Each year when Sept. 30 rolls around, I never have to remind myself of the day’s significance to women’s health as the anniversary of the Hyde Amendment – which bans abortion coverage for women who get their healthcare from Medicaid - or how long this restriction has been around. Having been born the same year that the Hyde Amendment was first enacted, I don’t have to stop and think about how many years this restriction has blocked so many low-income women from receiving a safe and legal medical procedure that they need.
As a child of the mid-seventies, I’m fortunate to have never lived in the pre-Roe vs. Wade era, which was marred by the injury and death of too many women as a result of illegal and unsafe abortion. However, over my lifetime I’ve witnessed a disturbing regression to some of the dark realities of that time in our history, particularly for women of color and low-income women who are navigating increasingly hostile abortion laws on top of bans on coverage.
The gap is widening between those states where a woman can find an abortion provider and access care in a safe and affordable manner, and those states where abortion services are almost altogether out of reach. In 2013, 56 percent of women of reproductive age lived in one of the 27 states considered to be hostile for women seeking abortion. This means that over half of the women of reproductive age in our country face politically motivated and medically unnecessary restrictions on their legal right to access abortion services. In many states, this means costly and needless waiting periods, forced ultrasounds, or arbitrary and onerous restrictions designed to shut down clinics.
But the new wave of state-level restrictions on abortion providers and the women who rely on their services are even more insidious when understood in the context of decades-old bans on abortion coverage.
For women of means, who have long been insulated from the struggles of those with lower incomes, the last few years have been an unprecedented new attack.
For women of color and low-income women, these laws only add obstacle to obstacle, often increasing the cost of abortion for patients and making an already untenable situation even more desperate.
Make no mistake: the Hyde amendment was crafted as a deliberate attack on low-income women’s reproductive freedom by placing abortion out of reach financially. As Rep. Henry Hyde (R-Ill.) himself, the author of this restriction, told his colleagues during a congressional debate over Medicaid funding in 1977: "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. Unfortunately, the only vehicle available is the…Medicaid bill."
As a consequence of structural barriers that make it harder for women and people of color make ends meet, women of color are more likely to be eligible for Medicaid. Today three in 10 Latinas, and three in 10 black women are enrolled in Medicaid, and one in five southeast Asian women is enrolled. When abortion coverage is denied, these women are forced to make unimaginable choices between paying for rent or groceries or finding the money to pay out-of-pocket for an abortion.
While the Hyde Amendment prohibits the use of federal funds for abortion services, some states have decided (or are required by court order) to cover abortion with state funds. While this means that some women escape the direct harms of Hyde, it further worsens the disparities between states that do and don't provide abortion coverage and leaves women's health in the hands of state legislators or judges.
Currently 17 states provide public coverage for abortion services. Perhaps unsurprisingly, these are usually the same states that have resisted or rejected restrictions on abortion providers and women seeking the procedure. So for women in my home state of New York, for example, circumstances are (comparably) better. But for my hermanas in states like Texas and Florida, it's a completely different story. Unfortunately, the states that don't cover abortion using state funds are largely the same states where restrictions have taken root.
And so nearly 40 years after Hyde, the distance between the "haves" (women living in states with coverage and without restrictions) and "have nots" (women living in hostile, coverage ban states) is greater than ever.
What's more--a majority of women of color in the US live in, you guessed it, the doubly hostile states. In fact, nearly half of Latinas and approximately 70 percent of black women live in states without public coverage of abortion, most of which are also now considered "hostile" due to newer state restrictions.
In essence, it would seem that in 2014 we are living in two starkly different nations for reproductive healthcare, one of which is caught in something resembling a pre- Roe vs. Wade time warp, where women with money travel to get an abortion when they need it, and where women of color and low-income women risk their health and economic security, desperate to access care.
When my birthday rolls around, I often think about what I've done with my life, who I am, and who I want to be. Since The Hyde Amendment and I share a birthday year, I have some advice.
It's time for us all to think about what kind of nation we want to be: one where human rights, health, and the ability to make personal decisions about pregnancy are valued, where women can get the care they need without politicians interfering. Or one where your zip code has the potential to relegate you to the indignity, uncertainty, and at times mortal risk of having no where to go for the health care you need.
I know which nation I want to live in, and the future I want to build for my family and my community. I know we can't win reproductive justice until we win it for all people, no matter where you live.
It's time to unite, it's time to be bold. It's time to repeal the Hyde Amendment.
González-Rojas is executive director of the National Latina Institute for Reproductive Health.