Wet-nurses stage a comeback? According to Time magazine, a mini-surge in popularity for the practice comes because breastfeeding is at a fifty-year high, and today’s young moms believe breast (milk) not only best, but also better from a breast. At about a thousand dollars per week, wet-nurses earn more than nannies do or than gestational surrogates receive to carry out another intimate and arguably relational task, that of pregnancy. While it might seem that breastfeeding and abortion have little in common, delve further. The Supreme Court with its recent decision about later-term abortion believes that legally women do not enjoy agency over their own reproductive decisions. Pair this reality with another: procedures or practices that are advantageous to doctors and hospitals, pharmaceutical companies or insurers have security over ones that are not.

Reintroduction of wet-nurses is a small-scale occurrence (at a thousand dollars per week, enough said). Yet, even if the service were less expensive, it’s unlikely that most women would opt for a wet-nurse because cross-nursing (a woman breastfeeding another woman’s baby) is a fairly taboo practice. Our society defines the breastfeeding relationship as one between mother and child, largely for the very sound reason that it is intimate. When the wet-nurse story ran on the Today show, an academic likened wet-nurses’ services to gestational surrogates’ services, asserting that the emotional fallout possible from paying for such personal tasks seems great. Gestational surrogates, like other aspects of fertility assistance, are regulated primarily by private agencies. There’s little federal regulation regarding fertility assistance, mainly due to legislators’ unwillingness to navigate hot-button issues involving reproduction. Reproductive technologies aren’t uniformly covered by insurance and thus can become very expensive (and simultaneously extremely lucrative for doctors), adding economic pressures to political ones. Economist Debora Spar, in her recent book, The Baby Business , illustrates just how meteoric the rise in treatments has been in a very brief window: “Between 1995 and 1998, the number of in vitro procedures performed in the United States rose by 37 percent, from roughly 59,000 to roughly 81,000. During the same period, the number of fertility clinics rose from 281 to 360.”

If fertility is relatively unregulated, abortion services are ruled by legal and social constraints. The anti-abortion movement has commandeered the concept of “life” so thoroughly that clinics providing pregnancy termination services must sit behind virtual bunkers. Metal detectors, discreet signs—if signage appears at all—and every privacy measure in the book characterizes the clinic experience these days. Threats of harassment and physical violence to clients and doctors not only enshroud the service itself in a climate of fear, but also a climate of being, at least somewhat, wrong. With all of these measures in place, the entire endeavor feels shady, a procedure at best lurking on the edges of the law. So often language surrounding abortion is apologetic—even from those who support the right. Missing, even from supporters, is mention of the unwavering fact that women cannot function as equals to men in our society without the ability to exert agency over saying yes or no to pregnancy. We think of this primarily in terms of unplanned pregnancies, but without later-term terminations, women may lose their lives or their future fertility because a medical option has been taken from them (and their doctors). Providing abortion services—along the risk of being a dangerous endeavor—isn’t necessarily a lucrative undertaking, with high costs of insurance and security and potential loss of patients (for other services).

No commensurate moral quandary over midwives exists, yet access to midwifery care in this country is being compromised for the overriding reason of profitability. Although midwives enjoy better outcomes—lower infant mortality rates, fewer interventions including episiotomies, inductions and cesareans (in one recent study midwives’ rate was under 10% compared to 22% for obstetricians)—access to midwifery care is shrinking. One estimate is that midwives attend only one out of every twenty births in this country. The cost of training midwives, according to a study at Johns Hopkins, is a quarter of what it takes to train an obstetrician.

It seems too simplistic to say that access to the widest range of services involving reproduction is available to the country’s wealthiest women. But that’s the case, nonetheless; no fertility assistance measures are available to poor women. Medicaid does not pay for abortion. Even if insured, most women cannot afford to secure a midwife’s services—pregnancy care, labor, delivery and a hospital stay—unless that choice exists within her network of approved providers. Two principles need to guide those of us who care about the quality of women’s health services and about women’s equality: authentic access to health care options for all women and ensuring that women have true agency over their bodies.