Leah Libresco's Blog, page 4
September 28, 2022
How Reversible are LARCs?
For a long time, I’ve wondered how easy it is for poor women to get IUDs removed. Long active reversible contraception (LARCs) are strongly recommended for poor women, but they can face the greatest barriers to seeing a doctor, and can be stuck, unable to have the children they want. I was glad to get to research this for the Institute for Family Studies.
The glossy tone of the [contraceptive program] ad camouflages this reality, framing birth control as an expansive way of life, rather than a response to a narrowing of a woman’s options. But behind the PSAs, the advisories for doctors are more candid about how LARCs fit into a culture that disempowers women.
Part of the case for LARCs, as explained by the Maryland Health Department, is that vulnerable women have only limited access to health care. Pregnancy and the immediate post-partum period might be the only time that vulnerable women can afford to see a doctor, since their pregnancy makes them eligible for Medicaid. The coverage lasts only two months post-partum, so the window for follow-up care is narrow. A woman who expresses a wish for a LARC at her six-week follow up may have only two weeks to receive it before her coverage lapses. Significant proportions of mothers do not make it to their six-week visit at all.
Thus, the American College of Obstetrics and Gynecologists (ACOG) recommendation is to take advantage of the moment when “the woman and clinician are in the same place at the same time.” The ideal, according to ACOG, is to place the IUD “within 10 minutes of placental delivery in vaginal and cesarean births.” In some hospitals, that may mean the IUD preventing future births is placed before the present baby has been handed to his or her mother. The ACOG notes that IUD placement immediately post-partum has a higher failure rate (where the IUD is expelled) than placement later after birth. But they estimate that a poorer success rate is better than a purely hypothetical higher success rate. If a later appointment is impossible, then the success rate is nil.
The ACOG covers some possible counterindications and topics for discussion with women considering post-partum IUDs or implants. But they do not suggest doctors ask the question: “Do you have a plan for obtaining care to remove your IUD or implant when you are ready?”
[…]A woman who relies on an IUD depends on a doctor to be able to have children again. If IUDs are specifically recommended to women who have difficulty accessing medical care, these will also be the women who face the most obstacles to being able to conceive the children they want.
September 19, 2022
A Breast Pump Designed for Your Boss
In “Designing Women,” I’m writing at Comment on how the tools intended for women often serve the interests of someone else. I’m very much indebted to Designing Motherhood, which I draw on in the piece.
A doctor’s office and tools are more often designed for the convenience of the doctor, not the patient. A breast pump is another intimate tool that appears to be designed for the needs of a hidden end user—not the mother but her boss. A breast pump attenuates the claim a child makes on its mother. A breast pump does not cry. It does not interrupt. It is (allegedly) hands free. It comes with an off switch. A child demands; a breast pump is available on demand.
It is easier for an employer to point to all these seeming efficiencies and offer the mother less: pump later, pump less often, pump in a dark storage closet or hidden in your car or the toilet. In a survey of mothers working outside the home (sponsored in 2020 by companies that sell breast pumps, lactation pods, and milk-bank services), a quarter of women said that they didn’t have a dedicated space to pump at work.
If the baby were at work, it would be obvious that the child’s hunger cannot be put off forever. Alone with a pump, the mother suffers from unjust demands silently, as her breasts engorge and plugged ducts fester into mastitis. If the baby were visible, it would be obvious you can’t lock a vulnerable person in a closet. But the mother, no less valuable, is more easily mistreated.
Read the whole thing at Comment.
And I hosted a follow-up conversation about the piece at Other Feminisms.
The Invisible Infrastructure of Immigration
After Florida governor Ron DeSantis flew migrants to Martha’s Vineyard, I wrote about how non-profits cover the gaps of our broken immigration system for Deseret.
This is the pattern; the official system is broken, and charitable organizations and activists keep a broken system from being even worse than it is.
It’s organizations and individuals who put out water in the desert, trying to save migrants from death by dehydration. It’s border-based religious charities like HIAS and Catholic Charities that wait at bus stations, help migrants reach their intended destinations and settle in a city where they have family or countrymen. It’s people who work every day on the border who have a Quechua translator on retainer.
The space between what the government provides and what asylum-seekers need is a gap that can’t be covered simply with good intentions and a willingness to get involved. It requires sustained investment and institutional presence.
September 12, 2022
How Do We Value Care Work?
As the cover story for Mere Orthodoxy’s third issue, I wrote on how we value care work, and the thin line between humility and degradation. A care worker knows that they are not easily replaceable, and they can’t rely on the kinds of labor power that unions use to shut down a factory.
Many workers stay for overtime or take on tasks that go outside the work they are compensated for, because they know their charge intimately and are moved by their need. This can be framed as a kind of emotional blackmail — the worker has their “no” taken away. But Kittay sees an alternative way of thinking about it: the worker wants to be able to say “yes” to their charge’s need, but the “yes” can be too costly for them to be free to offer.
Workers who care directly for the vulnerable have the relief of knowing they aren’t working what David Graeber terms “bullshit jobs.” They can see that their work matters. Without their help, their charge could not use the bathroom, might not eat, would die. But that means they lose the leverage other workers have to strike, engage in work stoppages, or sometimes even to quit.
In Full Surrogacy Now, author Sophie Lewis claims that abortion is the kind of strike available to surrogate mothers. When they face exploitation, Lewis suggests, they can refuse to work, which means severing the connection between themselves and the child who depends on them, delivering a corpse where their employers hoped for a child. Few consider this option, no matter how dire their circumstances. Care workers are close to the people entrusted to them; they learn to see the world through their charge’s eyes in order to understand their needs.
Read the whole thing at Mere Orthodoxy
I hosted a follow up conversation about this piece at Other Feminisms.
July 8, 2022
Life Costs More Than Death
In the aftermath of Dobbs, I wrote for Deseret on what comes next for the pro-life movement.
The Supreme Court ruling in Dobbs v. Jackson Women’s Health Organization limits the danger to children in the womb, but the justices cannot confer dignity, safety or hope by fiat. That’s the continued work required of the anti-abortion movement, work that offers chances for alliances with advocates for abortion rights. We don’t have to agree about the moral weight of abortion to acknowledge that America has neither a culture of life nor a culture of choice. We live in, as Pope Francis has termed it, a throwaway culture.
The majority of abortions in the United States are sought by women who have previously given birth to a baby. They don’t need to see an ultrasound to make the connection between pregnancy and parenthood. When mothers seeking abortion were interviewed in-depth, many said that they wanted to be able to give birth to the child they were carrying, but they felt it wouldn’t be fair to the children they were already struggling to care for. These women pass the test of the abortion-rights slogan “Every child a wanted child.” But they could tell that their children were unwanted by the rest of us. Death was the only “choice” that we, as a nation, made provision for.
July 4, 2022
Avoiding Pitting Mothers Against Babies
Both pro-life and pro-choice people all support saving the life of a woman who has an ectopic pregnancy. I wrote about my own experience losing my child, Camillian, in an ectopic pregnancy for the New York Times. My goal was to explain not just what a pro-life perspective permits but what it makes possible to support the dignity of mother and child.
The first person to see us was another ultrasound technician. Her voice got sharp when I asked if our baby had a heartbeat. “It’s not a baby, don’t talk like that,” she told me, as I lay on the table. Her voice softened a little, “You don’t have to think of it that way.” For her, part of providing care was denying there was any room for grief.
But when the surgeon came in, he began by expressing his condolences. He talked about our options, he talked about our baby as a baby. He answered our questions about recovery times from surgery as naturally as he did our questions about how to specify that we wanted our child’s body for burial. He took our request seriously and told us that we should know that as far as he could tell, our baby had already died and it was the placenta that was still growing and putting me in danger. But if he could, he would make sure that our baby wasn’t treated as just a tissue sample but as a child lost.
I also wrote a little on Other Feminisms in response to the comments I received.
June 7, 2022
Asserting Individual Freedom from Individualism
I had the pleasure of reviewing American Shtetl: The Making of Kiryas Joel, a Hasidic Village in Upstate New York for First Things. The book is a legal history of the struggles of this Jewish enclave to run itself independently of the surrounding town. It’s a fascinating story, especially in the context of certain disagreements over post-liberalism.
As Stolzenberg and Myers describe it, the village was shaped by a clash between “illiberal liberalism” and “liberal illiberalism.” The surrounding community took the approach of “illiberal liberalism,” paying lip service to pluralism but unwilling to tolerate the “wrong” kind of community. The people of Kiryas Joel took the approach of “liberal illiberalism,” mustering the distinctively American rights system to carve out a space free of individualist values and the aspects of American culture that conflicted with their faith. The fights between the two began over zoning and multifamily housing, but soon shifted to their natural battleground: the schools.
Schools lie on the border between the family and the wider world. Both parents and teachers see it as their job to shape character, not just convey sterile facts, and they are right to do so. But when the values of families and the values of a country diverge, the school is the place these clashes come to a head.
May 16, 2022
The Long Wait for Weddings
As America geared up for a wedding boom in the summer of 2022, I wrote about the obstacles that disrupt weddings and other communal rites of passage in non-covid times.
No matter how stripped down the ceremony, people need to be able to plan travel. The people we love are too scattered for spontaneity. We want to be well knit into the fabric of our church, but too much of our lives lies outside the parish boundaries. It isn’t an insurmountable obstacle, but it makes it feel like we schedule the most sacred sacraments around secular concerns and scheduling. It’s a one-time version of families’ ongoing struggle to make sure Sunday worship isn’t crowded out by their children’s sports programs.
We had more flexibility to choose dates for marriage and baptism, but the service that is hardest to schedule is a funeral. Death comes on its own schedule. Even though a memorial service might wait for a month in order to accommodate all those who need to gather, grief does not wait for the convenient time.
May 9, 2022
A Better Way to Debate Abortion
Shortly after the draft Dobbs decision leaked, I wrote a piece for America, reflecting on the time I invited friends to come to my house and have a better fight about abortion.
In 2016, I opened my doors for what I expected would be the worst event I would ever host. In the wake of the Supreme Court’s decision in Whole Woman’s Health v. Hellerstedt, my husband and I invited about a dozen pro-choice and pro-life friends over to eat cookies and talk about abortion.
I had been part of terrible conversations on this topic, online and off-line, and I knew I wanted something different. I had friends on both sides of the divide, and it was surreal to be in a position where we all thought the other side was complicit in grave evil.
I also asked the Other Feminisms community what readings they would recommend to set the table for a better conversation.
May 6, 2022
Family Policy Can’t Be Gender Neutral
For Mother’s Day, I wrote for Deseret on why gender neutral family policy tends to shortchange mothers.
In an uneventful pregnancy, a mother will still have a harder timechan than her partner as she navigates fatigue, nausea and pain. Drawing attention to these difficulties can feel like letting other women down — if women carry heavier burdens as parents, admitting to them gives employers an excuse to prefer men. But women aren’t helped by pretending to an equivalency that doesn’t exist.
Pregnancy, birth and recovery are not gender-neutral processes. Women need time to heal and financial cushions to care for their children. Mothers and fathers have unique responsibilities and gifts. Mothers carry the greater physical burden by nature; good fathers are distinguished by the way they choose to carry weight for their partner and their children. Mother’s Day is a fitting time to remember that if our family policy is just, it will not treat parents as interchangeable.
I also commented on family leave for a round up of pro-life, whole-life policy asks for Tish Harrison Warren’s column at the New York Times.
