Abortion in the Religious Zionist Community

See below for an update.

In this week’s newspaper Makor Rishon, Yifat Erlich interviews couples in the national religious community who underwent abortions because of health problems with the fetus. Afraid of criticism from their close-knit communities, many ended up alone during this traumatic period.

More from the article:

• Two medical clinics in Jerusalem treating risky pregnancies each reported that 70% of pregnant women in the national religious community undergo testing for Down’s Syndrome. (I presume this referred to blood tests and follow-up amniocentesis when indicated.) In 90% of the cases where Down Syndrome is detected, the couple decides to terminate the pregnancy. One of the doctors interviewed said that this statistic is not new, but people have begun talking about it. A higher number of abortions are being performed only because of more accurate testing.
• Ten years ago, Rabbi Shlomo Aviner wrote an article encouraging older women (over 37) to become pregnant, and promised to “stand beside them” if a deformity would be discovered. This was understood to mean that in theory, he would rule to allow abortion in the case of Down Syndrome. Obstetricians hung the article in their offices and called the resulting babies “Aviner’s children.”
  In the Makor Rishon article Rabbi Aviner is quoted as saying that if the parents would not be able to cope, for instance if there are already many children, he would permit an abortion of a baby with Down Syndrome. In the case of CMV where it is not clear whether the baby has been affected, he leaves the decision up to the parents.

I am not sure that knowing that a rabbi might allow an abortion helps parents who end up in that place. Having to deal with the devastating news and make such a difficult decision—because you can never be certain how you will feel when it is real—is still a deterrent to pregnancy for older women. Also, pregnancy at a later age is riskier for the mother and should not be taken lightly.  But Rabbi Aviner believes that the risk of one terminated pregnancy should not prevent two hundred healthy babies from being born.

The relatively liberal attitude in the national religious community toward termination of abnormal pregnancies reflects the overall Israeli attitude toward prenatal testing. Israel’s mothers undergo more prenatal testing, including multiple ultrasounds and state-of-the-art tests paid for by the government, than those of any other country. A doctor quoted in the article said that Israel has the world’s highest termination rates because of fetal defects.

The religious internet site Kipah has a new forum for support after pregnancy loss.

Updates:

• Here is a link to the text of the article, posted on the Kipah forum. Thank you to commenter Keren.

• Commenter Annie pointed out that according to this Ynet article, Israel’s overall abortion rate is lower than that of most countries in Europe, and dropping.

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Supply and Demand in Breastfeeding at Green Prophet

I have a guest post up at Green Prophet, Breastfeeding and “Supply and Demand.” If you know anyone worried about not having enough milk, this is a good place to start.

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Dr. Hanna Katan: Large Families,Yes. Demanding Careers for Mothers, No.

Ynet interviews Dr. Hanna Katan, religious Zionist mother of thirteen and gynecologist with a sub-specialty in fertility. Katan considers a large family to be the ideal and has served on a committe to encourage secular mothers to have more babies. Her own mother raised eight children and served as a role model for her.

When asked about combining a career with a large family, Katan responds:

“I wouldn’t recommend it. The list of priorities was always clear to me: My family comes before my career. When my daughter expressed an interest in medicine, I suggested that she study nursing and become a nurse. It’s very difficult having such a demanding profession as a woman: The unending duties on Shabbat and on holidays as well, the kindergarten birthday parties I missed.

She mentions that she did not advise any of her children, male or female, to study medicine.

Katan disagrees with the stereotype of an unhealthy, poor mother whose many children don’t get enough attention.  According to Katan, studies that show disadvantages among children of large families are based on populations without the resources that Orthodox Jewish families enjoy. [My husband read somewhere that modern Orthodox Jews and fundamentalist Christians are the only educated, socio-economically stable population to raise large families.]

As a fertility specialist, Katan has helped families who struggled to get pregnant with their ninth child. When asked about lack of attention, she responds, “There is extra attention from the older siblings which smaller families lack, and it’s as important.”

For me, spacing of children is more of an issue than the number. Toddlers need their parents (ideally their mothers, if she is the primary caregiver) as much as they did when they were newborns, if not more. Couples who plan to try and conceive before their baby is a year or so need very strong support.  Relationships with older siblings are wonderful but babies and toddlers are still the parents’ primary responsibility.

Of course, each family is different and spacing of children is only one factor in the success of a family.

Related posts:

Child Spacing Part 1: When Does Chinuch Begin

Child Spacing Part 2: Fertility and Parenting Styles

How Do Large Families Manage? Meet Tal and Talia, parents to a fictionalized large family.

Thanks to Jameel for sending the link.

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An easy baby?

Occasionally you will hear a discussion among mothers about which number baby is a bigger adjustment. Typical answers:

• The first, because you are new to motherhood.
• The second, because you must balance the needs of two.
• The third, because you only have two hands, or because the children now outnumber the parents.

When I ask the mothers for more details, I often find that the answer has more to do with the individual personality of the baby than the number of children in the family.

I have been thinking about this in preparation for my upcoming annual trip to the US, to visit my father. I always agonize over which children to bring, because my husband stays here works most days but still has to be responsible, on some level, for the ones left here. Last year I brought numbers 3, 5, and 6. This year 1, 2, 4, and 6 are the lucky ones.

In general, I avoid labelling or comparing my children. But in my family, 1, 3, and 5 are the quiet, even-tempered ones. The other three are also good-natured, but when stressed their anxiety or frustration level can go from zero to ten in a matter of seconds, and they tend to get overexcited when happy, too. (“Odd”-tempered, but even-numbered?) I am hoping that the little one (3) will outgrow this, but judging by her current bounciness I don’t expect it. My husband just commented this morning on the number of her bruises, most recently a cut lip from taking too many stairs at once.

I looked back over the years and asked myself: Which pregnancies were the most difficult? 2, 4, and 6. Which births were difficult? Only 4, thank G-d. Which after-birth adjustments were the most challenging, involving extenuating circumstances? 2, 4, and 6. (Perhaps I will write more about these another time.) Which babies were “harder,” meaning that they cried more frequently, needed more holding, and didn’t settle easily? You guessed it.

I’m sad to leave any of my children behind, but at least I know not to expect a quiet, boring trip!

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Close spacing Part 2. Fertility and Parenting styles

Part 1: When does chinuch begin?

There is a direct connection between the type of parenting and child spacing. When the baby stays with his mother day and night, nurses on cue without bottles and pacifiers, starts solids gradually and appropriately, and spends a good deal of his time either nursing or in close physical contact with his mother, the mother’s natural postpartum infertility generally lasts for a year or two. (Six to twelve months is fairly common.) When you hear of mothers who exclusively breastfed and still had a return to fertility or a pregnancy at three months postpartum, it’s often (but not always) related to scheduled nursings, mother-baby separation, or a baby who is encouraged to sleep through the night. Because most young couples and health-care professionals lack knowledge regarding breastfeeding and fertility, the parents can’t make informed decisions. When I counsel haredi mothers they are desperate for such information. This information should be readily available to everyone, but it is especially sad when it is lacking in a community that discourages use of artificial birth control.

Here are some ways I have seen families cope with closely spaced children:

• Sending very young children out to daycare (and not necessarily because both parents are working). Keeping two at home is unusual in Israel, and daycare is dirt cheap in haredi communities.
• Inferior daycare: In my neighborhood a man noticed four or five infants crawling on the sidewalk and in the street. It turned out that they had escaped from a local daycare center (for large families) where the door had been inadvertently left open.
• Giving excessive responsibility to older children..
• Going to a “beit havraah” after birth. This is de rigeur in charedi families, and many municipalities and health funds chip in after the fourth birth. The problem is that because these institutions view their role as giving the mother an opportunity to rest, they interfere with the mother’s bonding with the baby and breastfeeding (because they don’t allow the mother to have the baby with her at night and encourage supplementation). One mother I spoke to discovered when she got home that her baby really needed to nurse every two hours, instead of the five-hour schedule he had been on in the beit havraah (undoubtedly he had received bottles of formula, but she didn’t know about it.) In almost every case the money for this “vacation” would be better spent on household help, meals, and child care, allowing the mother to rest in her own home and be available full-time for the baby and her older children.
• Continuing this pattern at home and allowing others to take over care for the baby so that the mother can recover from birth, and not because the mother had medical complications.
• Sending a toddler to the neighbor’s house for two full weeks after birth, during which time the child does not see his mother.
• Forcing children to sleep through the night before they are developmentally ready.
• Mixing cereal with milk or formula and giving it in a bottle, instead of taking time to feed the baby a meal.
• Unnecessary supplementing and early or sudden weaning.
• Ignoring the toddler except for diaper changes and meals.

We need to question the idea that if something is good for the mother, the baby benefits (“me” time, sleeping through the night, babysitters). We instead need to be pointing out that most things that are good for our babies, ultimately benefit the mother and the entire family.

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Child Spacing, Part 1 When Does Chinuch Begin?

I believe that mothers need at least a year, if not two, between pregnancies to recover from birth. Both the toddler and baby are also shortchanged with closer spacing. Each family is different and with a lot of help and support, along with an understanding of attachment and infant development, it’s possible overcome this challenge. I am colored by my own experience: My oldest two, now teenagers, were born 18 months apart. I would never willingly repeat that experiment, and I am still not sure whether we came out of it okay.

Many Orthodox couples have their first two (or three) very close together. They are reluctant to use birth control at such an early stage, and because they haven’t had experience with toddlers they don’t quite know what’s in store. (Rabbi Maryles discussed some of the halachic issues surrounding birth control.) But young couples are well, young, and most have the energy to run after a toddler (or older baby) all day and wake up with a newborn at night. When there’s a ratio of one child per adult, young babies and slightly older babies can both still get their needs met.

Large, loving, emotionally healthy families are possible because it’s relatively easy to care for a baby while meeting the needs of older children. While you can never give the same amount of attention to two children that you can give to one, different ages require different things and their needs can be balanced. You can nurse a newborn while reading a toddler a story. You can place an infant in a sling while walking an older child to school or helping him in the bathroom. If you have built a good relationship, teenagers will find a way to have those crucial conversations even when life gets hectic. And both older and younger siblings benefit from the relationship. Children learn empathy from seeing their parents respond quickly to a baby’s distress. Older siblings realize that while they are able to wait a bit, helpless babies can’t.

The problem is that the needs of young infants and older infants/toddlers are still very intense. I generally observe the following principle in my own family: The younger the child, the more immediate the need. But there is another school of thought: Get through the baby/toddler stage until the real chinuch (education) begins.

Young babies can’t state their minds. Adults often assume that they don’t notice who holds them or even if they are held at all. Hands-off relationships with babies are acceptable in all segments of our society. “Travel systems,” where the baby’s carseat is strapped into a stroller base, allow the baby to go for hours without being touched. Cribs, playpens, pacifiers and bottles (not to mention Kallah’s bottle-proppers) are tools that create distance between the baby and the rest of the family, and if overused become poor substitutes for social and emotional needs. Babies are human beings and social creatures, and they need to be with people, especially one person who knows them well and tries to understand what they want.

My principle above can’t apply to the age between one and two if a younger baby is in the house. One-year-olds require even more time and energy than babies. They are just starting to learn about themselves and they haven’t gotten around to others yet. Naomi Stadlen, in her brilliant book “What Mothers Do: Especially When It Looks Like Nothing,” writes about an 18-month-old who is only beginning to show some signs of empathy toward a playmate in distress. They are learning about their physical surroundings, their bodies, their boundaries, and their language. They require constant supervision, interaction, and physical closeness. Parents must consider the effect of a new pregnancy on a toddler, and whether the arrangements made for him during the mother’s birth and recovery respect his emotional and physical needs.

Mothers also miss out when the birth of a new baby interrupts their intense relationship with a young toddler. Parents benefit from caring for their children; it’s not just a one-way street. And best of all, this type of parenting investment builds security, love, and communication, making child-raising easier in the long run.

Part 2: Fertility and Parenting Styles

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