights.

It should be noted that in 2004, The Kaiser Family Foundation [KFF] found that over 16 million low- income women used Medicaid as their primary health insurer. It is the ¡°largest source of public funding for family planning services, with benefits totaling $771 million in 2001¡± (Kaiser Family Foundation, 2004, p. 2). The Hyde Amendment restriction is not only discriminatory but it is also predatory, since there is a clear value judgment made when federal funds can be used ¡°for all other [reproductive] medical care except abortion¡± (Roberts, 1997, p. 232). Many liberal and progressive human rights outlets have begun to address the obstacles that legislature like this places on specific individuals.

The ACLU supports Roberts¡¯ claim by explaining that politicians impose their value systems on those seeking abortions under Medicaid. These people are characteristically poor women and all other aspects of family planning are covered (ACLU, 2004, p. 2). In fact, in a cost-benefit analysis by the research institute of Planned Parenthood, the Guttmacher Institute, demonstrates that ¡°if public funds are not available to pay for abortions, a far greater amount of money will be spent to provide maternity care, medical care for the infant…and nutritional assistance to women on Medicaid (as cited in National Committee for a Human Life Amendment, 2008, p. 4). Roberts (1997) corroborates, explaining ¡°this was certainly not a cost-saving measure, since paying for abortions would save…the cost of prenatal care and delivery¡± (p. 230). This both economically and racially depleting legislature is rooted in the prevailing notion that a woman, only if she is willing to conform to middle-class, patriarchal values, is deemed worthy of government support. As demonstrated by Roberts and the Guttmacher Institute, following these traditional roles is actually pricier for the state, yet outdated values prevail over fiscal responsibility. Fundamentally, reproductive choice is limited for women on the whole but disproportionately for black women. Where there is no financial justification there is inherently patriarchal, racist justification.

Gender Assumptions

The struggle of balancing national values based in the patriarchal, heterosexual family ethic with pressure for progressive gender ideas and the issue of gender equality in the context of sexual regulation of women¡¯s bodies lies in the construct of gender itself. Lorber (1994) breaks down this social institution, claiming that gender is all at once ¡°a process of creating [unequal and] distinguishable social statuses for the assignments of rights and responsibilities…[and] a major building block in the social structures built on these unequal statuses¡± (p. 6). Ways of choosing who performs which duties in a society can be based on talents or constructions, with the latter being statuses like ¡°gender, race, ethnicity ¨C ascribed membership in a category of people¡± (p. 2). Lorber (1994) argues that these are meticulously formed through ¡°teaching, learning, emulation, and enforcement¡± (p. 2). The ability of individuals to classify and therefore stratify members of society inevitably leads to separate and unequal ideals for each. Men have historically benefitted from this construction, and are often in control of the information that is mass-produced in support of these ¡°norms.¡±

Men have historically been distinguished as superior in American society, and despite progress made by waves of feminist advocates, men statistically remain holders of ¡°power, prestige, and economic rewards…[reaped by the] valued gender¡± (Lorber, 1994, p. 7). This is evidenced in their positions of authority in government, military and law¡ªthree highly valued American institutions. The authority inherently granted to males over females due to social construction of gender continues the national narrative of domination and distance between these two groups. Abramovitz (1996) argues a gender bias is built into the Social Security Act that ¡°has enforced the economic dependence of women on men, regulated women¡¯s labor force participation, assured women¡¯s role in maintaining and reproducing the labor force and in general upheld patriarchal social arrangements¡± since 1935 (p. 235). In other words, society explicitly demands that men belong in the economic sphere, and women should remain at home but only supported by a male breadwinner. Those who were chronically single and impoverished, which tended to be black or immigrant women were¡ªand still are–as backwards as it may seem, most undeserving of aid.

Even among times of economic and political trouble, such as post World War I and the Great Depression, women were held to standards that were based around the notion of the woman¡¯s place in the home. During the Progressive Era, the most progressive legislation for women¡¯s labor causes was ¡°based on motherhood, female fertility, and special privileges for the home¡± (Abramovitz, 1996, p. 188). Mother¡¯s Pensions became a short-term answer, which campaigned to keep women without a male breadwinner, the ideal, at home to reproduce and rear the future labor force. At a base level, women were seen as a means to the end of reproducing economic labor. These programs favored ¡°those who complied with the family ethic¡± and who were deserving of aid based on their projected ¡°suitability¡± to raise children; and they ¡°further enforced patriarchal norms insofar as it encouraged the economic dependence of women on men and defined child rearing as women¡¯s exclusive responsibility¡± (p. 200).

This vision of exerting ¡°social control of poor immigrant families and the neglect of black women¡± has carried over into the current welfare state, which places exclusive value on the stay-at- home, dependent, ¡°deserving¡± woman who only suffered temporary economic disadvantage, not those who were poor due to ¡°inefficiency and immorality.¡± This logic of 1913 still prevails today (Roberts, 1997, p. 204; Abramovitz, 1996, p. 200). Black mothers were seen as completely ¡°outside the elite white women¡¯s paternalistic concept of the national community¡± and excluded from earlier legislature altogether (Abramovitz, 1996, p. 207). Now they are stigmatized in the same system as dependent, lazy and promiscuous. Roberts (1997) argues ¡°the image of the welfare mother quickly changed from the worthy white widow to the immoral black welfare queen¡± who ¡°deliberately becomes pregnant to receive public assistance¡± (p. 207, 215). Despite the reality of who receives aid, policies favor white women. Very few black women were and are served without bias. Still, both races of women are stripped of their individual rights to reproductive choice and held to the often unrealistic, socially constructed ¡°feminine¡± ideal because of social policies.

The Color of Choice

By taking this idea of socially constructed inequality one step further, the creation of racist gender identities, like the one of the black welfare queen, serves to maintain the hierarchy with white women atop the shared gender identity of ¡°female¡±. With gender as the constant, the social idea of race difference becomes a factor in superiority. Roberts (1997) explains that ¡°the new era of welfare…has become a tool of social control, a means of improving the behavior of poor families¡± by regulating the fertility of those families and stripping them of their reproductive choice (p. 210). This reproductive control has been asserted through various means, such as sterilizing contraception, Family CAP laws, and restriction on availability of comprehensive healthcare (Roberts, 1997). From behavior modification bills introduced as recently as the 1970s mandating sterilization of women who gave birth to illegitimate children, to current policies that violate a woman¡¯s right to privacy by ¡°conditioned payments on [the] mother¡¯s compliance with standard sexual and reproductive morality¡± (p. 228). All of these prevailing social norms are outdated and justified in what Roberts (1997) identifies as myths about women and their social statuses, particularly black women, which manifests in economic disadvantages that render them subhuman in the eyes of white, elite, and patriarchal society.

Black women are not afforded nearly the reproductive rights that white women are, which are meager still. Because of the Hyde Amendment¡¯s prevailing dangers associated with discouraging reproductive clinic patients, typically black women, from considering abortion as an option, the whole black community suffers. The policy successfully perpetuates their inferiority. Black women rely on clinics funded by Title X monies. Justice Harry Blackmun stated ¡°¡®women seeking the services of a Title X clinic has every reason to expect…that her physician will not withhold relevant information regarding…her visit¡¯¡± even if that includes abortion if it is in her or her child¡¯s best interest (as cited in Roberts, 1997, p. 235). This deliberate withholding of information furthers the ignorance in these communities, and ultimately ¡°limits indigent women¡¯s control over their own bodies by making it more difficult to realize their reproductive decisions¡± (p. 235). Should women who are forced by a racist economy to rely on publicly funded healthcare have to sacrifice their right to independent choice when it comes to their bodies? The prevailing answer as actualized through the ways policies affect these populations is yes.

Sadly, statistics on reproductive rights support this theoretical framework. Roberts (1997) makes the strong claim that ¡°policies effectively impose a rule that poor people should not have children.¡± This disproportionately affects minority families. The Center for Reproductive Rights¡¯ 2007 report outlines the continuation of discriminatory policies and practices in the United States that prevent marginalized women from accessing reproductive healthcare and asserting their right to choose how to care for their bodies. These include: lack of affordable private healthcare, restrictions on government health programs, the pervasiveness of abstinence-only programs, and lack of access to family planning education and services (Northup, 2007).

These factors affect women of color and low- income women because of their reliance on these systems, more so than white women of middle or upper class. The overwhelming ideology is that reproductive freedom depends on social status, class, race and wealth. The statistics presented give concrete evidence of the perpetuation of discrimination with regard to reproductive rights.

They explain that African-American women are nearly four times more likely to die in childbirth than white women, and they are 23 times more likely to be infected with HIV/AIDS than their white counterparts. American Indian/Alaskan Native women are over five times more likely than white women to have Chlamydia, a sexually transmitted infection particularly harmful to women¡¯s health. The unintended pregnancy rate among Latinas is 75 percent higher than among non-Hispanics, and Latinas are three to four times more likely than white women not to use contraceptive measures (Northup, 2007, p. 2).

In fact, the case may be that it is in white women¡¯s best interest to keep black women at a disadvantage in order to promote their self- interest. They ¡°perceive black people¡¯s social position in opposition to their own… [because] Blacks¡¯ social advancement diminishes white superiority¡± (Roberts, 1997, p. 244). The underlying racial injustice prohibits gender successes for women as a whole, and limits the meaning of freedom for all females.

With the factors of race, gender and socioeconomic class combined and pitted up against male-centric, religiously derived policy, women¡¯s battle for the right to choose with regard to their bodies and their reproductive health is very much alive. The complex issue of sexual regulation of women¡¯s bodies can be restructured in policies through an attempt to extrapolate the sources of women¡¯s oppression and identify means to combat them from a gender perspective.

The Fight for “Reproductive Justice”

Because reproductive inequality and the sexual regulation of women¡¯s bodies is so embedded in society¡¯s patriarchal, white preference and privilege, an ideological shift would be necessary to eradicate racist and sexist policies that control reproductive freedom. A redefining of racial and gender constructs with emphasis on reproductive liberty would help validate a woman¡¯s right to choose as necessary and important to ¡°human dignity and equality¡± (Roberts, 1997, p. 245). No step in improving theory or policy is too small to begin the journey toward equal entitlement, accountability and freedom.

First, the current welfare state operates fundamentally at a level of oppression for low- income black women. It would need to be completely restructured to value reproductive contributions to society. This could be through an allotment of family allowances that are independent of any social or racial factors other than number of children, similar to the UK¡¯s Child Benefit and Guardian Allowances (Care and the Law, 2008). This policy still emphasizes the individual, micro attention to reproductive choice that limits the responsibility that can be placed on the state and lawmakers.

By placing emphasis on reproductive rights in the United States as an essential human right on the macro level, accountability can be placed on society itself. The social constructions of gender and race will have to be altered to encompass this issue as a right that essentially precedes those stratifications. It will also have to address the larger issue of total reproductive justice. It cannot become distracted by individual issues such as abortion. With a systemic overhaul that does not favor specific classes or races, issues such as abortion will then be available for restructuring. Price (2010) argues that the micro-level attention to reproductive issues and the individual idea of choice is precisely what has held back the movement.

To begin, however, the forerunners of this movement should include black women themselves, as well as other ¡°undeserving groups.¡± It will take the demand for their ¡°subjugated knowledge¡± as a subordinate group to break through to become ¡°dominant knowledge¡± in a patriarchal, white, middle-middle class ruled society (Collins, 1990, p. 1). This will happen most effectively, Collins (1990) argues, through a non-confrontational, open-minded approach from which each group can ¡°perceive its own truth as partial¡± and ultimately unfinished until integrated into the larger perspective. Black advocates will have to actively integrate their agenda into the acceptance of partiality as a condition for change, which can only happen if they speak not from a place of being essentially separate from the puzzle seeking equality but rather a basic component that can only operate within the confines of other objective truths (Collins, 1990). For black women to attain a level of reproductive liberty that is unbiased and just, they must work along side other minorities and white women to create a comprehensive structure that challenges the pervasive patriarchal ideal and upon which change can be built for all.

While the tangible repercussion of reproductive injustice include women¡¯s inability to choose and the sexual regulation of their bodies, the only way to totally escape the subordination is to acknowledge the fundamental connection of this issue to ¡°other social justice issues such as poverty, economic injustice, welfare reform, housing, prisoners¡¯ rights, environmental justice, immigration policy, drug policies, and violence¡± (Price, 2010, p. 2). Roberts calls for a racial and class examination of the issue, but this still falls short of an all-inclusive attack on the constructs that keep women¡¯s reproductive rights at bay. The focus needs to be on reproductive activism at a grassroots level in order to transform public opinion of what reproductive justice and freedom is at its most basic level. The availability of the type of reproductive care that is provided now only slightly by the highest bidder in private settings should be a reality for all. That reality should be exercised by policy free from prejudice. The challenge is for that definition to be inclusive of all women and men who wish to exert a collective identity that is empowered by having the rights to their bodies.

Practice and Activist Implications

Currently, much of the power to regulate sexuality and reproductive rights lies with states. Therefore, the political agenda that governs them heavily dictates how funding is distributed and policies enacted with regards to reproductive rights. Emphasis needs to be on promoting the passage of new laws that protect the fundamental rights of a woman to choose what to do with her own body as it was outlined nearly 40 years ago by Roe v. Wade. In practice, social workers¡ªeven on an individual, direct practice level, should be aware of the economics of women¡¯s reproductive repression. The systemic, legislative bodies and their ideals that keep women, in particular women of color, oppressed need to be brought to the attention of the public at large. With the recent controversy over federal Title X funding, millions of individuals mobilized, specifically with Planned Parenthood, to prevent severe cuts. Social Workers have an ethical obligation to stand for issues that affect disenfranchised populations. Family planning falls under this umbrella. In addition, knowing the laws and economics at play can ultimately help clinical, community organizing, and administrative social workers advocate not only for the issues, but also for the individuals suffering due to inequalities in reproductive rights. Access to unbiased and comprehensive reproductive healthcare that enables the right to choose is available thanks to programs such as Planned Parenthood. By understanding the dynamic systems regulating these programs, social workers can ultimately help women escape the prison of personal sexual regulation that plagues America.

References

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Kliff, S. (2011). Mike Pence¡¯s war on Planned Parenthood. Politico. Retrieved from http:// http://www.politico.com/news/stories/0211/49609.html.

Lorber, J. (1994). The Social Construction of Gender. Paradoxes of Gender. New Haven, CT: Yale University Press.

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Williams, S. (2011). In wake of Title X cuts, Planned Parenthood to close six clinics. Minnesota Planned Parenthood Advocate. Retrieved from http:// http://www.plannedparenthoodadvocate.org/2011/06/ in-wake-of-title-x-cuts-planned-parenthood-to- close-six-clinics.html.

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About the Author

Veronica Mollere is a graduate of Fordham University, where she majored in Social Work and Visual Arts. She is a 2012 graduate of Silberman School of Social Work at Hunter College with a specialization in Clinical Practice with Children, Youth, and Families. Ms. Mollere has worked with youth survivors of human trafficking and commercial sexual exploitation in New York as well as Thailand, where she was a 2009-2010 Fulbright Scholar. That work, both domestically and abroad, has solidified for Ms. Mollere a commitment to working with children and young adults who have endured traumatic experiences. In addition, she hopes to combine her passions for women¡¯s rights and the arts with direct practice as she advances her career in social work. Ms. Mollere can be reached at veronica.mollere@gmail.com.

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