Accidental Blogger

As a concession to the grumbling GOP members of the Congress, President Obama dropped the provision for family planning and contraception for low income families from his economic stimulus package. Not that it did much to garner bipartisan support – no Republican voted for the bill.  The conservatives had argued that family planning is not a means of stimulating the economy. As usual, they are wrong. Helping low income families have fewer children may not be a direct way to boost the economy in terms of creating jobs but indirectly it is indeed a way to create prosperity by reducing costs in social services. As Speaker Nancy Pelosi points out in the article, savings too are good for the economy.

House Speaker Nancy Pelosi-D-Calif., appeared to sidestep the question when she was pressed over the weekend to explain how family-planning money would boost the economy or create jobs.

"Well, the family-planning services reduce cost. They reduce cost," she said on ABC.

"The states are in terrible fiscal budget crisis now, and part of it, what we do for children's health, education and some of those elements, are to help the states meet their financial needs," she said. "One of those, one of the initiatives you mentioned, the contraception … will reduce cost to the state and to the federal government."

Unfortunately, in the minds of conservatives any discussion of contraception and family planning here and around the world, is inextricably linked to just one thing – abortion. Every time the matter of limiting birth rate comes up, the specter of abortion becomes front and center. In their zeal to abolish abortion, the right wing often ends up opposing funding and education for any form of birth control.  There is much to be settled in the abortion debate. However, family planning is NOT abortion. If anything, proper contraception is a deterrent to abortion, making it unnecessary.

I was born in a country where overpopulation is the single most identifiable cause of poverty, infant death, poor maternal health and malnourishment of the young. Far be it for me to dictate who should have a baby and who should not. But it doesn't take much deductive power to figure out why large numbers of children around the world are condemned to a life of need and unrealized potential. Most of them are poor and often born in families with too many mouths to feed and too many minds to nurture.  One image of a perfect (or near perfect) world that I envisage is where most, if not all babies are born to responsible and willing parents who can provide them with the basic minimums of health, nourishment, emotional support and education. That of course, is an idealistic dream. Meanwhile, responsible governments everywhere should have that very goal in mind for their citizens as far as is practical. I am not for eugenics, communist China style punitive measures of limiting family size nor the coercive attempts at population control  that Indira Gandhi attempted in India in the 1970s for which she was rightly voted out of office. But what about common sense?  What is not desirable about educating people that given the limited global resources, small families are good for parents, children and the world at large and then aiding those who like the idea?

Of course, the right wingers who are perpetually on a warpath against abortion in particular and contraception in general to a large degree, hardly ever raise their voices at irresponsible child bearing. (How else can they maintain a steady pool of man power to do cheap labor and fight the wars? ) More often than not, we hear from them that "children are gifts from god." God or not, most children born to poor mothers without access to contraceptives, especially in underdeveloped countries indeed are born the old fashioned way. But that doesn't hold true for wealthier, developed societies. Medical science now plays a vital role in making childbirth possible for parents who otherwise would remain childless. Fertility drugs, in-vitro births, surrogate pregnancies etc. are now thriving businesses of birthing. The alarming case of Nadya Suleman, the 33 year old single, unemployed mother of six who gave birth to an additional set of octupulets recently, has focused the public's attention on the physical, social and ethical aspects of unbridled fecundity. When does someone else's personal choices become our business? What ethical guidelines are there in place for the fertility industry? What are the penalties for non-compliance?  Ellen Goodman explains with her usual aplomb.

MAYBE we owe an apology to the doctors who made the birth announcement with such pride and excitement. The delivery of eight babies in five minutes was, they exhaled, "amazing." The mom was "incredibly courageous." All in all, it was a "very exciting day," a feat for which the 46-member medical team at the California hospital expected kudos and high-fives.

But instead of smiles, they saw jaws drop. Attention turned from the doctors to the mom, from her courage to her judgment, from the medical success of this delivery team to the ethical failures of fertility treatment.

It turned out that Nadya Suleman already had six kids. The Suleman Fourteen don't have a father, they have a sperm donor. They were apparently all conceived by in vitro fertilization, with the last eight presumably implanted en masse. For good measure, their mother has no job. And her family recently filed for bankruptcy.

Before she left the hospital, before the babies left intensive care, the whole country had gone from "Gee whiz!" to "Are you kidding?" Everything that we don't really want to talk about in terms of pregnancy and child rearing – marital status, money, individual choice, responsibility, and technology – had converged in the shouting and blogging over Nadya Suleman's womb mates.

Does anyone have a right to tell anyone else how many kids to have? Can only people who can afford them bear children? Do you need a husband to have a baby? These are questions that make us feel queasy when we are talking about old-fashioned families. But they take on a new flavor in the unregulated wild west of fertility technology.

Need we review exactly what's happened since Baby Louise came out of a petri dish and reproduction became a family business? We now have tens of thousands of healthy children born each year through fertility drugs and IVF to delighted families.

Fertility doctors don't say no – nor should they – to single or gay patients or those who already have children. Doctors do not do home visits or psychological evaluations or socio-economic profiles on patients who want children. At most, doctors do what bioethicist Arthur Caplan calls "a wallet biopsy" to see if they can pay the bill.

We are far more rigorous about accepting people for adoption or foster care than for fertility treatments. But shouldn't there be limits?

Suleman's mother now famously describes her daughter as "obsessed with children," and wishes that she'd chosen to be a kindergarten teacher. But it turns out that you can have six children and still be treated for "infertility." And – here we get to the heart of this case – it turns out there are no laws in this country limiting the number of embryos that can be implanted in one womb.

As bioethicist Lori Andrews says, "Women's bodies are not large enough to hold a litter."

If, as we are told so far, Nadya Suleman was implanted with eight embryos left over from her earlier treatments, it is something akin to malpractice. If she wanted all eight implanted knowing she would refuse to terminate any, it's close to mal-mothering.

The reason why we haven't seen Nadya's fertility doctor on "Larry King Live" (yet) is that it's against all guidelines to implant more than one or two embryos in a woman under 35. Given our experience with the extraordinary high risk of multiple pregnancies for mothers and babies, anyone who endangers patients ought to lose their license.

This is more than an individual decision. Suleman's babies weighed between 1 pound 8 ounces and 3 pounds 4 ounces. They will cost at least $1 million in neonatal care and more if they have the typical range of disabilities for premature babies. The meter is running at the neonatal unit.

Meanwhile, a reproductive business that generates so much controversy has produced a remarkable consensus. Infertility treatment for an unemployed, single mother of six? Eight embryos in one womb? There must be a proper word in the medical literature to describe this achievement. I think the word is "nuts."