Monthly Archives: April 2017

The Right to Choose for All? Abortion Access for Low-Income Americans

As patients shuffle in and out of the Planned Parenthood health center in Boston, 69-year-old John Russo paces outside the Commonwealth Avenue clinic. Around his neck, a black sign hangs; it reads, “PRAY TO END ABORTION.”

Russo, a retired engineer from Norwood, Massachusetts, is in the last week of a biannual 40-day campaign protesting Planned Parenthood. He has been been doing this for three and a half years, along with his wife, for the Boston branch of 40 Days for Life, an international organization that aims to end abortion with prayers, vigils and community outreach.

“I’m hoping that by being out here, I can raise enough awareness to make people not want to have an abortion,” Russo said. “So we’re here to make it unthinkable versus illegal.”

For many women, though, what is unthinkable is being forced to remain pregnant when they do not want to be—for health, financial, emotional or other personal reasons. Though the Supreme Court legalized abortion nationwide more than 40 years ago, the procedure continues to be stigmatized, and American women face increasingly strict regulations to abortion access.

As Russo protests outside Planned Parenthood, scholars gather at Boston University less than a mile down Commonwealth Avenue for a roundtable event titled, “Legal, Structural and Stigma-Related Restrictions on Reproductive Justice.” Bayla Ostrach, an assistant professor in the Boston University School of Medicine, says that abortion stigma is especially harmful for marginalized groups—in particular, low-income women—who already struggle with access.

“If you also layer on a lack of race and class privilege, poverty…anything else that is going to make it harder for them to access resources, [abortion stigma] is just going to compound that,” said Ostrach, who studies reproductive anthropology and abortion access.

Roe recognizes reproductive control  

The constitutional right to abortion stems from Roe v. Wade, in which the Supreme Court ruled in 1973 that criminalizing abortion in the early stages of pregnancy was unconstitutional.  

Left, Norma McCorvey, the anonymous plaintiff in Roe v. Wade, stands on the steps of the Supreme Court with her lawyer Gloria Allred in 1989. Photo courtesy (cc) Lorie Shaull

Jessica Silbey, a Northeastern School of Law professor, said Roe was the first time that the court recognized the importance of a woman’s right to control her reproduction. Silbey studies constitutional law with a focus in reproductive justice, and represented the Planned Parenthood League of Massachusetts as a full-time litigator.

“Roe v. Wade was a case that basically confirmed what most women who engaged in heterosexual sex, whether by choice or not, knew to be true about their life—which is that controlling whether or not you are a parent was essential to freedom,” Silbey said.

When asked about whether he wanted Roe v. Wade overturned, Russo said he was less concerned with shaping laws and more focused on changing people’s minds.

“I think you have to be careful when you think about laws. Laws don’t govern morality. It’s the other way around,” Russo said. “Our morality generates the laws that we have.”

At the roundtable event, Ostrach also used a morality argument—but in favor of abortion access.

“Denying someone a wanted abortion is clearly unethical,” Ostrach said. “It exposes that person to increased risk for reproductive harm, and increased risk for ending up in poverty and increased risk for being in an abusive relationship years later.”

Hyde restricts federal funds

Though he is less interested with the legal side of the debate, Russo said he did not believe the government should support and pay for abortions.

“If we live in a society that says, supports and pays for a woman, encourages a woman, to bring her child here to have its life ended, then what does that say about the rest of our culture?” Russo said. “It doesn’t say anything good.”

Russo’s implication that the government pays for abortions, however, is misleading. Ostrach said similar calls to defund Planned Parenthood and pull taxpayer money out of abortion services were a distraction technique meant to drum up abortion stigma.

The Hyde Amendment already prevents people from using Medicaid—a federally-funded health care program for people in poverty—to pay for their abortions. There are exceptions if the pregnancy threatens the woman’s life or if it was conceived as a result of rape or incest, but Ostrach emphasized that even cases that fall under those exceptions are sometimes denied.

People in poverty can only use Medicaid to cover their abortions if a state provides its own funding—17 of which currently do.

This map from 2009 shows 16 states that provide Medicare funding for abortions. Since then, South Dakota has also joined the list. Dark blue represents states that provide it through legislation, while the others are through court orders. / Photo courtesy (cc) 2009 American Civil Liberties Union, Wikimedia Commons

“Most people in the United States, if they’re in poverty, still have to come up with money to pay out of pocket for an abortion,” Ostrach said. “And that’s because of the Hyde Amendment.”

Though the Hyde Amendment poses a significant challenge for low-income women, it has not qualified as an undue burden—which the Supreme Court ruled states cannot impose on women’s access to abortion in the 1992 case Casey v. Planned Parenthood.

What the court says is that inability to exercise your choice is not the state’s doing. The state didn’t create that hurdle, that hurdle can from someplace else,” Silbey said. “I find this incredibly troubling and a twisted way of understanding how class and poverty work to restrict women’s choices.”

The real costs of abortion

What affects low-income women more than the cost of the abortion procedure, which Silbey said ranges from $250 to $500, are the costs associated with traveling to the clinic—some of which are up to 300 miles away.

Restrictions have tightened around the country, with some states now requiring multiple visits days apart for an abortion. This means women are tasked with taking more time off work, paying for nights in hotels and spending more money on childcare (as more than 60 percent of women who terminate a pregnancy already have at least one child).

“For women in parts of the country where clinics are not easily accessible, within an hour or two drive for example, and where the states require multiple visits, those women who tend to be non-urban working-poor or poor are deeply affected by (these regulations),” Silbey said. “And they often don’t have abortions.”

Even in states that provide Medicaid funding, low-income women worry over basic costs associated with accessing their abortions, Ostrach said.

“People have said to me, ‘You know, I knew I was going to have that Medicaid coverage by the time it finally came through…I knew the abortion would be paid for. What I didn’t know was how I was going to eat while I was there,’” Ostrach said.

Victimization in abortion access   

When it comes to abortion access, Russo said he sees multiple victims.

“There’s the unborn child who loses its life. There’s the mother,” Russo said. “And there’s also the family.”

But for people who have worked closely with women trying to access abortion, they see health care barriers and abortion stigma as the causes of victimization. Ostrach and Silbey understand that abortion access is the difference between freedom and second-class citizenship.

“A legal or high-quality abortion is one of the safest and most common medical procedures performed,” Ostrach said. “That’s why it’s ridiculous that it’s not on this list of sort of essential services provided by all health care plans.”


Washington lawmakers take steps to ease birth control access


Washington lawmakers passed a bill allowing women in the state to get 12-month refills. / Photo courtesy (cc) 2014 Sarah Mirk

A common argument heard from some anti-abortion activists (namely, the non-religious ones) is that women should use contraceptives instead of resorting to abortion as a form of birth control. But here’s a little dark secret that most people often don’t talk about: birth control pills aren’t all that easy to get.

Under most forms of private insurance, birth control are free or available at a low cost. However, due to those insurance restrictions, women can often only get packs that last one month at a time. In some cases, you can get packs that last for three months.

The result is a lot of trips to the pharmacy, which can be a burden for middle-class or upper-class women, but nearly impossible for low-income women—especially those who work long hours or multiple jobs, don’t have cars or can’t afford public transportation.

Lawmakers in Washington State just took a step to make getting birth control a bit easier for women in the state. The State Legislature passed a bill allowing women to get 12-month refills for their prescriptions at a time. It now awaits a signature from Gov. Jay Inslee.

If passed, the law would do wonders to ease access to birth control for women in the state, especially those who face additional barriers due to their income status.

As US tightens abortion regulations, Canada makes abortion more accessible


The Canadian province New Brunswick will soon offer an abortion pill for free. / Photo courtesy (cc) 2006 Alex Indigo

The Canadian province New Brunswick announced last week that it would start providing the abortion pill Mifegymiso—typically valued at $300—to women in the province for free.

The move is an effort by the Canadian health department to reduce financial barriers to abortion and to make abortion more accessible for women who live in rural parts and cannot make the trip to clinics. Surgical abortions are already covered under the provincial health plan.

“By making Mifegymiso available free of charge for all New Brunswick women, our government is ensuring that financial barriers do not stand in the way of a woman’s right to choose,” Health Minister Victor Boudreau said.

This moves stands in stark contrast to how American states have taken to regulating abortions in their jurisdictions. Instead of making it more accessible, it seems conservative U.S. lawmakers have tried to implement every barrier imaginable—especially for low-income women. These include but are not limited to: mandatory waiting periods, mandatory counseling and required ultrasound viewings.

Coverage for abortion varies across provinces, but the Canada Health Act generally covers the cost of abortion for Canadian citizens, with some clinics implementing their own additional fees.

Meanwhile in the United States, Medicaid—which provides health insurance for those under the poverty line—cannot be used to pay for abortion. Yet every day, conservative Republican lawmakers and evangelical activists fight to “Defund Planned Parenthood”—which, in practice, would really look like stripping funds for cancer screenings and tests and treatments for sexually-transmitted infections including HIV.

It’s worth noting that as American state governments do everything in their power to put up obstacles for women trying to exercise their constitutional right to choose, the Canadian government has gone in the opposite direction, doing everything in its power to make sure women can practice that right if they choose to do so.

Scholars, activists and students gather at Northeastern’s reproductive justice conference

Iowa State Legislature passes bill banning abortions after 20 weeks


The Iowa State Legislature votes to ban abortion after 20 weeks. / Photo courtesy (cc) 2017 J. Albert Bowden II

The Iowa State House passed a bill last week that bans abortions in the state after 20 weeks of pregnancy.

The vote in the House came a month after the State Senate approved the measure, and the bill is now headed to Iowa Gov. Terry Branstad, a Republican.

If passed, Iowa would become the 18th state to prohibit abortions after 20 weeks. It also adds a three-day waiting period between a woman’s first doctor’s visit and when she can receive an abortion.

Branstad is likely to sign the bill into law, just before he leaves to serve as President Donald J. Trump’s ambassador to China.

The bill makes an exception for abortions passed the 20-week mark if the pregnant woman’s life is in danger. It does not make exceptions if the fetus has genetic disabilities.

The 20-mark period in pregnancy is in the middle of the second trimester (which lasts from week 13 to 27) and abortions performed at this point are often referred to as “late-term abortions.”

What Republican congresspeople fail to realize is that many women who are getting abortions at this point are not making the decision lightly. Often times, the fetus has severe disabilities, some of which may result in imminent death.

Rep. Sharon Steckman shared a story on the House floor about a woman who aborted her fetus after 20 weeks when she discovered it had a serious lung condition.

“The baby had a condition where the lungs would not develop,” Steckman said. “So if that baby had been born, it couldn’t breathe and the parents would literally watch it suffocate.”

Wendy Davis, a former Texas state senator, became famous for filibustering an anti-abortion bill on the floor of the Texas State Legislature for 13 hours. She would later open up about an abortion she had after the 20-week mark.

“I discovered that my daughter was suffering from an irreparable and non-life sustaining brain deformation or malformation, and it was one of the most heart-wrenching decisions I’ve ever had to make,” Davis said to Mic. “And I made my decision out of love.”

These women, among many others, do not need to experience more challenges than they already are when they chose to get an abortion after 20 weeks. And they certainly do not need to be lectured about the morality of the decision they are making. Ultimately, they are making the decision they believe is best for them and their fetuses—and the government should stay out of that decision.

Indiana judge strikes down abortion ultrasound waiting period


An Indiana federal judge struck down a law Friday requiring a woman to have an ultrasound 18 hours before getting an abortion. / Photo courtesy (cc) 2011 by Rob McBell

In a win for women’s rights, a federal judge in Indiana struck down a state law requiring that women receive an ultrasound at least 18 hours before receiving an abortion.

The state law replaced a prior statute that required women to get an ultrasound before having an abortion, but did not specify when. The new mandate would have forced women to make at least two separate trips to the clinics—which was ruled to be an undue burden particularly for low-income women who would have to travel to the clinics and then pay for lodging and miss additional time off work.

The basis for an ultrasound law comes from the paternalistic idea that women who are getting abortions (many of whom are already mothers) do not really understand what they are doing. The thinking behind this law is that a woman must be forced to see the image of her fetus, have its developing organs pointed out by a doctor and listen to its heartbeat—because only then can she wrap her mind around the gravity of what she’s doing and see the error in her ways.

Except here’s the thing: It doesn’t work. A study cited in the Indiana ruling found that 98.4 percent of women who view their ultrasounds still go through with their abortions, compared to 99 percent of women who did not view ultrasounds.

The reason it doesn’t work is because women do understand what they’re doing. More than 60 percent of women who have an abortion in the United States already have at least one child. They understand what it takes to bring a child into this world and raise him/her. They understand the time, energy, attention and money that it requires. And even for the 40 percent who are not mothers, they too understand that it is not the right time for their lives or the choice for their bodies to go through with their pregnancies—for one reason or another that is really no one’s business.

That’s why the overwhelming majority of women who are forced to watch ultrasounds of their fetuses (a measure that seems to serve no purpose other than as punishment) continue to go through with their abortions. They understand what they’re doing, and they don’t need to be enlightened by a bunch of anti-abortion men who will never have the chance of becoming pregnant themselves.

And who do we have to thank for that original ultrasound law in Indiana? Vice President Mike Pence, who signed the bill into law as Indiana governor in March 2016; a man who is so well-versed on women’s rights that he cannot eat alone with women other than his wife.