Access to Abortion Care
Abortion care is a safe and time-sensitive medical option that 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 a matter of reproductive justice, and unrestricted access to abortion services must be considered part of basic primary healthcare. We must trust Black women, girls, and gender-expansive individuals to make the personal decisions that are best for themselves and their families.
This right should not be infringed upon by the law. However, in June 2022, the Supreme Court of the United States overturned nearly 50 years of its own precedent with its majority opinion in Dobbs v. Jackson Women’s Health Organization, which reversed the constitutional right to abortion care that had been enshrined by Roe v. Wade. The 5-4 decision was made possible by President Donald Trump’s appointment of three justices to the Court, allowing a conservative, activist, anti-abortion majority to take control of the highest court in the land.
The only people who should ever be involved in decisions about abortion care are the person seeking services, their trusted medical professional, and whomever the care-seeker may choose to include—not politicians. Nevertheless, anti-abortion federal politicians have infringed on access to abortion care for decades, beginning with the Hyde Amendment. Since 1976, Hyde has banned abortion care in federally funded programs. Its restrictions affect Indigenous peoples who receive 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 enrolled in Medicaid are women of color, and 55 percent of these women live in states that restrict insurance coverage for abortion except in limited circumstances. Research suggests that bans on Medicaid coverage for abortion result in one in four low-income women carrying an unwanted pregnancy to term. This outcome—a pregnant person denied an abortion—can push an individual into poverty or 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. Several factors drive 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 programs that restrict coverage for abortion care.
In addition to programs impacted by the Hyde Amendment, the Affordable Care Act 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. 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, dozens of 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 are primed to enact near-total bans on both surgical and medication abortion. Many states are also attempting to ban access to medication abortion not just within their borders, but nationwide. Black women, girls, and gender-expansive individuals are more likely to live in these states—the same states that make it harder to access contraception and offer the fewest resources to help Black families care for their children. Black pregnant people living in poverty and battling systemic racism cannot 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 in sexual and reproductive healthcare, 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, which 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 Presidential Administration must act to ensure that the right to abortion care is fully available to all people.
Key Policy Recommendations to Improve Access to Abortion Care
- Pass the Equal Access to Abortion Coverage in Health Insurance (EACH) Act
- Pass legislation, 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
- Remove all cost-sharing for abortion services
- Eliminate funding for crisis pregnancy centers
- Allow trained and licensed advanced practice medical professionals to provide early abortion care
- Prohibit the abuse of “religious freedom” to restrict and/ or ban access to abortion care
