Bans on public coverage for abortion are unjustified by science and outright harmful
With the U.S. Supreme Court poised to take up its first abortion case since Brett Kavanaugh’s confirmation and consider a Louisiana law designed to shut down abortion clinics in the state, it’s important to remember that low-income people in Louisiana and across the country already struggle to afford legal abortion care.
Last year, the Federal Reserve noted that almost half of U.S. households did not have $400 cash on hand to cover an unexpected emergency. When I heard that news, I thought of women who discover they are pregnant when they do not want to be. On top of the challenge of sorting through their options and deciding what to do in this situation, those who choose abortion often have to scramble and stress to gather cash to pay for their procedure.
Most pregnant people who seek abortion have health insurance coverage, whether private insurance or through Medicaid. But more than half of all patients pay for their abortion out of pocket. Why? Because for more than four decades, politicians have used an antiquated federal budget policy to keep abortion out of reach for low-income people.
The Hyde Amendment, first passed in 1976 and affirmed by the Supreme Court in 1980, prohibits federal funds from being used for abortion care except in cases of rape, incest, or endangerment of the pregnant person’s life. The law essentially leaves the decision of whether to cover abortion care to the states and most states choose not to. This means that in most states, low-income people who use Medicaid for their pregnancy-related health care can’t use it for abortion.
Many people are rightly concerned about the recent wave of state-level policies seeking to ban abortion outright. But right now, research shows the Hyde Amendment has more impact on people’s ability to get an abortion than these attempted bans do. Because Medicaid coverage of abortion is prohibited, approximately one in four low-income women who would otherwise have an abortion instead give birth when this coverage is unavailable. Since the Hyde Amendment was enacted more than 40 years ago, estimates suggest that more than one million women have been compelled to go through unwanted pregnancies and give birth instead of being able to obtain the abortion they would have preferred.
Women of color in particular bear the brunt of this restrictive policy. For complicated reasons having to do with racism, discrimination and economic inequality, women of color are disproportionately insured by Medicaid. In states that follow Hyde, more than half of reproductive-aged women enrolled in Medicaid are women of color.
As a public health researcher, I believe our health policy should be based in the best available evidence. And that evidence shows that there is no legitimate medical or public health reason for the government to refuse to cover abortion care. Abortion is a safe, routine health-care procedure — in fact, it is 14 times safer than childbirth. Years of rigorous research has demonstrated that abortion is not associated with any significant negative physical, emotional, or mental health effects.
In fact, it is being denied a wanted abortion that harms women. Research by my colleagues at ANSIRH, based at UC San Francisco, have shown that women who can’t get the abortion they want are more likely to live in poverty, to experience violence and to have worse physical health years later, compared to those who were able to obtain a wanted abortion. When women have the ability to say no to an unwanted pregnancy or yes to becoming a parent, both women and their children do better.
Whatever our personal views about abortion, we should acknowledge that bans on insurance coverage for abortion are based in ideology, not evidence. The evidence is clear: Abortion is safe and restricting access to it poses real risks to women’s health and well-being. Banning public coverage of this basic reproductive health care is not only unjustified by science, it is outright harmful.
Katie Woodruff, Dr.PH., is a public health social scientist at ANSIRH (Advancing New Standards in Reproductive Health) UC San Francisco.