Poverty and Fertility

March 22, 1994|By ELLEN GOODMAN

Boston. -- If you were trying to create a fantasy to fit every stereotype about welfare, or for that matter about government, you couldn't have scripted a more incendiary plot. Imagine this one: In Massachusetts, the government has been paying for fertility drugs given to Medicaid patients.

The same society concerned about the number of children born in and to poverty, the same government trying to get mothers and children off AFDC, paid to help poor parents conceive more children. It's no wonder the story made headlines and made heads shake.

In the scheme of things, there wasn't much money involved. The cost came to $45,000 in a state Medicaid budget of $3.2 billion. Nor were that many people involved. Only about 260 were prescribed the drugs.

But it was the principle of the thing. Or rather, the conflicting principles of the thing. Or the lack of any guiding principle behind the thing.

Of the patients who received fertility treatments, 58 percent were on AFDC and 63 percent already had one or more children. While a handful of them were using these drugs to treat breast or prostate cancer, most were trying to get pregnant. And while the decision to prescribe these drugs had been left to individual doctors, the bill -- and the shock -- went to the state.

It didn't take long for Bill Weld, the Republican governor with a two-point program to get criminals in jail and welfare mothers off the dole, to cut off the payments.

Even Ted Kennedy, the ninth child of the Kennedy family, said, ''Our goal in using tax dollars wisely is to reduce welfare dependency, not create more of it.''

So much then for this story of ''creation.'' But before we close the book, we should note that it wasn't wholly unique. What happened in Massachusetts was just a reverse, upside-down, inside-out, extreme example of the conflicting policies about reproduction that are commonplace. It was another angle on the confused ways that we deal with poverty and fertility.

Consider a composite picture of what's going on in the country.

Yes, Massachusetts briefly paid for AFDC mothers to conceive more children. But while that happened, New Jersey and Georgia decided not to pay when additional children were born to welfare mothers.

Twenty-one states are now considering capping welfare payments for the second or third child born to an AFDC mother. But again, at the same time, 38 states refuse to pay for Medicaid abortions. Some don't want to pay for poor women to have abortions or to raise the children.

Everyone agrees that teen-agers should become adults before they become parents. But do our laws and our policies support that common belief? Increasingly we make teens jump over hurdles -- gain parental consent or stand before a judge -- to get an abortion. We make them jump through hoops to get birth control. We make it harder for them, not easier.

Today, old Draconian attitudes about controlling the poor and fertile appear with a certain vengeance. In the last two years, a rash of states from Mississippi to Maryland have considered proposals that would require women to be sterilized or get long-term contraceptives like Norplant before they could receive welfare. Do the legislators who introduce these laws know or care if women have voluntary access to family planning? A survey in Nevada, for example, showed that 80 percent of those on AFDC receive no counseling at all.

Massachusetts, which mandates that private insurers cover fertility treatments -- including the expensive and dicey in-vitro fertilization -- may have assumed that the public insurer should provide equal treatment for the poor. But Massachusetts got it wrong.

In a time when words like ''rationing'' appear next to health care, we have to decide what to do with limited dollars. Paying for fertility treatments for those who already have a child -- through Medicaid or through a national health plan -- ranks so far down the list of priorities it falls off the page.

A society, like a family, has to balance the needs of the children they have against those they might have. How do you justify paying for fertility treatments while cutting payments for existing children? Government-funded conception flies in the face of common sense.

It's this sixth sense, this common sense that seems in such short supply. But it's what we need to straighten out the policy messages about poverty and fertility that are being sold now under the generic and dangerous label of welfare reform.

Ellen Goodman is a syndicated columnist.

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