From the NNAF publication: Legal But Out of Reach

Abortion in the U.S. Today, Legal But Inaccessible
by Marlene Gerber Fried

"Mary" calls from South Dakota asking if we can help. "Susan," her seventeen-year-old daughter, is pregnant. The man involved is the father of Susan's two-year-old child, but she has a restraining order against him. She is in her second trimester, and the one clinic in their state does not perform abortions after the fourteenth week of pregnancy, so she will have to travel to Kansas, 1000 miles away, to have the abortion. They have tried, but they cannot raise all the money needed for the trip and the procedure. The man's mother could contribute, but she is pressuring Susan to have the baby and give it to her to raise. Mary is worried and scared. She is also angry. Before she got to us, she had called many agencies and pro-choice organizations and had not found any resources for women and girls in her daughter's situation.

Susan was out of options, and running out of time. At NNAF we get many calls like this one from women all over the United States: women in prison, young women, women who have been raped, women who are undocumented, women without resources.

Fortunately "Susan" was helped by several of the funds in the National Network of Abortion Funds, who worked together to raise the $2000 she needed. Unfortunately, though these groups spent over a million dollars in 1996, assisting 7000 women, the need is far greater. A tremendous gap has been left because public funding for abortion is not available in most states.

While the question of the basic legality of abortion has been settled - at least temporarily - the question of accessibility has not. The contemporary struggle for abortion rights is over the legal conditions under which it will be available and the restrictions which limit its accessibility. There have been many losses in access to abortion. Since the victory of Roe v. Wade in 1973, millions of women have experienced the "right" to abortion as just an empty promise. Lack of government funding, decreases in available services and providers, violence towards and harassment of clinics and clinic personnel, and legislative restrictions such as parental consent laws and 24-hour waiting periods effectively eliminate the abortion rights of women like Susan. Every day, activists working in grassroots abortion funds deal with the consequences of these erosions in abortion rights.

Although legal abortion is one of the safest surgical procedures in the US today - a first trimester procedure is comparable in risk to a tonsillectomy - and although it is relatively inexpensive compared to other surgical procedures, it remains out of reach for tens of thousands of women annually.

Lack of funding is central in abortion access. The Hyde Amendment, which prohibits federal Medicaid funding except in cases of life endangerment, has been passed every year since 1976. Abortion is the only reproductive health care service for which Medicaid does not pay. Exceptions for rape and incest were added in 1993, only after a long battle. Even this minimal "liberalization" was resisted by the states and had to be fought in court. Most states followed the lead of the federal government in Hyde, by cutting state funds as well. As of December 1996, only eighteen states provide coverage beyond these narrow exceptions¹.

Before Hyde, the federal government paid for about one-third of all abortions - 294,600 in 1977; after Hyde, it paid for virtually none. The impact on low income women has been devastating. For some, denying coverage for abortion services is the same as banning it outright. It is conservatively estimated that one in five Medicaid eligible women seeking an abortion is unable to obtain one. The average cost of a first trimester abortion is $250, nearly two-thirds the amount of the average maximum monthly AFDC payment for a family of three².To pay for an abortion, Medicaid recipients are forced to divert money from other essentials such as food, rent and utilities. The search for funding compromises women's health by delaying their abortions.

Lack of funding compounds other barriers to access. The number of abortion providers (hospitals, clinics and physicians' offices) has declined since the 1980s³,and services are very unevenly distributed. Nine in 10 abortion providers are now located in metropolitan areas; about one-third fewer counties have an abortion provider now than in the late 1970s. Ninety-four per cent of non-metropolitan counties have no services. One quarter of women having abortions travel more than 50 miles from home to obtain them⁴.

In 45 states the number of providers has gone down, as have the opportunities for training - only 12% of ob/gyn residency programs require training in first trimester abortions. It is the most common ob/gyn surgical procedure in the U.S. today, yet one-half of ob/gyn residents have never performed one. Only 7% of residency training programs require training in second trimester procedures. Many hospitals do so few abortions they could not be appropriate training sites.

Anti-abortion violence and harassment aimed at doctors and medical students contribute to this situation. Clinics and individual providers have been targets of violence since the early 1980s. Over 80% of abortion and family planning clinics have experienced severe anti-abortion attacks. These include death threats, stalking, chemical attacks such as with butyric acid, arson, bomb threats, invasions and blockades. In three separate incidents, five clinic workers (two doctors, a volunteer escort and two receptionists) were murdered at abortion clinics⁵.

The anti-abortion movement has also used the funding issue to further its broader political objectives. Battles over abortion funding have been opportunities to consolidate the opposition to abortion, draw in new supporters, and build support for other restrictions.

These battles have played a significant ideological and symbolic role as vehicles for asserting moral disapproval of abortion. Withdrawing public funding for abortion has not been about saving dollars. The joint federal-state Medicaid program covers every other pregnancy related service, all more costly than funding abortion. The denial of funding contributes to the stigmatization and isolation of the doctors who perform abortions, the women who seek them, the hospitals and clinics where they are provided and, ultimately, abortion itself. Today, even many supporters of abortion rights define abortion as a necessary evil. The pro-choice President Clinton describes his position in terms of a commitment to keeping abortion safe and legal, but to making it rare. In the effort to ban a specific late abortion procedure, intact dilation and extraction (D & E), voices on all sides portray second and third trimester abortions negatively. Unfortunately, the pro-choice movement decided to fight the proposed ban without highlighting the women most affected - low-income and young women who have later abortions because they could not gain access earlier.

The same mentality that has characterized anti-abortion offensives can be seen in the demonization of unwed mothers, especially teens, who have become the scapegoats for most social ills. "Welfare reforms" - such as "family caps" (child exclusion policies), coerced contraception, workfare, and the absolute termination of welfare if a minor is unmarried - are just the other side of the abortion restriction coin.

Until recently, the strategies of the major pro-choice organizations have not reflected this understanding of the connections between abortion access and abortion rights. Advocacy efforts focused primarily on the legal right to abortion, virtually ignoring all aspects of obtaining and providing abortion services. That terrain was left to the anti-abortion movement, which successfully appropriated issues regarding quality of services, women's experiences of abortion, direct services to assist pregnant women and even adoption.

Abortion Funds fill a significant gap in pro-choice strategies. They offer direct political resistance to the erosion of low-income women's rights by unequivocally advocating for access to abortion and by offering a form of political action which was a central element in the fight for legalization of abortion.

Funds also provide a powerful response to the constellation of fear, shame and guilt in which the anti-abortion movement shrouds abortion. The very fact that these funds exist makes a significant political statement. It says that advocates of abortion rights will not allow the most vulnerable women to be the political pawns of the anti-abortion movement. Most important, it says that the lives of low-income women have value.

This booklet gives us a glimpse into those lives. It shows us why a poor woman has an abortion - she may be unable to take care of herself and the children she has; she may be battered; pregnant from rape or incest; ill and suffering complications with the pregnancy; a drug or alcohol user; homeless; trying to finish school or not in a relationship which can support parenthood. Like all women who have abortions, poor women are trying to do their best for themselves and their families, and their decisions are based on the circumstances of their own lives.

These stories were selected to demonstrate the different barriers to access faced by low-income women. While lack of funding is key, the women here have multiple problems leading them to their decision. The National Network of Abortion Funds does not believe that women seeking money for an abortion should have to justify themselves to us. Our funds do not evaluate a woman's reasons for wanting an abortion; women seeking assistance have only to demonstrate financial need.

We are publishing these stories not as justifications, but because we believe the voices of women currently being denied the right to safe, legal ttle power or access to those making policy decisions. Low-income women are the least likely to be heard in the public debate over abortion, yet it is their lives which are affected most immediately by restrictions. We hope these stories will help convince legislators, judges, and the general public that poor women deserve the same abortion rights as women with money.

We need these voices to combat an opposition whose strength lies in the ability to make women invisible. And we need them to remind ourselves that this really is a fight for women's lives. These stories reignite our rage. Working with these women inspires our activism.

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FOOTNOTES

1 Induced Abortion, The Alan Guttmacher Institute, January 1997. Even in states with Medicaid funding, many women are left out because of increasingly stringent eligibility requirements.

2 Donovan, Pat. The Politics of Blame: Family Planning, Abortion and the Poor. The Alan Guttmacher Institute, 1995. Donovan also points out that even before Hyde, not all women in need of subsidized abortion services were able to obtain them. An estimated 133,000 Medicaid eligible women were unable to obtain a publicly funded abortion because the services were not available or accessible to them or because the states had policies prohibiting coverage.

3 Frye, A., Atrash, H.K. and Lawson, H.W. et al, 1994. "Induced Abortion in the United States: a 1994 Update." Journal of the American Women's Medical Association, 49(5): 131-136.

4 Henshaw, S. 1995. "Factors Hindering Access to Abortion Services." Family Planning Perspectives. 27(2): 54-59, 87.

5 In 1993 Dr. David Gunn was murdered by Michael Griffin in Pensacola, Florida. In 1994 at the same clinic, Dr. Bayard Britton and clinic escort James Barrett were murdered by Paul Hill. In 1994 in Brookline, Massachusetts, Shannon Lowney, a clinic receptionist at Planned Parenthood and LeeAnn Nichols, a receptionist at nearby Preterm Health Services, were both murdered by John Salvi.