Stacy Torres is a PhD candidate in sociology at New York University.

The American value of individualism affects us all, but what happens when you are not able to express that value? This is a dilemma for older people subject to stereotypes of dependency. They face special challenges in striving for this ideal and feeling comfortable enough to accept help so that they can remain self-sufficient. In my last post, I explored some reasons why older people may not want to move in with their families. Given these cultural pressures, how do elders living on their own negotiate their need for care and autonomy?

Programs like Meals on Wheels help older people remain independent in their homes. (Image via Wikimedia Commons.)

Polls consistently show that older adults and aging baby boomers want to “age in place”—or remain in their homes independently for as long as possible. This arrangement, desired by ordinary people as a means of preserving autonomy and by policy makers who view this as a cost effective alternative to nursing homes, requires that seniors—often in conjunction with their families—patch together creative ways to support their independence.

The day-to-day managing of routine tasks like grocery shopping, doctor’s appointments, and household chores, usually necessitates a little help from a supportive web that includes family, friends, neighbors, and social service agencies. Family may help older relatives with chores, coordinate medical appointments, and pay for supplemental help when possible. Network studies have foundthat friends are especially good at providing emotional support and a sympathetic ear when life’s travails require someone to bear witness. And neighbors can pitch in with practical help, such as picking up a few things from the store when an older person has trouble leaving the house. For years I have observed how eighty-year-old Joe’s next-door neighbor has served as his link to the outside world whenever his swollen ankles and knees leave him homebound. She brings him a copy of The Daily News and groceries whenever he needs a few days to mend.

Beyond kin and friendship networks, senior centers provide a range of services to community-dwelling elders, though they are also usually the first candidates for budget cuts. A few older people I’ve met over the years regularly took advantage of the cheap but nutritious meals offered daily by a local senior center for a dollar, which saved them the hassle of cooking for one and the cost of eating out but also provided a little companionship. Nonprofit organizations that serve older adults, such as the Jewish Association Serving the Aging (JASA), offer comprehensive access to services that help older people deal with the challenges of living alone in an expensive, gentrified city like New York, including benefits screening for programs such as food stamps and Medicaid. As I walked past a Midtown Manhattan food pantry the other day and saw the line stretching a half-block long, filled with mostly Asian and Latino elders and their shopping carts waiting for donated potatoes, rice, and canned vegetables, I was reminded again of how crucial these stop gaps are for those struggling to remain independent in old age.

But in some cases, elders may go too far in keeping their family at bay due to fears of losing their independence if they reveal their physical or financial challenges. In my own research I’ve found that some people feel so threatened by the prospect of moving in with family (or worse, a nursing home) and ashamed of asking for help that they sometimes go to great lengths to cover up health issues and other difficulties. It’s often only after a crisis that families learn of mounting problems. For example, after 83-year-old Dottie ended up hospitalized for a heart attack her daughter discovered that she had not seen a doctor besides her podiatrist for several years. In the absence of regular medical care, Dottie had improvised her own self-care measures such as weighing down a shopping cart with telephone books for support when she walked, rather than using a cane or walker. When Theresa, in her mid-70s, fell and twisted her ankle, her family discovered the severity of her dementia, which had eroded her ability to tell time and remember dates. Afterwards she moved closer to where her brother lived.

How can we support elders so that reaching out for help doesn’t pose a threat to independence but rather ensures that a bad situation doesn’t get worse or become an unnecessary crisis? Perhaps the first step is recognizing that none of us can do it alone and that at every age we achieve self-reliance by drawing on a mix of social resources and supports.

Update on Research from Jennifer Glass

Why are divorce rates higher in religiously conservative “red” states and lower in less religiously conservative “blue” states? After all, most conservatives frown upon divorce, and religious commitment is believed to strengthen marriage, not erode it. Even so, religiously conservative states Alabama and Arkansas have the second and third highest divorce rates in the U.S., at 13 per 1000 people per year while New Jersey and Massachusetts, more liberal states, are two of the lowest at 6 and 7 per 1000 people per year.

Evangelicals and divorce. For a study earlier this year in the American Journal of Sociology (abstract only), Demographers Jennifer Glass at the University of Texas and Philip Levchak at the University of Iowa looked at the entire map of the United States, going county by county, to examine where divorces occurred in 2000 and what the characteristics of those counties were. Their work confirms that one of the strongest factors predicting divorce rates (per 1000 married couples) is the concentration of conservative or evangelical Protestants in that county.

DivorceFinalPrevious discussions of this puzzling paradox have focused on three alternative explanations.

Is it poverty? Some scholars argue that it has nothing to do with religious beliefs and practices, but reflects the fact that conservative religious groups are most concentrated in rural and Southern counties, which tend to have lower wages than the national average and higher rates of poverty. And research does show that such conditions do raise the risk of divorce. Yet even controlling for income and region, divorce rates tend to be especially high in areas where conservative religious groups are prominent. more...

Stephanie Coontz has an excellent Op-Ed on the front of today’s New York Times Sunday Review, which draws out the implications for family instability of the connection between increasing gender equality on the one hand, and increasing economic inequality and insecurity on the other. The new instability is disproportionately concentrated among the population with less than a college degree.

To help with her research, I gave Stephanie the figure below, but it didn’t make the final cut. This shows the marriage history of men and women by education and age. She wrote:

According to the sociologist Philip N. Cohen, among 40-somethings with at least a bachelor’s degree, as of 2012, 63 percent of men and 59 percent of women were in their first marriage, compared to just 43 percent of men and 42 percent of women without a bachelor’s degree.

I highlighted those numbers in the figure. Also striking is the higher percentage of divorced people among those with less than a BA degree (and higher widowhood rates). Click to enlarge:

age marriage history

Cross-posted on the Family Inequality blog.

Joanna Pepin is a graduate student in sociology at the University of Maryland, College Park. Follow her on Twitter at @CoffeeBaseball.

Comedian Louis C.K. has a comedy bit about the bravery necessary for heterosexual dating. He points out, perceptively and with humor, that (traditionally) men have to summon the courage to ask out a potential partner while women are courageous for dating men at all.

How do women still go out with guys, when you consider that there is no greater threat to women than men? We’re the number one threat to women! Globally and historically, we’re the number one cause of injury and mayhem to women. You know what our [men’s] number one threat is? Heart disease.

Although women continue to date, love, and sometimes marry men, marriage has been in decline for decades.

The response to this demographic shift has been to invest billions of dollars in marriage promotion. Although the primary (flawed) justification given to emphasize marriage is to decrease poverty – especially for single mothers and their children – marriage promotion activists also have argued that “marriage dramatically reduces the risk that mothers will suffer from domestic abuse.” This ideological thinking was debunked as early as 2004, but was revived when Brad Wilcox and Robin Fretwell Wilson published a piece in the Washington Post claiming the solution to violence against women is marriage.

The pro-marriage activists rely on statistics that compare rates of violence between cohabiting and married couples.  What they ignore are selection effects. For instance, research from the longitudinal Fragile Families and Child Wellbeing Study illustrated mothers’ strategies to keep their children safe by leaving relationships they see as unhealthy, especially those involving physical abuse. Sociologists Catherine Kenney and Sara McLanahan show in their research analysis of data from the National Survey of Families and Households that selection out of cohabitation and into marriage – and selection out of marriage through divorce – creates an apples-and-oranges comparison between these two groups.

Another talking point for the marriage promoters is that married men have lower rates of criminal activity compared to non-married men. However, the research is still unclear on whether marriage per se decreases criminal activity, or if crime cessation is associated with stable family ties — cohabiting, married, or otherwise. Moreover, this line of research investigates generalized crime and not intimate partner violence (IPV) specifically. There is no reason to think IPV operates in the same way, given that DV is characteristically a uniquely individual dynamic of one person establishing power and control over another. It also ignores research on violence in later life, which shows that violence doesn’t decrease over the course of a relationship, but rather abusive tactics change. If the marker of a lifelong commitment is what decreases IPV, having children together should also be associated with lower rates of DV.  However, many survivors of IPV continue to experience abuse during their pregnancies (and after) and there is some evidence that the risk of violence increases during pregnancy.

To no one’s surprise, the federally funded marriage promotion programs have had no impact on relationship quality of participants, couples were no more likely to stay together or marry after participating, and they had no effect on the frequency or severity of IPV. Yet, we continue to spend scarce welfare dollars on marriage promotion at the expense of the very real economic resources survivors of domestic violence need.  For example, although a Family Violence Prevention option grants temporary waivers of public assistance requirements for survivors of domestic violence, women are rarely screened for domestic violence and few are able to obtain the mandated services even when they do report domestic violence to their case worker.

Contrary to the theory that marriage reduces IPV, one could theorize that marriage is actually more dangerous for women. Sociologist Philip Cohen showed that prevalence of IPV has been declining over the same time period as marriage rates have been falling. While the myth of widespread stranger danger is pervasive, according to a report from the U.S. Department of Justice, in two thirds of female homicides, women were killed by an intimate partner or family member (24% were killed by a spouse or ex-spouse; 21% were killed by a boyfriend or girlfriend). Marriage theoretically increases perpetrator access to victims, and social sanctions as well as legal ties make it more difficult to leave dangerous situations.

Indeed, evidence we do have demonstrates marriage is no safe haven for women. In some ways our societal obsession with the institution of marriage may be placing more women at risk. Data from the Washington State Coalition Against Domestic Violence Fatality Review Project reveal that 45% of the women killed in DV homicides committed by male perpetrators had been married. These couples were more likely to be living together, have children together, and be in the process of ending the relationship. Public health researcher Sara Shoener affirmed what I witnessed as an advocate working with survivors of abuse: cultural narratives of linking marriage with success, the stigma of single motherhood, and religious beliefs about divorce hinder survivors’ ability to access the vital resources they need to keep themselves and their children safe. Creating a no-win situation, mothers are condemned if they raise their children alone, blamed if they don’t leave an abusive relationship to protect their children, and criticized for deliberately obstructing relationships between children and fathers if they exit an abusive relationship.

Image by the Washington State Coalition Against Domestic Violence. Data from Domestic Violence Fatality Review Project.
Image by the Washington State Coalition Against Domestic Violence. Data from Domestic Violence Fatality Review Project.

The pro-marriage movement seems to be borrowing a concept from the National Rifle Association, that “the only way to stop a bad guy with a gun is with a good guy with a gun.” As the NRA asserts that the solution to gun violence is more gun violence, pro-marriage advocates assert the solution to men’s violence against women is for women to marry men. Increase both access and dependence. Raise the stakes. Make the relationship permanent. This solution is not only illogical and unsubstantiated, it’s dangerous.


“It’s my home,” Sylvia, 85, offers as a simple but profound explanation for why she’s not ready to give up her Manhattan apartment and move in with relatives. Though she lived with her own parents as they aged, Sylvia has lived alone for almost twenty years, since her husband passed away, as does her 92-year-old sister-in-law and many of her contemporaries in old age.

People increasingly prefer to "age in place"--near rather than with family.
People increasingly prefer to “age in place”–near rather than with family.

The advent of Social Security gave older people—and more often than not, older women—the financial resources to live on their own. Economists Kathleen McGarry and Robert Schoeni found that 59 percent of widows over the age of 65 lived with adult children in 1940, compared with 20 percent fifty years later. Today nearly a third of all older adults live alone. These rates rise with age and follow distinct gendered patterns, with women much more likely to live alone than men at all ages. By age 85, 47 percent of women and 27 percent of men lived alone in 2010.

Many older people struggle to make ends meet on Social Security as their sole source of income, or in combination with modest savings and pensions. For immigrant elders in cities like New York, living alone is often not an option due to a lack of affordable housing, linguistic hurdles, and cultural traditions of multi-generational living arrangements. While poverty rates rise with age and hit women hardest in late life, as my analysis of Census data has found, those who can afford to live alone usually do. Researchers expect that these trends will only increase with the aging of baby boomers, who have experienced higher rates of divorce, cohabitation, lifelong singlehood, and childlessness during their lifetimes. more...

Here’s a reprint of my column on family medical leave, originally posted at GirlwPen; today’s post includes updates of additional studies further highlight the need for paid leave that extends to all workers.

From Flickr Creative Commons.
From Flickr Creative Commons, by Lenneke Veerbeek. Click image for details.

Over 20 years ago Congress passed the Family and Medical Leave Act, and President Bill Clinton signed it into law two weeks after his inauguration in 1993. Remember the optimism? Under the FMLA a qualified employee can take up to 12 weeks of unpaid leave to care for a sick family member or for pregnancy, newborn, newly adopted, or for care of a new foster child. In a good-news bad-news sense, one of the notable features of the FMLA was that it was gender-neutral: men and women equally had no funding for their job-protected leave for up to 12 weeks per year. Otherwise, this policy for helping families has been the weakest compared to other rich countries. At the time, the FMLA was the “foot in the door” for improving the situation of working families. A hint for how FMLA is doing today was offered by Girlwpen’s Susan Bailey earlier this year.

So…how’s that foot in the door now? Several recent studies offer new tools for analysis. In “Expanding Federal Family and Medical Leave Coverage,” economists Helene Jorgenson and Eileen Appelbaum investigated who benefits from FMLA using the 2012 FMLA Employee Survey conducted by the Department of Labor. About one in five qualified employees has used FMLA leave within the past 18 months, according to a new Center for Economic and Policy Research (CEPR) report. The authors found an extensive amount of unmet need for family and medical leave. UPDATE: In June 2014, Jorgensen and Applebaum published “Documenting the Need for a National Paid Family and Medical Leave Program: Evidence from the 2012 FMLA survey.” They reported that,”One-in-four employees needing leave had their leave needs unmet in the past 12 months. Not being able to afford unpaid leave (49.4 percent) and the risk of loss of job (18.3 percent) were the two most common reasons given for not taking needed leave. Employees with children living at home and female employees had the greatest need for leave, but also had the highest rates of unmet leave.”

Several key limitations of the FMLA mean that, in practice, the law doesn’t apply to a large share of the workforce. The FMLA does not cover workers in firms with fewer than 50 employees. As a result, 44.1 percent of workers in the private sector (49.3 million workers) are excluded from protected leave for caring for their sick or vulnerable relations. The FMLA also excludes employees who have been at their current job for less than a year or have worked fewer than 1250 hours in the past year.

Not everyone with needy kin works in mid-to-large size firms nor has regular employment. So, those limits on access to FMLA do not affect everyone equally. Young workers and Hispanic workers had lower rates of eligibility than other groups. Education level was the strongest predictor of eligibility. People with less than a high school degree were 13.6 percentage points less likely than those with “some college” to have access to unpaid leave for family and medical concerns. Meanwhile, those with a college degree were 10.7 percentage points more likely than those with some college to have access to FMLA leave.

From CEPR’s “Expanding Federal Family and Medical Leave Coverage” (Feb 5, 2014) by Helene Jorgenson and Eileen Appelbaum.


Have there been improvements in the past two decades? Another recent study from CEPR and the Center for American Progress, “Job Protection isn’t Enough: Why America Needs Paid Parental Leave,” by Heather Boushey, Jane Farrell, and John Schmitt, points to no. Analysis of data from the Current Population Survey over the past 20 years revealed two key things: First, women take leave way more than men despite the gender neutrality of the policy. Men have increased from a very low rate, but the ratio in the last five years studied is about nine to one. In addition, over the past two decades there has been essentially no change in women’s rates of leave-taking.

Also, per Boushey and colleagues, guess who is most likely to benefit from leave? Women with college degrees and those in full-time jobs. Commenting on their statistical analysis, the authors state, “Better-educated, full-time, union women are more likely than their otherwise identical counterparts to take parental leave” (p. 12). Not everyone can be in a job that qualifies them for FMLA leave; however once qualified, not everyone has the financial security to use that leave.

These authors—like Jorgenson and Appelbaum—applaud the FMLA and the opportunities it has provided to qualified workers—but their data show that the 1993 Act did not generate a cascade of family-progressive policies for men, women, and families. But one can hope. Jorgenson and Appelbaum demonstrate that a policy that reduced the firm size from 50 to 30 and reduced the hours worked in the past year from 1250 to 750, an additional 8.3 million private sector workers would be eligible for family leave under FMLA. UPDATE: In an April 2014 study, Jorgensen and Applebaum zeroed in on FMLA’s exemptions–such as small firms. They calculated that,”If the FMLA were amended to cover all firms and worksites regardless of size, an estimated 34.1 million private-sector employees would gain access to job-protected family and medical leave, if they otherwise meet the eligibility requirements relating to length of tenure and hours of work.”

There are some pretty great examples of places in the United States where better family leave policies have been put in place and have worked well. California passed a paid family leave act in 2002, and after twelve years, the program has been highly successful. Appelbaum and Ruth Milkman reported in 2011 about the social, family, and economic benefits of the program. Washington State passed similar legislation in 2007 but it has been help up since then. New Jersey did so in 2008, and Rhode Island’s law was implemented in January 2014. Another review of the California paid leave program demonstrates the growth in uptake since its initiation, but reports that uptake continues to be low because while the leave is paid one’s job is not protected.

We just celebrated 50 years of the Civil Rights Act. Last year we celebrated 50 years since the Equal Pay Act. Retrospectives on such landmark legislation includes successes as well as persisting shortfalls. We are at 21 and counting with FMLA. These studies remind us that with FMLA we need to do more to have more success than shortfalls.

The following is a repost in honor of the 51st anniversary of the Equal Pay Act. You can download this essay as part of CCF’s Equal Pay Symposium(.pdf).

Gender inequality within families is reciprocally related to gender inequality in the paid workplace. That is why one of the legacies of the Equal Pay Act, which brought scrutiny and sanctions to bear on gender discrimination at work, has been growing egalitarianism within families as well. Research consistently shows the effect of workplace progress on equality within couples. Most recently, analysis of the American Time-Use Survey confirms that women’s own earnings are associated with the amount of housework they perform. Each thousand dollars of earnings is associated with a 14-minute reduction in daily housework.

Photo by Kate Ter Haar via Flickr CC.
Photo by Kate Ter Haar via Flickr CC.

In 1962 fewer than one-in-seven nonfarm managers were women, according to Bureau of Labor Statistics data. Women earned less than 10 percent of degrees in law and medicine, and full-time employed women earned just 59 percent of what men made. Not surprisingly, at that time just 7 percent of wives ages 25-54 earned more than their husbands – and wives did almost six-times as much housework as husbands. Their constrained workplace opportunity weakened their relative standing at home. more...

Click for image source.
Click for image source.

The following is a re-post in honor of the (2014) 50th Anniversary of the Civil Rights Act.

Greater Acceptance, Persisting Antipathy:

Catholic and Jewish Americans Since The Civil Rights Era

The Civil Rights Act of 1964 not only ushered in stronger federal protections for racial and ethnic minorities and women, but also for religious minorities. Antipathy toward Catholics and Jews in the US was a persistent and prevalent theme through much of American history. It was common for these groups to be labeled “un-American” and even categorized as “non-white.” Members of these religions were often discriminated against in hiring and in admission to institutions of higher learning (this was especially common for Jewish applicants) and excluded from many neighborhoods, clubs, and political positions. From the late 19th through the mid-20th century, organized hate groups, most notably the Ku Klux Klan, used the threat of violence to intimidate not only African-Americans but Jews and Catholics as well.

After World War II, these restrictions and prejudices eased somewhat. By 1955 the now-classic essay Protestant Catholic Jew could proclaim that although these three religions were the primary sources of identity in America, they were now “alternative ways of being an American” rather than two of them being seen as Un-American.

Still, anti-Semitism and anti-Catholicism persisted. In the 1960s, some commentators worried that President Kennedy, a Catholic, would take orders from the Pope. In the 1970s, President Richard Nixon was recorded making several anti-Semitic comments. And even today nativist hate groups continue to perpetuate centuries-old hostilities against Catholic and Jewish Americans. But the Civil Rights Act did give these minorities protection against outright exclusion and discrimination, and other religious minorities have also looked to it for security as the American religious landscape has diversified. more...

Ashton Applewhite hosts *This Chair Rocks.* By Clipper (Own work) [CC-BY-SA-3.0 (], via Wikimedia Commons
Ashton Applewhite hosts *This Chair Rocks.* Image by Clipper (Own work) [CC-BY-SA-3.0 (], via Wikimedia Commons

June 30th saw the release of the 65+ in the United States 2010 U.S. Census Bureau Report, the latest overview of how older Americans are faring socially and economically. Brace yourself: “the U.S. population is poised to experience a population aging boom over the next two decades.” Uh oh, right? Despite the fact that longer lives reflect a remarkable public health achievement—the redistribution of death from the young to the old—there’s more hand-wringing than back-patting going on.

Much of the apprehension centers on the “dependency ratio”: the fact that the number of people over 65 is growing and the number of people the workforce shrinking. Fiscal crisis! Social collapse! In fact that ratio’s been falling pretty steadily for over a century. Over the same period national GDPs, along with lifespans, have rapidly increased.

People don’t turn into economic dead weights when they hit 65. As the Census Report documents, they’re participating in the labor force in ever-greater numbers. It also notes that “the dependency ratio does not account for older or younger people who work or have financial resources, nor does it capture those in their ‘working ages’ who are not working,” and that many caregivers are over age 65. Because it’s unpaid, this work is omitted from our national accounting. Millions more older Americans would like to continue to contribute, but are prevented by age discrimination in the workplace, which relegates them to jobs that don’t take advantage of their skills and experience—if they land one at all.

The “approaching crisis in caregiving” that the Census Report calls out is real and growing more acute. But people are healthier as well as longer-lived, and are not an inevitable sink for healthcare dollars. According to the ten-year MacArthur Foundation Study of Aging in America, once people reach 65, their added years don’t have a major impact on Medicare costs. As the Census Report details, the number of Americans aged 65+ in nursing homes declined by 20 percent in the last decade, “from 4.6 percent in 2000 to 3.1 percent in 2010.” That’s three percent of Americans over 65.Chronic conditions pile up, but they don’t keep most older Americans from functioning in the world, helping their neighbors, and enjoying their lives.

The Census Report includes an oft-cited statistic: “An unprecedented shift will occur between 2015 and 2020, when the percentage of people aged 65 and over in the global population will surpass the percentage of the very young (aged 0-4) for the first time.” This means that by 2020 there’ll be one older adult for every child—far better for children’s welfare than the inverse, as well as for the women who once had to produce enough of them to survive famines, wars, and epidemics.

It’s also helpful to keep in mind that the projections that have Americans so worked up are largely the result of a specific historical phenomenon: the cohort effect of the baby boom growing old—the proverbial bulge in the python. This effect will peak by midcentury, although, tellingly, few graphs extend far enough out to show the downturn. Much was made of the first boomers turning 65 in 2011, but a 2013 milestone went largely unremarked. That’s when millennials first outnumbered baby boomers. The number of boomers will continue to decline.

Even countries that are rapidly aging can produce “youth bulges”, as demographer Philip Longman pointed out in 2010, describing them as looming disasters “with all the attendant social consequences, from more violence to economic dislocation.” Can’t win for losing. In that same Foreign Policy article Longman warned of a “’gray tsunami’ sweeping the planet.” Journalists jumped on this frankly terrifying metaphor, and “gray tsunami” has since become widely adopted shorthand for the socioeconomic threat posed by an aging population.

What we’re facing is no tsunami. It’s a demographic wave that scientists have been tracking for decades, and it’s washing over a flood plain, not crashing without warning on a defenseless shore. This ageist and alarmist rhetoric justifies prejudice against older people, legitimates their abandonment, and fans the flames of intergenerational conflict. If left unchallenged, ageism will pit us against each other like racism and sexism; it will rob us of an immense accrual of knowledge and experience; and it will poison our response to the remarkable achievement of longer, healthier lives.

Ashton Applewhite blogs at This Chair Rocks where she also frequently updates her page Yo, Is This Ageist? Reach her on twitter at @thischairrocks.

"They did not know the laws of nature" Advertisement (1926).  Source: Wikimedia Commons
“They did not know the laws of nature” Advertisement (1926).  Wikimedia Commons

Nearly 50 years ago, in the 1965 Griswold v Connecticut case, the Supreme Court declared birth control legal for married persons, and shortly afterwards in another case legalized birth control for single people. In a famous study published in 2002, “The power of the pill,” two Harvard economists reported on the dramatic rise in women’s entrance into the professions and attributed this development to the availability of oral contraception beginning in the 1960s. Several years ago, the CDC reported that 99% of U.S. women who have ever had sexual intercourse had used contraception at some point. So the recent controversial Hobby Lobby case no doubt appears somewhat surreal to many Americans who understandably have assumed that contraception—unlike abortion–is a settled, non-contentious issue in the U.S.

To be sure, some conservatives, fearful of a female voter backlash in November, have tried to claim the case is about the religious freedom of certain corporations, and not contraception. But the case is about contraception. The Majority in Hobby Lobby made this clear, claiming the decision only applies to contraception and not to other things that some religious groups might oppose, such as vaccinations and blood transfusions.

So why are Americans still fighting about something that elsewhere in the industrialized world is a taken for granted part of reproductive health care? As Jennifer Reich and I discuss in our forthcoming volume, Reproduction and Society, contraception has always had a volatile career in the U.S., sometimes being used coercively by those in power, and at other times, like the present, being withheld from those who desperately need it.

The contraceptive wars started with the notorious campaign in the late 19th century of the Postmaster General Anthony Comstock, who successfully banned the spread of information about contraception under an obscenity statute. Margaret Sanger, who starting in the early 20th century, sought to bring birth control information and services to American women, was repeatedly arrested, before her eventual success in starting Planned Parenthood.

Gradually, after the Supreme Court cases mentioned above, the discovery and dissemination of the pill and steady increases in premarital sexuality, contraception became far more mainstreamed. Indeed, among its severest critics were feminist health activists of the 1970s, concerned about the safety of early versions of the pill and IUDS, as well as the use of Third World women as “guinea pigs” for testing methods. Federal and state governments became actively involved in the promotion of birth control: Title X of the Public Health Act of 1970 became the first federal program specifically designed to deliver family planning services to the poor and to teens. This legislation in turn drew angry protests from some activists within the African American community who, pointing to the disproportionate location of newly funded clinics in their neighborhoods, raised accusations of “black genocide.” (Title X exists to this day, albeit chronically underfunded and always threatened with being defunded entirely).

For a fairly short period after the Roe v Wade decision in 1973, contraception was seen as “common ground” between politicians who were proponents and opponents of that decision. But as the Religious Right grew more prominent in American politics, contraception became increasingly attacked for enabling non-procreative sexual activity, as epitomized in the statement of the presidential candidate Rick Santorum, promising to eliminate all public funding for contraception if elected: “It’s not okay. It’s a license to do things in a sexual realm that is counter to how things are supposed to be.”

Moreover, many anti-abortionists have come to reframe some forms of contraception as “abortafacients.” Indeed, much of the Hobby Lobby case can be understood as a profound disagreement between abortion opponents and the medical community as to what constitutes an actual pregnancy and how particular contraceptives work. For the former, pregnancy begins the moment that sperm meets egg and fertilization takes place; for the latter it is the implantation of the fertilized egg in a woman’s uterus (the first point at which a pregnancy can actually be ascertained). The four contraceptive methods at issue in the Hobby Lobby case—two brands of Emergency Contraception and two models of IUDs–are deemed by many conservatives, including the plaintiffs in Hobby Lobby, to cause abortions, while the medical community has gone on record as saying these methods cannot be considered in this light, as they cannot interfere with an established pregnancy. According to medical researchers, these methods work by inhibiting ovulation, while one of the IUDs in question may prevent implantation in some circumstances.

Numerous other challenges to contraceptive coverage in Obamacare are expected to come before the Court, and some will seek employers’ right to deny all forms of contraception. What the outcomes of these cases will be and what success President Obama and Democrats will have in finding the “work-arounds” that they have pledged to pursue are not entirely clear at this moment. What is clear, however, is who suffers most from Hobby Lobby — not only the huge pool of women directly affected, but their families as well. Though we typically think of contraception as a “women’s issue,” in fact it plays a huge role in family well-being. A massive literature review by the Guttmacher Institute reveals the negative impacts on adult relationships, including depression and heightened conflict, when births are unplanned, and also shows the health benefits to children when births are spaced.

But the most effective contraceptive methods are the most expensive ones. As Justice Ruth Bader Ginsburg noted in her scathing dissent, the upfront cost of an IUD can be a thousand dollars, nearly a month’s wages for a low income worker. And many women who can’t afford an IUD apparently want one. One study has shown that when cost-sharing for contraceptive methods was eliminated for a population of California patients, IUD use increased by 137%. In light of this, my depressing conclusion about the Hobby Lobby case is that it follows a familiar pattern of American policies about contraception, and indeed of this country’s social policies more generally: the poorest Americans always seem to get the short end of the stick.

Carole Joffe is a professor at the Bixby Center for Global Reproductive Health at the University of California, San Francisco, professor emerita of sociology at U.C. Davis, and the author of Dispatches from the Abortion Wars: The Costs of Fanaticism to Doctors, Patients and the Rest of Us, and co-editor, with Jennifer Reich, of Reproduction and Society: Interdisciplinary Readings.