My decision to have an abortion in 2010 wasn’t influenced by a lack of financial stability; I knew at 30 years old that I didn’t want children of my own. The circumstances that led to my unplanned pregnancy, however, were entirely due to almost a decade of living with food insecurity.
We use the word “choice” constantly in the reproductive rights movement. Almost always, this is to indicate the legal right to choose what happens to us, as though life is so easily reduced to such technicalities. But the existence of a right does not ensure that those who need to exercise it will have access to it. I didn’t choose my economic circumstances or the discrimination inherent in the pre-Affordable Care Act for-profit insurance industry, which together allowed the pregnancy to happen. So I have always bristled at the way an overuse of “choice” implies that options are a guarantee. In order for health and true equality to be in reach for all, we must understand what poverty is, who is affected by it, and deal with our discomfort as a culture acknowledging the millions who live and struggle under its weight.
When you are one of the 49 million United States residents who can’t be sure they’ll eat tomorrow or next week, every aspect of your life is about economics. The longer you live with uncertainty and instability, the more you realize that those who don’t share your experience are unaware that all issues, movements, and public policy are rooted in economic justice—or injustice. I know firsthand that for many people, poverty is often related to a lack of access to basic health care, including abortion. This growing burden, carried primarily by poor people, is a blind spot for many legislatures and courts around the country, particularly where restrictions on abortion and other kinds of reproductive care are concerned.
I was reminded of the link between health-care access and poverty yet again in the face of the justifications from the current wave of governors and state representatives proposing rules undercutting vital food assistance programs. Maine’s governor is worried about pickles; a Missouri lawmaker thinks Supplemental Nutrition Assistance Program (SNAP) recipients are living large on crab legs; and the Wisconsin legislature can’t continue to abide poor people eating potatoes and jarred pasta sauce. Every week, it seems, another lawmaker is trying to find a guilt-free way to shave one percentage point off the budget by cutting programs that keep people alive and create economic growth.
Sex. Abortion. Parenthood. Power.
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Earlier this month, when the latest of these restrictions trickled down through the media, I found myself brimming with anger in response to the stigmatizing language and the pervasive focus on the middle class with no mention of the poor. Eventually, this spilled over into a hashtag on Twitter, #PovertyIs, which managed to trend briefly, despite the rarity of this topic in public conversations. People from around the world defied stigma and shaming to share their everyday experiences with poverty—the emotion, the strain, the stress, the hunger, the physical discomfort, and the decisions our friends and neighbors don’t have to weigh constantly.
As I read the responses, I was reminded of my own abortion story—how for me, like many others, poverty meant deciding between food and other necessities. In my case, that was birth control.
Five years ago, I was still living in Chicago when the generic birth control pill began to fail at countering my monthly migraines, debilitating cramps, and other symptoms that made working on my feet impossible. So I was prescribed the NuvaRing. It worked like a charm—at almost $80 per month, because it was name-brand-only and the prescription plan I paid for out of pocket wouldn’t cover it. At a healthy, pre-existing condition-free 28 years of age in the years before the Affordable Care Act, my health care was costing me an outrageous total of $350 every month, assuming I didn’t actually use it to see a doctor or fill additional prescriptions. Following my third job loss that year, I was forced to choose between food and birth control—certainly a health “care” system failure.
When I became pregnant as a result, I was relatively lucky in terms of getting to the procedure itself. My Chicago address had made it relatively easy to access care; even though many of the clinics in the city are picketed, there are, in fact many clinics. I was also lucky to have managers and co-workers at both jobs that either understood or didn’t care that I needed a couple days off for a medical procedure. I even had my own OB-GYN with whom to discuss my circumstances. I only ended up at Planned Parenthood because my insurance didn’t cover the elective procedure, so I went where I could find a way to afford the appointment.
Still, the most expensive part of my abortion wasn’t the $400 or so I charged to my credit card at the clinic; it was the unpaid time off from four shifts at two jobs. The ACA may have improved matters in some respects by eliminating the co-pays for contraception and annual exams—for which I am very grateful every day I enjoy the freedom of my IUD—but people still have to be able to physically access a clinic in order to appreciate this policy upgrade. When doctors’ appointments require travel, time off, child care, follow-up prescriptions, follow-up appointments, and trips to the pharmacy, co-pays were never the only expense. And those of us living in poverty feel every payout. I wouldn’t have been in a position where $80 could break me if my economic circumstances had been at all stable before the prescription upgrade or losing that third job.
Recently, an unexpected medical bill led me to a new perspective on my unplanned pregnancy from five years ago. I’m one of many long-term underemployed United States residents with little-to-no room for error in my monthly budget. This latest health surprise put me over the edge completely. I wasn’t able to play bill roulette or juggle basics or max out a credit card to bridge the gap this time around, so I applied for CalFresh, California’s food assistance program.
After two years of covering the fight to keep Mississippi’s only clinic open and spending time with activists in the Rio Grande Valley, my new situation, combined with the flood of proposed SNAP restrictions and the #PovertyIs responses, has re-centered economic justice in my advocacy and reporting. It’s also refocused my abortion story, leading me to be bolder about the root causes of my unplanned pregnancy. I always cared about people’s economic circumstances, but I now have a fundamentally different relationship to those affected by abortion restrictions and to the phrase used to measure the unnecessary ordeal they endure to attain access.
The undefined, unequally applied “undue burden” standard makes the disproportionate effect of abortion restrictions on the poor especially evident. The Fifth Circuit’s most recent ruling again moves the goalposts on “undue burden” by deeming the ambulatory surgical center requirements of the Texas omnibus anti-abortion law HB 2 valid. Though the Supreme Court has stayed the ruling for now, according to advocates, if implemented, this provision of HB 2 could shutter all but nine clinics in the state.
Simply looking at the second largest state in the union on a map is enough to grasp some level of how disastrous this would be for its 27 million residents. Living in the center of West Texas already meant at least a five-hour drive in one direction or another to access a clinic in either San Antonio or New Mexico. Add in waiting periods, ultrasounds, counseling, admitting privileges that limit the number of doctors available to perform procedures in any given region, and my two days off work and $1,000 grand total in out-of-pocket cost and lost wages seems like a drop in the bucket. My ordeal five years ago was enough to go through, considering it shouldn’t have been necessary. But my white, cis, documented, able-bodied privilege all stacks up to a comparatively easy road. Even my finances were less strained thanks to timing and hard work coming together; I didn’t have $1,000 lying around to throw away, but I was able to find it.
Texas is hardly an anomaly—it’s simply a powerful visual depiction of how abortion restrictions affect a population over an enormous area. But the corridor stretching from the western border of Idaho to the eastern borders of North and South Dakota is a nearly 1,200-mile-wide clinic desert. Some states only have a single full-scale reproductive health clinic. Defunding Planned Parenthood through cuts to family planning services has caused five clinics to close in Indiana—none of which even provided abortion care. These “pro-life” policies have created a public health crisis in an area currently dealing with an HIV outbreak.
Meanwhile, on a federal level, House Republicans are attempting to eliminate Title X funding, a program that has provided millions of low-income people with STI testing, cancer screenings, contraception, and treatment since President Richard Nixon championed and signed it into law in 1970.
Nixon matter-of-factly explained why he was backing the law at the time: “It is my view that no American woman should be denied access to family planning assistance because of her economic condition.”
Almost everything seems to have changed in the past 45 years. The more I watched people on the #PovertyIs thread discuss putting off medical care despite having insurance because they couldn’t get off work or couldn’t afford the co-pays, the more absurd the debate about burden became to me. HB 2 alone has been in appeals for two years. How long does it take, exactly, for a handful of judges to decide whether 500 miles over three days or more, hundreds of dollars in lost pay and child care, and the emotional strain of navigating the ever-changing landscape is too much to put people through when they have the power to prevent all of it from happening in the first place? Why do those in power see the concept of “burden” as solely a political and/or legal issue, without direct connection to people’s economic condition?
To those with modest or substantial means, the burden is automatically attached to the concept of our rights: how far is too far and how much is too much to exercise a constitutional right? But for those of us without a safety net, burden is a word that feels heavy. It sounds like the keys of a calculator clicking to determine whether this month’s math means we eat, have heat, and can put enough gas in our cars to get to work. That heaviness is the intersection of reproductive justice and economic justice, and it should be given equal weight in policy discussions, in advocacy, and in our media.
Just as SNAP funding provides a lifeline to those who need it, access and funding to reproductive health care provide a basic level of bodily autonomy and the opportunity to determine one’s own present and future. You can’t be a functional, autonomous human without the ability to eat, just as you can’t be fully human and free without the ability to control if, whether, and when you become a parent. These connections have long been clear and foundational to the reproductive justice movement built by women of color too-often sidelined and silenced by mainstream feminist and reproductive rights advocates. It’s long past time that their voices and approach to culture change became the standard for advocacy work.
Bodily autonomy is about more than just controlling what is happening right now in your reproductive system. Having final say over what happens within and around your body determines whether or not you are the one who decides the direction of your life. Ensuring self-determination for all people is the foundation to achieving economic justice; acknowledging this reality strengthens our movement and ensures that we strive to help people in need today as we secure the rights of everyone for the future.