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.”


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