“Family planning services reduce costs.”
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.