The Economic Barriers To Abortion Access That Conservatives Don’t Want To Talk About
Blog ››› ››› SHARON KANN
When the Supreme Court releases its opinion in Whole Woman’s Health v. Hellerstedt this June, the landscape of abortion rights in the United States will be fundamentally altered -- for better or for worse.
Pro-choice advocates have called Whole Woman’s Health v. Hellerstedt “the most consequential case for abortion rights in this country since Roe v. Wade.” The case itself challenges the constitutionality of Texas’ HB 2 -- a sweeping anti-choice bill that severely limits access to abortion and medical care. HB 2 requires that abortion providers have admitting privileges to a hospital within 30 miles of their clinic, and that clinics themselves meet the standards of ambulatory surgical centers (ASCs) in order to remain operational.
Proponents claim these restrictions are medically necessary to protect the health and safety of women during abortions -- a claim echoed throughout right-wing media and by other anti-choice legislators. Texas lawmakers pushing for the legislation in 2013 capitalized on myths from anti-choice extremists about abortion safety to insist abortion providers required increased regulations. At the time, media gave this claim further oxygen by promoting the misinformation that HB 2’s restrictions were medically necessary. In the years since the bill’s passage Fox News has continued to advance the claim that these anti-choice restrictions improve clinic safety without impeding access to care.
In reality, these restrictions are based on medically inaccurate information, and they serve only to further limit already marginalized communities’ access to abortion by building on pre-existing economic barriers to care.
Even without HB 2, the economics of abortion access are complicated, greatly disadvantaging marginalized communities. According to Salon’s Christina Cauterucci, “Studies show that poor women take up to three weeks longer than other women to secure an abortion” partly because of the time necessary to gather the money for the procedure. She continued that “the further along the fetus, the more expensive her abortion will be and the more likely she is to experience health complications.”
For many low-income patients, however, federal funding restrictions have already created a significant barrier to accessing necessary funds for abortion services. For example, the Hyde Amendment greatly disadvantages low-income communities by blocking use of federal Medicaid funds to cover abortion care except in cases of rape, incest, or to save the life of the mother. In a July 2015 report, the National Women’s Law Center explained that the Hyde Amendment puts low-income persons at a substantial financial disadvantage in obtaining abortions, and it says they “may have to postpone paying for other basic needs like food, rent, heating, and utilities in order to save the money needed for an abortion.”
This financial challenge adds to the usual barrage of anti-choice restrictions already complicating access to abortion care. Between mandatory waiting periods, long wait times to get an appointment, and the great distances many patients must travel to reach a clinic, abortion care is already tenuously out of reach for many. As Amy Hagstrom Miller, president of Whole Woman’s Health, explained during a June 7 press call, HB 2 means there is “a situation in Texas where a right exists on paper, but it is out of reach for a tremendous amount of Texas women.”
Yet media frequently ignore or underestimate the impact of these barriers when talking about abortion. In a recent study, Media Matters analyzed 14 months of evening cable news, looking at discussions of abortion. We found that only eight news segments mentioned the economic barriers women face to accessing reproductive health care -- and even those discussed it only briefly. Although much of the media coverage of abortion restrictions hasn’t emphasized the significance of economic barriers to abortion care, clinic accessibility has been a central aspect of the legal debate over Texas’ HB 2.
During oral arguments on March 2, Justice Elena Kagan described HB 2 as “the perfect controlled experiment” for what will happen if extensive anti-choice restrictions are allowed to take effect. Before Texas lawmakers passed HB 2, there were more than 40 clinics in Texas providing abortion services. According to the Center for Reproductive Rights, “that number has dwindled to 19,” with even more clinics at risk. Indeed, as Eesha Pandit reported for Salon, if HB 2 is upheld, “there would be 10 clinics left in Texas, a state of 27 million people,” and there would be “more than 500 miles between San Antonio and the New Mexico border without a single clinic.”
In a series of studies, the Texas Policy Evaluation Project (TxPEP) evaluated the impact of HB 2 on Texas women’s access to abortion care. In a November 2014 study, TxPEP researchers predicted that if the Supreme Court upholds HB 2, “abortion self-induction will increase” in Texas. Researchers further reported that at the time of the study, between 100,000 and 240,000 Texas women between the ages of 18 and 49 had already attempted to self-induce an abortion. In a January 2015 study, researchers conducted a series of interviews with women “who either had their abortion appointments cancelled when clinics closed or who sought care at closed clinics" following the passage of HB 2. According to a news release about the study, researchers found that because of HB 2, access to care was “delayed, and in some cases [patients were] prevented altogether” from obtaining an abortion.
Dr. Daniel Grossman, a co-author in both TxPEP findings on HB 2's effects on patients, explained that the bulk of TxPEP’s research "demonstrates that the sudden closure of clinics created significant obstacles to obtain care, forcing some women to obtain abortion later than they wanted, which increases the risks and cost." Grossman added that if HB 2 remains in effect, the undue burden on women would grow, as "wait times to get an appointment will likely increase in most cities across the state, as they recently have in Dallas and Ft. Worth, because the 10 remaining facilities will not be able to meet the demand for services statewide."
These clinic closures have had a disproportionately large impact on Texas’ substantial Latina population. In an amicus brief to the Supreme Court about the impact of HB 2, the National Latina Institute for Reproductive Health (NLIRH) cited previous District Court decisions to argue that due to the geographic locations of remaining providers, for many Latina women, clinic closures are “a complete ban on abortion.” Research by the NLIRH indicates that disparities in Latinas’ access to health are now so dire that they could constitute “violations against basic human rights.” Beyond abortion care, research shows that such laws exacerbate the “significant geographic, transportation, infrastructure, and cost challenges in accessing health services” for Texas Latinas more broadly.
As Tina Vasquez reported for Rewire, the impact of HB 2 on undocumented persons would be even more extreme. She wrote that “while a person’s citizenship status affects her ability to access health care throughout the United States, this is especially true in Texas, which has the second-highest undocumented population in the country and some of the nation’s harshest anti-immigration laws.” According to Ana Rodriguez DeFrates, NLIRH’s state policy and advocacy director, internal immigration checkpoints mean “if you’re undocumented, you simply couldn't get to the heart of the state where abortion access is available.”
The potential impact of HB 2 extends far beyond Texas. All four of the mostly likely positions the Supreme Court could take in deciding Whole Woman’s Health v. Hellerstedt would have wide-reaching implications for clinic access across the country. As Nancy Northup, president of the Center for Reproductive Rights, explained, HB 2 represents “a watershed moment in the battle for reproductive rights.” She continued that if the Supreme Court rejects HB 2 it would “protect the health and safety of women and put a stop to the onslaught of laws restricting access to safe and legal abortion.”
For people in Texas, however, HB 2 has already had a decidedly negative impact. Writing in The New York Times, Valerie Peterson recounted the challenges she faced trying to access safe and affordable abortion care in Texas:
Nearly six months after my abortion I still carry the scars of the experience — not of the procedure itself, which was a blessing I will never regret, but of how hard it was to get the care I needed in the state where I live.
After my doctor called the clinic, I was told I would have to wait three to four weeks for the next available appointment. There was no way I could wait that long. Not only would I be carrying a baby I knew wouldn’t survive, but that kind of wait could push me past the 20-week mark after which almost all abortions are illegal in Texas.
My doctor was able to find me an appointment the following week instead. But when I found out the procedure would then take three to four days to complete as a result of other restrictions that include mandatory counseling, a required sonogram and an additional 24-hour waiting period, I broke down.
I didn’t know how I was going to make it that long. One unnecessary additional day was one more than I could bear.
Through a friend, I was connected to a clinic in Florida that caters to women who are terminating for medical reasons, and I spoke to the doctor and nurse there. The doctor explained that Florida didn’t have a 24-hour waiting period, and they could get me in the next day.
I booked the first plane ticket I found. I got a hotel room and rental car. I flew to Florida on Friday, and my procedure was over by Saturday afternoon. Including the cost of the procedure, I had to spend close to $5,000.
I remember thinking: What happens to women in my situation who don’t have the ability to do what I just did? My heart aches for those women.
* Image courtesy of Cosmopolitan