| print |
abortion became legal, the desired attributes advocates
sought were these: safe and legal. In an
article on the economics of abortion access for (Conscience,
the journal of Catholics for Choice, Winter 2005-2006), Marlene
Gerber Fried writes about Laura Kaplan, author and former member
of the Jane Collective, a feminist underground abortion service
which provided 11,000 abortions to women in Chicago between 1969
and 1973. "Kaplan notes, 'The cost of abortion was a constant
problem, since few women, regardless of their economic status, could
easily manage $500.' The women in Jane were constantly arguing and
negotiating with their provider to get him to drop his price. After
the women in the collective got rid of their 'doctor' and became
providers the group dropped the price to $100, but a woman only
paid what she could afford and Jane became essentially a service
for poor women." Although some -- like the Jane Collective
-- long ago understood it to be an issue, access was not the third
attribute listed after safe and legal.
Fast forward to 2005:
abortion remains legal, but with many caveats; depending where you
live, abortion might be effectively illegal. Not only is access
to abortion constricted in this country, other legal health care
is also no longer universally accessible, including emergency contraception
(the "morning after" pill) and oral contraceptives. With
this smattering of examples, you will glimpse just how limited access
to routine reproductive health services has become twenty-three
years after Roe:
fact sheet on abortion explains that "since 1995, bans
on safe abortion procedures have been enacted in more than half
the states and challenged in courts throughout the country."
Thirty-one states have enacted bans on safe abortions. Although
the bans have been challenged and struck down in twenty-one states,
other states continue to introduce new bans.
Thirty states have mandatory
delays and require that clinics share biased information with their
clients. This is enforced, according the Center
for Reproductive Rights, by twenty-four of those states.
In 1976, the Hyde amendment
halted Medicaid's provision of funding for abortion. Only seventeen
states still provide limited Medicaid funding for abortion. Again,
according to the ACLU: "Federal funding restrictions have left
some women on Medicaid little choice but to use money they need
for food, rent, clothing, or other necessities to pay for an abortion.
One study showed that nearly 60% of women on Medicaid were often
forced to divert money that would otherwise be used to pay their
daily and monthly expenses, such as rent, utility bills, food and
clothing for themselves and their children. Many Medicaid-eligible
women delay their abortions, increasing their medical risks, while
they scrape funds together. Other women have been forced to carry
their pregnancies to term or to seek illegal abortions.
Studies have shown that
from 18 to 35 percent of Medicaid-eligible women who want abortions,
but who live in states that do not provide funding for abortion,
have been forced to carry their pregnancies to term." The
National Network of Abortion Funds points out in its report, "A
Matter of Justice," that women of color are disproportionately
represented among low-income women. Because of this, they also represent
a high proportion of welfare recipients, meaning that the lack of
Medicaid funding has a higher impact upon women of color, especially
black women, than any other group. Sharon Hays, professor and author
Broke With Children researched mothers and welfare. "When
abortion isn't covered by Medicaid, then women find themselves pregnant
without options," she explains. "The caps on welfare are
such that an unmarried woman who becomes pregnant after she's begun
to receive aid cannot get assistance for that child, if she continues
Beyond funding for abortions,
locating abortion services is increasingly difficult. The Abortion
Access Project (www.abortionaccess.org)
reports that as of 2002, 87 percent of all U.S. counties and 97
percent of all rural U.S. counties have no abortion provider.
A 2002 article in the Expectant
Mother Care newsletter reported that New York City was "the
first city in the country to make abortion training mandatory for
the 150 residents who pass annually through the eight city hospitals
that offer OB-GYN programs." Exemptions were granted to those
declaring religious or moral grounds. This development was especially
newsworthy when the numbers of providers are considered. The number
of abortion providers in the United States fell by one-third between
1982 and 1996, to roughly 2,000, according to the most recent study
by the Alan Guttmacher Institute (guttmacher.org), especially because
half of those doctors are slated to retire in the next 10 years.
In 1996, the Accreditation Council for Graduate Medical Education
began requiring OB-GYN programs to provide instruction on abortion
and family planning. These initiatives have considerable impact:
the National Abortion Federation reported that between 19995 and
2002, the percentage of residency programs that included routine
abortion training rose from 12 percent to nearly half of all programs.
This doesn't mean that
providing abortion services is a safe endeavor for doctors, though.
According to the Abortion Access Project, there have been 15,087
reported instances of violence and/or harassment against abortion
providers since 1977, including 7 murders and 17 attempted murders
(actual instances are most likely much higher the report suggests).
In 2000, more than half of all providers experienced harassment
from anti-abortion forces.
Access has been severely
limited by court rulings. Judge Alito's nomination to the Supreme
Court has reproductive rights advocates worried because he dissented
in the Planned
Parenthood v. Casey case, which was about spousal consent
to abortion. Although spousal consent was overturned, laws in effect
that mandate the involvement of at least one parent in the abortion
decision exist in thirty-four states.
In those states with
parental notification or consent laws, teenagers unable to tell
their parents must either travel out of state or obtain approval
from a judge -- known as a "judicial bypass" procedure
-- to obtain an abortion. A report from the Planned Parenthood Federation
of America (plannedparenthood.org) cites research indicating that
"sixty-one percent of the respondents reported that at least
one of their parents knew about their abortion. Of those minors
who did not inform their parents of their abortions, 30 percent
had histories of violence in their families, feared the occurrence
of violence, or were afraid of being forced to leave their homes.
Minors who did not tell their parents were also disproportionately
older (aged 16 or 17) and employed." As abortion advocates
and health care providers working with teens have said for decades,
most teens do tell a parent or other, significant and trustworthy
adult. Younger teens especially entrust this information to their
parents, unless they cannot.
One development thought
to potentially decrease the abortion rate in this country was introduction
of Emergency Contraceptives (EC, basically a very high dose of an
oral contraceptive). Five states have passed laws requiring medical
providers to offer Emergency Contraceptives to rape victims treated
in emergency care facilities. Yet, according to a recent study by
the ACLU, "fewer than 40 percent of emergency care facilities
in eight of eleven states surveyed provide EC on-site to rape victims."
If taken within 72 hours of unprotected intercourse or contraceptive
failure, EC reduces the risk of pregnancy by as much as 89 percent.
Pennsylvania lawmakers introducing a bill that requires hospitals
to offer EC to women after a rape noted that of the 300,000 women
raped each year in the United States, it is estimated that more
than 25,000 women become pregnant as a result of rape.
Hospitals and Emergency
Care Centers are not the only ones impeding access to EC. Since
1997, Wal-Mart has refused to sell EC. The company calls this a
business decision, without regard to the fact that for many women,
Wal-Mart is the only pharmacy within miles. A report by the Alan
Guttmacher Institute explains this policy has an especially broad
reach for women living in rural areas. "A 2003 projection estimated
that Wal-Mart would control 25% of the drug store industry by 2007."
General access to contraceptives
is also limited for many women. The Center for Reproductive Rights
explains the disparity that purchasing contraception creates between
women and men: "Women of reproductive age spend 68% more than
men on out-of-pocket health care costs, largely on reproductive
health care services. Two-thirds of U.S. women of childbearing age
rely on private, employer-related plans for their health coverage,
yet 49% of large group plans do not routinely cover any contraceptive
method." When the United States government allowed comprehensive
coverage for contraceptives, that out-of-pocket gap was narrowed.
But Medicaid doesn't cover contraception costs, nor are caseworkers
even permitted to discuss family planning. Sharon Hays remarks,
"By law, caseworkers aren't allowed to utter the phrase 'birth
control.' Further, they are pressured to push abstinence. The mixed
messages for poor women are hopelessly confusing: the government
is pro-abstinence, pro-marriage, against contraceptives. Welfare
imposes family caps and yet provides no coverage for abortion."
The Center for Reproductive
Rights quotes an article in the Economist from April of this year: "A rising number of pharmacists are
refusing to dispense prescriptions for birth control and morning-after
pills, saying it is against their beliefs." Currently, four
states-Arkansas, Georgia, Mississippi and South Dakota-have laws
or policies on the books that explicitly allow pharmacists to refuse
to dispense contraceptives. Similar legislation was introduced in
nine other states this year, although none became law.
Teens might face roadblocks
other than pharmacists' refusals or cost when seeking contraceptives.
Only twenty-one states and the District of Columbia grant all minors
the authority to consent to contraceptive services. Approximately
eleven other states grant most minors this authority.