Separate and Unequal: How Abortion Bans Exacerbate Discrimination
Abortion is perhaps top of the list of reproductive and sexual health care to which low-income women and women of color are disproportionately denied access, with devastating health effects. One of the primary barriers, since its passage in 1976, is the Hyde Amendment sponsored by Rep. Henry Hyde (R-IL) which bars federal funds from covering abortion services. The impact of this policy on the lives and health of low-income women and women of color is immense, as detailed in Separate and Unequal, a new report from the Center for American Progress co-authored by Jessica Arons, Director of CAP's Women's Health and Rights program. The report examines the effects of the Hyde Amendment and other policies on sexual and reproductive health disparities and related discrimination affecting the health and well-being of women of color and low-income women.
While it's true that with a new, more anti-choice Congress and in the wake of health reform fight which culminated in more restrictions on access to abortion for lower-income women we're not in a place to seriously consider repeal of the Hyde Amendment in the near future, there are, as Arons says, "steps to be taken."
"As we begin to implement health reform and evaluate what does and does not work in our health care delivery system, we should examine the consequences of abortion funding bans on the physical, emotional, and financial well-being of women and their families. And we should be vigilant in seeking opportunities to improve access to quality, timely, and affordable abortion care."
The health reform discussion and subsequent law has allowed advocates and providers to address some serious inequities when it comes to women's health access more broadly. Pregnancy as a pre-existing condition and therefore as an excuse to deny a woman health insurance coverage? The majority of independent health insurance plans refusal to cover maternity care? Preventive reproductive and sexual health care like annual exams, Pap smears, breast exams and more not covered as basic care for women? All of these were examined and found to be discriminatory and flawed policies which placed profit above quality care for women, and were ultimately changed in the Patient Protection and Affordable Care Act.
But the Hyde Amendment has also been the basis of an entire system of abortion funding bans which can and should be addressed, says the report. Millions of women suffer from an inequitable system which includes a ban on abortion funding for military women (or, for that matter, female relatives of military members covered under their health insurance) which bars all abortions at military hospitals and/or on military bases except when the woman's life is endangered by the pregnancy; Medicare-banned abortion coverage which ensures that disabled women covered under Medicare do not have access to abortion; and abortion bans within the Indian Health Service which bars Native American women from accessing abortion care except in cases of rape, incest or life endangerment.
And here's the thing. Women of color are most affected by all of these various funding bans.
The report is clear: women of color are more likely to be covered under government programs like Medicaid and Medicare, they are more likely to use military insurance covered by the Department of Defense, and, obviously, Indian Health Services specifically provides care to Native American women. So, we've built a wall to separate women of color and low income women from access to abortion - and it's not an accident.
Arons writes that Rep. Hyde's reason for enacting his ban on federal funding for abortion care is not out of concern over taxpayer money for abortion. Hyde:
"admitted during debate of his proposal that he was targeting poor women because they were the only ones vulnerable enough for him to reach. “I certainly would like to prevent, if I could legally, anybody having an abortion, a rich woman, a middle-class woman, or a poor woman,” he said. “Unfortunately, the only vehicle available is the … Medicaid bill.” [emphasis mine]
Hyde (and presumably most anti-choice advocates) wished to ensure the end to legal abortion for all women in this country, and targeted low-income women and women of color because they were (are) perceived as easy prey, so to speak.
And here is yet another reason to address the Hyde Amendment and related discriminatory policies directed towards women of color and lower income women. The targeting of marginalized groups of women who are considered vulnerable. A perfect example is what's been deemed a "minority outreach" anti-choice campaign by Georgia Right to Life (with the extensive help of Priests for Life) - a campaign which presents millions of Black women as pawns in a medical system, spearheaded by reproductive health providers and advocates, intent on enacting "genocide" upon the Black race in this country. The campaign which includes billboards that proclaim African-American babies as an "endangered species" and outright stating that "Abortion is Genocide," seeks to dis-empower women of color by presenting them as victims of a predatory system which forces them to have abortions. It presents women of color as voiceless and powerless when it comes to abortion.
The campaign turns a frightening history of control over and abuse of women of color and low income women's fertility by the U.S. government and health care providers into an anti-choice campaign which, ironically, would enact more control over women's health and lives by implementing more abortion restrictions which affect women of color and low-income women the most. U.S. policies which control or attempt to control women of color and lower income women’s fertility are nothing new. The U.S. government has kept a firm grip on women’s ability - especially lower income women’s and women of color's ability - to decide when (not to mention where or how) to have children or how many to have for years. The report thoroughly addresses our shameful history of forced sterilization of poor women (under threat of losing federal health benefits), forced childbirth for female slaves pregnant through rape, and the continued pressure upon low income women to accept longer acting forms of contraception.
But the truth is that women of color experience outrageous disparities when it comes to health outcomes from almost all reproductive and sexual health related issues from maternal and infant mortality to rates of HIV infection to unintended pregnancy. Abortion is one more reproductive health issue where women of color and lower income women are not provided adequate access to care. As the report details:
The disparities observed for unintended pregnancy and abortion rates among women of color do not exist in a vacuum. In fact, they are repeated in almost every measure of health and well-being that gets tracked. Profound racial and ethnic disparities persist across a range of health outcomes, including diabetes, cardiovascular disease, hypertension, obesity, and some forms of cancer. People of color bear a disproportionate burden of disease as a result of chronic exposure to racism, alongside deeply entrenched inequities in the areas of health insurance coverage, health care, income and wealth, access to healthy foods, transportation, education, and employment, all of which influence access to health-promoting resources.
Black women are 15 times more likely to contract HIV, than White women. Black women are four times more likely to die in childbirth, and their infants are 2.5 times more likely to die than White women’s babies note the statistics from 2005. The number two cause of death among pregnant women in this country is homicide. And the likelihood that a pregnant woman will be a victim of violence at the hands of a partner increases if she's a woman of color. But all of these issues seem not to concern the anti-choice crowd which campaigns on the “abortion is genocide” platform.
Why do extremist, anti-choice campaigns which use higher abortion rates among women of color purely as an excuse to push more restrictive abortion laws, seem to gloss over one clear, obvious fact? Women of color experience higher rates of abortion, in part, because as they have higher unintended pregnancy rates. They have higher unintended pregancy rates because, as mentioned numerous times in this report, they are more likely to be lower income which means, in this country, limited or no access to primary care and trusted health care providers, limited access to quality educational and informational resources and a lack of cultural competency when it comes to health care.
There are many hard-working and effective reproductive justice organizations, working on the ground, on behalf of women of color, led by women of color, encompassing a diversity of reproductive justice advocates, who are "fighting back" against a long history of discriminatory policies and practices. CAP's report highlights these many advocates and groups, including SisterSong, the Black Women's Health Imperative, Asian Communities for Reproductive Justice, the National Latina Institute for Reproductive Health and others in order to make clear that - in direct contrast to many of the anti-choice efforts which seek to present women of color solely as easily duped by predatory providers and pro-choice advocates - women of color are far from voiceless, powerless victims.
In addition, groups like the National Network of Abortion Funds (as well as the remaining fourteen feminist women's health centers) exist to help women who cannot afford to pay for an abortion on their own, cover the costs associated with an abortion (which may include transportation and other travel related costs if a woman lives in a state with abortion access restrictions).
Reproductive justice advocates, notes the report, continue to fight "for access to safe and voluntary reproductive health services, including contraception and abortion." The Hyde Amendment is but one more - though admittedly extremely significant - barrier to safe, legal reproductive health care for low income women and women of color in the United States. Addressing Hyde in the context of a long line of discriminatory practices, on the part of the U.S. government and the medical system, against low income women and women of color is crucial whether the immediate political climate is conducive to change or not.