Realigning the C-section incentives

Check out my new piece on Crosscut about steps Washington state is taking to reduce C-sections by, as President Obama would say, "realigning incentives. It's on the homepage right now; find the permalink here.

Parade's push for child care

Parade, that feminist rag. Who knew? Perhaps only the unassailably bland newspaper insert could get away with such an unapologetic insistence on the critical need for affordable, high-quality child care, calling it not just a crisis, but a 25-year-old one that is past due for solving.

The choice of anecdotes to lead “The New Push for Quality Child Care” with is deft: Timisha Daniels describes leaving the work force after having a child, deciding that child care would eat up too much of her salary and not trusting child care much anyway. Now her husband is laid off, she’s been struggling to find work, and she wishes she had made a different decision. The story neatly, but gently, illustrates the economic forces that steer women to ever so reasonably enter traps.

The author puts America’s refusal to provide social benefits to mothers in unflattering context by explaining that, “In European nations, high-quality child care, especially for 3- to 6-year-olds, is seen as a right of citizenship. Governments view it as an investment in the nation’s future, and excellent facilities with top-notch care are plentiful,” and noting that the only countries that fail to offer paid parental leave besides the U.S. are Lesotho, Papua New Guinea, Liberia, and Swaziland.

Gotta love the blithe sweep of “experts on family issues and child development say the realities of the 21st century demand” social support for child care. (Finally, a journalist uses “experts say” to good ends.) None of this is really groundbreaking, except that after all these decades of day care horror stories and the assumption that child care is a necessary evil, it’s a delight to read so unwavering a disposal of all that. In Parade!

It’s all a little less surprising if you notice that the author is Leslie Bennetts, former New York Times reporter, Vanity Fair contributing writer, and author of The Feminine Mistake, one of the recent salvos in the quote unquote Mommy Wars. Here’s the blurb on the book:

…Women are constantly told that it’s simply too difficult to balance work and family. Not only is this untrue, Bennetts says, but the arguments in favor of stay-at-home motherhood also fail to consider the dangers of dependency and the difficulty of reentering the workforce after opting out. When women sacrifice their financial autonomy by quitting their jobs, they become vulnerable to divorce as well as the potential illness, death, or unemployment of their breadwinner husbands.

Timisha Daniels, exhibit A.

"Nonworking parents"?

I have a snowball's chance in hell of getting this letter published in The New York Times. But as The Daily Show* would say, who needs the old media? I have a blog!

Therefore:

To the editor:
A phrase in the July 5 article “Safety Net Is Fraying for the Very Poor” made me scratch my head. “Nonworking families with children”? As a parent of two small children, I know that no parent is nonworking. I think the phrase the reporter was looking for was “nonearning parents.”

This isn’t just semantics. Accepting that parenting is a socially valuable job that the market fails to remunerate implies providing social benefits to parents, such as paid family leave and what you might call parental wages—welfare without the stigma, without the punitive restrictions and narrow time limits, and with benefits robust enough to actually remove becoming a parent from the list of leading causes of poverty spells. This would mean a repudiation of welfare reform’s insistence on “pushing single mothers into jobs” (as if they didn’t by definition already have them), a policy whose shortcomings your article highlighted.

* Ridiculing newspaper reporters for...using land lines? Excuse me, but just where does Jon Stewart get the loads of good information that go into his monologues? The New York Times and other sources of "aged news." Criticize The New York Times for its failures of journalism, like boosting the case for the Iraq War (which the Daily Show did, briefly), but not for using land lines. (How many times has your cell phone dropped a call--do you want to be the reporter getting the big scoop from a whispering source and having to say, "Can you repeat that louder? What was that? You're breaking up"? Let's hear if for land lines.) This segment was juvenile, unfunny, and plain old mean.

Breastfeeding a crime?

If you thought staying home was the way to avoid being hassled for breastfeeding, watch out for BWI. That’s Breastfeeding While Intoxicated, and apparently it’s a crime, even when done in the privacy of your home. A North Dakota woman was jailed after cops were called to her house on a report of domestic violence, when she appeared drunk and she nursed her baby in front of them. Now the woman is in jail, facing up to five years in prison, and her nursing baby has been taken away from her.

Comments from one of the cops suggests that it wasn’t the drunkenness that got her arrested. It was the breastfeeding. Grand Forks Police Lt. Rahn Farder told the AP, "It is quite unusual for a mother to be breastfeeding her child as we are conducting an investigation, whether she was intoxicated or not." It actually sounds like good parenting in a very stressful circumstance. With cops bursting in and a man possibly having just beaten up the mother, the baby was probably screaming her head off, and there isn’t any better way I know to quiet and soothe an upset baby than breastfeeding.

While it’s probably not healthy for a nursing baby’s mother to be repeatedly intoxicated, there’s no evidence that breastfeeding during a single episode of drunkenness harms a baby at all, as a doctor blogging at Skeptical OB notes. On the other hand, the doctor says, feeding a baby a bottle while drunk actually might be harmful, because mixing formula in the wrong proportions could harm a baby. Yet all the details of the story suggest that the police would not have arrested her if she had been feeding the baby a bottle.

And of course separating a nursing baby from its mother is clearly harmful.

According to Salon, the cops didn’t do a blood alcohol test on either the mother or the baby.

What about the domestic violence that brought the cops to the house? The boyfriend who was likely the cause of the mom’s beat-up face was not charged. And people wonder why women don’t report domestic violence more often.

The mother has apparently pleaded guilty to the charges, which suggests she had a very bad lawyer. The case reeks. Where’s an ambulance-chaser when you need one? ACLU, somebody, sue the pants off that police department.

BTW: Love the Skeptical OB on this story and her point about Americans’ inability to assess relative risk (including her dig about the risk of putting kids in automobiles). She’s got some whiggy ideas about homebirth, though. I suspect she’s using bad data on homebirth safety—I look forward to checking into it.

Health care reform and midwives

Below find an open letter from Suzy Myers, midwife and women’s health care pioneer. Certified Professional Midwives, whom she represents, are the midwives who practice independently, outside of hospitals, i.e. at home births or freestanding birth centers. The other kind of midwife is nurse midwives, who largely practice in hospitals. If CPMs are federally recognized, covered by Medicaid, and become more widely used, the U.S. could save millions, perhaps billions, of dollars on childbirth while improving care.

June 20, 2009

We are at a moment in history that could affect the future of midwifery for decades. We have the opportunity to positively influence health care legislation to ensure access to midwifery care or be left behind as details of a reformed system are established in law in the next few months.

The M.A.M.A. campaign is a historic coalition of the key midwifery and consumer organizations in the U.S. unified behind the goal of achieving federal recognition of Certified Professional Midwives. Our specific goal in the next weeks is inserting an amendment into the health care bills that are moving through congress right now to mandate Medicaid coverage for CPM services on the federal level.

This multi-faceted campaign is being directed by a steering committee of dedicated volunteers, and paid staff: an experienced lobbyist in Washington D.C. , campaign coordinator and a project consultant with national health care reform experience and connections.

This week Amber Ulvenes, MAWS lobbyist and midwifery consumer, and I are participating in a country-wide “fly-in” of midwives and advocates to DC to work with the campaign’s federal lobbyist to amend this language into the Senate Finance bill when it goes to committee mark-up the week of June 22nd.

In addition to mobilizing grass roots support, right now funds are urgently needed to sustain this work through the next few months when legislation is being drafted.

What you can do:
1. If you are a midwife, talk with each of your current clients about the M.A.M.A. campaign. Give them the link to the web site: http://www.mamacampaign.or g/. Ask them to sign up, endorse, give money and volunteer to pitch in. If you have an e-list of past clients, please send a personal message asking for their support and directing them to the web site.

2. Send this message to everyone you think supports increased access to midwifery care and ask them to join the M.A.M.A. campaign and donate.

3. Sign up yourself! Numbers count. Dollars count. This is a moment when we must mobilize all available resources!

Thank you,
Suzy Myers
Midwives Association of Washington State Board of Directors
National Association of Certified Professional Midwives Board of Directors

Childbirth: the low-hanging fruit of health care reform

Quick, what’s the number one reason to be hospitalized in this country? Heart attack? Car accident? Here’s a hint: It’s not a disease. It’s not even an injury.

The answer is childbirth. And what’s the most common operating room procedure? C-section.

Given that 85 percent of women give birth and it’s no secret how 240 million Americans arrived in the world, this shouldn’t be a surprise. Nor should it really be a surprise that maternal and newborn charges are far and away the nation’s number one hospital cost, $86 billion in 2006, according to Childbirth Connections. Given all this, you’d think that, as talk of health care reform, and especially containing health care costs, fills the media, childbirth would be a major topic.

You’d be wrong. I haven’t read a peep about it in all the newspaper and magazine articles on Obama’s drive to cut health care costs, except for a couple of good articles in USA Today last December, generated by a report from Childbirth Connections.

There’s been a lot of attention paid to the ways the country pays too much for the wrong kind of care. A recent article in the New Yorker made the point that some parts of the country spend much more on medical care than others, without being healthier for it, the moral of the story being that we can cut costs while improving care. Obama reportedly passed this article around to members of Congress (hallelujah, an intellectually curious president for a change).

Yet oddly the article didn’t mention childbirth, even though C-section rates vary wildly by region and by hospital, and the nation’s C-section rate is over 30 percent, more than double what the World Health Organization recommends, which is to say that half of all U.S. C-sections are unnecessary. USA Today estimates unnecessary C-sections per year cost the nation at least $2.5 billion a year, but that is surely conservative, given that there are probably 700,000 unnecessary C-sections, each costing at least $5,000 more than a vaginal birth (not to mention the costs from additional medical complications). Add in the other childbirth interventions—such as episiotomies or continuous fetal monitoring—that are routinely done far in excess of what evidence recommends, and there have to be tens of billions of dollars that could be cut from our spending on childbirth each year while improving care.

As a doctor put it to USA Today, "Fortunately, maternity care is a place where good care and good economics come together."

Why aren't other media covering this?

Thank you, Dr. George Tiller

I’ve been thinking all week about George Tiller. As sad and angry—particularly at the negligent law enforcement officers of Wichita—as his murder makes me feel, what I know about George Tiller’s life uplifts me. That there was a man who, knowing he was risking his life, dedicated himself to helping women gives me new love for half the species. Reading the newspaper—yet another story of a man who murdered his children to get back at his ex-wife, or hired someone off Craigslist to rape his wife at gunpoint—I often find myself consumed with misanthropy. (Wrong word, I know—it’s not humanity I’ve got a beef with—but there isn’t the right word. No coincidence, that.)

George Tiller reminds me that while men too often consider women’s freedom a threat to be countered with brutal violence, men are also capable of making the highest sacrifice to defend the right of women to self-determination. Thank you, Dr. Tiller.

Dr. Tiller was one of only four doctors nationwide who provided the kind of late-term abortions he did. As Salon asks, where will women—and sadly, girls—go now?

"We always sent the really tragic cases to Tiller." Those included women diagnosed with cancer who needed abortions to qualify for chemotherapy, women who learned late in their pregnancies that their wanted babies had fatal illnesses, and rape victims so young they didn't realize they were pregnant for months. "We sent him 11-year-olds, 12-year-olds."

To make a donation in Dr. Tiller’s name to the National Network of Abortion Funds, to help provide the kind of health care he did to poor women and women facing major obstacles to getting abortions, go here.

An end to the chain gang?

Good news for a change, though this is one of those silver linings that come with dark clouds: Last week New York’s legislature passed a bill outlawing the practice of shackling women prisoners during childbirth. The new law will make New York the fourth state to restrict cuffing of women in labor.

Do the math: That means 46 states and the federal government allow this “barbaric and unconscionable” practice (in the words of Senator Velmanette Montgomery, one of the bill’s sponsors), although apparently the feds are taking steps to restrict shackling of laboring prisoners.

It makes you wonder if, huh, it might be men making these policies. Anyone who has ever been in labor knows you gotta move. Forcing women in labor to lie down and lie still is cruel and unusual punishment that increases pain and raises the likelihood of complications harmful to mother and baby. Shackling a woman raising the likelihood a woman may need a C-section and in turn can cause delay when an emergency C-section becomes necessary, delay that can endanger mother and baby.

(Come to think of it, it’s kind of a metaphor for the ordinary treatment of women in labor by the American medical establishment. In fact, not so long ago, women in labor were regularly tied down to hospital beds.)

Back in 2006, when Amnesty International did a study on the phenomenon, the New York Times ran an article on it. It quoted an Arkansas prison spokeswoman (of course they dug up a woman) defending the practice: “Though these are pregnant women, they are still convicted felons, and sometimes violent in nature. There have been instances when we've had a female inmate try to hurt hospital staff during delivery."

In fact, most women in prison (a full 70 percent) are there for nonviolent offenses, and when Amnesty asked prison officials for examples of women trying to escape during labor, they couldn’t come up with a single case.

Yeah, bulletin to prison officials: a woman in labor is busy (that’s why they call it labor). She doesn’t have time or energy to spare on running away.

(Not surprisingly, this news stirred barely a ripple outside the feminist blogosphere. Cheers to Salon and Our Bodies Ourselves’ blog.)

Another related cloud: A lawsuit by an Arkansas prisoner (serving a brief sentence for a nonviolent offense) over her shackling during labor is still wending its way through the courts. A three-judge panel of the Eighth Circuit Court of Appeals threw out the claim that the shackling was cruel and unusual punishment, but the ACLU’s National Prison Project successfully demanded a rehearing by the full court. Stay tuned.

Rosin smackdown

Discovered a new blog today, PhD in Parenting, and found the best researched answer to Hannah Rosin's Case Against Breastfeeding I've yet seen. Check it out.

Premature births in Washington shooting up

“The rate of premature births is climbing in the United States, with Washington's rise among the steepest in the nation,” shooting up about 30 percent in the last ten years, reports the Seattle Times. Who knew? Why Washington? I can’t imagine, and want to hear more.

There’s lots more that’s intriguing in the article, including this: “Breast-feeding premature babies within the first hour of birth boosts their survival, as does skin-to-skin contact.” And yet I know that these are not the practices of our local hospitals, including the hospital with one of the busiest birth units, which touts itself as Seattle's state-of-the-art place to give birth—Swedish First Hill. A woman I know who was trying to breastfeed her premature infant there was told by a nurse that a premature baby uses more calories trying to breastfeed than she takes in, so why bother. She was also told that breastfeeding, even holding the baby, would “overstimulate” and tire the baby.

(And by the way, speaking of birthing practices that are contrary to what evidence says is best practice: At the same hospital, I have heard numerous stories of women whose non-premature babies were given bottles, despite the mother’s stated wish to breastfeed and without any discussion of alternatives that don’t undermine breastfeeding. Such as, in the case of a newborn who isn’t getting enough milk from nursing, feeding with an eyedropper or with a tube at the mother’s breast, as I did in my first child’s early days.)

The article notes that prematurity occurs at high rates in both third-world and developed countries, but doesn’t explore why this might be, or that the answers look very different for the two categories (or even among populations within, say, the U.S.—such as among affluent, older women having IVF-induced multiple births versus poor, young women of color). Worse, it doesn’t mention that rates of prematurity vary tremendously among countries, even among developed countries. For example, the U.S.'s rate of premature births is double Europe's.

That leaves open the field for readers to dismiss the issue, as one commenter did: “Perhaps we can waste some more time trying to fix something that will always occur.” Premature births will always be with us, like the poor.

As it happens, premature births in the U.S. have been on the rise in tandem with the rise in poverty and inequality. As I've ranted about elsewhere, correlation is not causation, but...

A specter is haunting health insurance

Ah, the power of a little fear to make corporations do the right thing. And what could be more terrifying than the specter of (a teensy dose of) socialism? Seems that, faced with the threat of a government-run plan, health insurers are ready to mend their discriminatory habit of charging women more than men for health insurance. This is only the latest bone they’ve thrown: In November insurers agreed they’d accept all customers, without regard to preexisting conditions, and in March they said they’d stop charging more to sick people. Apparently they’ll concede anything to fend off having to compete against a public option, as the Wall Street Journal put it.

It bodes well that the issue is being framed in the terms (and in the Wall Street Journal, no less). All us good capitalists are in favor of competition, right? Why should a private company fear having to compete with clumsy, bloated, ineffective government? This is just the framing supporters of a public option would want. Still, the fight to ensure that there is a public health plan option will be monumental, insurers correctly sensing that this is the crucial nose of the camel of eliminating our crazy system of private insurance.

Back to the issue of gender discrimination in health coverage: When The New York Times began covering the discriminatory insurance practice last fall, insurers defended the practice as based on sound actuarial data; women use more health care than men, especially during their reproductive years.

They were right.

On the data, that is, not on the morality of their discrimination. The issue raises important points about the need to socialize health costs, especially the costs associated with reproducing the species.

The insight goes beyond health costs. Should women bear the overwhelming burden of the caregiving (of both children and the elderly) necessary to continuing the species or should society as a whole share that burden? And what should sharing that burden fairly look like?

Wouldn’t it be nice if health care reform provoked that long overdue conversation. Don’t hold your breath.

P.S. Check out MoveOn's funny ad on the issue of a public health coverage option.

Happy Equity Pay Day!

Congratulations, sisters, we've finally reached that day in the year when we've caught up to what our brothers earned last year. Now we can start trying to catch up on this year.

Yup, since we earn on average 78 cents for every dollar a man earns, it takes us several months extra to earn what a man earns every year, putting us farther and farther behind. And then there are those raises that are based on what we're currently earning. Goes a long way toward explaining why so many women are in poverty and especially why so many old women are poor.

But sorry, if you're a single mother, you've got a few more months of catchup, since you only earn 60 cents on a man's dollar.

Breastfeeding not a feminist issue?

Annals of unsurprising news: Someone has finally studied the economic impact of breastfeeding and found, you guessed it, breastfeeding for a “long” time—anything more than six months—hurts a woman’s earnings. This via Slate’s Hannah Rosin, of “The Case Against Breastfeeding” fame, who correctly notes that the impact of breastfeeding on women’s earnings should be an obvious question, yet none of the breast-feeding literature mentioned it until now.

Like Rosin, I’m glad someone finally studied the question. It is maddening the way that the “breast is best” campaign treats the decision whether to breastfeed as if it occurred in a vacuum, as if it were solely an individual mother’s responsibility, rather than a social one—whether to create a society that enables breastfeeding or not. To push breast-feeding “as if it only affects an infant's health, and not the woman's life or position in her family, and her workplace” is wrongheaded. It’s also, by the way, an anti- or at the very least non-feminist move.

So Rosin’s right that not all efforts to push breastfeeding are feminist. Perhaps that’s all she means by her zinger of a last line: “Breast-feeding now loses its free pass into the feminist cause.” But she seems to imply much more—that breastfeeding isn’t a feminist issue at all.

It’s interesting to consider the history of the original breast-is-best-ers: the founders of La Leche League, who thought of themselves as early feminists and sought to wrest control of mothering back from the experts. At the time their movement arose, medicine typically assumed that mothers knew nothing about the business of mothering and that the female body was a defective object. Edwina Froehlich, one of the founders, was told by her doctor to forget about trying to breastfeeding because, at 36, she was too old. That she did so anyway must have been tremendously empowering. A friend of mine told me she once looked at her plump, six-month-old, entirely breastfed, child and thought proudly, “That’s all me.” Consider that no one but a nursing mother is ever indispensable to anyone. The inventors of formula sought to dispense with her.

As the La Leche League founders saw, breastfeeding is an issue about women's power. That makes it a feminist issue.

Yet the La Leche League founders were all Catholics housewives and they wrote in their breastfeeding manual as late as 1981, “Our plea to any mother who is thinking about taking an outside job is, ‘if at all possible, don’t.’ ”

That’s hardly a feminist position, precisely because it assumes the male-dominated standards of the work world, rather than questioning them. But that’s just what Rosin seems to be doing. There is, currently, a conflict between the demands of work and the needs of mothers; surely any feminist worth the name thinks it’s the work world that needs to change, not mothers.

Balance this

This is one of those stories that makes my eyes roll so hard they nearly pop out of my head: “A business class at George Washington University aims to teach young women how to balance their careers with their personal lives," reads the promo for an NPR program.

I hoped for a moment that this was a case of media distortion and the class was really something else entirely. Nope. Professor Kathy Korman Frey describes balancing work and family as “a real entrepreneurial experience,” and says “so much of work-life balance is really practical, so it’s really teachable.” For example, one “time-management” assignment is for students to examine their daily schedules for a 24-hour day and “find an extra hour.”

There are so many things wrong with this, I don’t know where to start. How about with the fact that NPR and a prestigious university found it plausible to discuss the topic of work-life balance as an individual dilemma without once mentioning the political context that creates the dilemma, namely the American absence of social supports for parenting? Or that it never occurred to NPR to invite a guest who might mention these political questions, such as, oh, say, a feminist?

As the NPR host actually (sort of) noted, this class is home ec for the new century. Instead of learning to make potholders or jello molds, these future Suzy Home-and-career-makers learn how to “find an extra hour” and how to “locate and hold on to good childcare.” (It’s so hard to find good help these days.)

I’ll tell you how to hold on to good childcare: Create a nationally subsidized system of childcare centers that pay workers living wages. Treat childcare as a fully tax deductible and refundable business expense. And for balancing life and work, few things work so well as paid family leave.

The NPR program was weirdly vague. Just what “work-life” balance might mean wasn’t made clear. It appeared merely to mean being really busy, especially as the professor described the issue as affecting even her busy but childless students. Nowhere was there any reference to the specific, crushing difficulties faced by parents in our society—difficulties which for most mothers are desperate economic problems—let alone the specific historical and political facts that created these difficulties.

The insidious thing about the class is that it responds to a profound social problem in such a way as to silence potentially political discontent.

Balance this, George Washington.

Ominous news on child poverty

A new report on child poverty [PDF] by the research organization Child Trends makes for disturbing reading. Its findings—among them that child poverty has been on the rise since 2000—are especially ominous in the current economic crisis.

If one in five U.S. children were poor in 2007, and 8 percent were in deep poverty (below 50 percent of the poverty level), how many more children are now suffering all the consequences of poverty documented in the report? If a society accepts such high levels of child deprivation in good times, how much child misery will it tolerate as times worsen?

Even as poverty was rising and deepening (and as elements of the social safety net, such as welfare, were being dismantled), families were becoming less likely to use the social programs for which they were eligible. Maybe there’s a silver lining in that. The solutions seem clear—more outreach to inform families about safety net programs and streamlining of the application processes. Also, as the economic crisis ripples out to affect more and more people, perhaps awareness of safety net programs will grow.

Given its shocking findings, the solutions Child Trends advocates are tepid. Though the report notes that childcare is a major drain on poor families’ income (23 percent of low-income two-parent families and 40 percent of families headed by single mothers spend more than half their income on childcare), its suggestion is merely to continue existing childcare subsidies and “assess whether more funding is needed.” Other suggestions (such as encouraging marriage and discouraging single motherhood or redoubling efforts at child-support enforcement) ring of last century’s political debates (the child-support enforcement proposal seems particularly tin-eared in this economy—can you squeeze blood from stones that have already been laid off and foreclosed on?). Nor is there mention of current proposals to transform the conditions that make childhood (and parenthood) such a predictor of poverty—such as paid family leave or federally mandated paid sick leave.

While the report concludes that its findings “underscore the need to resume efforts to reduce child poverty,” readers will have to seek elsewhere for systemic proposals to reduce child poverty, let alone eliminate it.

For more warnings about what the economic downturn may mean for children, go to the Center for Budget and Policy Priority’s page on poverty and see especially the graphs about children at the bottom of the page.

Two (or three or eight) embryos no better than one, IVF study says

Timed perfectly in the still-buzzing hullabaloo over the octomom, a new study has cast doubt on the American practice of implanting multiple embryos when doing IVF, in the hopes of upping the odds of a successful pregnancy. The study found that implanting multiple embryos at a time didn’t increase the odds, and of course it does increase the costs and the dangers brought by multiple births.

Our Wild Western approach to fertility treatment contrasts with the more regulated European model, which it appears not only has safety and cost-containment to say for itself, but also effectiveness. The elephant in the room, of course is our insane employer-based healthcare system. Here’s hoping that studies like these encourage Obama and others, as they seek to reform our healthcare system and contain its out-of-control costs, to look at placing limits on the number of embryos that can legally be implanted at a single go.

So far, even as discussion of cost-containment is getting lots of play, I haven’t heard discussion of birth practices. Yet the American love of technology has spectacularly played itself out when it comes to birth, turning a basic human rite of passage into a miracle of science. Not, in fact, quite such a miracle, if you look at what we have to show for it: rates of maternal and infant mortality, premature birth, and complications that are nothing to brag about. Talk about win-win: changing our birth system to something less medicalized would contain costs and improve health. And regulating reproductive technologies by limiting embryo implantation would be one step in this effort. For starters, it would likely bring our out-of-control C-section rate down significantly.

I’m also fascinated by the sociological implications of our IVF practices. America has been engaging in a living social experiment: What does a dramatic rise in the incidence of twins (and triplets) do to a society? I hope some brave sociologist plans to study the phenom, even as it may be coming to an end. Historians may someday speak of this era’s children as “Generation Twin.”

Discrimination straight up, nothing reverse about it

“Reverse discrimination” being an oxymoron typically used by bigots with a sense of entitlement, I expected to read of such a case when I saw this headline: “Prosser couple claims reverse discrimination.”

Turns out, by my lights, Charlene Honeycutt and Charles Weems were discriminated against. They live together and had until 2007 received healthcare benefits through Weems’ employer, Batelle Labs. The couple considered marrying, but that would have cost Honeycutt, a widow, her Social Security benefit from her dead husband. In October 2007, Honeycutt was just finishing up radiation treatments for breast cancer when Batelle informed its employees that it would no longer offer opposite-sex domestic partner benefits.

The discrimination seems pretty clear. It’s too bad that Honeycutt and Weems (and their lawyer) have chosen to call it “reverse discrimination,” implicitly blaming gays for Battelle’s misbehavior (quite the “What’s the Matter With Kansas" moment). There’s nothing reverse about it. It is part of the web of injustice woven by a) our employer-based healthcare (non) system and b) patriarchy (not unrelated systems). They’re being punished for not being married.

Although the modern nuance of offering same-sex partner benefits adds a wrinkle, Battelle is quite clear that marriage is being enforced: “’The company only extends medical benefits to same-sex domestic partners because they "have no other legal way to obtain health care benefits,’ [Battelle spokesperson Staci] West said.” That is, marital status is the proper way to deliver benefits—not, say, as a right of citizenship (or of simple humanity). People should get married, and if they fail to do so, they lose their claim to benefits. Those who can’t get married are a special exception.

There’s also the unsurprising fact that Battelle was looking to save money by denying benefits to anyone it could by law or social code get away with not insuring. That's called capitalism, and it's one of the many reasons delivering healthcare via employers is bankrupt.

None of this is the fault of gays, though the “reverse discrimination” language suggests they’ve hogged an unfair share of some scarce resource. However, the movement for “marriage equality” does bear some blame. It contributed to the social acceptability of Battelle’s behavior by furthering the idea that marriage is the ideal and the proper unit for allocating social rights and benefits. Time was when, instead of demanding their right to the benefits allocated through marriage, gays questioned the institution of marriage altogether—and I for one mourn that earlier incarnation of the movement.

And then there’s the issue of Social Security, a system designed to support the primacy of the male breadwinner and which discriminates against working wives and single women (see my earlier post).

I would agree with marriage equality advocates that the state of Washington’s domestic partnership law, which grants many of the rights of marriage to same-sex couples and opposite sex couples over the age of 62 is no solution. Now, when 40 percent of babies in this country are born to unwed mothers, most women spend most of their lives unmarried, and we are on the brink of overhauling the employer-based healthcare system, is hardly the moment for the state to renew its enforcement of marriage.

Vote! Should media continue the Mommy Wars?

Unsurprisingly, “The Case Against Breastfeeding” has provoked a deluge of responses (including my earlier one), and like clockwork the media have digested Hannah Rosin’s nuanced, complex (and problematic) account of her own experience into a soundbite. MSNBC, for example, blithely spews, “Some women are questioning whether the health benefits are worth it. Breast-feeding provides benefits to mothers and babies, but can also be uncomfortable and inconvenient for working moms.” Our work culture erects nearly insurmountable barriers to breastfeeding, so we should…forget breastfeeding. The bathwater is indispensable; out with the baby.

It gets better. Find this at the bottom of the MSNBC article: “Vote! Should Mothers Breastfeed Their Babies?”

Hilarious. An article decrying the oppressiveness of judging women for their breastfeeding practices prompts a public vote to tell mothers whether to breastfeed.

For a soundbite that gets it right, try this from MomsRising: “Moms are being urged to breastfeed but set up to fail.” Quite.

How about a bailout for single moms?

We're aren't hearing much about the needs of women, let alone single moms, for economic stimulus these days, so word out to Kelly White, writing at WeNews. Her article is jam-packed with data, including this addendum to my post about the high cost of childcare: single mothers spends 45 percent of their income on childcare. And you wonder why so many single moms and their children are in poverty.

The case against self-hatred

Where to begin to rebut the “Case Against Breastfeeding”? In this month’s Atlantic, Hannah Rosin claims breastfeeding keeps women down—she compares it to the vacuum cleaner of the 50s ‘Feminine Mystique'—and that the evidence for its health benefits is thin.

There are some serious flaws in Rosin’s claims about the science, nicely described here. And the idea that breastfeeding is itself as oppressive as being a 1950s housewife is just weird.

But what I find the most intriguing element of the piece is what shows up in the first two paragraphs. Rosin describes being ostracized in the playground when she tells other mothers she’s thinking about cutting short the breastfeeding of her third child.

…circles were redrawn such that I ended up in the class of mom who, in a pinch, might feed her baby mashed-up Chicken McNuggets. In my playground set, the urban moms in their tight jeans and oversize sunglasses size each other up using a whole range of signifiers: organic content of snacks, sleekness of stroller, ratio of tasteful wooden toys to plastic. But breast-feeding is the real ticket into the club.

There’s so much here to, as they used to say in grad school, unpack, that the mind reels. It’s a classic reactionary setup, really quite Rovian: It sets up a hated elite (lattes and chardonnay here are replaced by organic snacks and sleek strollers, but the effect is the same as in a Limbaugh rant) who engage in terrible oppression, which justifies a counter-attack, much as the Christian right typically must paint themselves as oppressed and embattled to justify their attacks on gays, civil liberties, and women’s reproductive rights.

Yet in the real world, it’s women who breastfeed for the full two years the WHO recommends who are the struggling minority in the U.S. Only 31 percent of U.S. babies are breastfed exclusively for even three months, and only 11 percent are exclusively breastfed through six months, and that with breastfeeding having recently reached new highs. Among the reasons women most commonly cite for giving up breastfeeding or supplementing with formula is—can you guess?—returning to work. This is no surprise, given that there is no such thing as paid family leave in this country, nor even are most workers guaranteed their jobs back if they take unpaid leave.

In my highly progressive, pro-breastfeeding circles, I know of almost no mothers who returned to work fulltime who continued breastfeeding exclusively. It is nearly impossible to do so.

Still, I think Rosin is, in a warped way, on to something in perceiving herself ostracized among her privileged community for considering cutting breastfeeding off. Our misogynistic culture maddeningly, at once curtails our choices (by not offering paid leave, for example, or for permitting hospital practices that discourage breastfeeding) and valorizes individual choice as its pre-eminent value. Women often respond to this contradiction by turning on other women. It exacts such a toll in this culture to acknowledge that one hasn’t acted freely—especially in the deeply intimate sphere of reproduction--that many women would prefer to embrace their supposed “choices” and vilify other women who made different “choices.”

I think of the friend of mine who, while 8 months pregnant, was sneered at by another mother for planning a nonmedicated birth. “Well, if you want to be a martyr, you go right ahead.” Given the high rate of women who report having had disempowering birth experiences, I suspect that many women who have experienced awful treatment in birth have as the path of least resistance embraced their “choices,” leaving no honest outlet for their anger, which gets channeled at other women.

This is a problem that goes way beyond breastfeeding and it’s far past time for women to stop turning on each other. I welcome thoughts.

Childcare is breaking families' budgets

Nearly one-third: that's the share childcare takes out of the budget of the average middle-income family of four with young children. Eating up 29 percent of their money, childcare represents the single largest item in these families' budgets, according to a report from Pre-K Now.

If you don't have kids and this figure astounds you, I'm here to tell you it's about right. I guess my partner and I and our two kids are getting a bargain; only 25 percent of our budget goes to childcare.

Given that a parent can't work for a wage unless she has childcare and (especially since the end of welfare) can't live unless she has a wage-earning job (or a sugar daddy), this is a crisis.

Boys been reading Rock the Cradle

Some college kids in California have filed a ballot initiative to do just what I’ve been advocating: get the government out of the marriage business. No surprise, the media are largely getting it wrong, calling it a “gay marriage initiative” and suggesting it’s a joke.

The boys’ initiative would erase “marriage” from the legal books and grant everyone the right to “domestic partnerships,” gay or straight. It’s unclear to me whether the contract would have to be a sexual one, or if you could create a union with your sister, friend, cousin, whatever, for purposes of life partnership, sexual or not.

I first learned of this from a libertarian-leaning blog in my home state, which got the point better than the MSM mostly did, although he did file the post under “gays.” Are other posts tagged “straights”? “Squares”? “Bigots”?

And the initiative sponsors don’t have quite the right analysis of their brilliant idea, calling it a “compromise.” There’s nothing compromising about it. It's a radical departure in the right direction. See my blog post on the subject.

Anyway, way to go, boys.

This trend just in

Different media same day: “Some Laid-Off Women Now Stay-at-Home Moms” (MSNBC) and “As Economy Slips, New Mothers Cut Short Their Maternity Leave" (Wall Street Journal). I thought I’d wandered into an Onion parody. Which is it—are women being opted out or opted in?

Both stories are no doubt true—as descriptions of the experiences of some moms, somewhere. But that’s not how the pieces are framed. Instead they purport to describe a new “trend.” Trend stories are the slipperiest game in journalism. Journalists especially love to get breathless about supposed trends in women’s social roles, mixing up description and prescription, from the supposed marriage dearth peddled in the 1980s and debunked soon after by Susan Faludi to the “opt-out revolution” hyped by the New York Times’ Lisa Belkin in this century and debunked by Joan Williams in the American Prospect, among others. The New York Times’ trend stories are weirdest, warped as they are by the confluence of gender and class. Their m.o. is to pick some tiny slice of the East Coast’s ultra-privileged and take them as representative of the whole country.

Strollers are bad for you

I always wondered what the effects of all the containerization we subject kids to these days might be. From carseats to strollers to high chairs to motorized baby swings, we love to place our babies inside of plastic containers removed from human contact.

It didn’t seem like the effects could be good. My kids howl whenever I stick them in their lonely carseats, although the sensory deprivation eventually puts them to sleep.

Researchers in Britain wondered, too, and have found evidence that, indeed, forward-facing strollers, which cut children and parents off from almost all sensory contact with each other—no touch, no eye contact, on noisy streets we can't even hear each other—have bad effects. Spending a lot of time in one of these strollers apparently retards children’s language development.

I fear that the stroller controversy will become one more thing for moms to feel guilty about and one more thing for poor folks who can’t afford fancy front-back convertible strollers to get beat up about. Keep in mind, though, a swag of cloth tying a baby to your body beats the fanciest stroller any day.

(And I’m still unconvinced by the efforts to tell parents that a fancy crib is better than sleeping with their babies. Last I checked we were still mammals, and mammal babies need touch. To convince me otherwise, show me the research and don’t sweep all those crib recalls under the rug.)

The petri dish can't replace the female body

It’s not really surprising, but it is interesting that evidence of the long-term health risks to babies born from IVF is starting to emerge. For a while now there has been some evidence of higher rates of prematurity, low birth weight, and birth defects in IVF babies. What’s more interesting is what the New York Times is reporting today—that there are “unusual gene expression patterns”—bad ones—in IVF babies.

This dovetails precisely with what current biological science would predict. Turns out that the science I was taught in high school biology class about genes, that they are blueprints from which critters are mechanically churned out, is nearly all wrong. The blueprint, or computer code, metaphor doesn’t work. We can’t be said to simply be the sum of our genes. It’s more like we’re the sum of a process, namely what’s called by biologists “development”—the precise, complex choreography that results in the growth of a creature from (almost) nothing.

So it makes sense that doing part of that development in a Petri dish instead of the human body would have consequences, genetic ones at that. The age-old yearning to be free of the female body has once again been frustrated.

Everybody's favorite villain (again): the single mom

Events have shifted that octuplets story. I figured it would play out the way the story of the McCaughey septuplets in Iowa did—with oohs and ahs and a donated 16-room house, 15-passenger van, baby food from Gerber, and a lifetime supply of Pampers from Procter & Gamble —and I was all set to rain on that parade.

Never underestimate the power of race or sexism to flip a story. Now that it has emerged that the mother of the octuplets is unwed (and has six other kids), there isn’t much gushing. The headline in my local paper reads, “Winning Sympathy the Hardest Task.” In the article, a call-out headed “Cost of 14 Kids” reads “for a single mother, the cost of raising 14 children through age 17 ranges from $1.3 million to $2.7.”

Excuse me?

Last I checked, children cost the same to raise whether by a single mom, a single dad, two moms, two dads, or a mother and a father. Suggesting children cost more if raised by single mothers vilifies single mothers, implying they’re parasites on society. The birth of the octuplets already burdens society, in the form of the millions of dollars their birth cost our medical system, but that would be true even if Ozzie and Harriet were their parents.

This woman is surely crazy, but then so are the McCaugheys and the Gosselins (of the TLC reality show). It’s just that certain forms of insanity—such as having sextuplets in God’s name or putting your children on a reality show—are socially acceptable and others aren’t.

Lynn Paltrow of National Advocates for Pregnant Women (so glad to learn about them!), put it best (courtesy Salon’s Broadsheet):

"When the pregnant woman is not brown or black and the drugs/technologies are provided by big pharma, the discussion focuses on questions of ethics. But if the issue is childbearing by low-income women of color, and the drug is homegrown/ illegal then the debate is a question of punishment through the criminal justice or civil child welfare system." Paltrow also cited a study showing that, while we often talk about the effects illegal drugs can have on pregnancy, "women who take fertility drugs and choose to carry three or more embryos to term often experience pregnancy loss and risk severe, lifelong harm to the children who survive."

Why aren't Sasha and Malia going to public school?

Michelle Obama rocks, but I'd feel a lot more excited about her recent visit to the Department of Education and promises of improvements in public education if she and Barack sent their kids to public school.

I can just hear the but of course they can't do that guffaws, and it may be true that DC public schools suck. That begs the question of why they suck. I bet they'd stop sucking if the elites sent their kids there. The bottom line is that our public schools should be good enough for the president's children. This is a democracy. We should expect no less.

Strange choices bring octuplets

I’ve been spending a lot of time in the last few weeks talking to mothers who can’t get the most basic health care for their children—because they have no health insurance—so the story of the octuplets born this week stuck in my craw. Even as mothers can’t get their daughters the asthma medications they need, can’t get their children to the dentist, can’t get their son’s broken shoulder set properly, get taken to collections for the bill from treating a child’s ear infection, 46 doctors and untold millions of dollars have been devoted to this freak of un-nature.

And it is certainly not natural. The newspapers are being coy about the question how the mother came to bear so many babies at once. But they do note that there’s virtually no chance this happened naturally; it’s a near certainty the parents used fertility treatments, most likely IVF, and that the parents refused what’s delicately termed a “reduction.” Yet as AP notes, “Multiple births can be dangerous for babies and their mother, and in some cases, may result in lasting health problems.” That’s an understatement. One of the doctors in the case noted that the human uterus is designed to hold at most two babies. Putting more in there puts a mother’s life at risk and is likely to cause terrible health complications and suffering for the babies (including long-term physical and cognitive problems).

Make no mistake, therefore, octuplets are the result of choices, some very strange choices at that, most likely based on strange and incoherent ideas about God’s will. The parents and their caregivers chose to have multiple embryos implanted and they chose not to reduce the number of fetuses in the interests of the health of mother or babies.

This case is also the result of choices we as a society have made, to devote resources to enable these strange choices, at the expense of basic health care for all children. The AP article on the case quotes a doctor saying that doctors can’t force women to have reductions, but in most European countries there are limits on the number of embryos doctors are allowed to implant or the number of cycles of IVF covered by national insurance (and there is evidence that increasing the number of embryos doesn't increase the odds of success).

All of us bear the cost of extraordinary medicine like this, through our insurance premiums and our tax dollars, in the form of the state and federal funds that go to hospitals, doctors, and medical schools. As I have listened to Vicky worry about her daughter’s next asthma attack, Paula anguish over missed check-ups and dunning letters from collections, and Traci worry about the pain in her son’s teeth, I am disgusted by my society’s choices. The octuplets are no miracle.

The change cometh

What more can I add to all that’s been said about this beautiful week? Not much. Just when I was coming off my inauguration high, Obama’s first executive orders came down. Oh, yes, it’s real. Closing Guantanamo, ending torture, opening government, protecting public lands from oil drilling, lifting the global gag order—sweet rain in the desert.

And then there was the news that Michelle Obama does not plan to spend all her time on selecting ball gowns and redecorating the White House. She has just appointed the general counsel of the National Partnership for Women and Families to be her policy director. The Wall Street Journal describes Jocelyn Frye as “one of Washington’s most visible advocates of expanding family leave and ending pregnancy discrimination” and reads the appointment as a signal that Michelle Obama is “preparing to take an activist stance on such policy issues as family leave and flexible scheduling.”

Looks like Michelle too may have the Obama touch, the ability to make hot button issues safe for prime time, She’s jujitsuing the requirement for the First Lady to focus on family into a feminist agenda.

Online sex predators a rare breed

My favorite “Dog Doesn’t Bite Man” news of the week: “Threat overblown of online sexual predators.” A task force of state attorneys general has found that sexual solicitation of children online is not a significant problem.

People seem to love to get hysterical about this supposed problem, perhaps because it is an excuse to a) violate civil liberties, including free speech, and b) avoid addressing the real sexual threats to children, namely people known to them. It’s so much nicer to pretend the problem is scary faceless Others, not the people close to us. If we admitted that the problem is close to home, we’d have to accept its causes in our culture and, for many, complicity in it. Children are most often abused by someone they know, and what may be worse, they often aren’t protected or supported by the people closest to them. In my experience as a teacher, I’ve heard quite a few stories of abuse and it seemed that worse than the abuse itself was the experience of not being supported, protected, or believed by those they most trusted and loved.

Here’s to the attorneys general for the reality check.

Mom's fault, as usual, or, yet another installment of crummy science reporting

Get a load of how the media played today’s story on new evidence of the risks of early C-section. Here’s the LA Times lead: “Thousands of women put their babies at needless risk of respiratory problems, hypoglycemia and other medical ailments by scheduling cesarean deliveries too early.” It’s women who put babies at needless risk. Not doctors or hospital policies. As usual, it’s mom’s fault.

Why would silly moms do this? NPR concluded its spot on the same research by noting that women may be scheduling C-sections early to insure that their “personal physicians” (idiotic term) were available to deliver their babies. To protect their babies, women may just have to let go of that choice, intoned the reporter.

The research looked at “elective” C-sections, that is C-sections for which there is no medical reason. Why would anyone have such a thing? The Times opined that it was women who are “too posh to push.” Again, those irresponsible moms.

Nowhere in the stories was there any mention of whether medical practice and policy might have anything to do with this problem. Nowhere in the stories was there any attention paid to the strange fact that doctors perform such a thing as a C-section for which there is no medical reason, or the disturbing fact that researchers could find 13,000 elective C-sections to study.

In further scolding of women, the LA Times mentioned that the American College of Obstetrics and Gynecology has counseled that women wait until 39 weeks before having an elective C-section. But missing from the stories was the information that ACOG and the American Medical Association have ruled elective C-sections to be ethically neutral, despite the health risks C-sections pose to women and babies (especially repeat C-sections) or that when researchers have looked for women who chose C-sections for the heck of it, they haven’t found any.

The Listening to Mothers survey, the biggest and best look at the subject, managed to find one woman among the 1600 surveyed who chose a C-section of her own volition. A full quarter of those who’d had C-sections described themselves as “pressured” by medical caregivers to have the operations—information that doesn’t appear in medical records that term the C-section “elective.” And, thanks to another directive from ACOG, fewer and fewer hospitals will allow women to even attempt vaginal birth after C-section. Women’s childbirth choices certainly play a role in this issue, but their choices aren’t made in a vacuum.

Nor did the stories mention the inherent risks of C-section, regardless of when they’re scheduled. The LA Times story did contain a hint in that direction: “The initiation of labor is a baby's way of signaling that it is ready to live outside the womb,’ [Dr. John Thorp, a professor of obstetrics and gynecology at the University of North Carolina at Chapel Hill and coauthor of the study] said. When doctors schedule elective C-sections, ‘we're saying we're smarter than that signal,’ he said. ‘There are some babies who aren't ready to make that transition and are forced to do so.’ ”

Bread (and roses), not circuses

Amazing fact: Forbes calculates profits of the big four sports (I guess that’s baseball, football, basketball, and tiddlywinks?) at $1.6 billion, but these industries receive taxpayer subsidies totaling more than $2 billion a year. That is, taxpayers provide the entire profits of sports. Explains a lot, doesn’t it?

I’ve always had a deep resentment of sports analogies, the continued job security of sports writers even as investigative reporters become an endangered species, and sports films with “universal appeal,” not to mention taxpayer-funded stadiums. Why am I supposed to take overgrown boys’ games any more seriously than I would expect anyone to take pedicures, eye-brow-plucking technique, or the collection of Beanie Babies?

Now I know what I've always suspected: the whole sports business really is parasitism, pure and simple.

The above revelation comes from a terrific article in the current issue of Mother Jones laying out how we can get the economy back on track. Check it out.

Another fact to ponder in a different article in the same issue of MoJo: Tax cuts and credits for corporations and wealthy individuals have a negative return on investment—less than 37 cents on the dollar—while every dollar spent on food stamp benefits returns $1.73 to the economy. I’d like to see what the return on investment in childcare or paid family leave might be. Something tells me it’d be better than sports stadiums.