Wednesday, June 25, 2014

A Communal Emphasis on Child-Having

Spring 2013

My husband and I are trying to conceive. It's been several years and has included the ups and downs of miscarriage and medical intervention. When relevant, when speaking to someone newly married and under 35, or with children or grandchildren in that situation, or who asks me about my child-having journey and what they can do to help, I want to scream, "DO NOT WAIT. IF YOU WANT CHILDREN, HAVE THEM NOW."

I turned 40 in the days after we found out about our second miscarriage. It is not unlikely that we will have a child; in fact, I feel optimistic. But the three children that were my intent as a younger woman seem impossible, now. And, our pregnancy journey is already long, exhausting, medically invasive and genuinely expensive. We may use an egg donor or adopt, each of which I feel lucky to even be able to consider, but each of which are options to grow accustomed to. And, we may choose between owning a house and having a child.

I have had a lot of "what if" kinds of thoughts: What if I had frozen my eggs? What if I had worked harder to marry younger? What if we were certain we could afford IVF and the rest of our dreams? In any of these cases, would I have more children? Would I have them at a younger age? Would I be less tired and more healthy when I eventually become a parent?

Marriage and childbirth are loaded in many communities, no less so within Jewish life. Not all have the freedom to marry legally. Not all want children. Communities are not always welcoming to "non-typical" families, including single adults or couples without children. Jewish law, halacha, and assisted reproductive technologies are not always in harmony.

These are truly complicated issues, and while they deserve full attention, I want to focus on other ideas related to child-having.

Because when people ask what they can do (after my miscarriages), or they ask how I am, I don't scream, or even say matter-of-factly, Please start having children now. I keep silent. Our society is structured so that it is essentially not my business who has children, when they have children, and how they have children. The taboos of talking about how people had children, if they miscarried, why they might have had only one child - these taboos are deep. They are also genuine roadblocks to the spread of information.

I always wanted kids and imagined my life with them. If I had thought about it at all, I would have imagined the actual having of the children as something that would happen easily, not something that I needed to pay attention to. But I didn't think about it; my mind was elsewhere and I was unprepared. When I was 30 and perhaps should have frozen my eggs, I was in graduate school, pasting together a living from part-time jobs, having come to school after earning an entry-level salary. If it had occurred to me to freeze my eggs, I would not have had the thousands of dollars needed. I had no understanding of a future. Freezing eggs asks that we pay an annual storage fee, possibly for dozens of years into the future. At 30, I could see months, not years ahead.

At the same time, I did not really understand the ramifications of trying to bear children as an older woman. When I was younger, I had plenty of mentoring opportunities. I went to sessions at conferences for young professionals, was matched one-on-one. I had close colleagues, sometimes decades older than me, who were plenty concerned about my romantic life. But no one ever talked about how to have children. As a result, I'm not sure that, when it was biologically or medically relevant to me, I knew the possibilities that were open to me.

We should strive to make it as easy, easy, easy as possible for women and individuals in any situation – in their late thirties and forties, gay and single – to have children, thereby building the Jewish community in imperative ways.

Four calls for action


Offer financial assistance for assisted reproductive technologies


In most states, health insurance does not cover assisted reproductive technologies (ART), particularly the more expensive technologies. Sometimes, couples try less expensive but less successful technologies, because they can afford them or because their insurance covers them; these less successful technologies might work but they might not, and they can postpone the women's age of childbirth and exhaust potential parents, exacerbating the problem. Like me, many twenty- or thirty-somethings do not even consider freezing their eggs because the cost is prohibitive within the context of their day-to-day expenses. In the 1970s, Jewish Family Services in a variety of communities launched adoption services, opening up the black box of adoption for families, helping families find Jewish-born babies when possible, providing a trusted service in-community, and subsidizing the cost. Similarly, a few Jewish Family Services are beginning to work in the area of infertility. Too few, though, have the resources to offer financial support. The costs of ART can be significant, but Jewish life holds significant philanthropic dollars, particularly for the purposes of Jewish continuity. By offering financial support of any size, Jewish organizations would subsidize Jewish communal growth and validate infertile adults' incredibly challenging journey.

Make talking about fertility a priority


Medical professionals own the complicated web of facts and figures that is the field of ART. This is reasonable; the information is multi-faceted and driven by complex scientific research. But, particularly because most medical offices work independently, this means that each medical professional can offer a different opinion, and individuals need to swim through the complexity,playing detective, identifying different sources, putting together facts and ideas, trying to determine what is best for them, and usually doing this analysis in their own living rooms, away from the bias – but also away from the expertise – of professionals. Sometimes, potential parents' analysis moves onto web sites and into chat rooms, but these virtual resources are often not a satisfactory replacement for a confusing, lonely, and emotionally fraught process.

Well-networked, Jewish organizations can collect and present information about fertility, amassing experts with different ideas, putting together information evenings that allow interested potential parents to explore options without the pressures of shopping for “right” decisions. More than information, such evenings and workshops can offer ideas embedded among the riches that Jewish community offers: a larger communal, spiritual, and emotional context of support.

Talking about fertility needs to happen with those seeking parenthood immediately and also with those who want one day to be parents. Information sessions about ART can also be offered for younger individuals, particularly women in their twenties who have eventual marriage but not immediate parenthood on their minds. Jewish organizations should put such information in front of individuals' minds and hearts, again, making it easy for women to see their options early, at the right time.

Some Jewish Family Services offer support groups for infertile adults; more should, and these support groups should be well advertised and linked to fertility clinics so that they are easy to find. Kveller.com has a series on infertility, and this is helpful, but internet support can be – literally – cold comfort. This conversation cannot be kept in the medical and therapeutic realm, and it needs to be personal. Rabbis and Jewish educators seem rarely to approach this issue in public and outside of pastoral relationships, particularly from the bimah. Those who interact with twenty- and thirty-somethings and with parents – rabbis of synagogue young adult groups and early childhood educators, for example – need to be able to talk openly about resources for primary and secondary fertility, to make it easy for those suffering to approach them and ask for guidance and support.

Create public ceremonies for mourning fetal loss


Mourning fetal loss within a Jewish context is challenging. Jewish law, halacha, does not acknowledge fetal loss as death, which I appreciate. At the same time, recognizing the gray in this part of life, for hundreds of years Jewish women have acknowledged that even without official death there is room for grief. Private rituals for women or, now, families to mark loss are collected in Four Centuries of Jewish Women's Spirituality1 and on ritualwell.org.

But what about public conversation? I recently was invited to a ceremony in a church, sponsored by home-birth midwives, to honor the "unborn." I was compelled by the concept but also wanting it to be in a such a different form: I wanted to have this conversation and ceremony in my space, in a Jewish space, with community members whom I see every Shabbat, with people with whom I have an ongoing spiritual relationship, using Jewish symbols and ideas. Religion is exactly about each of these things: using the familiar space, symbols, and community or family to mark, celebrate, or mourn time. Our communities could develop space to hold and manage these rituals and ceremonies, acknowledging that fetal loss is a part of life and that we - as a community - are in the work of building families together. Rabbis can talk of fetal loss from the bimah, making it safe to acknowledge out loud, even if – according to Jewish law – kaddish is not said for these losses.
Progress is this area is beginning. In San Francisco, a Memory Garden for fetal loss is held at a local Jewish cemetery, creating the space for families to honor and mourn their loss. Abby Michelson Porth, one of the founders of the Garden, discusses the importance of this Garden as linking emotional loss, which might happen in Jewish space, and the physical or medical loss that typically happens within the medical realm. Media coverage of the Garden has stressed the extent to which Jewish women have felt silenced about their fetal loss.2 By creating public spaces and opportunities for mourning, we invite possibilities of conversation. We begin to break down taboos around infertility, miscarriage, and pregnancy loss.

Build an Institute for the Jewish Family


As described, the “family” as an issue of conversation and investment is inherently political. This, perhaps, is less about Judaism and more about America, or maybe it is just part of being human.
Still, this investment is no longer something to set aside as too controversial or too difficult to measure. Caryn Aviv recently wrote an impassioned letter to Jewish communal mega-philanthropists; no one, perhaps, could say or has said it better. She called for a “Jewish National Reproductive Fund” as “an act of Jewish vision and courage.”3 Indeed, it is. Let's put our stakes in the ground and say, We believe in Jewish children. Let's not put pressure on those who are reluctant to have children, and let's continue to make sure that single adults are as welcome in Jewish life as families of any size are. But let's also recognize that Jewish children will create Jewish community, and that Jewish adults need help having Jewish children.

The Hasidah Foundation4 launched over a year ago with the goal of supporting adults' use of ART. We need even more than that. We also need thought leaders around the Jewish family, those who are advocating for local conversation and work related to family growth, fertility, and family loss. We need someone to consolidate smart practices among Jewish Family Services and synagogues, to write and teach curricula for Jewish fertility/unwanted infertility support groups, to keep this on the agenda of these organizations. We need articles in newspapers and uncomfortable but safe conversations in 20- and 30-something spaces. We need Jewish men and women to know about their options, and we need their options to be easier.

Jewish community has many moments when it is at its best. Right now, to be blunt, some of its weakest moments coincide with the worst moments in some of our lives. Like a journey through infertility, this effort can seem overwhelming. Yet, it begins in conversation, in individual leadership, by reaching out. It needs financial investment, but it begins with awareness, with Jewish communal professionals and leaders learning about the issues and then making space for conversation and program. Start by asking friends, colleagues, and acquaintances about their own experiences with infertility. Open up questions. What would they have wanted? Needed? What did they look for that they could not find? Begin by talking. See what ideas grow, and the pain won't go away, but it might be easier to take.




1 Ellen Umansky and Dianne Ashton, eds (Massachusetts: Brandeis University, 1992)
2 “Memory Garden: Soon, a Place for Parents to Reflect and Meditate” j Weekly November 8 2012 http://www.jweekly.com/article/full/66974/memory-garden-soon-a-place-for-mourning-parents-to-reflect-and-meditate/ retrieved May 30 2014.
3 "Abandon Hope? A Polemic and a Plea” http://shma.com/2014/03/abandon-hope-a-polemic-and-a-plea/ retrieved May 29, 2014.
4 "An Organization to Help Those Struggling with Infertility” http://shma.com/2014/03/an-organization-to-help-those-struggling-with-infertility/retrieved May 29, 2014. Kayama Moms is another advocacy organization (kayamamoms.org), focusing on Israel-based single mothers by choice.