So
how did we get here? Where might all of these various roadblocks
to reproductive freedom lead us? Marlene Gerber Fried directs the Civil Liberties
and Public Policy Program at Hampshire College. An author and
editor (Fried was most recently the co-author of Undivided
Rights: Women of Color Organize for Reproductive Justice,
South End Press, 2004), Fried also co-founded both the Abortion
Rights Fund of Western Massachusetts and the National Network of
Abortion Funds. As a longtime advocate for reproductive justice,
her perspective on dwindling services is: "After Clinton was
elected, there was this brief period when the legal rights seemed
safe: not true during the Reagan era. So, advocacy groups formed
to work on access, because it was clear during Reagan access had
been compromised."
"Most groups approached
access in terms of providers, and not necessarily in terms of low-income
women," she says, and the number of groups focused upon access
has increased. "Since 1993, a great deal of organizing has
taken place, including NNAF." Originally a coalition of 24
community-based funds helping low-income women pay for abortion
services, NNAF is now a consortium of 102 grassroots organizations
that advocates on abortion access issues nationally, as well as
providing direct assistance for those in need. Fried also cites
efforts like those of the Abortion Access Project (abortionaccess.org)
and the National Abortion Foundation (naf.org) to train mid-level
providers such as nurse midwives and Physician Assistants to perform
abortions. Fried says, "In the late 1990s, when medical abortion
was just being introduced into the United States, advocates saw
the possibility of normalizing abortion by integrating it into routine
health care. However, FDA regulations on Mifipristone as well as
state and federal restrictions on abortion which apply to both medical
and surgical procedures, created significant barriers. Despite the
obstacles, some primary care providers are offering medical abortion
in places where previously there were no abortion services."
The advent of medical
abortion (RU486) affected access because it was much easier to provide,
even in a family practice doctor's office. "While medical abortion
blurred the line between a procedure and more routine health care,
normalizing early abortion at the same time, the restrictions are
the same as for those providing surgical abortions. Thus, few doctors
outside the abortion clinic setting are willing to prescribe the
medication."
While obtaining services
-- medical or surgical abortion -- may be difficult for women with
financial resources, for women on welfare the task is nearly impossible.
Sharon Hays underscores this point: "The problems, the absolute
Catch-22 poor women face, are so evident to welfare caseworkers.
While the Federal Government pushes women to get connected to men
-- to marry them -- women on welfare have trouble gaining access
to birth control, and should they find themselves pregnant, no resources
are available. It's hard for middle-class people to conceptualize
the multiple difficulties poor women face. Say, for example a woman
with two children is working as hard as she possibly can to get
things together in terms of work, raising the kids, getting some
education or vocational training and then she becomes pregnant unexpectedly.
She has no options. I've seen caseworkers hand state monies under
the table to women to help them pay for abortions, because they
know how dire the situation really is for these women, women doing
all they can to survive."
Linda Wharton was lead
co-counsel in the Casey case. While overturning Roe is the scenario flooding the news each time a potential Supreme
Court nominee is named, Wharton warns other scenarios are more likely
and probably equally worrisome. She says, "A more likely scenario
[than overturning Roe] could occur, in which the Court
would eviscerate Roe by interpreting the Casey undue burden standard in ways that allow multiple, harmful restrictions
on access to abortion."
The role Judge Alito
played as a dissenter in the Casey decision is, according
to Wharton, real cause for concern. "Alito," Wharton continues,
"would have upheld the husband notification provision. He purported
to apply the undue burden standard; however, he was willing to overlook
the severe obstacles to abortion access posed by this provision
to victims of spousal assault and rape. Instead, in his dissent,
he highlighted all the women to whom the husband notification provision
did not pose a problem. He also assumed that victims of spousal
assault would evade the requirement by falsely reporting that they
had told their husbands. Lastly, he deferred to the judgment of
the state legislature that it had provided adequate exemptions in
the statute. This approach suggests that he will rarely, if ever,
be willing to find that restrictions on access, short of outright
bans, unduly burden women. What we may be left with is protection
for outright bans, but no protection whatsoever for restrictions
on access that, in practice, make abortion effectively unavailable
or extremely difficult for certain women. Although the trial record
showed that husband notification posed a lethal threat to some women,
Alito found no undue burden."
The radical right has
used Roe to galvanize its forces, as attention over Supreme
Court nominees and their potential views about abortion reveals.
In doing so, the right has attached increasing stigma to abortion
itself. Policies that make abortion inaccessible -- due to funding,
difficulty in finding a clinic or getting to one, fear of on-site
violence, or laws that enforce waiting periods or parental consent
or notification -- increase fear and shame for women. "Fear,"
says Barbara DiTutullio of the Women's Law Project (womenslawproject.org),
"is a big factor."
For a woman seeking an
abortion, slowing her ability to obtain the procedure -- due to
physical distance from clinic care, economic factors or the time
it takes to seek judicial bypass or travel out-of-state for care
-- the consequences are real. Delays increase the monetary cost
of the abortion and often add to the physical and emotional health
risk, since early abortions are less involved procedures. Up to
seven weeks, medical abortions are available; up to twelve, the
care can be completed in one office visit, rather than an additional
day for pre-operative care.
DiTutillio worries about
doctors and hospitals refusing care. "This 'conscience clause'
turns health care delivery into a choice. It's dangerous to have
health care delivery be optional. When you add in the bans on various
services-from emergency contraception in certain places to partial
birth abortions -- along with all the regulations that limit access
-- you have so many limitations upon care, it's no longer clear
whether a woman can actually secure services."
Marlene Fried is even
more emphatic about providers' citing "conscience clauses."
Fried says, "Being a pharmacist or a physician isn't a right.
A right in this country is access to health care."
Dayle Steinberg, CEO
of Planned Parenthood of Southeastern Pennsylvania believes that
access will be won or lost state-by-state. "We have to push
our state reps and state senators on issues of access," she
urges.
The New York Daily Record
(November 20, 2005) reported on just such an initiative. Because
Pennsylvania hospitals are not required to offer Emergency Contraception,
two Pennsylvania senators and one state representative have introduced
bills that would mandate hospitals to provide information about
the pills and give them to rape and sexual assault victims who want
them. The legislation as it is written has no opt-out for individual
doctors or religious-affiliated facilities Currently, some hospitals
offer the medication, while others have policies that allow health-care
providers to opt out of providing the medication because of personal
religious or moral reasons.
As Steinberg points out,
the country largely -- sixty-five percent, that is -- supports a
woman's right to have an abortion. "Roe might signify
to people that abortion remains legal. That's why we have to get
people more concerned about what's happening locally, because it's
in so many individual states that the rights are being taken away."
Sharon Hays believes
that advocates should be looking at another generation entirely.
"Children pay the largest price for welfare and Medicaid policies
that make raising children as a single mother incredibly arduous.
Children's suffering becomes invisible," says Hays. "A
child born poor is doubly disadvantaged in these times." Looking
back before so many of these cuts and regulations went into effect,
Hays believes the solution for poor women lies in returning welfare
services to the place they were thirty years ago. "We'd be
in good shape," Hays asserts, "if we provided more aid,
fewer untenable restrictions and caps, and again offered all health
care -- including reproductive health care services -- to women
on welfare." She believes that education about the situation
is critical as a first step. "People need to understand the
issues involved, how deeply problematic the situations are that
poor women and children face in this country. It's as if poverty
has gone underground. The only way to change the situation is to
make it visible again."
If the obstacles poor
women face have invisibility attached, what will make issues of
access visible? Dayle Steinberg muses, "When women who have
enjoyed access all along, even as it's been lost for many women,
lose access, they will be angry. The majority believes that women
have an absolute right to health care. And anger is what changes
things."
mmo : december
2005
page | 1 | 2 | print | |
