I have read many recent articles of supposedly sisterly advice for women from people in authority. The fact that this advice comes from people who are women themselves (e.g., Sheryl Sandberg et al.) makes it sound realistic. Much of this advice does make some sense—for wealthy, good-looking and otherwise privileged women. For the rest of us, I’m afraid we are being lied to.
This is not conspiracy theory: I don’t think that these supposedly wise cultural elders are telling us nonsense in order to advance the capitalist cause of turning most of us into commodified units of production. Nor do I think that cabals of sexist patriarchs are conspiring to keep intelligent women down. However, I do feel that the much hyped conversation in the mainstream media aimed at women, most recently under the theme of “having it all,” could use a few voices speaking the realities of life in America’s not-so-fabulous ZIP codes. My own personal experiences in this area have made me certain that well-meaning people are driving not only a rather insipid conversation but also terrible policy. I can serve as an example of the result: I am a woman on a path to childlessness, driven by biological reality and financial constraints brought on by conforming to expectations about success in American society.
The one moment of my medical education I remember best did not happen at a patient’s bedside or in the lab. It happened when, while looking at an Ivy League medical school that had accepted me, I asked some uncomfortable questions about repaying the student loans they proposed. I pointed out that the numbers simply did not make sense. The financial aid officer, then a late-twenty-something single black woman, said to me: “Well, people... by the time they need to pay these off, they marry someone with a real job.”
If I were more naïve, I might have wondered to myself: “If working as a resident doctor didn’t qualify as a real job, then what on earth possibly could?” But I already understood, from my experience, the tacit ethnocentrism by upper-class whites that is the norm in the American higher education system. In a way, I must congratulate such people on their total color-blindness and class-blindness, but I must point out that they are, unfortunately, reality-blind as well. I meet well-meaning people like this all the time inside helping professions. One recently told me about how I “chose a career” as opposed to marriage and children. It never occurred to her that my choice was to attempt survival in a capitalist market economy, as every generation of women in my family has done since the end of slavery. I was tempted to point out that I “chose” a career over being a maid and make-up saleslady like my grandmother, and that this was the extent of my choice as a black woman of limited means. Eventually my medical studies took me to Israel, where I found it easier to accept the incorrect assumptions people made about me.
My personal feelings towards the American academy include bitterness. Any establishment that puts people in up to 6 figures of debt that they often have no hope of ever repaying should be considered predatory. But I believe that problems inside the American academy are just a piece of a puzzle that, when assembled, presents a picture of a fundamentally flawed and distorted society. It is my feeling that the American educational system is particularly punishing for women, because here the ever-inflating expectations collide with biological reality.
In Israel I saw how policy and attitudes have made a huge difference in helping women combine work, motherhood and marriage. Israel is by no means unique in this: many (formerly) socialist countries were, in the words of almost every woman I have talked to who was from one of them, “ahead about women,” even if they were behind in nearly everything else. But America won’t be changing into some kind of feminist utopia anytime soon, which is why I am writing this article: I want women to know the truth.
It is well known that many American women, perhaps one in five, now leave their reproductive years childless, but not by choice. The structure of higher education and the workforce need not foster such a situation, and indeed does not in many countries. When I read that a leading academic like Marcia Inhorn of Yale is encouraging egg-freezing as a solution to these types of issues using the megaphone of CNN, I wanted to cry in despair. As a medical doctor, I know that there is no technological trick that can save most of us from childlessness without incurring an unbearable cost. That a leading academic would suggest that a generation drowning in debt should take on more debt, and an increased risk of cancer and other bad outcomes, shows just how badly American society is being shaped in terms of work and family. Moreover, such a suggestion would only worsen the situation of women who cannot find partners, because in many instances these women are least able to cope with the costs—both financial and medical—of such high-tech reproductive adventures. As a physician, I can assure you that reproductive technology, in its present state, isn’t going to save the majority of American women from having to make painful choices made necessary by bad policies.
American women also need to know that our country's adoption system is a bureaucratic nightmare run for the benefit of administrators, lawyers and social workers. Some women may incorrectly assume, as I did, that although they are giving up a normal chance of childbearing by pursuing a career, they will be able to easily create a family through adoption. The adoption system is a machine that works well for administrators and lawyers who want to get rich, but it doesn’t actually work all that well for prospective parents or parentless children. The number of laws around adoption grows every year. Depending on which state you live in, these laws regulate everything—from where the exits in your home must be to what kind of adult relationships you can have if you ever want to bring home a baby… and, mind you, the biological parents can often snatch that child back without having to meet such stringent requirements.
The only reliable way to get to bring up a child seems to be to make one yourself: an activity that isn't yet entirely controlled by an army of greedy lawyers. Yet many well-meaning people will tell you what my psychologists, psychiatrists, school counselors and other people in authority told me in one form or another over and over. “Don’t be promiscuous, stay in school, work hard, and then later you can have everything you want…” Well, that method might work for men. If men stick it out in the rat race, and make all the right moves, they may at some point bring home the kind of money it takes to support a family. At what point men aim to start a family is changing because, thanks to technology (Viagra and Intracytoplasmic sperm injection) that has become fairly cheap, they can achieve their personal dream of starting a family late in life, even though this delayed fatherhood certainly isn't good for anyone. As fatherhood gets pushed later and later the risks for the children, from genetic problems to an untimely yet predictable death of a parent, get higher and higher. Most men are smart enough realize that they would create serious issues by delaying fatherhood beyond a certain point, but many women do not seem to realize they will have no such choices until it is too late for them to ever build a family.
The typical narrative running through the heads, or at least out of the mouths of many of our cultural elders is that women can make choices to “empower” themselves by avoiding childbearing and focusing on a career. I know many such women who were, as a result trying to conceive at 40, faced odds that were against them. The poor ones like me are in some sense lucky because at least they won't be wasting unspeakable sums of money on fertility treatments that are only guaranteed to make some health care administrators very wealthy, but probabilistically unlikely to actually help them. The wealthy “successful ladies” may be going down for easily about quarter million dollars of medical expenses, a near death experience from ovarian hyperstimulation syndrome and, of course, a whole lot of disappointment. This is the scenario that actually played out for a close friend of mine. Ironically, it is my debt from medical school that has helped me avoid such a fate, so I walk around surprised and saddened as my colleagues belittle women smart enough not to do much in terms of marketing their labor and start a family while they can.
Many doctors, as well as other professionals I have worked with, are empathetic, caring people. The problem is that they are also delusional. They have fixed beliefs about what the correct choices are for women in terms of when to have children, and these beliefs are simply false. They incorrectly assume that all women have nearly endless choices in how they design their lives, because we live in a culture that perpetuates the myth of infinite choices in spite of their obvious absence. For most of us, American life is not an endless buffet stocked with delicacies; it is more like a run-down corner convenience store in a ghetto: lots of choices, but surprisingly uncontaminated by anything nutritious. Nonetheless, we American women are being fed myths that we can do whatever we want with our lives, and that upward mobility is probable, if not guaranteed, with hard work. For typical women—ones who aspire to one day start a family—these myths are simply not true. Fertility treatments, just like nannies and affordable quality daycare, exist only for the privileged few.
My colleagues often make lots of assumptions about women who choose to bear children early in life. These assumptions boil down to the idea that these women are not only deeply irresponsible but also illogical. I often have to remind my colleagues that teen moms and welfare moms are far wealthier than they are by virtue of the fact that zero is a larger number than the large negative balance of student debt most of us carry. Women who refuse to take on educational debt and have children instead are often better off than hard-working achievers in terms of sanity as well.
Any objective cost-benefit analysis of when and how to have children is difficult to accomplish. Can you really put a price on the joy of having children? On the other side of the equation, American universities put an exact price on having a chance at professional success. The prices are often well above what any normal woman can afford without spending half a lifetime servicing student debt. Women should keep in mind that there seems to be no end to how far down the hole America is willing to throw people as they struggle in vain to climb up the socioeconomic ladder. The Wall Street Journal ran a piece this year about one of my fellow doctors who ended up over half a million in debt as a result of her medical education. The most disturbing aspect of her story was that it could happen to any of us… scuttling down the halls of the hospital, going the extra mile for patients... accidentally ignoring calls about student loans. An usurious late fee here, a missed payment there and the quarter million a typical doctor takes on in student loans suddenly becomes over half a million. The 41-year-old doctor told the reporter that she and her boyfriend were delaying having children. She probably said this sarcastically, given her professional knowledge of how female fertility declines with age. Or perhaps she was not sarcastic but resigned to going through egg “donation.” Maybe she will be willing to help (or exploit, depending upon how you look at it) a woman almost as poor as her present self. Such medically risky “donations” are often a desperate move by young women hoping to pay down—you guessed it—a student loan. What these young “donors” are not told is that they may well be damaging their own hopes of ever having children. Short of getting into the ethically tricky, not to mention financially difficult, proposition of “donor” eggs, most women have a limited number of options in terms of how they create a family life for themselves.
I make no blanket prescriptions for women, because we are all individuals in different situations. Some women genuinely do not even want children, although I suspect this lack of desire may often be an outcome of a culture that prizes material possessions over relationships. My prescription My prescription is for anyone, especially people in positions of authority, who dare look down their nose at the fertile young women who choose not to get into what the mainstream deems a successful lifestyle. They need to seriously rethink their definitions. “Empowering women towards success” really means “coaching women towards living in crushing debt while minimizing their reproductive capacity.” Their prescription for success is in fact a prescription for sterilization through debt.
If you let go of the myth that there are infinite possibilities open to all women, you might not only make better choices in your own life, but also become a bit more understanding of the different choices made by all kinds of women throughout the world, who are healthier, wealthier and happier for it.