Women Living in Poverty Make Up Increasing Share of Patients Seeking Abortion Care

Jodi Jacobson

The proportion of abortion patients who were poor increased by almost 60 percent between 2000 and 2008, according to a new report by the Guttmacher Institute.

A new analysis by the Guttmacher Institute reveals that women living below the poverty line make up an increasing share of those seeking abortion care in the United States.

In what the authors called the “most striking finding” of the report,  Characteristics of U.S. Abortion Patients, 2008, the share of abortion patients who were poor increased by almost 60 percent over an eight-year period—from 27 percent of all women seeking abortion care in 2000 to 42 percent in 2008.  The analysis is based on a nationally representative survey of women obtaining abortions in the United States. The authors note that “While the data permitted the researchers to calculate the proportion of women obtaining abortions in each socioeconomic category, it did not provide the number or rate of abortions in the United States.”

Aside from the shift in income status relative to choices about unintended or unwanted pregnancies, little changed in the profile of women obtaining abortions between 2000 and 2008.  Women in their twenties, cohabiting, black or poor “remain overrepresented among abortion patients.”

As in 2000, the vast majority of women seeking abortion in 2008 were in their twenties and thirties and already had children. Women 20 years old and younger made up roughly 18 percent of all abortions, while those younger than 18 made up less than 7 percent.

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“A broad cross section of U.S. women have abortions,” noted the Institute’s release:

  • Fifty-eight (58) percent of abortion patients in 2008 were in their twenties;
  • Forty-five (45) percent were never-married and not living with a partner;
  • Sixty-one (61) percent were already mothers;
  • Forty-two (42) percent were living below the federal poverty line;
  • Thirty-six (36) percent were white;
  • Fifty-nine (59) percent had at least some college education; and
  • Seventy-three (73) percent were religiously affiliated. 

Thirty seven percent of those identified as Protestant while 27 percent identified as Catholic.  One in five identified themselves as evangelical, fundamentalist, charismatic or born-again. The study notes that “[w]hile the Catholic Church has strong proscriptions against abortion, the relative abortion rate for Catholic women was no different from that for all women.”

It is not surprising that a growing share of women seeking abortion care are poor. An increasing number of women and children in the United States are falling below the poverty line.  Indeed, an increasing share of those who are poor are living in what researchers call “severe poverty.” Women, faced with the possibility of giving birth to a child for which they can not provide may make the decision to terminate an unintended pregnancy as early as they can. 

According the National Poverty Center at the University of Michigan, the federal poverty rate increased each year between 2000 and 2004, to reach 12.7 of all Americans in 2004. The poverty rate among women has grown rapidly.  According to a September 2009 Guttmacher report, the proportion of women in the overall population who were poor increased by 25 percent between 2000 and 2008.

Black women and children are most likely to be living in poverty. The National Poverty Center notes that poverty rates for blacks and Hispanics greatly exceeds the national average. In 2008, for example, 24.7 percent of blacks and 23.2 percent of Hispanics were poor, compared to 8.6 percent of non-Hispanic whites and 11.8 percent of Asians.

Poverty rates are highest for families headed by single women, particularly if they are black or Hispanic. In 2008, 28.7 percent of households headed by single women were poor, while 13.8 percent of households headed by single men and 5.5 percent of married-couple households lived in poverty.

Moreover, the share of Americans living in severe poverty–earning less than half of the poverty threshold–also grew by 20 percent between 2000 and 2004, and the proportion of the population in higher income tiers fell. A 2006 study published in the American Journal of Preventive Medicine found that the number of Americans living in severe poverty increased by 3.6 million between 2000 and 2004. Severe poverty is also dramatically worse among African Americans and Hispanics.

Children represent a disproportionate share of the poor in the United States and black children represent a disproportionate share of all children living in poverty. Children make up 25 percent of the total population, but 35 percent of the poor population. Black children make up 34 percent of all children in poverty, the highest share for any sub-group. And, according to Steven H. Woolf, MD, MPH, Professor of Family Medicine, Epidemiology and Community Health, Virginia Commonwealth University, and lead author of the study in Preventive Medicine: “The rise in severe poverty is striking children the hardest.” Children account for 45 percent of all Hispanic and African Americans living in severe poverty.

Woolf states that the likely health consequences of these trends in poverty include “a higher prevalence of chronic illnesses, more frequent and severe disease complications, and increased demands and costs for healthcare services. Adverse effects on children carry long-term implications.”  These realities do not escape mothers or parents-to-be struggling simply to have food on the table each day. 

Economic circumstances are a driving factor in determining how and when people build their families. As the recession has persisted and poverty among already-disadvantaged groups deepened, women make rational decisions about their ability to support a child, or in the case of the vast majority of women seeking abortions who are already mothers, to add another child to an existing and already struggling family.

As Guttmacher’s report on the recession notes:

Decisions that women and their partners make about family planning—when to have a child, how many children to have and even whether to have children at all—take on a special significance and urgency during periods of economic turbulence. The ongoing recession in the United States has altered the economic realities of many families’ lives, and it has dramatically reshaped the environment in which people make, and try to act upon,
decisions about their reproductive lives.

Researchers note that in addition to economic circumstances, long-term and persistent discrepancies in access to pregnancy prevention and other basic reproductive health services are behind the increasing concentration of poor women among those seeking abortion care.

“Gaps in unintended pregnancy and abortion between poor and more affluent women have been increasing since the mid-1990s, so—sadly—none of this comes as a surprise,” says Sharon L. Camp, president and CEO of the Guttmacher Institute.  She continues:

“Reproductive health disparities, and health disparities more generally, are endemic in this country and stem from broader, persistent economic and social inequities. We need to bridge these reproductive health gaps by ensuring that all women, regardless of their economic circumstances, have meaningful access to the full spectrum of information and services—both contraceptive services to reduce levels of unintended pregnancy and abortion services.”

For the first time, the Guttmacher survey used to develop this analysis asked patients about their health insurance status and how they paid for abortion services. Results showed that these women were fairly evenly divided among those with private insurance (30 percent), those with no insurance (33 percent) and those covered by Medicaid (31 percent). Although a majority had some type of public or private health insurance, it is not clear how many of those plans actually included abortion coverage or had a high deductible that discouraged its use for coverage of abortion.  Still, 57 percent of all women obtaining abortions reported that they paid out of pocket for the procedure, while 12 percent used private insurance. Twenty percent of women relied on Medicaid and almost all of the women in the Medicaid group lived in the few states that use their own funds to pay for abortions. Among women on Medicaid who lived in states that use their own funds to pay for abortions, more than nine in 10 relied on this method to pay for their abortion. Some 13 percent of abortion patients relied on financial assistance programs to cover at least some of the cost of the procedure.

The report notes the pressure that demand for abortion care among low-income women have placed on service providers and nonprofit abortion funds across the country, which “have sought to meet the growing need among poor and low-income women by providing services on sliding fee scales and by subsidizing abortion services through charitable donations.”

These services may have allowed some poor women to access services they might not have otherwise been able to afford.

Roundups Politics

Campaign Week in Review: ‘If You Don’t Vote … You Are Trifling’

Ally Boguhn

The chair of the Democratic National Convention (DNC) this week blasted those who sit out on Election Day, and mothers who lost children to gun violence were given a platform at the party's convention.

The chair of the Democratic National Convention (DNC) this week blasted those who sit out on Election Day, and mothers who lost children to gun violence were given a platform at the party’s convention.

DNC Chair Marcia Fudge: “If You Don’t Vote, You Are Ungrateful, You Are Lazy, and You Are Trifling”

The chair of the 2016 Democratic National Convention, Rep. Marcia Fudge (D-OH), criticized those who choose to sit out the election while speaking on the final day of the convention.

“If you want a decent education for your children, you had better vote,” Fudge told the party’s women’s caucus, which had convened to discuss what is at stake for women and reproductive health and rights this election season.

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“If you want to make sure that hungry children are fed, you had better vote,” said Fudge. “If you want to be sure that all the women who survive solely on Social Security will not go into poverty immediately, you had better vote.”

“And if you don’t vote, let me tell you something, there is no excuse for you. If you don’t vote, you don’t count,” she said.

“So as I leave, I’m just going to say this to you. You tell them I said it, and I’m not hesitant about it. If you don’t vote, you are ungrateful, you are lazy, and you are trifling.”

The congresswoman’s website notes that she represents a state where some legislators have “attempted to suppress voting by certain populations” by pushing voting restrictions that “hit vulnerable communities the hardest.”

Ohio has recently made headlines for enacting changes that would make it harder to vote, including rolling back the state’s early voting period and purging its voter rolls of those who have not voted for six years.

Fudge, however, has worked to expand access to voting by co-sponsoring the federal Voting Rights Amendment Act, which would restore the protections of the Voting Rights Act that were stripped by the Supreme Court in Shelby County v. Holder.

“Mothers of the Movement” Take the National Spotlight

In July 2015, the Waller County Sheriff’s Office released a statement that 28-year-old Sandra Bland had been found dead in her jail cell that morning due to “what appears to be self-asphyxiation.” Though police attempted to paint the death a suicide, Bland’s family has denied that she would have ended her own life given that she had just secured a new job and had not displayed any suicidal tendencies.

Bland’s death sparked national outcry from activists who demanded an investigation, and inspired the hashtag #SayHerName to draw attention to the deaths of Black women who died at the hands of police.

Tuesday night at the DNC, Bland’s mother, Geneva Reed-Veal, and a group of other Black women who have lost children to gun violence, in police custody, or at the hands of police—the “Mothers of the Movement”—told the country why the deaths of their children should matter to voters. They offered their support to Democratic nominee Hillary Clinton during a speech at the convention.

“One year ago yesterday, I lived the worst nightmare anyone could imagine. I watched as my daughter was lowered into the ground in a coffin,” said Geneva Reed-Veal.

“Six other women have died in custody that same month: Kindra Chapman, Alexis McGovern, Sarah Lee Circle Bear, Raynette Turner, Ralkina Jones, and Joyce Curnell. So many of our children are gone, but they are not forgotten,” she continued. 

“You don’t stop being a mom when your child dies,” said Lucia McBath, the mother of Jordan Davis. “His life ended the day that he was shot and killed for playing loud music. But my job as his mother didn’t.” 

McBath said that though she had lost her son, she continued to work to protect his legacy. “We’re going to keep telling our children’s stories and we’re urging you to say their names,” she said. “And we’re also going to keep using our voices and our votes to support leaders, like Hillary Clinton, who will help us protect one another so that this club of heartbroken mothers stops growing.” 

Sybrina Fulton, the mother of Trayvon Martin, called herself “an unwilling participant in this movement,” noting that she “would not have signed up for this, [nor would] any other mother that’s standing here with me today.” 

“But I am here today for my son, Trayvon Martin, who is in heaven, and … his brother, Jahvaris Fulton, who is still here on Earth,” Fulton said. “I did not want this spotlight. But I will do everything I can to focus some of this light on the pain of a path out of the darkness.”

What Else We’re Reading

Renee Bracey Sherman explained in Glamour why Democratic vice presidential nominee Tim Kaine’s position on abortion scares her.

NARAL’s Ilyse Hogue told Cosmopolitan why she shared her abortion story on stage at the DNC.

Lilly Workneh, the Huffington Post’s Black Voices senior editor, explained how the DNC was “powered by a bevy of remarkable black women.”

Rebecca Traister wrote about how Clinton’s historic nomination puts the Democratic nominee “one step closer to making the impossible possible.”

Rewire attended a Democrats for Life of America event while in Philadelphia for the convention and fact-checked the group’s executive director.

A woman may have finally clinched the nomination for a major political party, but Judith Warner in Politico Magazine took on whether the “glass ceiling” has really been cracked for women in politics.

With Clinton’s nomination, “Dozens of other women across the country, in interviews at their offices or alongside their children, also said they felt on the cusp of a major, collective step forward,” reported Jodi Kantor for the New York Times.

According to Philly.com, Philadelphia’s Maternity Care Coalition staffed “eight curtained breast-feeding stalls on site [at the DNC], complete with comfy chairs, side tables, and electrical outlets.” Republicans reportedly offered similar accommodations at their convention the week before.

Commentary Politics

Democrats’ Latest Platform Silent on Discriminatory Welfare System

Lauren Rankin

The current draft of the 2016 Democratic Party platform contains some of the most progressive positions that the party has taken in decades. But there is a critical issue—one that affects millions in the United States—that is missing entirely from the draft: fixing our broken and discriminatory welfare system.

While the Republican Party has adopted one of the most regressive, punitive, and bigoted platforms in recent memory, the Democratic Party seems to be moving decisively in the opposite direction. The current draft of the 2016 Democratic Party platform contains some of the most progressive positions that the party has taken in decades. It calls for a federal minimum wage of $15; a full repeal of the Hyde Amendment, which prohibits the use of federal Medicaid funding for abortion care; and a federal nondiscrimination policy to protect the rights of LGBTQ people.

All three of these are in direct response to the work of grassroots activists and coalitions that have been shifting the conversation and pushing the party to the left.

But there is a critical issue—one that affects millions in the United States—that is missing entirely from the party platform draft: fixing our broken and discriminatory welfare system.

It’s been 20 years since President Bill Clinton proudly declared that “we are ending welfare as we know it” when he signed into law a sweeping overhaul of the U.S. welfare system. The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA) of 1996 implemented dramatic changes to welfare payments and eligibility, putting in place the Temporary Assistance for Needy Families (TANF) program. In the two decades since its enactment, TANF has not only proved to be blatantly discriminatory, but it has done lasting damage.

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In one fell swoop, TANF ended the federal guarantee of support to low-income single mothers that existed under the now-defunct Aid to Families with Dependent Children (AFDC) program. AFDC had become markedly unpopular and an easy target by the time President Clinton signed welfare reform legislation into law, with the racist, mythic trope of the “welfare queen” becoming pervasive in the years leading up to AFDC’s demise.

Ronald Reagan popularized this phrase while running for president in 1976 and it caught fire, churning up public resentment against AFDC and welfare recipients, particularly Black women, who were painted as lazy and mooching off the government. This trope underwrote much of conservative opposition to AFDC; among other things, House Republican’s 1994 “Contract with America,” co-authored by Newt Gingrich, demanded an end to AFDC and vilified teen mothers and low-income mothers with multiple children.

TANF radically restructured qualifications for welfare assistance, required that recipients sustain a job in order to receive benefits, and ultimately eliminated the role of the federal state in assisting poor citizens. The promise of AFDC and welfare assistance more broadly, including SNAP (the Supplemental Nutrition Assistance Program, commonly known as food stamps) benefits, is that the federal government has an inherent role of caring for and providing for its most vulnerable citizens. With the implementation of TANF, that promise was deliberately broken.

At the time of its passage, Republicans and many Democrats, including President Bill Clinton, touted TANF as a means of motivating those receiving assistance to lift themselves up by their proverbial bootstraps, meaning they would now have to work while receiving benefits. But the idea that those in poverty can escape poverty simply by working harder and longer evades the fact that poverty is cyclical and systemic. Yet, that is what TANF did: It put the onus for ending poverty on the individual, rather than dealing with the structural issues that perpetuate the state of being in poverty.

TANF also eliminated any federal standard of assistance, leaving it up to individual states to determine not only the amount of financial aid that they provide, but what further restrictions state lawmakers wish to place on recipients. Not only that, but the federal TANF program instituted a strict, lifetime limit of five years for families to receive aid and a two-year consecutive limit, which only allows an individual to receive two years of consecutive aid at a time. If after five total years they still require assistance to care for their family and themself, no matter their circumstances, they are simply out of luck.

That alone is an egregious violation of our inalienable constitutional rights to life, liberty, and the pursuit of happiness. Still, TANF went a step further: It also allowed states to institute more pernicious, discriminatory policies. In order to receive public assistance benefits through TANF, low-income single mothers are subjected to intense personal scrutiny, sexual and reproductive policing, and punitive retribution that does not exist for public assistance recipients in programs like Social Security and Supplemental Security Income disability programs, programs that Democrats not only continue to support, but use as a rallying cry. And yet, few if any Democrats are crying out for a more just welfare system.

There are so many aspects of TANF that should motivate progressives, but perhaps none more than the family cap and forced paternity identification policies.

Welfare benefits through the TANF program are most usually determined by individual states based on household size, and family caps allow a state to deny welfare recipients’ additional financial assistance after the birth of another child. At least 19 states currently have family cap laws on the books, which in some cases allow the state to deny additional assistance to recipients who give birth to another child. 

Ultimately, this means that if a woman on welfare becomes pregnant, she is essentially left with deciding between terminating her pregnancy or potentially losing her welfare benefits, depending on which state she lives in. This is not a free and valid choice, but is a forced state intervention into the private reproductive practices of the women on welfare that should appall and enrage progressive Democrats.

TANF’s “paternafare,” or forced paternity identification policy, is just as egregious. Single mothers receiving TANF benefits are forced to identify the father of their children so that the state may contact and demand financial payment from them. This differs from nonwelfare child support payments, in which the father provides assistance directly to the single mother of his child; this policy forces the fathers of low-income single women on welfare to give their money directly to the state rather than the mother of their child. For instance, Indiana requires TANF recipients to cooperate with their local county prosecutor’s child support program to establish paternity. Some states, like Utah, lack an exemption for survivors of domestic violence as well as children born of rape and incest, as Anna Marie Smith notes in her seminal work Welfare Reform and Sexual Regulation. This means that survivors of domestic violence may be forced to identify and maintain a relationship with their abusers, simply because they are enrolled in TANF.

The reproductive and sexual policing of women enrolled in TANF is a deeply discriminatory and unconstitutional intrusion. And what’s also disconcerting is that the program has failed those enrolled in it.

TANF was created to keep single mothers from remaining on welfare rolls for an indeterminate amount of time, but also with the express goal of ensuring that these young women end up in the labor force. It was touted by President Bill Clinton and congressional Republicans as a realistic, work-based solution that could lift single mothers up out of poverty and provide opportunities for prosperity. In reality, it’s been a failure, with anywhere from 42 to 74 percent of those who exited the program remaining poor.

As Jordan Weissmann detailed over at Slate, while the number of women on welfare decreased significantly since 1996, TANF left in its wake a new reality: “As the rolls shrank, a new generation of so-called disconnected mothers emerged: single parents who weren’t working, in school, or receiving welfare to support themselves or their children. According to [the Urban Institute’s Pamela] Loprest, the number of these women rose from 800,000 in 1996 to 1.2 million in 2008.” Weissmann also noted that researchers have found an uptick in “deep or extreme poverty” since TANF went into effect.

Instead of a system that enables low-income single mothers a chance to escape the cycle of poverty, what we have is a racist system that denies aid to those who need it most, many of whom are people of color who have been and remain systemically impoverished.

The Democratic Party platform draft has an entire plank focused on how to “Raise Incomes and Restore Economic Security for the Middle Class,” but what about those in poverty? What about the discriminatory and broken welfare system we have in place that ensures not only that low-income single mothers feel stigmatized and demoralized, but that they lack the supportive structure to even get to the middle class at all? While the Democratic Party is developing strategies and potential policies to support the middle class, it is neglecting those who are in need the most, and who are suffering the most as a result of President Bill Clinton’s signature legislation.

While the national party has not budged on welfare reform since President Bill Clinton signed the landmark legislation in 1996, there has been some state-based movement. Just this month, New Jersey lawmakers, led by Democrats, passed a repeal of the state’s family cap law, which was ultimately vetoed by Republican Gov. Chris Christie. California was more successful, though: The state recently repealed its Maximum Family Grant rule, which barred individuals on welfare from receiving additional aid when they had more children.

It’s time for the national Democratic Party to do the same. For starters, the 2016 platform should include a specific provision calling for an end to family cap laws and forced paternity identification. If the Democratic Party is going to be the party of reproductive freedom—demonstrated by its call to repeal both the federal Hyde and Helms amendments—that must include women who receive welfare assistance. But the Democrats should go even further: They must embrace and advance a comprehensive overhaul of our welfare system, reinstating the federal guarantee of financial support. The state-based patchwork welfare system must be replaced with a federal welfare assistance program, one that provides educational incentives as well as a base living wage.

Even President Bill Clinton and presumptive Democratic presidential nominee Hillary Clinton both acknowledge that the original welfare reform bill had serious issues. Today, this bill and its discriminatory legacy remain a progressive thorn in the side of the Democratic Party—but it doesn’t have to be. It’s time for the party to admit that welfare reform was a failure, and a discriminatory one at that. It’s time to move from punishment and stigma to support and dignity for low-income single mothers and for all people living in poverty. It’s time to end TANF.