Contraception: A Foreign Service Perspective

This blog is really all over the place isn’t it?

On the one hand, it’s my blog, and I can write about whatever I like. On the other hand, since I am the wife of a Foreign Service officer, there is a general theme at work (most of the time). Because being a Foreign Service officer is more than just a job. You don’t clock in at 9 and clock out at 5—and your family certainly doesn’t.

I wouldn’t call it my life, because, well….ew. I’m just not a person who can say “my husband’s career is my life.” I mean, really, that is never going to happen. But, because of his career, I have spent most of my adult life living in other countries. And that has shaped my thoughts and opinions on just about everything. Including this latest stuff going on in the States about contraception.

What follows is my opinion, and my opinion only.

Most of the women—in fact, all the women—I know are just gobsmacked that contraception can even be considered “controversial” or an “issue” in 2012. That includes women who have never lived anywhere outside the U.S. It includes churchgoing Baptists, Catholics, and women from every generation. You definitely do not have to have lived overseas to be completely amazed and royally pissed off at what is going on.

The photo that made millions of women see red.

Some people are convinced that this is about “religious freedom.” I have not yet heard one woman of my acquaintance express this point of view. Not one. Because we know that contraception is as basic to health care as childhood immunizations. And we know exactly what’s going on here.

I have a feeling that I would be plenty angry about this “Mad Men” mass delusion that is going on even if I had never set foot outside my home state. But having lived overseas, and particularly in the third world, my anger has an extra edge.

Meet “Beatrice.”

Beatrice, her daughter and my daughter.

Beatrice was our housekeeper when we lived in Zambia in the early 90s. She was a smart woman with what I would say was the equivalent of  middle school education. She could read and write fluently in English (not her native language), do sums, and take accurate phone messages. Her brother held a clerical position with British Airways. Beatrice had dropped out of school to go to work so that he could continue with his education. Otherwise, I am certain she would have been capable of working as a secretary, at the very least.

Beatrice was about 35 at the time she worked for me, and had eight children, which was actually below the average per woman for Zambia at that time. But hey, she still had a good ten years to work on that. She was always tired, slightly stooped, and walked like a woman twenty years older than she was. Her breasts were long, wrinkled tubes that she pulled out of her blouse and literally unrolled when her youngest needed to nurse.

Halfway through our tour, her husband (who was older than she was and had already worn out one wife with several children) dropped dead in our backyard while sitting outside their two-room concrete house. This left Beatrice with all those kids to feed, clothe, and educate (school is not free in much of the third world). But, she was determined that her oldest daughter would stay in school, and watched her like a hawk whenever the maintenance men were around.

I do not know what happened to Beatrice after we left Lusaka. Fortunately, Beatrice’s little house came with the job, and it had a garden plot as well. But, not everyone would be willing to take in a housekeeper with eight kids running around. (In fact, to be honest, we kind of got suckered into it.) She may well have ended up jobless and homeless. I really doubt that daughter was able to stay in school.

Now, imagine Beatrice’s prospects with just two or three kids. Imagine the kids’ prospects. Imagine how much healthier and better-educated they all would have been, with or without a husband and father in the picture.

In the Foreign Service, we have just about all known at least one “Beatrice.” They aren’t dumb, and they aren’t lazy. They work their butts off, as a matter of fact. But they lead impoverished, shortened lives because they come from large families themselves and have too many children to support.

By the way, I once talked with a Catholic missionary in Lusaka who earnestly explained that they were teaching women the rhythm method so they could learn “self-control. This, in a country with a stratospheric HIV rate, a high incidence of rape, and a serious machismo problem. Lack of female “self-control” was not the reason for the birth rate or the HIV rate in Zambia.

It was difficult to keep a straight face. What planet was this person living on? Evidently, the same one currently inhabited by Rick Santorum and Bob McDonnell. Planet Mad Men. A world in which men with no medical knowledge (and no uteruses) get to decide what is best for women, whether it’s deciding that birth control is not essential to health care or that women should be forcibly subjected to medically unnecessary procedures as “punishment” for accidentally getting pregnant.

In the Foreign Service, we quite often feel like we’ve entered a time warp and are getting a peek into a reality that is long-gone on our side of the world. Including Planet Mad Men.

I have done a lot of research on my own family’s roots. Nearly all of my ancestors were poor-to-respectable southern farmers. Of my four great-grandmothers, one had ten kids (producing them continuously until she was 47 years old—older than I am now!); one had nine kids and lived a long, if hard, life; one had nine kids and died when youngest was two years old, leaving her oldest daughter to raise the rest; and one limited her family to four kids—maybe in part because her own mother died birthing her seventh child.

In short, less than a hundred years ago, my great-grandmothers were not living all that differently from Beatrice. The babies just kept coming, and the work never stopped. It wasn’t until my grandparents’ and parents’ generations that the babies slowed down. It was incredibly hard on the women, but it was difficult for the men, too.

My grandfather dropped out of school in third grade because he was the oldest of seven surviving kids and had to work in the fields to help feed everyone else. And what did he and his wife do? They held the line at five kids (four plus one surprise) and every single one of them graduated college, mostly through military scholarships. I don’t know what my grandmother did to limit babies, but she evidently figured something out.

And what did those kids do? With readily accessible contraception they all held the line at two or three kids who grew up in middle-class households with no doubt whatsoever of a college education for both the boys and the girls.

I have two kids, one-fifth as many as my great-grandmother. My barely literate grandfather’s great-granddaughter is on a full academic scholarship to an excellent university and realistically considering Ivies for graduate school. The sky is her only limit, and she can have five kids, two kids, or no kids. It’s completely her choice–though of course I’m hoping to get a grandbaby or two eventually!

The other lines of my ancestry tell similar stories. Each generation produced fewer kids that were more educated than the previous one, and went on to greater prosperity than their parents. And the women, as a rule, lived longer, healthier lives the fewer children they had.

OK, so contraception may not have been the only factor at work here. But was it one of the most, if not the most important factor? Absolutely.

In part because my overseas experiences, and in part because of my own family’s history, when I think about the Beatrices of the world, I think: there but for the grace of contraception go I.

So, Rick Santorum, Bob McDonnell, and all the rest of you sad little men who would like to send us back in time?

You all can kiss my healthy, birth-controlled, educated, middle-class, well-traveled ass.


  1. Excellently written and great historical personal perspective. The need for the GOP to remain politically correct in order to pursue the conservative religious factions has left them hanging limply on the vine, trying to appease a group that wants to shove their morality down everyone’s throat. This is because they know what is better for everyone.

    I have done some recent readings on the history of the catholic church. What I learned was deeply disturbing in its ability to encourage the genocide of indigenous populations because the heathens were better off dead then to wander this earth not embracing the church’s one “true” god.

    The catholic church has never been very good for any of the cultures it has attempted to convert by any means necessary. They need to stay out of politics and my living room and our children’s future.


    • My thoughts exactly (and far better written than I could have done). It’s outrageous to me that this is even a matter for legislation except in the positive, which these moves are clearly not. I do think that birth control is as much of a men’s issue as a woman’s which is why I’m okay with there being men on that panel. Though all men? Ridiculous. i’d like to see more money and more effort poured into easy birth control solutions that are accessible, functional and acknowledge shared responsibility for women AND men. In the meantime, every letter I write to my representatives (that’s right, Bob McDonnell, I’m looking at you) says everything short of WTF. I like to think his recent last minute couse correction on transvaginal ultrasounds was due to my strongly worded letter.


  2. Thanks for a great post on a maddening topic. Incidentally in grad school I did research on an ‘updated’ rhythm method being exported to third world countries with sky high fertility and HIV infection rates, and I always felt like I was talking to brick walls when I spoke to the researchers who came up with it. That we’re talking about these things in the United States in 2012 boggles the mind. Planet Mad Men is right.


    • How does one “update” the rhythm method? Drums? A little Barry White?

      This may be TMI, but I have to say, I was never all that regular, and if I had relied on the rhythm method, I’d have like 8 kids by now, for sure.


      • The cycle method is like the “pullout method” and the response to the following question: do you know what they call people who use the cycle method? Umm, yes, I do. Parents.


      • Frankly, I used the “updated” method (it goes under many names, but involves a few things including daily temperature taking with a sensitive thermometer, checking mucus levels (yes, you do have to do that), and the ability to take, keep, and analyze data) for about 5 years during which I intentionally avoided pregnancy, and I also intentionally conceived a much loved baby. So, yeah, jokes aside, it does work for some committed couples with a certain amount of energy to spend on it.

        As far as “exporting” that method to countries where the access to sensitive thermometers is quite low, where education is highly restricted for women (reducing the ability to take, keep, and analyze data), and cultures where “machismo” takes precedence over committed couples agreeing on their intentional future, well, I suspect that’s just not going to work.

        Birth control, in all its guises, should be available to all people. I think it’s despicable that the US Congress couldn’t conceive (heh) of a reality where perhaps a religious woman could have a relevant perspective. All babies should be wanted, loved, welcomed, and well raised. Anything that stops those 4 conditions from being met is not helping society further itself.


      • riffraff – you are absolutely right. This can work for committed couples with the energy (and training) to make it work. (And the willingness to have a baby or deal with an unplanned pregnancy if it doesn’t.) I am always glad to hear that it can work for some people. It is a lot of work! I am more concerned about it from an exportation perspective, especially to areas where family planning goes hand in hand with STD prevention, and for all the reasons you mention. Because no matter how well you use natural family planning methods, if one of the couple has an STD, there’s no barrier using this method.


  3. I hope every woman here in the states reads this and understands that this is a global issue that we all need to fight for. I can’t believe we’re talking about it here either. Planet Mad Men indeed.


  4. Another FS spouse here! I think your blog is great.

    As a conservative Christian, personally I have no issues with birth control (okay, I DO have some issues with the “morning after pill” but that’s a whole ‘nother conversation) and have used them in various forms myself. In fact, most of my “adult” life I’ve been on them due to various medical issues, and do believe that had I been born in a different time, I’d be one of those females who died early, either from those medical issues, or from worn out from childbirth. So, I thank God for them, cause in a different time, I wouldn’t be here.

    HOWEVER, I do understand others not believing in it, and they have the freedom of that choice, and in our wonderful country, they have a right to believe what they want. I also don’t believe in them being denied access, or in it not being covered (or doctors not allowed to discuss it if working at certain hospitals, etc.). Every woman does have the right to access. That is a personal decision that should be a woman and her doctor (and her spouse, etc).

    But, I do have issues with them being forced to pay for it, or their insurance plans being forced to cover (which only means their insurance premiums are going to go up yet again) the copay. That DOES go against their religious freedom rights and we just can’t do that. With my medical issues, coughing up a $40 copay a month does start to add up and it stunk royally. I wasn’t in a position where I had much of a choice and so I scrounged and paid every single month. Since the age of 18. Minus the 4 years I was pregnant, breastfeeding, and trying to get pregnant, of course. So to me, the issue is really not the access, but the cost.

    I think getting the drug companies and insurance companies to lower the cost (or copay) of these meds is more of a solution. They’ve got women basically by the crosshairs for about 25 years of their lives. It’s not like women are going to stop using it – we’ve been paying large copays for this long, it’s not like women are going to stop using it. But to allow access to MORE women, the cost (for those without insurance) and the copays HAVE to come down. Why would they charge me $10 for one med and $40 for birth control each month? I think that is the real discrimination. If insurance companies weren’t allowed to charge a premium copay to birth control, AND it would all HAVE to be covered (verses just one generic option), or pharmaceutical companies couldn’t charge more than $X to women without insurance, that would open up access to a large amount of women in the US.


    • Julie–thank you for your thoughtful comment! One point though–there is considerable evidence that insurance premiums do not, in fact, go up when companies are required to cover contraception. Contraception saves them money–they can pay for a whole lot of it and still come out ahead of paying for a pregnancy and birth.

      Before, thank heaven, two FEMALE Senators insisted that the FEHB cover contraception, I also had to pay for my own BC pills. It wasn’t the drug companies I was mad at then, but the insurance company. One because it was refusing to pay for essential health care and two, because it just didn’t even make sense!

      If you require drug companies to charge less for a medication, then you are interfering in the free market, which is what Republicans are supposed to (theoretically) be against. The market should determine the price, right? But if you require insurance companies to cover it, then you are putting it in the same category as other things that society considers to essential and of mutual benefit, such as immunizations. Furthermore, you are requiring that they not discriminate against a class of people–women. It’s like requiring that they cover sickle cell testing and treatment for black people.

      There is plenty of precedent, and religion should not enter into the discussion. It’s a federal law regarding healthcare, and healthcare only. It is completely consistent with the first amendment. It does not establish a religion nor does it prohibit the free exercise of it. Whether or not to use contraception is completely up to the individual. And if churches feel so strongly about it, then they don’t have provide health insurance to their employees at all. I think they may have a hard time finding employees if they don’t. But again, that’s the free market at work. Republicans are supposed to like that.

      That’s why I think Obama’s solution to the problem was the right one, and probably the one he should have proposed in the first place.

      The problem with people like Santorum is that he just won’t let that go. Why? Because he doesn’t actually think women should be using birth control! Or working outside the home. Or basically being equal to men. The man has a track record in this regard. Same with Bob McDonnell. He is a graduate of Pat Robertson’s university, for heaven’s sake. You can look up his graduate thesis online. It’s some seriously Taliban-esque stuff. It’s not about freedom of religion for these people. It’s about imposing THEIR religion on everyone else–and keeping women in their place.


  5. I’m thankful that 2 very nice men (with lots of initials after their names) helped me over many years finally get (and stay) pregnant with youngest munchkin. One of those men even took care of my permanent contraception afterwards as well. 🙂

    But the reality is that not all men (especially those w/o all those fancy initials after their names) know what in the heck they’re talking about … My body, my decisions? Apparently, not so.


  6. I absolutely agree with you, share your outrage, and think your analysis is spot-on. However, I have to say that I’m a little uncomfortable with you using XXXXX’s story and picture without her permission, especially as it includes such personal details about her.


    • Bronwen, you are right. I have to admit, I was not expecting this post to get as much attention as it has, and so didn’t consider it to be so “public.” I have changed her name to an alias. Thank you for pointing this out.


  7. Loved your post! And shared on my fb page. This issue has so galvanized women in Virginia that a hastily called meeting of the Women’s Committee at the Fairfax County Democratic Committee got 35 RSVPs in a couple of hours. Nancy Pelosi said it best, “Don’t agonize, organize.”


  8. Sigh. A friend of mine in the USA mentioned she was pissed that Obama was making churches pay for abortion. I have to assume she heard that at church although when I asked where she heard it she never replied. I think there’s a tiny difference between insurance providers of religiously-AFFILIATED (i.e., not the religion themselves even!) institutions being allowed to offer birth control and churches themselves paying for abortions.

    This is a good reason why GOP women aren’t enraged. They are being lied to as to what this is all about and not bothering to find out the truth.


  9. Why is it always the men telling women about self control? Why is it men making rules about women? I don’t hear any men talking about themselves and their “impulses” And what bothers me the most about this needless distraction from real issues is that it’s coming from the political group that wants LESS government intervention.


  10. Being of a different generation than many of the responders to this blog – which is absolutely spot on and a must read! – I am of the age of the original bra-burner, pre Roe vs. Wade, pre oral contraceptive era. We worked and marched and politicked until we achieved these first very important “rights” – and in the VERY recent past. The achievement we failed to gain is the very thing that is allowing all of this “women in their rightful place” action now. We failed to get an equal rights amendment for women to the the constitution. We got close, but it failed to ratify. I am still reeling over that incongruity after these 20 years. How could the US fail to consider all of its female citizens to be less than equal? But here we are. Where all MEN are created equal. Ladies, this has got to stop and this will only stop when we are constitutionally protected. This action will not come from our seated politicians. It will come from us, the women of the United States, standing together to DEMAND equal rights. God, I hate to sound like I am speaking from the 60’s, but do you know what? It feels exactly the same as it did then and I am just as angry! With a daughter and granddaughters now as well, I am completely beside myself as we all should be. We are not talking about a third world country here, we are talking about the United States of America. With this many-pronged attack on the middle class, our granddaughters may very well be able to experience life in a third world country without the need for a passport!


  11. K,
    I know you have had a lot of feedback both as comments and through emails from friends. Do you have more thoughts on these issues that you might put together as another post, based on this feedback and all the attention you have gotten?


  12. The Catholic church hasn’t taught the “rhythm method” in many years. What they do teach is called Natural Family Planning or Fertility Awareness.

    Mother Teresa was teaching Natural Family Planning among Hindus, Muslims and Christians in Calcutta and that BMJ study found a virtual “0” failure rate.

    The other problem with your scenario is that birth control is not the panacea you present here. Not only has the WHO-IARC listed COCs as Class I carcinogens, but hormonal contraceptives also make women more susceptible to infection with the HIV virus. It increases a woman’s susceptibility to serious and potentially fatal blood clots, a risk that is multiplied many times if she has one of a number of normally silent genetic mutations (the Factor V Leiden mutation being the most common one).

    Natural Family Planning also does not require the use of a thermometer. There are other effective means for determining a woman’s fertile period that are low-tech and easily teachable. It does not poison women’s bodies or the environment. Instead it helps women own their own fertility and understand how their body functions.

    Finally if you have genuinely never heard one woman of your acquaintance explain this as a religious liberty issue – well, you may have lived in several more countries than I have, but your world is much narrower.


    • It’s a FAUX religious liberty issue. The insurance companies are happy to provide contraception for free because it’s so much cheaper for them to prevent a pregnancy than it is to pay for one and then insure the additional child or children. The employers are not being asked to pay for it. The claim of violation of religious liberty is simply a political stunt that is backfiring and is mobilizing support from people who care about families. My parents started using “Natural Family Planning” after their third child, but gave up and started using the pill after their sixth, so I’m a bit skeptical of claims about how successful this method is. Although my parents were extremely fertile, they were able to stop having babies after my mother went on the pill, which probably saved the mental health of both of them. They were at their wits’ end, especially as my mother had to deal with increasingly bad post-partum depression with each baby. I imagine, Kamilla, that you are one of those women who has 8 or 10 children. I admire people who can cope with those numbers and still meet all their children’s needs and make sure they all go to college. For most people, this simply isn’t possible.


      • Judging from the mounting number of lawsuits against the administration regarding Obamacare and the HHS mandate, I’d saintly are wrong about what is backfiring. The HHS definition of religious liberty is breathtakingly narrow and virtually unprecedented. The administration would do well to consider that the last time they tried to use a construction of religious liberty this narrow, SCOTUS slapped them down 9-0 in the Hosanna-Tabor case.

        The idea that this will save the insurance companies money and that people are getting their OCPs is,vwell, risible. There is no formulary restriction, the mandate requires that all FDA-approved drugs be covered without cost sharing or co-pay of any sort. This prejudices the market towards the most expensive high-end drugs. No program like that has ever saved money. This is nothing short of a huge$$$ gift to Big Pharma, Obama’s biggest bundlers.


      • ” The insurance companies are happy to provide contraception for free because it’s so much cheaper for them to prevent a pregnancy than it is to pay for one and then insure the additional child or children. ”

        One last comment from me – this is patently false. If it were true, all measures (drugs, procedures, etc) that had a net negative cost would be provided free.

        Can you give me an example of even one insurance plan that covers even one such thing with no out-of-pocket expense to the consumer that hasn’t been mandated?


  13. I wonder if it’s considered good foreign policy to advocate birth control on foreign countries, regardless of local attitudes. (Can’t they do that themselves if they want it?) I wonder whether it’s wise to promote drugs that are strongly linked to breast cancer (estrogens ARE a carcinogen – both the WHO and the FDA have so declared, and this is borne out by MULTIPLE studies from all over the world). I wonder if you have considered that birth control is actually linked to higher rates of AIDS, because people tend to engage in riskier behavior when they think they are “safe”. Some types of birth control act as abortions, so I wonder if it’s wise to push that on people who may have very different attitudes about life than upper middle class, professional, Western women.

    For what it’s worth, I think this blog post mischaracterizes the debate about the HHS mandate. Birth control is not expensive. Anyone who wants it can go get it. This was not a problem and it didn’t need a solution (in fact, there’s depopulation in most of the world already according to the UN’s own statistics). The issue isn’t birth control – Griswold isn’t about to be overturned any time soon.

    The issue is that the HHS mandate forces employers to pay for it, particularly religious employers who believe that it is immoral and unjust. It’s not just about the Catholic Church. This includes Muslims, Orthodox Jews, evangelical Christians and Catholics as well and there are objects from all of these groups and more. Why do we want religious people/organizations not to be free? This is a direct interference in the freedom to exercise religion, multiple religions, and I do not think it will stand constitutional scrutiny.

    As for my own personal opinion, I don’t think ANYONE should be forced to pay for something just because someone else thinks its necessary. We’re allowed to disagree in a free society. The breast cancer issue ALONE is enough to put me off wanting to force this stuff on anyone OR wanting to pay for it for someone else. I wonder how long big pharma thinks this charade can really go on? Eventually the truth will out. Wyeth found out the hard way and it’s now out of business. The other shoe will drop. It’s only a matter of time. Until that happens, I’d like to think I did everything I could to keep more women from getting breast cancer.


    • Thank you for your comment. I will probably post a follow-up article eventually in response to the many comments this post has received, but I do want to make the quick point now that I never said anything about foreign policy. I called it a “Foreign Service perspective” because it’s my perspective as someone who has lived overseas for many years as the spouse of a Foreign Service officer. I am not a Foreign Service officer myself. This is my personal blog, and my personal point of view, and that’s all. Just in case anyone is confused about that!


      • Beatrice was your housekeeper? I am curious if she gave you permission to use her photo and describe her personal circumstances? I would be interested in her perspective as a Foreign Service housekeeper. It seems to me that many women have their own context and that it’s a gracious gesture to try to understand their points of view, even when they are living in circumstances that seem undesireable to us. Many women who transplant into Western world still do not adopt Western women’s sexual and reproductive practices. I think there is a lot we could learn from each other even if we do not like the role of the male (which I found hard to understand in some of my Middle East travels), their birth rates, their dress, etc. While we might think contraception is the magic bullet to ease their lives, that’s just not obvious when you consider other factors. Hans Rosling’s Ted Talks on population growth and his recent one on the Magic Washing Machine actually challenge the assertion that birth control is the crucial component to improving the economics of women living in poverty.


  14. What a wonderful article!!! It really resonated with me because my dear mama always informed me, when I was growing up in the 70s and 80s, that I would not be using contraception ever because I was Catholic! “My dear, you can’t get away from your uterus!” she would tell me. My parents would not pay for my university education, although they paid for private schooling AND university education for all my brothers. Although I got better grades, I went to a state school and had to cover the costs of my own education — because I was simply going to be a walking uterus, so education was wasted on me. I wish no other girl ever had to grow up with this bigotry and these handicaps, but, sadly, women in Africa and some other places live with such craziness all the time and are denied fulfilling their potential and helping their children as a result. I totally agree with you — contraception that is almost 100% fool-proof is THE reason for women’s progress and social progress in general. I will have my daughters read your blog post. Thank you for writing it!


  15. Hmm…I found this blog while exploring possibilities of a foreign service career. I think it’s unfortunate that hormonal birth control is so often pushed as the cure-all in such situations. I think it’s even more of a concern because hormonal birth control is very much linked to certain societal values. In reality, the Catholic Church teaches Natural Family Planning, which is just as effective as other forms of birth control, and this has been tested. Many may counter with anecdotes or opinions, but the research bears it out. People often deride it out of a lack of knowledge.

    So given that there *is* a viable alternative to hormonal birth control that would also enable couples to determine when to conceive, and that such an alternative would be more in keeping with those cultural values in addition to being much more economical and healthier…I think it’s fair to ask the question why such a method automatically receives such backlash.

    I am not the world traveler that others are, but it seems that *children* are actually not the problem here. And I think it is a distinctly Western perspective that looks at all the factors involved in the creation of such poverty and determines that lessening the number of children is the solution. I don’t believe that people should have children that they cannot take care of; at the same time, for some, children themselves are considered a blessing–and having many of them more so. Westerners typically value greater economic prosperity over children and it concerns me that that mindset is being projected onto societies that don’t have that mentality. Again, a couple has to be able to take care of the children they have. But I’m guessing that’s why the Catholic missionaries are teaching women natural family planning, so that they can do just that.


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