Abortion

Study: Abortion Access Is ‘Desperate, Not Equal’

The report's authors call public funding restrictions on abortion "state and federally sanctioned classism and racism," as the United States has shifted its public health responsibilities to private donors and nonprofits.

The study suggests young women and Black women bear the brunt of state and federal policies that limit or bar public and private insurance coverage of abortion, a system that bakes in racial and socioeconomic inequity. Joe Raedle/Getty Images

Abortion may be legal in the United States, but it’s increasingly out of reach to many with low incomes, especially young women and Black women, according to new research.

The study, the first to look at women who seek private financial assistance to help pay for abortion, paints a bleak portrait of the economic, geographic, and legal barriers to abortion care access nationwide.

The research indicates that half of the women who sought financial help to pay for abortion care were Black, though Black people make up only 36 percent of Americans who have abortions. Twenty percent of those seeking monetary assistance were 19 or younger, compared to 14 percent of abortion patients nationally.

Lead researcher Gretchen E. Ely, associate professor at the University at Buffalo School of Social Work, said the study suggests young women and Black women bear the brunt of state and federal policies that limit or bar public and private insurance coverage of abortion, a system that bakes in racial and socioeconomic inequity.

“Public health policy turns its back on these women,” Ely told Rewire. “What you’re seeing is the structuring of a two-tiered system of reproductive health access.”

The research appears last week in the print issue of Social Work in Health Care and in the report “The Undue Burden of Paying for Abortion: An Exploration of Abortion Fund Cases.”

The research builds on work that found funding restrictions, like the federal Hyde Amendment, stigmatize and marginalize abortion and delay access, particularly among people of color, who are more likely to be enrolled in the government insurance program Medicaid. Experts suggest as many as 37 percent of Medicaid recipients who become pregnant are forced to carry the pregnancy to term because of the abortion-funding ban.

Financial constraints also lead more people to try to end their pregnancies at home.

“It makes sense that you would see higher proportions of Black women and younger women because they are having problems with access all over the United States,” Ely said. “I think this parallels some other research that racism and ageism play into a lack of access to contraceptive care,” which is also associated with higher numbers of unintended pregnancies.

Ely and her co-authors looked at 3,999 cases of women requesting help to pay for abortion care from 2010 to 2015 from the George Tiller Memorial Fund. The fund is run by the nonprofit National Network of Abortion Funds, which comprises over 70 independent funds that provide aid to pregnant people with low incomes. The fund is named for Dr. George Tiller, a Kansas abortion provider who was murdered in 2009 by an anti-abortion extremist.

The research team found that time and money were the enemy for these women, about a third of whom relied on public assistance like food stamps to make ends meet. As women raised the funds to pay for an abortion while navigating myriad barriers, the care became more costly and difficult to access.

Researchers found that fund recipients had scraped together an average of $500 to pay for their abortions, which was far short of the $2,000 average cost of the procedures these women were seeking. The Tiller Fund gives priority to women seeking second trimester procedures—meaning these women weren’t necessarily a representative national sample, because most abortions take place in the first trimester. But like many pregnant people who seek abortions, the majority of the fund recipients already had children. Forty-one percent of those in the study had at least one child, and 17.5 percent had three or more children.

The research team looked at the average distance the fund recipients traveled to end their pregnancies. They found the distance doubled from 97 miles in 2010 to nearly 200 miles in 2015. It’s likely no coincidence that during these same years, GOP lawmakers across the nation enacted a blitz of 288 abortion restrictions designed to make it more difficult to get an abortion.

“For many patients, the situation can be described as desperate, not equal,” the authors noted.

The majority of fund recipients hailed from states where lawmakers either rejected Medicaid expansion under the Affordable Care Act or restrict private insurance coverage of abortion. Most lived in regions with onerous abortion laws and few clinics, with nearly half living in the South, and 27 percent living in the Midwest.

The report’s authors call public funding restrictions on abortion “state and federally sanctioned classism and racism.”

Ely said the United States, by outlawing public insurance coverage of abortion, has essentially shifted its public health responsibilities to private donors and nonprofits. Tiller Fund recipients, for example, often relied on more than one nonprofit abortion fund to pay for their procedure.

“These private organizations … that are funded by donations, are actually picking up a chunk of public health costs,” Ely said. “I don’t think people realize how much [abortion funds] are helping women access a procedure that should be part of the mainstream health system.”

The authors call for “abortion to be fully covered by all health insurance, both public and private.”