How Free is Free Choice?

                                                         Source: LiveNews

Every day we are constantly surrounded by choices. Living in America, we are free to decide where to live, what type of job we want, and the type of activities we would like to participate in daily. But are these decisions really a choice for everyone? Andrea Smith discusses this dilemma in her book Conquest: Sexual Violence and American Indian Genocide. In chapter four, she argues that the choice paradigm does not take into consideration the social, economic, and political conditions that influence a woman’s decision (Smith, 2005). Because of this, choice has developed to symbolize a white-middle class woman. In minority groups, free choice often seems meaningless since these groups are constrained by poverty and limited access to health care and other services (Smith, 2005).

Last summer, I experienced firsthand the implications structural inequalities have on a woman’s reproductive health decisions. For nine weeks, I interned for a nonprofit health organization in the small rural community of La Danta, Nicaragua. This community did not have running water or electricity, and was located three hours from the nearest hospital. My internship focused on determining why pregnant mothers were not attending the four recommended prenatal care visits during their pregnancy. With high infant and maternal mortality rates in Nicaragua, attending prenatal visits will help decrease risk of mortality through education and monitoring. For white middle class individuals living in America, it seems easy to get in the car and drive to the hospital without worrying about the cost because of health insurance. This is not the case in Nicaragua. The typical mode of transportation for the women was on horseback. There was a bus that traveled from La Danta to the hospital, but cost was too high for most of the families. Additionally, the mothers could not spend all day traveling to and from the hospital because they have other children to take care of as well as household obligations. Finally, majority of the mothers were unaware of the consequences associated with not attending prenatal visits since they did not have access to quality education. Because of the social and economic constraints faced by the pregnant mothers, they had limited choice in their ability to have a healthy pregnancy.

But we do not need to look abroad to understand how social, economic, and political conditions impact a woman’s choice in reproductive health. In Zoe Dutton’s article, Abortion’s Racial Gap, she discusses the different factors influencing abortion decisions. According to the Centers for Disease Control and Prevention, African-American women are five times more likely to have an abortion when compared to white women. But have you ever wondered why? At first glance, it is easy to judge minority groups for getting pregnant and stereotype black and Latina women as wild and licentious without taking into consideration other circumstances. Christine Dehlendorf, a professor at the University of California who specializes in reproductive health research states inequalities such as structural determinants, economic reasons, racial discrimination, opportunity differences and social differences are related to the discrepancy seen among unintended pregnancy and abortion (Dutton, 2014).

When compared to white women, minority women are less likely to have health care coverage, proper reproductive health education and a personal doctor, making it difficult to access birth control (Dutton, 2014). Without access to birth control, the risk of unintended pregnancy and abortion increases. According to Guttmacher Institute, unintended pregnancy rates are highest among low-income women and minority women. For instance, the rate of unintended pregnancy for black women in 2011 was 79 pregnancies per 1,000 women whereas the rate for higher income white women was 18 unintended pregnancies per 1,000 women. Therefore, it is not a surprise that 75% of the abortions in 2014 were completed by low income or below the poverty line women, since lower income women are impacted more by economic and social constraints (Guttmacher Institute, 2016).

Political institutions also limit a women’s ability to decide to have abortion.  After the Roe v. Wade case in 1973, women were given the constitutional right to make their own personal medical decisions, which includes abortion, without interference from politicians. Yet, in 2016, 30 laws have been passed in 14 states to regulate abortion by antiabortion advocates (Phillips, 2016). These regulations include waiting periods, health insurance restrictions, bans after 20 weeks of pregnancy, requirements for abortion clinics to meet standards similar to ambulatory surgical centers, and requirements for abortion doctors to have admitting privileges to local hospitals (Lu & Somashekhar, 2016). Just this afternoon, Ohio senators passed a bill that restricts abortions once a heartbeat is identified. A baby’s heartbeat can be detected as early as six weeks, which is often before the mother becomes aware she is pregnant, essentially banning abortion and making Ohio one of the strictest in the nation  (ABC 6 News, 2016). If this bill is passed by Governor Kasich and the Supreme Court, women will essentially be losing their reproductive rights.

In 2013, the New York Magazine published a feature article of 26 abortion stories from women of all ages and races. These stories expressed the emotional toll experienced by mothers because of political regulations, economic constraints, and racial discrimination.  Yolanda, aged 29, attempted to have an abortion after getting pregnant after not having birth control. But the clinic required someone else to drive home after the procedure. Because of this, she was forced to tell her friend, hoping she would drive to the clinic.  When she refused, Yolanda was not able to go back for the abortion.  She shared, “When the baby was little, our lights got turned off. I got depressed, kind of suicidal. Sometimes I’d think, I didn’t need to have this kid, and now he’s suffering with me.” (Winter, 2013). Yolanda knew she could not afford to raise the baby on her, yet, because of regulations she did not have a choice in the matter. So how is pregnancy and abortion a free choice for women?

                                                      Source: The Atlantic

References

ABC 6 News (2016, December 6). Ohio senate passes bill to ban abortion when heartbeat can be detected. Retrieved from http://abc6onyourside.com/news/local/ohio-senate-passes-bill-to-ban-abortion-when-heartbeat-can-be-detected

Centers for Disease Control and Prevention. (2006). Abortion surveillance. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/ss5808a1.htm?s_cid=ss5808a1_e

Dutton, Z. (2014, September). Abortion's racial gap. Retrieved from http://www.theatlantic.com/health/archive/2014/09/abortions-racial-gap/380251/

Guttmacher Institue. (2016, May 10). Abortion patients more likely to be poor in 2014 than in 2008. Retrieved from https://www.guttmacher.org/news-release/2016/abortion-patients-more-likely-be-poor-2014-2008

Lu, D. & Somashekhar S. (2016). How restrictive are abortion regulations in your state? Retrieved from ttps://www.washingtonpost.com/graphics/national/abortion-regulations/

Phillips, A. (2016). 14 states have passed law this year making it harder to get an abortion. Retreieved from https://www.washingtonpost.com/news/the-fix/wp/2016/06/01/14-states-have-passed-laws-making-it-harder-to-get-an-abortion-already-this-year/?utm_term=.9e38df3ee75b

Smith, A. (2005). Conquest: Sexual violence and american Indian genocide. Cambridge, MA: South End Press.

Winter, M. (2013, November 10). My abortion. Retreived from nymag.com/news/features/abortion-stories-2013-11/