Building a culture of care in America

I’m guessing that you, like me, have done a lot of thinking and feeling about abortion in the last couple of months. But what is it we think about when we think about abortion? The Supreme Court’s seeming disavowal of non-partisan reasoning? Religious debates about when life begins? The most tragic and extreme headlines? The so-called “abortion debate” has always struck me as painfully out of touch with the average, authentic experience of abortion, and pregnancy and birth more generally, for so many people.

First, some grounding facts: 1 out of 5 pregnancies ends in abortion and 1 out of 4 women has had an abortion by the time she is 45. The majority of those who seek out abortions are experiencing poverty and were using a form of contraception in the month that they got pregnant. Two-thirds of them have already given birth before. Over half of abortions are now medical, not surgical. And the majority of Americans believe that abortion should be legal.

When I look at those facts together, they paint such a different picture than the one that occupies the popular imagination about abortion. And when I zoom out on the accurate picture—the 30-year-old mom of three, sitting in a waiting room at her local clinic, scrolling through her bank statement panicked about making rent next month, confused about how her birth control failed when she was trying to be so careful—I see so much more.

I see a public high school classroom 15 years earlier where that 30-year-old mom (and the guys around her) probably got a sorry excuse for sex education, the kind of teaching that gives you almost no tools for navigating the real, complex world of negotiating concept, contraception, and desire. When I zoom out, I see her paying for her contraception at the pharmacy five months earlier, frustrated with all the side effects and the fact that she, not her boyfriend, has to add this to the mounting list of tasks and costs each month. When I zoom out, I see her struggling to figure out an affordable, workable childcare fit for her beloved kiddos. Her hours at the warehouse are unpredictable, sometimes during the day, sometimes at night; what childcare center wants to accommodate such a confusing schedule? There don’t even seem to be openings at childcare centers with traditional hours, and she certainly can’t afford a nanny. When I zoom out, I see her never ending troubles with transportation—the car is always breaking down, making it harder for her to get the kids where they need to be and her to work; and where would she put a fourth kid in their current car? When I zoom out, I see her late at night, googling “how to find a therapist,” and coming up with nothing helpful. Who could she see? How could she afford it? When would that fit into her already harried days with no alone time? A fourth child is not something she can afford, nor does she have the mental bandwith to give the attention she wants to give to another child; she already can’t mother the way she wants with the kids she’s got. Plus, she hears there’s a formula shortage; the idea of not being able to find food for her baby makes her feel panicked and anxious. Her last birth was terrifying; she was pressured into getting a c-section she didn’t want and the healing took forever. She had no maternity leave, so she had to work through the pain for weeks, missing her baby all the while. The last thing she needs is more sources of anxiety.    

This is all to say, the “abortion debate” isn’t worth a stitch if it doesn’t acknowledge the whole complex weaving of a caregiver’s life. And if we zoom out even the smallest bit, we realize how tragically we are failing caregivers in this country. Sex education in public schools is largely a joke. Contraception options are hard to navigate and afford in too many states. Prenatal and birth support are notoriously unequal and biased, leading not just to substandard care for some women, especially the most marginalized, but even death. We have no federally mandated maternity or paternity leave, a basic standard worldwide. We have failed, over and over again, to pass legislation that would make childcare more affordable and/or the childcare profession more dignified (though the science is crystal clear that ages 0-5 are the most important investment we could possibly make in the long term vitality of our people). We failed to even renew the child tax credit, which proved effective in cutting child poverty by 30%.

Under these circumstances, it’s hard for me to get interested in debating the purely hypothetical question of where life begins. I understand this question is important, even sacred, to a lot of people. Probably people I love, people who read this newsletter, people I would adore if I got to know them. I respect that this question is central to some people, but I also believe that those same people, like me, have the capacity, and what’s more, the moral duty, to fight for the lives that are already here—the people getting pregnant, and experiencing miscarriage, birth, or abortion, the babies and children who are already here, the childcare workers and unpaid caregivers who are keeping them safe and healthy and loved and learning.

I hunger so deeply for us to shift from a focus on control to a focus on care in this country. If only we could stop trying to convince one another about some ideological stance, and start looking at caregivers’ real lives and building systems, services, products and policies that actually make them better. Or just decent. Even that would be a step in the humane direction.

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As many of you know, one of my favorite roles is the storyteller-in-residence at The Holding Co, a lab to redesign care. Check out all the incredible people in our Care Guild who are trying to care, not control. It will give you a much-needed jolt of optimism.