WHERE ARE THE WOMEN IN THE ABORTION DEBATE?
January 22, 2001, marked the 28th anniversary of Roe v. Wade – the U.S. Supreme Court decision which transformed abortion from an experience that threatened the lives and health of women into one with the same mortality rate as a tonsillectomy. In the intervening years, anti-abortion forces have tried to make abortion illegal in the long run. Their strategy is to make it increasingly less available in the short run. From legal restrictions to the murders of those working in abortion care, opponents of abortion have succeeded in making it less accessible to women, especially those who are young, low-income and disproportionately, women of color. And they have deliberately made it more dangerous to providers.
With the George W. Bush presidency, the right to choose abortion will become more precarious still. Bush is committed to an anti-abortion agenda as his cabinet nominations of John Aschroft and Tommy Thompson – two staunch anti-abortionists -- make clear. If confirmed, they will be placed in positions where they can do the most harm to abortion rights and access.
We cannot look to President Bush even for the most basic protection of the constitutional right to abortion. He opposed legislation to protect abortion clinics in Texas. And he will have many more opportunities to undermine women's reproductive options through appointments to the Supreme Court, to lower federal courts, and to head federal agencies. He will be in a position to divert millions of federal dollars to anti-abortion counseling centers. And with the power of executive order, he will be able to prohibit federally funded family planning clinics from providing counseling about abortions or giving referrals.
The impact of such actions will be devastating to women, especially to those who are the most vulnerable – poor women, young women, and disproportionately, women of color. But where are these women in the abortion debate?
Women like “Michelle,” who escaped her abusive partner with her two toddlers and the clothes on her back. She feared that if she had her abuser's baby, she would never be able to get away and she was afraid he would kill her if he discovered she wanted an abortion. She had no money and fled to a shelter. For Michelle, continuing her pregnancy was literally life threatening.
Or “Carol” who is 15 years old. Her family is on welfare and she already has a college scholarship. She does not want her future to be shaped by her unplanned pregnancy. She has other plans which include finishing school.
Or “Mary,” pregnant as the result of rape; or “Susan” who is 13 and terrified to tell her parents she is pregnant, or “Irela,” recently immigrated to the U.S. who just learned that her fetus' brain was not developing, or the thousands of other women like them. For these women, abortion is out of reach. In these cases, the problem is lack of money. Federal Medicaid coverage for abortion is prohibited except in cases of rape and incest, and only 17 states pay for abortion. One third of private health insurance policies exclude or eliminate abortion coverage as well, and one third of women have no health insurance. Without insurance, public or private, women can obtain an abortion only with cash in hand. And for women who sometimes don't have enough money to pay the rent and put food on the table, there is no cash in hand.
Outside large metropolitan areas, the obstacles are greater. Eighty six percent of counties have no abortion provider. The provider pools is aging – 57% now are over 50 years of age, and new practitioners are not being trained to take their places. Until advocacy groups like Medical Students for Choice launched widespread organizing efforts, abortion was rarely taught or even mentioned in medical schools. And while increasing numbers residency training programs offer training as an elective, few require it. This means that many OBGYN residents will complete their training without having performed even a single abortion. Yet abortion remains one of the most common surgical procedures for women – 43% of U.S. women will have at least one abortion during their lives.
To confound the problem, men and women trained in and dedicated to doing abortions are being driven from this work. As the seven murders of abortion providers and clinic staff illustrate, theirs is a dangerous profession. It is the only medical specialty where the life threat to the doctor is greater than that to the patient; where doctors must display heroic courage just going to work.
As fewer and fewer practitioners perform abortions, women must travel, sometimes hundreds of miles, for care. Add 24- or 48-hour waiting periods, and the barriers are daunting: travel, lodging, and childcare – all of which have costs -- as well as additional time off from work, often at no pay.
Finding money and traveling to get an abortion take time. As women struggle to put a few dollars aside, pawn their possessions, and borrow from family and friends, one week evaporates into the next, and with every passing week the cost of the abortion climbs higher. As a result many poor women incur later, more expensive abortions. An estimated one-fifth of low-income women who want abortions never gather the necessary resources and are forced to carry their pregnancies to term.
As the potential barriers loom ever larger, I see access to abortion for poor women falling farther and farther beyond their reach. And leaving them out of the picture seriously distorts our understanding of the availability of abortion. We saw this in a recent front page New York Times article, “As Abortion Rate Decreases, Clinics Compete for Patients,” Gina Kolata, 12/30/00, which completely ignores the obstacles to abortion access. Instead, it focuses on competition for patients among providers in large urban areas. The article misses the fact that market forces are of no help to women who have no money. Michelle, Carol, Mary and Irela all live in large cities where there are providers. Yet without financial resources, they cannot obtain abortions.
On this anniversary of legal abortion, I suggest that we think about these women and the thousands like them who remain invisible as we continue to fight over this issue. It is their lives and futures which hang in the balance.
Marlene Gerber Fried, Director, Civil Liberties and Public Policy Program and Professor of Philosophy at Hampshire College; President, National Network of Abortion Funds