There are those who view poverty as if it were a choice, as if poverty could only be the result of a series of bad decisions. Poverty is many things. It is linked to hypertension and diabetes; it’s a carcinogen. For many, poverty results from a single event, such as job loss, a serious illness, or the birth of an unexpected child.
It is not a character flaw.
I continue to be amazed at how some people can ignore the all too common circumstances of life that throw us into poverty. In my work, I often speak with wealthy individuals to solicit donations. In conversations too numerous to count, a well-meaning donor has said to me: “Well, if they would only take proper precautions, then they wouldn’t have children they can’t afford.” I suppose the donor was saying, if “they,” meaning poor women, would only take the pill, or have an IUD implanted, or just wouldn’t have sex they would not be in this situation. There are many problems with this statement—I got stuck on “they.” I wondered if the donor realized that the “they” whom she referred to look like me.
Of course, every able woman has the responsibility to do her best to avoid unplanned pregnancies; the vast majority try. But if she doesn’t have access to information and reproductive care services, then she can’t make the best choices for her health and well-being. If she doesn’t have health insurance, then she likely can’t afford contraceptives. If a woman is poor and lives in a state without Medicaid expansion, she may not be able to afford to buy health insurance from the exchange. That apparently leaves her with one choice: abstinence.
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Should she be condemned for engaging in the most basic human activity?
I wonder what my donor would say to Natalie—not her real name—who in 2011, as a single mother of three working a low-wage job, experienced two life-changing events. First in July, just four days after moving into a rental home with her children, her boyfriend set fire to the house and burned it to the ground, destroying all of their possessions. She had not yet had the chance to secure insurance and so was unable to replace anything. Two weeks later, while living in an emergency shelter, she went to the hospital because she was not feeling well and found out she was HIV-positive and had been for some time. Her absences due to illness resulted in her losing her job, and for the next eight months, she moved from one friend’s house to the other. Now, imagine if Natalie had been pregnant.
Thirty-nine years ago, the Hyde Amendment began creating significant barriers to health for women, particularly low-income women, who are disproportionately women of color. This law bans the use of federal funds for abortion services for women who need them most—women most likely to face barriers to these services because of cost, lack of health insurance, and the inability to access abortion providers because they live in racially segregated or rural communities. Because of lack of access to abortion services and the many state restrictions that make accessing abortions so time-consuming, thousands of women have been forced to have children they are physically, psychologically, and financially ill-prepared to raise.
Half of all pregnancies are unplanned and 21 percent end in abortion. Tracy Weitz, an abortion researcher and investigator on the “Turnaway Study,” a five-year examination of the effects of unintended pregnancy on women’s lives by ANSIRH (Advancing New Standards in Reproductive Health), has found that the main reason women terminate their pregnancies is because they can’t afford to have a child.
That’s understandable. In 2014, the Department of Agriculture reported the average cost of raising a child by a couple whose income is between $61,530 and $106,540 per year was $245,000. For couples earning less than $61,530 per year, that cost was $176,550.
When a low-income mother is able to plan her pregnancies, she is much more likely to be able to provide for her baby. When she cannot get an abortion, if that is her choice, she is three times more likely to descend into and remain in poverty.
Women of color are more likely to live in poverty, and more likely to suffer the consequences of an unintended pregnancy. Women who cannot afford to pay for abortion services out of pocket are forced to delay or postpone the procedure for up to three weeks, if not longer. Forty-two percent of women obtaining abortions live below the federal poverty line, according to the 2008 report, Characteristics of US Abortion Patients. States such as Mississippi and Texas, with high poverty rates, have the most severe restrictions on abortion services.
A July 2014 report published by the Guttmacher Institute showed the overall incidence of abortions has fallen to the lowest level since the landmark Roe vs. Wade 42 years ago. This implies that many women who seek abortion care have been able to find and obtain services. However, one in four Medicaid-eligible women who seek an abortion must carry the child to term because there are no state funds available.
Grotesque billboard campaigns, sponsored by the anti-abortion group Life Always, have been placed in African-American neighborhoods, declaring “The Most Dangerous Place for an African American Is in the Womb.” Black women and Latinas face attacks from anti-choice groups running so-called crisis pregnancy centers that masquerade as legitimate health centers for women, but whose sole purpose is to deter women from getting abortion care services. These federally funded facilities misinform pregnant teens about the health risks of abortion, for example, by claiming abortion increases the risk of severe mental illness or that, contrary to science, there is a link between abortion and breast cancer.
After the Roe v. Wade decision in 1973, conservative politicians moved quickly to deny abortions to women in greatest need. Rep. Henry Hyde (R-IL) said, “I would certainly like to prevent, if I could legally, anybody having an abortion: a rich woman, a middle class woman, or a poor woman. Unfortunately, the only vehicle available is the [Medicaid] bill.” (Emphasis added.)
Anti-choice lawmakers have introduced hundreds of new restrictions on abortions since January. Who will advocate for poor women? Of 535 members of Congress, 27 are Black women and Latinas. Of the 7,382 members of state legislatures, only 337 are Black women and Latinas. We need lawmakers who are more likely to understand the realities of life for low-income women, regardless of political party. These are the men and women who will be inclined to enact legislation to ensure women get the care they need.
For those of us who care about the health and wellness of poor women, our challenge is to be critical but not to blame; to observe the reality of women’s choices while acknowledging the external forces that limit those choices; and to create a culture where every woman can do her best.