Tuesday, January 22, 2013

40 Years after Roe v. Wade, Why Are We Still Talking About Abortion?


Today marks the 40th anniversary of the U.S. Supreme Court decision Roe v. Wade.  It’s a date worth commemorating as a marker of progress in women’s rights, but also a call to arms to continue the work that remains undone:  to ensure an end to the segregated provision of health care to women.
Supposedly Roe, a decision from our nation’s highest court, established a woman's fundamental right to reproductive autonomy and, as “The Law of the Land,” protects all of us from encroachments on that fundamental right.  Right? 

Well, Roe most certainly opened a door to a world in which women’s reproductive autonomy could be fully protected.  Yet brick by brick, a wall has been going up that just as fully impedes a woman’s access to the health care she deserves.  Here’s today’s reality, 40 years post-Roe:  the range of reproductive health care services depends in large part on where a woman lives and how much she can afford.
Consider this:  Since 1995, state legislatures have enacted 755 anti-choice measures – 136 measures in the 2011-12 legislative session alone.  To name just a few of the most popular categories of restrictions (detailed further here), such provisions include the following:
  • Mandated counseling: 17 states mandate counseling before an abortion that includes information on specified topics, such as the purported link between abortion and breast cancer (5 states), the ability of a fetus to feel pain (12 states) or long-term mental health consequences for the woman (8 states).
  • Required minimum waiting periods: 26 states require a woman seeking an abortion to wait after she receives counseling before the procedure can be performed, usually 24 hours.  All of these laws required additional delay, and thus, expense – 9 of these states’ laws effectively require the woman make two separate trips to the clinic to obtain the medical procedure.
  • Parental consent or notification:  38 states require some type of parental involvement in a minor’s decision to have an abortion; 22 states require parental consent, 12 require parental notification, and 4 states require both.
Even if you don’t live in one of those states with burdensome restrictions on legal abortion, chances are pretty good that you live in one of the 87% of counties in the country that lack an abortion provider.
And guess what – a woman facing financial difficulty (under federal poverty guidelines, poverty for a family of 3 is defined as just over $19,000) is even less likely to be able to access an abortion because she can’t afford it.
  • 42% of women having abortions are low-income.  Unintended pregnancy rates are 5 times higher among low-income women than higher-income women.  (Source: Guttmacher Institute)
  • Even if a woman qualifies for Medicaid, abortions are unavailable in 32 states and the District of Columbia except in cases of life endangerment, rape or incest due to the federal Hyde Amendment, which forbids the use of federal funds in the joint federal-state Medicaid programs for abortions.  Only 17 states (including Washington State) use state funds to provide all or most medically necessary abortions.
  • A woman who has access to private insurance still may not be able to purchase coverage.  Eight states completely restrict coverage of abortion in private insurance plans, most often limiting coverage only to when the woman’s life would be endangered if the pregnancy were carried to term.  As a result, a woman’s decision whether or not to end a pregnancy might turn in part on what type of insurance she has access to or can afford.
So yes, perhaps Roe did shepherd in a new era in which back-alley or DIY coathanger abortions are no longer the concern.   But as Rebecca Rosen stated in The Atlantic, “Legally, women may have a right to choose whether to abort an early unwanted pregnancy or take birth control to prevent one, but for many women that choice is elusive, constrained by the limits of their resources, social, financial, or local. The bright line that runs between the twin spheres of legal and illegal is not what makes something available or keeps it out of reach.” 

So all this still leaves unanswered this question:  Does abortion matter anymore?  Or is it just a convenient litmus test for judges and politicians and an action item for the religious right?  According to a recent survey, 53% of adults say that abortion is not that important compared with other issues.  What is it that we are fighting about, anyway? 

I submit that abortion, and Roe, do still matter and are of paramount importance, and here’s why:  By age 45, one in three women will have an abortion.  And it’s not just unwed hussies and “sluts” who are having abortions (stated tongue-in-cheek - of course, labeling the patient as “worthy” or “unworthy” is just more gamesmanship with the goal of divisiveness).  In fact, six in 10 women who have abortions already have a child; the highly personal decision of whether to continue a pregnancy is most often informed by, if not grounded in, a woman's economic situation. 

Here’s the bottom line:  Abortion is not only NOT an anomalous procedure, but it is a part of a continuum of women’s health care that rightfully should have its place in the mainstream of health care coverage.

A woman should not have to fight to obtain medication or a device to prevent pregnancy, or to obtain maternity care, or for health care services, if having a baby is not the right decision for her and her family.  A woman should not have to travel to a stand-alone clinic facility, separate from her other health care providers – much less across county and state lines – to access common health care services.

It’s time to make the promise of Roe a reality by ensuring that state laws and court decisions don’t restrict access and that affordability is no longer a barrier.  It’s simply not a politician’s place to pass laws that, in effect, make that personal decision about whether to a woman should continue her pregnancy.  Nor should the amount of money a woman has or doesn’t have prohibit her from having an abortion.
Recent public opinion surveys, as well as those from 10 and 20 years ago, show that more than six-in-ten (63%) say they would not like to see the court completely overturn the Roe v. Wade decision.  Even the Catholics (63%) are down with that.
Are you one of those 6 in 10?  If not, why not?  We’d love to hear from you about how you feel about Roe v. Wade; you can share your reflection here.  And then, let’s get on with the important business of making sure every woman has the ability to meaningfully access abortion as well as any other health care that she needs.

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