Today, despite the overall decline of racism in American public life, those who wish to increase welfare funding of family planning do not challenge the eugenicist structure of the programs, but instead work within it. While they may not embrace the racist Jim Crow laws, as did the Senators who designed the programs they seek to expand, they do repeat the cynical cost-benefit analyses that those racists used to justify their policies. This final article in the series outlines the recent history of U. S. welfare family planning, showing how it preserves as its central working assumption the eugenicist principle that American society would be better off if poor children are never conceived.

“Averting Births”: The Clinton Era Medicaid Family Planning Expansion

By the early 1990s, Medicaid (the health care program of the welfare system) had become the federal government’s largest source of contraception funding. This was due in part to the growing political clout of the pro-life movement during the 1980s, which was able to slow the growth of direct federal funding for Planned Parenthood clinics through the other major source of federal funding, the Title X program.

Medicaid’s importance as a source of contraception funding was due mostly to the program’s open-ended structure. Medicaid is not really a health insurance program, but a reimbursement program. If it were a health insurance program, Congress would pay a fixed premium now to reduce future expenses. Instead, Congress promises to reimburse the states for a certain percentage of whatever they spend on eligible health expenses, whether that be $10 million per state or $10 billion. The states decide how much they will spend on Medicaid, and Congress just signs the check. For most medical expenses, the federal government reimburses the states at a little more than half of the state’s expenses, so that if the state makes its health care program too generous (by paying for redundant tests or experimental therapies, for example), it can break the state’s budget.

In the case of family planning funding, however, the states have an incentive to be profligate, because the federal government reimburses the states for 90% of their expenses. Not surprisingly, the states are very creative in finding ways to classify expenses as “related to” contraception. Many states have set up fancy “school-based health clinics” in public middle schools and high schools, complete with an M.D. on staff, and charge the federal government, not just for the contraception they give to the children, but also for the overhead costs of running the clinic. Hospitals and health clinics also have incentives to classify as many expenses as possible as related to “family planning services,” to take advantage of the extra federal money available.

When the states run out of ideas for exploiting this infinite funding stream, abortion providers such as Planned Parenthood are happy to think of some more. Even though Medicaid won’t pay for most abortions, Planned Parenthood clinics can get access to an unlimited amount of money for everything related to contraception, including overhead, secretaries, training, advertising, paperwork, etc. Since the same clinics usually also perform abortions, the money going for “contraception” subsidizes their abortion practice, too. In fact, the Guttmacher Institute frequently conducts symposia and releases special reports on innovative ways states can tap Medicaid’s giant pool of funds for contraception-related services.

Despite these creative efforts, however, there was always the problem that the funding for contraception could not grow unless the demand for contraception among the people eligible for Medicaid also grew. And by the early 1990s, the Medicaid eligible population was so saturated with birth control that demand was in danger of leveling off, threatening the budgets of state Medicaid bureaucracies and the ability of Planned Parenthood to open more clinics. So when Bill Clinton came to Washington, there was a chance to put some of the Guttmacher Institute’s more creative ideas into practice.

In 1993, the Clinton Administration approved a plan whereby states could expand Medicaid’s free family planning services to those who were too rich to be eligible for Medicaid. There was a catch, however—a state could have access to Medicaid’s contraception money only if it could promise that it would save the government money in the long run by “averting births” of children who were likely to be a drain on the welfare system. The Guttmacher Institute had been publishing papers since the 1970s arguing that averting the births of the poor would save money set aside for helping the poor; now the federal government was demanding that the states adopt this perverse argument in order to have access to more of Medicaid’s millions.

South Carolina was the first to be admitted under this program, and other states have followed suit—by March 2008, 26 states had adopted such programs, and several others were in the process of establishing them. To demonstrate that the extra spending saves money, all used some variation of the Guttmacher Institute’s figure purporting to show that every $1 spent on contraception would save the welfare system $4 in births averted. Medicaid even developed a model worksheet to guide the state bureaucrats in making this calculation. (This method has serious weaknesses, as detailed here).

The results have been an enormous success for the program’s designers. Overall Medicaid funding of family planning services more than doubled since the Clinton expansion program was started, driven by nearly 500% increases in the states that were the first to sign up. As of 2006, Medicaid was spending over $1.3 billion on family planning services, up from $536 million in 1994 (in constant dollars). Medicaid pays for 97% of the nation’s publicly funded sterilizations.

But the program cannot transcend its eugenicist structure. To the bureaucrats in charge, “averting births” of low-income children is all in a day’s work. They are ruthlessly utilitarian as they weigh the high costs of a new poor person against the few benefits his life is likely to bring to society, and they conclude that it is cheaper to invest in methods likely to avert his too expensive life. (For an example of this sort of calculation, see here).

The 2009 Stimulus Package

When Pelosi told George Stephanopoulos that “family planning services reduce costs,” she was defending a provision that would have made the Clinton Medicaid family planning expansions permanent. The Clinton-era family planning expansion program was effective but cumbersome. Because of the laws that govern the program, the states have to apply for a renewal every five years, and they had to conduct research showing the programs’ effectiveness. The Democrats saw the stimulus package as a way to make these programs permanent, so that any state could offer Medicaid-funded family planning to those earning up to double the federal poverty line (i.e., up to $39,000 for a family of four).

The original stimulus bill would have changed current law in other ways as well, according to Dennis Smith, the policy analyst at the Heritage Foundation whose paper first called attention to the contraceptive funding in the stimulus package. The provision would have provided discount contraceptives to college students in university health clinics, eliminated the parents’ role in contraception decisions for their children and allowed all children to have free government-funded birth control, given family planning to illegal immigrants, and denied the states the flexibility to accommodate religious objections to aspects of the program.

Not of all of these ideas are eugenicist. Pushing contraception on immigrants might be, but giving contraceptives to college girls at a discount has another motivation entirely. Yet all of these policies were designed to tap into Medicaid because of its extraordinarily favorable rules toward contraception, especially the 90% federal reimbursement rate for family planning costs and the rules giving Planned Parenthood and others access to children without their parents’ knowledge or consent. And as shown above, those policies were enacted as part of a desperate political compromise to avoid an alternative policy—mandatory contraception for welfare recipients—that the NAACP regarded as a racist and eugenicist nightmare.

A Simple, Substantive Fix

As long as Medicaid is structured this way, Pelosi’s eugenicist statements will accurately describe the intellectual justification for U.S. contraception policy. Congress could fix that with three modest changes: reimburse family planning services at the same rate as other services in Medicaid, make contraception an optional part of a state’s Medicaid plan (like most other services in Medicaid), and defer to the states’ policies on parental notification and consent. In other words, it could stop giving contraception special treatment, so that promoting the health of the poor would become at least as important a national priority as preventing them from having children. In that case, federal policy would treat contraception as an individual’s choice for which the state provides moderate financial assistance, rather than as a government priority with which the person on welfare is pressured to cooperate. There are stronger measures that could be taken, and many would dispute that Medicaid should pay for contraception at all, but these three steps would be enough to distance the federal government from an unsavory policy with a dark history.

Daniel Patrick Moloney, Ph.D., a former post-doctoral fellow at the Witherspoon Institute, was until recently Senior Policy Analyst in Religion and Civil Society at the Heritage Foundation, where research for this article was conducted. The author is solely responsible for the contents of this article. This article is the third in a three-part series.

Copyright 2009 the Witherspoon Institute. All rights reserved.

This article appeals to transcripts from the committee hearings to argue that the committee enacted these policies out of racist, eugenicist motives. While the motives behind the American welfare system were originally idealistic—providing temporary assistance to needy families while they climbed out of poverty—the committee hearings show that the senators believed that the mostly black welfare population was incurably lazy, promiscuous, intellectually substandard, and a burden on public schools, and, moreover, that they probably would remain so indefinitely. Birth control, therefore, was in their eyes a way to reduce the number of these undesirable people.

Federal Contraception Funding and Racial Eugenics: The 1971-2 Welfare Reform

In 1972, during debates over H.R. 1, the welfare reform bill that had passed the House, George Welch of Benton Harbor, Michigan, appeared before the Senate Finance Committee to argue that too many people on welfare were having children out of wedlock, causing welfare costs in his city to spin out of control. Consider this key moment from the end of his formal statement, as found in the Congressional Record:

“It is my strong belief that if anything should be done to curb the welfare problems of future generations that an incisive cut must be made into the accepted practices, of illegitimate births, especially as condoned and supported by public funds, for illegitimate births now pose an exponential rate of increase in the Nation. Unless these practices are reversed, future generations will suffer the costs, social stigma, and other burdens…

“In the past year, 118 illegitimate children were born in the city hospital [in Benton Harbor] . . . 34 families with illegitimate children joined the city population in the [welfare] caseload from other places just this past month. We conclude that the AFDC caseload [Aid to Families with Dependent Children, a primary welfare program of the day] which comprises one-third of the city’s population must contribute to the rise in illegitimate births . . . All of these children will most likely attend the public schools . . . These data clearly show that illegitimate births are on the increase among females in the earlier years, as low as 11 years of age… The greater bulge is in the age bracket 16 to 19, where family planning might be considered, but we believe it should be made mandatory since mothers under 18, at the present time, are automatically eligible to be added to the grant of their parents . . . ” [Emphasis added.]

Making an important distinction, Welch argued that “In these instances we must be talking about birth-control programs rather than family planning.” Welch continued this line of reasoning when he proposed, in the name of thirty business leaders and corporations in his Michigan county, that contraception be made mandatory for welfare recipients:

“These practices and the consequences to these lives are eroding our institutions, posing special human problems which we are simply unable to meet, and destroying the morale and will of the people throughout the area. We recommend that the committee give most serious consideration to include in the new standards a limit on the number of illegitimate children per family, with further requirements that it be mandatory that the mother participate in family planning programs and the father be identified for the purpose of enforced child support.” [Emphasis added.]

The powerful chairman of the committee, Democrat Russell Long of Louisiana, a supporter of Jim Crow and a signer of the “Southern Manifesto” condemning Brown vs. Board of Education, was excited by this proposal:

“Well, I want to say to you, Mr. Welch, that it is refreshing to hear somebody appear before the committee . . . who [has] some contact with the mainstream of the thinking in the United States and who can demonstrate a little common sense. We have heard some awfully ridiculous proposals made to this committee.”

Senator Wallace Bennett (R-UT), seconds his praise:

“I was just going to say these last two witnesses are probably more valuable to the committee than a dozen others we have been hearing today and the last few days. They get right down to the problem.”

Likewise, Senator Clifford Hansen (R-WY), calls this statement “refreshing” and “excellent.” He then asks for a clarification:

“The only question I have, Mr. Chairman, is this: . . . With respect to limiting the number of illegitimate births per family, it is your recommendation that that be accomplished by making it mandatory that the mother participate in family planning programs?”

Mr. WELCH. “Yes. I think in our area, Senator, we have launched planned parenthood [sic] programs and family planning clinics; they are beginning to show some productivity to this end and it would help us in our problems greatly if these people would be required to do that . . . The problems are highly debatable. However, in a community that is so overburdened and all of these youngsters are going to grow up in one situation go to one public school system, . . . [this] just simply is an overwhelming problem for us to try to cope with, to solve.” [Emphasis added.]

Mr. Welch’s seemingly radical proposal—to require that women be on birth control as a condition for receiving welfare support—received a very favorable hearing from some powerful senators, who were otherwise worried about the explosion in illegitimacy.

Racial Stereotypes and Black Illegitimacy

A subtext throughout the hearings, made explicit in the testimony of experts from civil rights groups, was that the welfare population was overwhelmingly black, so that plans to use the welfare system for social engineering would disproportionately affect blacks. Daniel Patrick Moynihan had drawn attention a few years earlier to the sudden increase in black illegitimacy, and awareness of this fact also added racial overtones to the contraception proposals.

At one point, for example, Clarence Mitchell of the Washington, D.C. branch of the NAACP felt the need to reprimand Sen. Long for remarks suggesting that black people on welfare were lazy:

“I do earnestly ask that you try to avoid the colorful descriptions of the welfare recipients, which themselves arouse prejudices in this country and make it difficult to pass these programs . . . ”

Mitchell also corrected Sen. Paul Fannin (R-AZ), another opponent of civil rights laws, when Fannin argued that mandatory birth control for welfare mothers was necessary to prevent these promiscuous women from having “regrettable” and “excessive” children. Mitchell pushed back, hard, against what he saw as Fannin’s prejudice:

“I happen to be a member of the Methodist Church and I do take my religion seriously. I do not believe that any human has the right to say as a matter of law to a fellow human that “You may not reproduce.” And for that reason I would not favor any mandatory participation in a birth control program as a condition of receiving assistance. But I do think realistically we can do things to educate people to make use of what knowledge we have on birth control.”

Mitchell asked the Senator to refrain from depicting the women on welfare as if they were “so unrestrained that they wind up with children on a kind of production line.” He even accused Sen. Fannin of trying to play God in his enthusiasm for mandatory birth control. These dramatic exchanges underlined what everyone in the room realized: mandatory birth control for those on welfare would quite directly lead to fewer African-Americans.

The Eugenicist “Compromise”

While this idea was attractive to some on the committee, as we have seen, it alarmed the NAACP and other civil rights groups, and after an intense lobbying effort they managed to change this very radical proposal before it left the committee. As a result of the deal, family planning would not be mandatory for individuals on welfare, but it would be mandatory for states to offer it for free through Medicaid, and it would be the most favored service in Medicaid. The committee’s family planning amendments to the welfare law were all adopted, and survive in current law, as characterized in the first article in this series.

The report emerging from the Finance Committee indicated that the idea behind these amendments was to shovel money to Planned Parenthood clinics so that they could quickly respond to the crisis of illegitimacy among the poor, especially teenagers:

The committee amendment would authorize States to make available on a voluntary and confidential basis family planning counseling, services, and supplies, directly and/or on a contract basis with family planning organizations (such as Planned Parenthood clinics and Neighborhood Health Centers) throughout the State, to present, former, or potential recipients including any eligible medically needy individuals who are of child-bearing age and who desire such services. The Secretary would be required to work with the States to assure that particular effort is made in the provision of family planning services to minors (and non-minors) who have never had children but who can be considered to be sexually active. [Emphasis added.]

This paragraph has been cited by federal courts as an authoritative expression of Congress’ intent. In the case T.H. v. Jones (1975) a federal district court cited this paragraph to strike down a Utah law requiring parental notification as a condition for a minor receiving Medicaid-funded contraception. The court rejected the idea that the central goal of the program was to give financial support to consenting adults in their reproductive decisions, so that Utah’s parental consent rules would not alter the program’s substance. Rather, it held that it was central to the intention of Congress in funding family planning that all minors who have reached puberty be eligible. The Supreme Court in 1976 upheld this interpretation.

The explicit mention of Planned Parenthood is interesting, if not surprising—after all, they were the main lobbyists for this law, which has earned them billions in government funds since its enactment. Although today Planned Parenthood often portrays its activities as simply enabling individual women to plan their pregnancies, it is clear that the Senate viewed the organization instead as an instrument of a government policy designed to limit the number of children born to poor women. As Welch put it, birth control, not planned pregnancies, was the Senate’s goal. Planned Parenthood readily accepted the government funds under those conditions, and has continued to lobby for expansions of this same program, as the third article in this series will detail.

Congress had refrained from making contraception mandatory for those on welfare. But it did mandate that the federal and state governments promote contraception rather than simply offer it to those who asked for it. While birth control was still voluntary, the government would henceforth push it heavily among the welfare population. Children of the poor would be encouraged by the state to go on birth control before they became sexually active, and their parents were not to be involved in the decision without the child’s permission.

While this policy was partly justified as a cost-cutting measure, that motive cannot explain the unique place of contraception in Medicaid. If it were part of a general strategy to reduce long-term costs through preventative medicine, that explanation might suffice. But as noted in the first article, no other category of preventative medicine under Medicaid receives treatment similar to contraception. In the context of the derogatory comments made by members of Congress about the lifestyles of minorities on welfare, and their quite serious consideration of imposing mandatory birth control on the welfare population, it becomes hard to deny that the extraordinary treatment of family planning under Medicaid was designed to further racist, eugenicist ends. Absent those ends, it is hard to justify giving it this singular treatment.

All subsequent welfare family planning programs work within this same policy framework. As Nancy Pelosi’s comments revealed, even today supporters still appeal to the same eugenicist logic when defending the special status of birth control in welfare. The third article in this series shows how the Clinton Administration perpetuated this same lethal logic.

Daniel Patrick Moloney, Ph.D., a former post-doctoral fellow at the Witherspoon Institute, was until recently Senior Policy Analyst in Religion and Civil Society at the Heritage Foundation, where research for this article was conducted. The author is solely responsible for the contents of this article. This article is the second in a three-part series.

Copyright 2009 the Witherspoon Institute. All rights reserved.

That’s what Speaker Nancy Pelosi told George Stephanopoulos on ABC’s This Week. She was defending a provision in the original stimulus bill that would have spent hundreds of millions of dollars for birth control. Republicans had criticized this provision, and so the Speaker responded that promoting contraception among poor people would both stimulate the economy and save the government money on welfare payments.

As the video clip shot around the web, public reaction was intense, and overwhelmingly negative—how could anybody think that preventing poor people from being born was the moral way to help poor people out of poverty? It had the air of eugenics about it, as if she were saying that one generation of poor people is enough. Even the liberal partisan Chris Matthews thought Pelosi’s position resembled China’s one-child policy. In response to the backlash, the President told Pelosi to remove the contraception funding from the stimulus bill.

America is supposed to be the land where the rags-to-riches entrepreneur can lift himself up by hard work. In this view, the poor represent a strength of our nation, living proof we are a land of opportunity. Economists in recent decades have termed this idea “human capital,” as in this Wall Street Journal editorial criticizing Pelosi:

The implication [of Pelosi’s comments] is that more people mean less economic growth . . . Ms. Pelosi’s remarks ignore the importance of human capital, which is the ultimate resource . . . The age and growth rate of a nation help determine its economic prosperity. A smaller workforce can result in less overall economic output. Without enough younger workers to replace retirees, health and pension costs can become debilitating. And when domestic markets shrink, so does capital investment. Whatever one’s views on taxpayer subsidies for contraception, as economic stimulus the idea is loopy.

It seemed a platitude when Whitney Houston sang that “children are our future,” and yet, puzzlingly, Pelosi seems not to think that applies to children on welfare. To her, we’re better off if they never exist.

Most Americans see welfare as a “safety net” or, as the name of the major federal welfare program puts it, as “Temporary Assistance to Needy Families.” That’s because most Americans share the optimistic classical liberal view of the poor. Pelosi’s argument, on the other hand, assumes that welfare is forever, that investing in the poor is useless, that their poverty is their destiny, and that rather than improving their lot, the most we can hope for is to contain their social pathologies. This fatalistic view of the poor is characteristic of eugenics, the science of increasing the ratio of “good” people to “bad” people, which has long been a major intellectual influence in family planning circles. And it is hard to deny that government policies which actively push contraceptives on poor people in order to reduce their burden on the public weal have a eugenicist purpose.

It’s a little unfair to single out Pelosi, however. She was simply repeating talking points provided by the Alan Guttmacher Institute, the think tank associated with Planned Parenthood, and by the respected center-left Brookings Institution. The Congressional Budget Office, which gives official cost estimates for legislative bills, had counted the expansion of contraception funding as a net savings for the federal government, showing that it too regarded children on welfare as mere economic burdens. The particular provision in the stimulus bill Pelosi was defending would have continued and expanded a practice of the Bush Administration, which itself was continuing a policy put in place by the Clinton Administration. And indeed, her main idea—that a desire to cut welfare costs could justify massive federal funding of birth control—has been U.S. policy since the Nixon Administration.

In other words, Pelosi was just repeating a commonplace of her milieu, a bedrock principle of our national sex policy. But that simply makes the puzzle bigger. How is it that so many national leaders of both parties have constructed a policy that rejects a major theme of our national story? Why do they see welfare as throwing good money after bad people, rather than as an investment in human capital?

The answer gets a lot easier to understand if we realize that our welfare system deals disproportionately with African-Americans, and that our national myth of the upwardly mobile poor has not, or not as often, been thought to apply to African-Americans. The enduring weakness of the black family has lead some observers to conclude that the black poor will be always with us, that there is something specific to African-Americans that warrants pessimism about their chances of improving their social status.

It is possible to investigate this claim delicately, using objective social science measures to weigh various theories about African-American exceptionalism. But it is also possible to jump to these pessimistic conclusions out of racism. Racism shares with eugenics the belief that some people are worse for society than others; racist eugenics uses the methods of eugenics to reduce the number of people of the “lesser” race(s) relative to the size of the “greater” race(s), with the goal of improving society. The historical record makes it likely that it is not just eugenics but racist eugenics that lies at the origin of our national family planning policy.

This is not to say that Nancy Pelosi is a racist, or that the scholars at the Brookings Institution advocate policies with racist ends. Although racism can be a motive for eugenicist policies, racism and eugenics are not the same thing. People can despair about the economic mobility of the poor for a variety of reasons, and not only because they think minorities are less suited than others for modern society. However, the eugenicist policies which Pelosi et al. advocate fit within a policy framework, the evidence suggests, that was established so that there might be fewer black people.

The rest of this article establishes several of the above claims: that current federal contraception policy was formulated in the Nixon Administration; that federal contraception policy has always been justified primarily as a way of saving welfare expenses; that the designers of the policy have assumed people on welfare will remain poor their whole lives; that key politicians who designed the current contraception framework supported Jim Crow laws; and that important observers, most notably from the NAACP, believed at the time that those politicians were trying to promote family planning policy as a cover for racial eugenics.

The 1972 Welfare Reforms and Current Law

Soon after Lyndon Johnson’s Great Society kicked off its enormous expansion of the welfare system, Congress realized that key programs were not working. The welfare rolls were ballooning, costs were increasing exponentially, and yet progress in the “War on Poverty” seemed no farther along than progress in Johnson’s other war in Vietnam.

In 1972, when Congress was debating the first major revision of the Great Society welfare laws, the Senate Finance Committee added a number of amendments which for the first time required that Medicaid pay for family planning services. The resultant law had several parts, all of which are still in effect today:

1) Birth control is a mandatory part of state Medicaid programs: any state that does not want to offer family planning services will face a penalty and lose other Medicaid funds (for most other medical services, including many life-saving procedures such as chemotherapy, the states have a choice about whether to offer them under their Medicaid program).

2) Family planning is the most favored service in Medicaid: the federal government will pay for 90% of a state’s birth-control-related expenses, a treatment accorded to no other category of mandatory services, nor to other preventative medicines.

3) Birth control must be available to all minors over the age of puberty: the states cannot adopt their own policies about how and whether to promote teen sexual activity.

4) Parents are prohibited from knowing if their children receive birth control: because Medicaid extends to children the same right to doctor-patient confidentiality that adults have, the states cannot protect parents’ rights to be informed of or involved with the health care decisions of their children.

5) Contraception must be free to people on welfare: the states cannot require even a nominal fee or co-pay.

6) The government must actively promote family planning services, especially to minors: state Medicaid programs cannot be neutral towards contraception—but helpfully, the costs associated with outreach, advertising, and sexual education are also reimbursed to the states at the same favorable rate.

These provisions of the new Medicaid program were not part of a general policy of promoting preventative medicine to lower Medicaid expenses—only family planning is given this special treatment. Nor was the government allowed to be neutral about these medical services—the federal and state governments are required to promote contraception, to the point of fostering demand if none exists. Nor were they simply supporting a woman’s reproductive choice—the goal was to limit welfare births, not to empower women (hence the emphasis on minors below the age of consent). Nor could the government wait for a teenage girl and her parents to talk about whether she was ready to initiate sexual activity—the government is instructed to promote contraceptive use directly to minors who are not yet sexually active, while involving their parents is prohibited. Nor did these provisions merely enhance existing state policies—they imposed a national program on all the states at once, and penalized those who dragged their feet in setting one up.

Today, Medicaid spends over $1 billion for contraception and sterilization per year, accounting for nearly 75% of all government funding for family planning and 97% of publicly funded sterilizations. Medicaid is also the largest government sex-ed program, as it will pay for all expenses related to education and outreach to family planning clients and potential clients.

Those receiving family planning products and services through Medicaid must meet strict eligibility requirements, the main one being that they have incomes below or just above the federal poverty line. The clear goal of these provisions is to encourage the poor not to have children, or at least to have fewer children, and to provide subsidies for their birth control and sterilization.

Before entering the Senate Finance Committee, the welfare reform legislation said little about contraception. The provisions that form the basis of our current policy, those that Pelosi wanted to expand, were added by that committee. So if we want to find out how birth control became the most favored service in Medicaid, we need to understand what happened in that committee. That story, which is not widely known, will be the subject of part two in this article series.

Daniel Patrick Moloney, Ph.D., a former post-doctoral fellow at the Witherspoon Institute, was until recently Senior Policy Analyst in Religion and Civil Society at the Heritage Foundation, where research for this article was conducted. The author is solely responsible for the contents of this article, which appears as the first installment of a three-part series. Please see Part 2.

Copyright 2009 the Witherspoon Institute. All rights reserved.