Mere months after the historic strike-down of Roe V Wade, women’s reproductive health may yet again be under attack in the U.S. Federal judge Matthew Kacsmaryk initiated a veiled attempt at killing Title X earlier this week. Under Title X (also known as the National Family Planning Program), federal grant funding is awarded to “assist in the establishment and operation of voluntary family planning projects which provide a broad range of acceptable and effective family planning methods and related preventative health services.” Among the provisions afforded under Title X are free or low-cost contraceptives, HIV/STD screenings and education, and screenings for cervical cancer and breast cancer. The program makes pregnancy testing possible for America’s poor and working folks. With enough pressure from conservative leaders like Matthew Kacsmaryk and their supporters, this critical access could very well come to an end. For those who depend on the low-cost services Title X-backed family planning clinics offer, opting out of conceiving and rearing children has larger-scale impacts. The fact that nearly 70% of Title X beneficiaries are at or below the poverty level (which was $23,030 for a family of three in 2022) and an estimated half are uninsured makes the axing of Title X especially concerning. This piece seeks to explore the possibility of a systemic collapse post removal of birth control access. It will outline and discuss the devastating effects the removal of Title X could have on the Black community in particular-as Black women and families are disproportionately at risk of having to absorb the consequences.
Title X-funded healthcare providers are required to provide care on a sliding fee scale for low-income patients. Because a vast majority of Title X funds go toward serving the poor in under-resourced communities, gutting the Title X program is an economic disaster waiting to happen. Economic inflation has steadily driven the costs of housing, gas, food, and other domestic goods up in recent years. Of all expenses, inflation has hit groceries and gas the worst. Considering the “greater proportion of household income that poorer families dedicate to food and energy costs,” we know inflation has disproportionately impacted the poor. As members of low-income households “are forced to spend more of their incomes on necessities, they have less money to allocate toward saving and investing.” In going a step further, we see the implications of being unable to save toward a more economically sustainable future. This makes all the difference in a family’s ability to cultivate the type of stability that makes shouldering and even rising above economically hard times more feasible. In the post-colonial U.S., family wealth is a pre-indicator of social mobility. Without it, low-income individuals and families stand to remain in a perpetual state of disadvantage as inflation continues to wreak financial havoc.
Birth control access impacts our capacities for mobility. Given that family wealth is a primary route for escaping or preventing the hardships associated with poverty, it’s imperative that we recognize women’s abilities to pursue educational and career goals as a significant factor in sustaining their families and/or themselves. Educational attainment is directly correlated with income. As such, we know individuals with access to education have a higher likelihood of earning more than those who are without. Having access to birth control is doubly effective in that it allows women (and families) more flexibility to further their education. It also allows more room for the pursuit of opportunities to generate more income-like working longer hours, working extra shifts, holding multiple jobs, going for promotions, or going for higher-stakes positions with higher pay-than might be possible when tasked with the responsibility of rearing children. Child-rearing is unquestionably costly. On average, childcare alone costs upwards of $10,000 per year. That’s roughly 10% of the median income for U.S. couples. Shockingly, it’s 35% of the median income for single parents.
The economic burden imposed by unsustainable childcare costs emphasizes the inequities constricting poor Americans. More children means more expenses for individuals and families. To do away with Title X, which indirectly aids in stabilizing national spending, is to set entire communities up for failure. The magnitude of people who would be impacted by proposed limitations on birth control access makes this an intersectional issue. We all face rising living costs, decreased access to housing, and a growing need for educational attainment to compete in today’s job market. We’re also required to offset various government expenses through tax deductions. As government budgets are squeezed dry to support an unprecedented amount of children being born suddenly, we may be required to pay more taxes. This, paired with the amplified pressure social services programs will be under with budget cuts, impacts us all on different levels. These consequences will cut across economic lines. Most importantly, they will decrease the quality life for America’s most vulnerable.
While it’s true that the repercussions of ending Title X would be felt across a spectrum of marginalized groups, a light must be shone on Black Americans. As of 2019, the median Black family in America had $24,000 in wealth while the typical White family in the United States had $189,100 in family wealth. An estimated 28% of Black families have no wealth at all compared with the 14% of White American families who have none. The racial disparities in family wealth speak to the disparate rate at which Black Americans attain education and incur student loan debt. Black Americans face higher student loan amounts than White Americans at 13% more for Bachelor’s Degrees and 26% more for Associates. Typically, they earn less for having the same levels of education as their White counterparts. On average, Black holders of Bachelor’s Degrees earn 27% less than White Americans with the same degree type. Blacks with Associate degrees earned 14% less than White Americans who had an Associates. Exacerbating these conditions are the disparate rates at which Black Americans face unemployment. In December of 2020, the unemployment rate was 9.9 percent for Black Americans (with Latinx Americans at a rate of 9.3) compared to the unemployment rates of 6.0 and 5.9 Whites and Asians came in at respectively.
Indeed, the wealth gap points to other systemic inequities. In a 2021 issue of the Harvard Gazette, it’s accredited with representing “the accumulated effects of four centuries of systemic and institutional racism” and being responsible for “disparities in income, health, education, and opportunity that continue to this day.” Despite there being a plentitude of evidence-based information on the existence of racial inequity, “no progress has been made in reducing income and wealth inequalities between Black and White households over the past 70 years.” The simple truth is that our system was built to disenfranchise people of color. For Black Americans, who were first obstructed from attaining mobility through enslavement and later through the restrictions of post Civil War Jim Crow laws, legal discrimination has kept these economic divisions in place. Upon the conclusion of World War II, when American war veterans first gained access to low-interest mortgages through the introduction of the GI Bill, Black vets were routinely denied loans or turned away from purchasing real estate outside of the Black community. They were subjected to redlining, a once-legal-but-now-illegal practice “in which lenders avoid providing services to individuals living in communities of color because of the race or national origin of the people who live in those communities.” This tactic prevailed from the 1930’s well into the 60’s, when the Fair Housing Act was passed in 1968. The systemic denial of mortgage loans and mortgage insurance in predominantly Black and Brown neighborhoods worked twofold to lower the values of Black-owned homes and restrict where Black Americans could live. At the center of this legacy is racism, which, beginning with the coercion of enslaved Africans and Indigenous peoples into forced labor in 16th century America, has served as “an economic imperative to harness land and labor for the purpose of wealth creation.”
Income inequality “diminishes opportunities for low-income families and for children of color.” That lack of opportunity is often exacerbated by the racial segregation that limits children and youth of color in the quality of education they receive. With the historic devaluation of black-owned properties yielding lower property taxes, schools in predominantly Black areas get less revenue for critically needed resources that help shape a quality education. Poorer quality education results in poorer career options. In short, the age-old theorem that “if a child grows up poor but works hard and takes advantage of life’s opportunities, that child’s children will have a better life” isn’t applicable. Not when our economic system was intentionally designed to exclude people of color from participating in the economy equally. The divide has only widened with time as Black and White children typically replicate the economic positions of their parents. Wealth inequality was thus produced cross-generationally, planting seeds for the cyclical nature of generational poverty to take hold. If we know our nation’s history of coding racism into legislation, policies, and ordinances both overtly and covertly, we know the attack on Title X isn’t a far cry from past attempts to keep the poor from ascending the socioeconomic ladder. It’s a resurgence of America’s most powerful tool being used to block minorities from successfully competing against White Americans for the means to build and preserve wealth.
Systemic racism has single-handedly led to Blacks having the highest rates of poverty, unemployment, and student loan debt in the U.S. It’s simultaneously created conditions for Blacks having the lowest income, family wealth, and educational attainment in the nation. This is factual even with Title X services being readily available to women who are at and below the poverty line. Without Title X, the constraints that have historically hit Black Americans hardest will continuously worsen. As more Americans are forced to navigate unwanted pregnancies with the removal of Title X, financial stressors that weigh significantly on family budgets (like childcare, housing, food, and healthcare costs) are bound to be felt more intensely. The more children there are, the more resources will need to be allocated to their well-being and care. For Black Americans in under-resourced communities, a dramatic spike in births would divest first from the budgets of individuals and families; then from the state and federal agencies sustaining so many of them.
Reducing available options for low-income women to prevent or delay pregnancy generally invites increased risk. For black women especially, childbirth presents heightened possibilities of complications and death. Black women are diagnosed with uterine fibroids (a reproductive disease that can cause fertility issues and complicate pregnancy) three times more than their White female counterparts. As of 2021, Black women are more than three times more likely to die in pregnancy than White women. Data collected from a series of death certificates examined between 2016 and 2017 revealed that the leading causes of Black maternal deaths were postpartum cardiomyopathy, a type of heart failure that can occur post giving birth, and the blood pressure disorders eclampsia and preeclampsia. Data showed that Black mothers died at 5x the rate of White mothers with postpartum cardiomyopathy, preeclampsia, and eclampsia-the leading causes of maternal death. Other causes were hemorrhaging and embolisms, which Black women were found more than twice as likely as to die from than White women. Ectopic pregnancies-a lesser yet still concerning risk factor-were the fifth leading cause of Black maternal death. In cases where medical emergencies arose during pregnancy and the birthing process, abortion has been a life-saving solution . Post reversal of Roe V Wade, 23 out of 50 states provide legal abortions with few or no restrictions while the remainder of states have abortion access that is restricted, severely restricted, or completely unavailable. With more legislative developments in opposition of women’s rights to choose on the horizon, canceling Title X would open the floodgates for more Black moms succumbing to pregnancy and childbirth complications.
We know inflation has impacted everything from housing costs to food and gas prices. If we think about all of the industries that rely on food and gas in order to operate, we can easily recognize this as a systemic issue. Adding to the economic pressure rising housing, food, and energy costs impose on the American people, are a host of systemic failures. We are under the effects of a national housing shortage. The shortage has been widely attributed to an underproduction of housing given that as far back as 2008, there haven’t been enough homes being built to sustain our growing population. The lack of housing available to low-income or working families is a factor in the housing crisis that isn’t discussed nearly enough. Despite the fact that the protections afforded by the Fair Housing Act of 1968 exist to prevent housing discrimination, real estate companies and developers have found subtle ways to continue to discriminate against people of color. Engaging in practices like exclusionary zoning, for instance, has allowed these entities to build housing developments that don’t accommodate larger families (which tend to be overrepresented by poor people of color). In conjunction, the general halt in production of dwellings since 2008 and the purposeful overemphasis on producing single-occupancy and single-family housing has led to a worse reality for families in communities of color. A national influx in family sizes following the removal of Title X would thus make the situation for low-income families even more dire.
The same can be said of the child care accessibility crisis. Since 2017, a growing shortage of childcare professionals has threatened to do the American childcare system in. The exodus of childcare workers stems from burnout and the absence of a living wage. On average, childcare workers earn just $7.04 per hour. The mass departure of so many professionals from the childcare industry has triggered mass shut-downs of in-home and center-based childcare facilities. The shut-downs have led to a significant decrease in available childcare slots, which has ultimately led to rising operations costs for remaining childcare providers. The combination of lost slots, workers exiting the industry, and the dip in affordability have left hundreds of thousands of U.S. families without childcare. The government’s inability to meet the demand for childcare would only be felt more harshly with a suddenly-swollen birthrate. Knowing that, we can reasonably predict that the childcare system will buckle if women in vulnerable communities are left with no choice but to conceive. In a world where people depend on childcare more than ever-especially in cases where parents hold multiple jobs, have work schedules that disallow them from being at home with their children, and/or don’t receive paid time off or paid leave-a broken childcare system would unfairly threaten the ability of America’s poorest (disproportionately represented by Black and Brown women) to survive.
Decreased access to quality education and healthcare based on geographic proximity are inequities that plague most poor and rural populations. So is the inability to sustain the alarmingly high cost of healthcare in today’s economic climate. In 2020, Americans’ spent roughly $4 trillion on healthcare; signaling that healthcare spending increased by 9.7% from the previous year. The average cost of monthly insurance premiums was $541 across all health plan types last year. For families consisting of four people or more, about $25,011 went towards family healthcare expenses on average in 2020. Over 50% of Americans receive health insurance through an employer. For those who are unemployed, underemployed, or self-employed, health insurance is either non-existent or inadequate. The added strain of out-of-pocket costs (like deductibles, copayments, and prescription drugs insufficiently covered by insurance carriers) can make preventative care seem daunting for anyone. For individuals and families already under the crushing weight of poverty, the cancellation of Title X would result in the birthing of more children. For many, this amounts to a very real possibility that involuntarily expanding their families will bury them under the additional childcare and healthcare expenses each additional child brings.
Then, there is the public school teacher shortage. The last few years have seen teachers leaving their field in droves. Their chief complaints were low pay and burnout. On average, teacher salaries start at around $41,770. When measured against factors like inflation, mounting pressure to meet targets for academic achievement, swelling class sizes, behavioral problems, and exposure to (Covid) health risks, the compensation doesn’t add up. A recent study conducted by the National Center for Education Statistics found that 44% of U.S. schools had teacher vacancies. A report from LinkedIn suggested the number of teachers who resigned this year was 41% higher than the number who quit in 2021. Schools in rural and poor communities are struggling to fill those vacancies more than schools in more affluent settings. In response, some schools are “allowing veterans and other non-credentialed workers to step in as teachers” and “reducing the school week to four days.” The problem is anticipated to worsen with time.
An American Federation of Teachers poll indicated 2 out of 5 educators are slated to quit teaching within the next two years. The biggest concern is vacancies in K-12 schools, given that 44% of K-12 teachers said they were burnt out as recently as February. Children who are already disenfranchised from receiving a quality education will be impacted by their disappearance most. For the nearly 73% of Black children who attend schools in high-poverty neighborhoods, this is especially true. These schools are under-resourced and understaffed as it is. The disparities in staffing and resources in comparison with schools in more affluent communities lead to gaps in academic performance that “challenge the education and career prospects of Black children early on.” As more teachers say sayonara to public education, these kids will fall further behind academically. The removal of Title X would further weaken our ability to support their development and growth. When the number of children born grows exponentially and at a steady pace, we can anticipate the conditions that are driving teachers away from classrooms will get worse. We’ll see larger class sizes with fewer resources, increased risks, and poorer quality of education as more individuals without teacher training and experience fill vacancies; all of which make for a future generation utterly unequipped to survive in this economy.
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