The benefits of contraception?

By David Hunter

The government in New Zealand is proposing to spend $1 million of funding for women on a benefit and their teenage daughters to get long-term reversible contraception – such as an implant. Advice on accessing this treatment and its implications will be provided by case workers in the Social Services.

The NZ government seems almost surprised that some people have been offended by the suggestion of this policy asserting that this is not interfering in the reproductive life of beneficiaries, and is just common sense – the Prime Minister John Key said

“Ultimately if people have unplanned pregnancies and are solely dependent on the state, you the taxpayer have to pay for a long period of time for that dependency and we know the outcomes aren’t terribly good.”

While I think they are quite right that this is not interfering in the reproductive life of beneficiaries this doesn’t exhaust the potential array of ethical issues involved in this sort of proposal.

It isn’t inherently coercive since offers are typically not coercive. However the close association between medical care and social services seems a little more sinister since it makes a connection (however unintended) between receiving social support and receiving this reproductive advice – and perhaps in the minds of some in taking it.

Could this connection be abused? Certainly. As one beneficiary notes

“she had already been told by a case officer to “shut your legs” I’ve even heard WINZ people say things worse than that to women. “I go in there for a fight, for an argument, every time. There are people in there who have huge power control issues and they just make it worse for us. They take their job description way too far.”

This doesn’t surprise me at all, any time policy is implemented it will sometimes be misapplied. And Work and Income New Zealand (WINZ) can be somewhat inflexible – when my first wife Kerry passed away I had to cancel her sickness benefit (she had cystic fibrosis) so her brother and I went into the nearest WINZ office to inform them. We were told we would need to fill in a change of circumstances form, and once we had completed this we were told that they couldn’t accept it because it would need to be signed by the recipient of the benefit… We eventually sorted it out, although we left with a copy of the paperwork to show to her…

Ronald Dworkin in his book Sovereign Virtue argues that the first and heaviest responsibility of a government is to treat its citizens equally. Does this constitute equal treatment? Targeting those on benefits in this way doesn’t seem to to me.

Providing long term contraception in general is a good thing (assuming cost-effectiveness & safety of course) since it provides for greater reproductive autonomy. But I’m not sure reproductive services ought to be targeted at the poor in this fashion. It seems to display the attitude of the government towards the reproduction of some of society’s poorest members – namely that it would be better if they didn’t breed – or as the government puts it “breaking the cycle of intergenerational welfare dependency”. And I am not sure that is an attitude that is defensible. While solving the cycle of intergenerational welfare dependency would be laudable, this strikes me more as a dissolution than a solution to the problem.

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