Access to Abortion Care
Abortion care is a safe and time-sensitive medical option. Access to abortion care cannot be separated from other human and reproductive rights. Every person has the right to make fundamental decisions about how, when, and whether they have children and expand their family. For this reason, access to abortion care is Reproductive Justice, and unrestricted access to abortion services must be part of basic primary health care. We must trust Black women, girls, and gender-expansive individuals to make the personal decision that is best for themselves and their families.
This right should not be infringed upon by the law. Still, in June 2022, the Supreme Court of the United States upended nearly 50 years of its own precedent and issued a majority opinion in Dobbs v. Women’s Health Organization that overturned the constitutional right to abortion care enshrined by Roe v. Wade. The 5-4 decision was made possible by President Donald Trump’s appointment of three justices to the bench—allowing a conservative, activist, antiabortion majority to take hold of the highest Court in our land.
The only people who should ever be involved in decisions about abortion care are the person seeking services, their trusted medical professional, and whoever the care-seeker may choose to include—not politicians. Still, anti-abortion federal politicians have infringed on access to abortion care for decades, starting with the Hyde Amendment. Since 1976, Hyde has banned abortion care in federally funded programs. Its restrictions affect Indigenous peoples who get their care through Indian Health Services; individuals in federal prisons and detention centers, including those detained for immigration purposes; beneficiaries of Medicaid, Medicare, and CHIP; low-income people living in the District of Columbia; Peace Corps volunteers; and servicemembers, veterans, and their dependents. The only exceptions are for pregnancies resulting from rape or incest, or when the pregnant person’s life is in danger.
More than half (51 percent) of women of reproductive age who are enrolled in Medicaid are women of color, and 55 percent of these women live in states that restrict insurance coverage for abortion exceptin limited circumstances. Research suggests that bans on Medicaid coverage for abortion results in one in four low-income women carrying an unwanted pregnancy to term. We know that this outcome—a pregnant person who is denied an abortion— can push an individual into poverty or even deeper into poverty.
Black women and girls account for more than one-third of all U.S. abortions, although they comprise just 13 percent of the population.32 33 There are several factors driving this disproportionately high rate, including the fact that Black women are more likely to lack economic resources, to be unemployed and/or uninsured, and to be insured by these programs that restrict coverage for abortion care.
In addition to programs impacted by the Hyde Amendment, the ACA does not require private insurance companies to cover abortion care; as a result, numerous states have enacted bans on abortion coverage for private insurers. Only a handful of states require insurance to cover abortion care.41 Bans and restrictions on abortion care also disproportionately affect young people, especially Black youth. Pregnant and parenting Black youth must be supported in making their own reproductive choices, including unfettered access to abortion, prenatal and post-partum care, and childcare.
They must have the same opportunities to continue their education and enter the workforce as youth who do not become pregnant or parents.
More than ever, anti-abortion activists are succeeding in their efforts to systematically dismantle the abortion care system and erect barriers that make services inaccessible—particularly for Black people who lack economic means and/or high quality insurance. Since the fall of Roe v. Wade, at least 14 states have enacted near-total bans on procedural and medication abortion, have no abortion providers due to previous restrictions, maintain gestational age bans that were previously unconstitutional under Roe v. Wade, or appear primed to enact near-total bans on surgical and medication abortion.43 Many states are attempting to ban access to medication abortion not only within their states, but nation- wide. Black women, girls, and gender-expansive people are more likely to live in these states—the same states that make it harder to access contraception and that offer the fewest resources to help Black families care for their children. Black pregnant people living in poverty and battling systemic racism are not able to simply travel to another state to receive abortion care.
The Dobbs decision and its continuing ramifications will be deadly for Black people. It compounds inequities we faced in sexual and reproductive health care services—including the highest rates of maternal and infant morbidity and mortality.
The Dobbs decision and its continuing ramifications will be deadly for Black people. It compounds inequities we faced in sexual and reproductive health care services—including the highest rates of maternal and infant morbidity and mortality. Black women, girls, and gender-expansive individuals are systematically denied the information and services they need to act in their own best interests—including abortion care that is critical to bodily autonomy. Only once all barriers to bodily autonomy have been dismantled can we make advances in generational wealth and seize opportunities to grow and excel personally, socially, academically, and professionally.
Today, we face a dangerous future where politicians are dictating the right to abortion based on their ideological agendas . Congress, policymakers, and the Biden-Harris Administration must act to ensure that the right to abortion care is fully available to all people.
• Pass the Equal Access to Abortion Coverage in Health Insurance (EACH) Act
First introduced in 2015 by Representatives Barbara Lee (D-CA), Diana DeGette (D-CO), and Jan Schakowsky (D-IL), this legislation would eliminate the Hyde Amendment and other onerous restrictions on federal abortion coverage. The bill would make the federal government a standard-bearer for abortion care by restoring coverage for abortion care to all individuals enrolled in government-sponsored or -managed health care plans and programs (e.g. Federal Employees Health Benefits [FEHB], Medicaid, Medicare, TRICARE) or who receive care from any government provider or program (e.g. Federal Bureau of Prisons, Indian Health Service, Veterans Health Administration). The legislation also prevents the federal government from placing restrictions on abortion care in the ACA’s private insurance marketplace.
• Pass the Women’s Health Protection Act (WHPA)
First introduced in 2013 by Representative Judy Chu (D-CA) and Senator Richard Blumenthal (D-CT), this legislation would preempt state efforts to limit access to reproductive health care through restrictions, regula- tions, or requirements that are medically unnecessary and/or create undue burdens on people seeking abortion care.
• Pass the Abortion is Health Care Everywhere Act
First introduced in 2021 by Representative Jan Shakowsky (D-IL), this legislation would repeal the harmful Helms’ Amendment and remove distinctions between abortion care and other reproductive care in international aid programs. Restrictions on the use of U.S. funds are rooted in colonialism and are an example of using white supremacy to control the bodies and reproduction of Black and Brown people.51 This Act would ensure that pregnant people have bodily autonomy and can seek reliable and effective care.
• Pass legislation modeled on Section 5 of the Voting Rights Act of 1965, requiring federal preclearance provisions for states and local governments with a history of restrictive reproductive policies that are medically unnecessary and/or create undue burdens
This type of preclearance would require any law related to reproductive health, rights, or justice to be scrutinized and approved by a federal body before being implemented. It would function similarly to Section 5 of the Voting Rights Act of 1965.53 Preclearance should be required for states and local governments that have demonstrated a history of restrictive and medically dangerous policies on abortion care.
Black women, girls, and gender-expansive individuals are systematically denied the information and services they need to act in their own best interests—including abortion care that is critical to bodily autonomy.
• Remove all cost-sharing for abortion services
Abortion is a safe, legal medical procedure, and should be affordable and accessible to everyone who needs it. Yet, according to the National Financial Capability Study, nearly “one in three Black Americans aged 18 to 64 has past-due medical bills.” To fully address systemic health disparities and economic inequity, health care costs should not be transferred to anyone seeking services, including abortion care.
• Eliminate funding for crisis pregnancy centers
Pregnant individuals need full and accurate information to make the best decisions for themselves and their families. Crisis pregnancy centers intentionally mis- lead clients, often by posing as legitimate and licensed medical centers, by providing inaccurate, non-scientific information and services in an attempt to manipulate pregnant people into maintaining a pregnancy.
• Allow trained and licensed advanced practice medical professionals to provide early abortion care
There is a significant need for more medical professionals who can provide abortion care, particularly in rural, predominantly Black and Brown, and/or economically challenged communities. Expanding the number of providers who can perform abortion services in pregnancy’s early stages will improve outcomes for a large number of women.55 Nurse practitioners, certified nurse midwives, physician assistants, and nurses should be allowed to provide this care.
• Prohibit the abuse of “religious freedom” to restrict and/ or ban access to abortion care
Religious or personal beliefs should never be allowed to impact or hamper someone else’s personal decision-making about whether and when to continue a pregnancy. Federal legislation should prohibit exemptions or accommodations from providing reproductive health services that are based on religious “freedom.” In addition, existing policy riders—which are designed to curtail reproductive health care—should be permanently repealed and blocked from being attached to annual federal appropriations.
