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It's Not a Choice If You Can't Afford It

Other countries recognize that women lose their lives to unsafe abortion and that safe abortion care is a crucial element in comprehensive women's health. The United States is out of step with the rest of the world.
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Along with most Americans, I was appalled that the budget debate in Congress largely ignored the public mandate to create jobs and build the economy, but instead focused on cutting basic health services for women. The primary goal behind the right wing proposal to defund Planned Parenthood was presumably to put an end to abortion services.

Supporters of women's health rightly pointed out that cutting funding would deny women access to needed cancer screenings, pap smears and STI testing. But some took their case further, seemingly to placate the extreme right, arguing that it's politically "safe" to fund family planning because after all, it's against the law to use federal dollars to pay for abortion.

The argument worked; legislators thankfully voted to preserve funding to Planned Parenthood, many convinced that as long as federal money doesn't pay for abortions, it was OK. Even Secretary of Health and Human Services Kathleen Sebelius asserted this as recently as April 8 in an article in Politico, adding a guarantee that federal funds would never be used for abortion. But should we be proud that our government doesn't provide any funding for a legal medical procedure? How does this serve women who live somewhere near the poverty line who come to the decision to end an unintended pregnancy?

I don't agree with the common wisdom that abortion is something to be ashamed of. Yes, it can be a complex or nuanced decision, even painful for some, but not inherently shameful. But this sense of shame is reinforced whenever we hear the federal abortion ban touted as positive. If you support women's autonomy, shouldn't you support the autonomy of all women, not just the middle and upper class ones? Abortion is a part of basic health care. Shouldn't all health programs (whether private or government-funded) cover it as they do appendectomies or pap smears?

This isn't a provocative or radical concept. Yet the recent debate demonstrated how hard it is for our leaders in Congress, and even advocates on the front lines of women's health, to stand up for poor women's rights to basic health care that includes abortion care. We aren't just talking about poor women in the United States either. We do this to poor women everywhere, in the United States via the Hyde Amendment and Medicaid, and in developing countries through the Helms Amendment to the Foreign Assistance Act. We send a very strong message that we support women's health -- unless they face an unwanted pregnancy.

The United States is out of step with the rest of the world. Other countries recognize that women lose their lives to unsafe abortion and that safe abortion care is a crucial element in comprehensive women's health. England, France and Spain include abortion in their national health plans. While the United States has been steadily restricting women's access to abortion since 1994, 28 countries, including Nepal and Ethiopia, as well as the Federal District of Mexico City, have reformed their abortion laws to make abortion legal under a greater number of circumstances or to decriminalize it completely.

In Ethiopia -- one of the poorest countries in Africa, with a per capita GDP of $398 -- abortion is covered in their public health service because the government recognizes that fertility control is crucial to a woman's health and survival, her children's health and survival, and ultimately, her country's development. But the United States, which has a frankly appalling rate of unwanted pregnancy and child poverty for a country so wealthy, does not. When we understand abortion as a lifesaving health service, making abortion legal but not including it in national health plans is about as logical as denying access to defibrillators without proof of insurance.

In Ipas's work in developing countries, we see relatively little difference in abortion rates in countries with liberal or restrictive abortion laws. Instead of reducing the abortion rate, restrictive laws only drive women to risk their lives with an unsafe abortion.

In the United States, economic restrictions, combined with 916 proposed state legislative restrictions, will have a dramatic impact on women's health -- both physically and financially -- but will barely affect the abortion rate. Even now, women on Medicaid make financial sacrifices to end unwanted pregnancies. In 2009, the average abortion cost $451. The average rent bill in the United States was $600, and the monthly grocery bill $511 for a family of four. And yet, for the sake of their families and their futures, women put off bills and buy fewer groceries to pay for an abortion. According to the Guttmacher Institute, the total number of abortions in the United States would only increase 2.5 percent if Medicaid were to start covering abortions.

It's foolish to think that simply denying coverage will bring down the abortion rate. Whether in the United States -- or in countries that flat out ban abortion like Nicaragua -- economic and legal restrictions only hurt women and their families. So unless your motivation is to punish women, what's the point?

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