Bernie, Tom, time for The Talk. About Abortion...

Bernie, Tom, Jonathan, Clare, Randi, and Pals: - Stories are afoot that some Dems aim to talk about income inequality separately from abortion rights, a matter of “identity politics versus economic opportunity.” Bernie Sanders supported Heath Mello for Mayor of Omaha, despite Mello’s support for bills mandating doctors to offer an ultrasound before performing an abortion, a 20-week abortion ban, and banning insurance plans from covering abortion. He reportedly expressed surprise that some feminists couldn’t see how Heath “could help break the grip of big money on the nation’s politics.”

While various stories circulate, a history of just such confused moves in the past by other Democrats suggests that it is useful to spell out some blunt truths:

Abortion rights are a key pillar of income equality. Wait, there’s more:

Opposition to abortion rights is a key factor keeping women and kids in poverty. And the clincher:

Opponents of abortion rights, though a minority of voters, are key constituents of the very gerrymandered districts that enable and perpetuate the grip of big money on state and national politics.

This case is abundantly documented in a policy statement adopted by the American Public Health Association in 2015: Restricted Access to Abortion Violates Human Rights, Precludes Reproductive Justice, and Demands Public Health Intervention. Excerpts (and a few updates):

A recent major report by the Center for Reproductive Rights and researchers at Ibis Reproductive Health evaluated the association between enactment of anti-abortion policies and passage of state policies known to improve the health and well-being of women and children or to improve state-level health outcomes in these groups. They also examined health policies and women’s and children’s outcomes in states with relatively few abortion restrictions.

The report evaluated the prevalence of 14 state abortion restrictions against indicators of population health in four topic areas: women’s health outcomes, children’s health outcomes, social determinants of health, and policies supportive of women’s and children’s health. The authors found an inverse relationship between a state’s number of abortion restrictions and its number of evidence-based policies supporting women’s and children’s well-being. States with more abortion restrictions tend to have fewer supportive policies in place, policies that are crucial to ensuring that women and families are able to live healthy and safe lives.

The authors also found that the more abortion restrictions that were present, the worse a state performed overall on indicators of women’s and children’s well-being. Among the 23 states with 0–6 abortion restrictions, 18 (78%) were above the median overall well-being score. In contrast, only 8 of the 28 states with 7–14 abortion restrictions (29%) were above the median.

Debate on abortion has polarized Congress and many state legislatures, undermining their ability to address other pressing policy concerns.

Local, state, and national laws and regulations, court challenges, and media campaigns that obstruct patients’ access to abortions are accelerating in number and severity. Since 2010, state legislatures in 36 states have enacted 205 restrictions on access to abortion care, leading to sharp increases in inequality in unintended pregnancies, births, and abortions in the United States, by race/ethnicity, income, and location; lower funding for women’s and children’s health services and worse health outcomes in states where anti-abortion campaigns have prevailed; and economic costs associated with exacerbated inequality.

Restrictions in public funding have concentrated the most severe and negative consequences among underserved and vulnerable populations with limited political power, namely low-income women and women of color.

Restrictions that deny, delay, and impede access to abortion services, increase women’s risk of injury or death; they also may coerce women to carry unintended pregnancies to term, elevating their risk of poverty and violating their human rights and rights as citizens.

Unintended pregnancies are increasing among low-income women and women of color and declining among women with incomes above 200% of the federal poverty rate and White women. Rates of unintended pregnancy and unintended birth among women of color are more than twice the rates for White women. Black women have the highest unintended pregnancy rate, while Hispanics have the highest rate of unintended births.

By limiting the availability of safe abortion services overseas, the Helms Amendment imposes barriers on access to basic reproductive health care, thereby violating women’s fundamental human rights. Even in countries where abortion is legal, women and girls incur preventable deaths and injuries because they are denied access to information and safe abortion care in US-funded clinics and facilities.

Access to safe abortion is a key factor in preventing deaths and disability among women due to pregnancy-related causes. Each year, an estimated 22 million women and girls have an unsafe abortion, almost all in the developing world. As a result, 47,000 lose their lives and millions more suffer serious injury. The economic and social costs of unsafe, delayed, or illegal abortions include maternal mortality, long-term complications from damage to reproductive organs, pelvic inflammatory disease, and secondary infertility, as well as potential harm to a woman’s existing children.

Countries’ health systems incur huge costs in managing these preventable injuries, and their economies suffer from diminished economic participation.

The Hyde Amendment, first enacted in 1976, prohibits spending federal funds for abortions in domestic US programs. The rule is not a permanent law; however, it is attached annually to congressional appropriations bills and has been approved by Congress every year since 1976.

Medicaid, a federally authorized health care program that is jointly funded and administered by the federal and state governments and covers low-income US residents, is the primary target of the Hyde restrictions. Current pending legislation, the EACH Woman Act (HR 771), would overturn the Hyde Amendment.

The funding ban has been extended to cover the Federal Employees Health Benefit Program, active duty and veteran women in the military, federal prison inmates, Peace Corps volunteers, and American Indian and Alaska Native women who obtain health care from the Indian Health Service.

The Hyde Amendment identifies exceptions, that is, circumstances in which federal funds can be used to pay for an abortion. However, “exceptions” … communicate loaded, destructive messages regarding women’s worth, sexuality, autonomy, and competence. One such message is that women are entitled to terminate a pregnancy only if they can establish that it resulted from circumstances beyond their control (rape) and/or a situation more morally reprehensible than their own customary behavior (incest).

The exceptions may also imply that funding for abortions in other circumstances is unwarranted, and therefore they unfairly target and discriminate against disenfranchised groups, particularly women of color, young women, and women in poverty. Such women are more likely to access vital reproductive health services through the public health system and lack funds to cover out-of-pocket expenses for safe abortion care outside of the recognized exceptions.

The Patient Protection and Affordable Care Act (ACA) restricts women’s ability to obtain coverage that includes abortion services.

These developments establish a questionable standard regarding the nature of “public” and “private” sources of payment for health care services and use of payment source as a basis for determining health policy. Domestically, this has contributed to destabilizing the basis for group insurance coverage

The Supreme Court’s decision in 2014 in the Hobby Lobby case …undermines the validity of scientific evidence as a basis for public health policy.

In summary, restrictions on coverage and funding for abortions undermine sound health policy, present significant risks to women’s health and rights, and disproportionately threaten the health and life chances of underserved communities by (1) codifying the government’s right to provide a lower standard of health care coverage based on gender and income and treating funding for abortions for low-income women differently, even though abortion is a legal health care service; (2) treating abortion differently from other health care services, thereby stigmatizing it; and (3) fragmenting women’s interests in and experiences of access to abortion by income and by characteristics associated with income, including race/ethnicity, level of education, and geographic location.

Impact of attacks on abortion care on discrimination: Social determinants of health begin with pregnancy, according to Marmot et al. “The interaction between gender inequities and other social determinants increases women’s vulnerability and exposure to risk of negative sexual and reproductive health outcomes. Poor maternal health, inadequate access to contraception, and gender-based violence are indicators of these inequities.”

The overall rate of abortions is declining in the United States as contraceptives become increasingly widespread and effective. However, while 40% of pregnancies are unintended worldwide, the US rate is higher, at 51%.

Poor women are five times as likely as higher income women to have an unintended pregnancy, five times as likely to have an abortion, and six times as likely to have an unplanned birth. Medicaid coverage of abortion has an important effect on the ability of poor women to end unintended pregnancies. About one in four women who would have had Medicaid-funded abortions instead give birth when this funding is unavailable.

Low-income women who are able to raise the money for an abortion have reported that they often do so at a great sacrifice to themselves and their families, diverting money that would otherwise be used to pay for rent, utility bills, food, and clothing for themselves and their children. In addition, costs and the risk of complications increase with increasing gestational age.

Impact of abortion restrictions on women’s incomes and income inequality: Policies that deny women abortions they seek deepen and entrench poverty among women and children. Preliminary results of the Turnaway Study indicate that parenting and raising a child as a result of an abortion denial reduces full-time employment, and increases poverty, public assistance receipt and the chance of living alone with children.

Association between anti-abortion measures and population health: States with more anti-abortion policies have significantly lower indicators of infant/child well-being. Women in states that prohibit Medicaid funding of abortions have significantly higher rates of postpartum depression than women in states that fund Medicaid abortions.

A public health strategy to achieve health in all policies, economic equality, social justice, and human rights should protect and advance women’s access to abortions and reproductive justice.

A public health strategy to achieve health in all policies, economic equality, social justice, and human rights should protect and advance women’s right to access to abortions and advance reproductive justice by (1) demanding public funding for abortions through reversing the Hyde and Helms amendments; (2) calling for reversals of all policies restricting access to abortions as a result of their negative public health consequences; (3) asserting that severe barriers to access to abortions violate women’s rights to bodily autonomy, equity, and privacy and constitute cruel, inhuman, or degrading treatment; (4) reversing stigma associated with abortion care services and creating solidarity with and respect and empathy for women who receive abortions; and (5) asserting support for the conscientious provision of abortions, with health care clinicians framing abortion care as an extension of their requirement to place patients’ needs as the highest priority in providing treatment.

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