How Safe is Your Right to Choose — and to Work?

A Status check on the anniversary of Roe V. Wade

Forty-seven years ago today, the constitutional right to access abortion safely and legally was enshrined by the Supreme Court through their landmark ruling in the case of Roe v. Wade. And in their ruling in 1992 in Planned Parenthood v. Casey, the Court reinforced that the “ability of women to participate equally in the economic and social life of the Nation has been facilitated by their ability to control their reproductive lives” — including the ability to safely and reasonably access abortion care. 

However, the past decade has yielded an unprecedented amount of attacks on abortion rights. 

Andrea Miller, the president of the National Institute for Reproductive Health, explains that since the Roe ruling, states have enacted more than 1275 laws against abortion — and 483 of those have been in the past decade alone. Alabama’s new law makes it illegal to perform all abortion, with no exceptions for rape or incest; Georgia enacted a ban on abortion after six weeks, before most women even know they are pregnant; Indiana’s law bans dilation and evacuation, the most common (and safe) form of second trimester abortion; and Missouri’s bans abortion after eight weeks gestational age.   

Since the Roe ruling, states have enacted more than 1275 laws against abortion — and 483 of those have been in the past decade alone.

And as research from the Guttmacher Institute has pointed out, this shift in the number of states that are now openly hostile to abortion rights also means that more than half of all American women of reproductive age live in a place with demonstrated hostility to abortion rights, which is defined by the Guttmacher Institute as a place that has passed and has two or more of the six types of abortion restriction laws currently in effect. And 43.4 percent of those women live in states with five or all of those kinds of laws currently in effect. 

This means that nearly 60% of American women of reproductive age — a staggering sector of the American workforce — face real barriers to accessing the healthcare they need. Whether for medical reasons or personal reasons, the Supreme Court has made clear that access to abortion is necessary for women’s equal participation in the American economy. 

“That massive uptick, that huge increase in states attempting to prevent people from accessing abortion, to make it unaccessible and unavailable, takes the biggest toll on those who are lower income, people of color, young people, and those living in rural areas,” Miller explains. 

And this has huge implications for so many people’s ability to engage in the workforce.

“It all comes down to not only do you want to be a part of the workforce, but does being a part of the workforce mean you and your family are economically secure and stable,” Miller says, of what it really means when folks are unable to make decisions about how and when to grow their families based on their own judgment about what it is they need to provide for their family. 

Which is why not only is the connection between abortion access and work unassailable, but so is ensuring that women and pregnant people are able to earn a fair wage when they are engaged in the workforce. 

The inability to access a wanted abortion is devastating for a woman’s economic stability and mobility 

Researchers at the Turnaway Study found that women denied abortions were three times more likely to become unemployed compared to women who were able to access abortion. Given that 76 percent of women seeking abortion care already do not have enough money to cover their living expenses, it is even more staggering to consider that being unable to access a wanted abortion also makes it four times more likely that a woman will go on to live below the federal poverty level

Diana Greene Foster, PhD, is one of the researchers at the Turnaway Study and a professor at the University of California-San Francisco’s Bixby School of Reproductive Health’s Advancing New Standards in Reproductive Health (ANSIRH). In new research that she co-authored, just out this week, Foster and her co-investigators tracked the credit reports of women who were able versus those who were unable to access wanted abortions. Bankruptcy and eviction rates spiked and credit scores dropped for a full five years after a woman is unable to access an wanted abortion. 

“What we find is that women continue on the trajectory they were on when they were trying to access abortion — accessing a wanted abortion is not a boost to someone’s economic prospects, but denial of abortion is a setback. This isn’t surprising, intuitively: Having an abortion enables women to do what they were doing before,” Foster concludes. “But the alternative is a major derailment.”

A win that could help level the playing field: The Hyde amendment may not be here to stay 

One significant win of the abortion rights movement over the past 10 years has been the prompting of a national conversation around repealing the Hyde Amendment, the federal law that bars Medicaid from covering abortion. Right now, women living in thirty-three states plus Washington, D.C. are severely restricted in their access to abortion care as a result of Hyde. 

Destiny Lopez, the co-director of the All Above All campaign to see the repeal of the Hyde Amendment, says that the fact that talk about repealing Hyde has made its way into the Democratic primary and become a key talking point of the 2020 presidential race is a major milestone not to be diminished — and one that stands to have a hugely significant impact on low-income women.

The fact that talk about repealing Hyde has…become a key talking point of the 2020 presidential race is a major milestone not to be diminished — and one that stands to have a hugely significant impact on low-income women.

Because of Hyde, all Medicaid recipients are outright banned from using that coverage for abortion. Which means that those whose income is low enough to qualify for Medicaid are forced to pay out of pocket for abortion, and the cost — both literal and figurative — is not insignificant. The average cost of an abortion at 10 weeks is $500 and at 20 weeks is $1,195. This means that even a woman whose income is at the higher end of Medicaid eligibility would be left spending between 30 and 90 percent of her monthly income on an abortion, should she be unable to use her Medicaid to cover the procedure. 

And that math just doesn’t work out.

More than 40 percent of respondents in a 2016 nationally representative survey of U.S. adults said they would be unable to find the money to cover an emergency expense of this scope, or would only be able to do so if they could borrow money or sell something. And 25 percent of respondents said they have simply forgone health care in the previous year due to unaffordable costs. And yes, this includes abortion. 

Lopez also points to the fact that when it comes to ending the ban on Medicaid coverage for abortion, the past decade has also seen a number of states that “really have done the right thing.”

Innovation in the states — a solution for some

In 2017, Oregon’s state legislature passed a bill signed into law by Governor Kate Brown that allows its Medicaid recipients to use that coverage for abortion care; it also ensured that all private insurance plans offered in the state, both on the marketplace and by private employers, offer abortion coverage. And when the law was tested through a statewide ballot referendum in 2018, Oregonians overwhelmingly voted 64 percent to 36 percent to let the law stand as written. 

The law has since gone on to serve as model legislation for other states wishing to implement similar measures as Hyde workarounds. This summer, Maine’s first female governor, Jennifer Mills, signed into law a bill that required all forms of health insurance in the state, public and private, to cover abortion. It now is the sixteenth state to allow its Medicaid recipients to use that coverage for abortion care. 

Governor Mills also signed into law a measure allowing mid-level providers, such as physician’s assistants and nurse practitioners, to perform abortions, thus increasing the number of providers in the state by allowing more than just doctors to do so. 

There are now also six states that require all private insurance plans in the state, including those sold through the marketplace, to cover abortion; three of those require that abortion be covered with no additional copays. 

And legislators across all levels of government are also innovating in terms of how to minimize any kind of negative economic impact from seeking out wanted abortion care. New York City established a fund last year to help low-income people cover the cost of abortion care, and this fall, the city council of Austin, Texas established a fund to cover expenses associated with abortion care, such as transportation, lodging and childcare for low-income individuals. 

Andrea Miller at NIRH points to the fact that nine separate states passed affirmative laws when it comes to abortion rights as an “important and big step,” albeit one that still fails to fully counter the harms of the past decade of restrictions on access that have only served to dually undercut not just abortion access, but economic stability as a result.

“There are a lot of factors that have influenced people’s ability to participate in the workforce,” says Miller, “and having the ability to make decisions about your reproductive life is a critical one in terms of women’s engagement and participation in the workforce. We can’t take away women’s ability to make these decisions.”