Numerous barriers stand in the way of many women’s access to abortion, an essential component of reproductive health care. Stigma, long travel distances to a clinic, bans on abortions after 20 weeks, and other restrictive laws such as parental consent requirements and mandatory waiting periods are just a few of the obstacles a woman may come up against. However, for many women, the cost of an abortion is the barrier that is most difficult to overcome.
“: […] the last thing you want to think about with a decision like this, is can I afford to make the right decision. Whether it’s right or wrong, or it’s good for you, or good for the child, or good for your soul, or whatever. That fact that then money comes into a factor makes it a whole different ball game.” – woman who had an abortion in Vermont¹
Although abortion has been legal in the US for more than 40 years, policies like the Hyde Amendment restrict many women from accessing abortion care. The Hyde Amendment, passed in 1976 and renewed annually as part of the federal appropriations process, prohibits federal funding for Medicaid coverage of abortion care except when a woman is pregnant as a result of rape or incest, or when her pregnancy endangers her life. Currently, 32 states and the District of Columbia follow the specifications of the Hyde Amendment. Remaining states use state-only funds to extend abortion coverage for women on Medicaid beyond the federal limitations of the Hyde Amendment.
Because the Hyde Amendment bans the use of federal Medicaid dollars to pay for an abortion, women enrolled in Medicaid whose insurance would otherwise cover their medical care are left to find the money to cover their procedure out of pocket. Women with limited incomes may have to forego basic life necessities such as paying rent, buying food, or paying their bills, in order to meet abortion costs; these can range from $400 to $800 for a first- and second-trimester abortion, respectively. In addition, indirect costs associated with the procedures—such as taking unpaid time off work and facing travel-related expenses—further exacerbate the financial hardship of obtaining an abortion, and disproportionately burden those who are already struggling to make ends meet.
“Well I felt really guilt because I would have loved to have just bought food, electricity, and put a little money in the savings account, but I figured -you know what else can I do? It has to go there and it’s put us back. We’re really low on food now and we’re really low on electricity and luckily my husband gets paid tomorrow, but it was a big setback. I was hoping to put that money to good use and instead I feel like I’ve wasted it, but at the same time it was a necessary waste.” – woman who had an abortion in Arizona¹
Women have the right to decide freely and responsibly on the number and spacing of their children--and this right should not be determined by their ability to pay for a needed reproductive health service. Under the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW), governments are obliged to guarantee women access to the information, education, and means to enable them to exercise their sexual and reproductive health rights. Despite being ratified by 187 other nations in the world, the United States has yet to ratify CEDAW. Policies such as the Hyde Amendment violates women’s rights by denying millions of women access to safe and affordable abortion care and by preventing them from exercising their fundamental right to decide if and when they want a child. All women, regardless of income or state of residence, should have the option and ability to access abortion care.
Here at Ibis, we are dedicated to conducting research that uncovers what is important to women and asks how policies and services could better serve women’s needs. Through various research studies, we have documented the impact of the Hyde Amendment on women’s sexual and reproductive health from the perspective of women and providers, and have developed actionable recommendations to improve access to care based on our findings.
Lifting restrictions like the Hyde Amendment that deny public health insurance coverage of abortion could immediately improve abortion access for women living in the 33 US states that prohibit abortion coverage through public health insurance plans. Further, improving education for Medicaid staff and for the public around Medicaid eligibility requirements and streamlining the enrollment process could help reduce the barriers faced by women who may be unaware of their ability to enroll in this type of insurance plan.
We hope you’ll join with us and other organizations as we continue our work to make abortion affordable, accessible, and safe for women everywhere. #BeBoldEndHyde
¹Quotes taken from Access to health care in states that heavily restrict abortion, a collaborative effort by Ibis Reproductive Health and the Center for Reproductive Rights.