Beyond Abortion: Reproductive Health and Rights of Low-Income Women
On April 25, thousands will March for Women’s Lives in support of “choice, justice, health, abortion, global and family planning” – a historic shift from a narrow focus on abortion to a more inclusive agenda. In particular, a growing recognition of the challenges facing low-income women is crucial for the future of the reproductive rights movement in America.
For reproductive rights to be meaningful, women must have access to a broad spectrum of services, including sexuality education, family planning, emergency contraception, prenatal and postpartum care, fertility services, reproductive cancer and STI and HIV/AIDS prevention, screening and treatment. Access also implies adequate transportation, child care, and linguistic and culturally competent services. However, the reality is that low-income women face numerous barriers that stand in their way.
Affordability of Care
Reproductive “rights” are illusory without the ability to pay for services, which is the case for too many uninsured women. According to the Henry J. Kaiser Family Foundation, one-third of low-income women between the ages of 18 to 64 have no health insurance, with Latina women in particular being uninsured.
The Medicaid program has played a mitigating role as the largest public payer of reproductive health services. However, federal restrictions limit Medicaid’s effectiveness. For example, since 1977 Medicaid dollars cannot be used to pay for most abortions, and only seventeen states make up the difference with their own funds. Protecting public programs and ensuring affordability to the full scope of health services are essential to reproductive health.
So called “welfare reform” is another area where public policies, often based on the false notion that low-income women have more children than other women, undermine low-income women’s reproductive health and rights. Policies such as family “caps” and work requirements, coupled with insufficient child care funding and health access barriers, may be influencing women to make unwanted choices. While further research is needed to determine any causal effect, an Alan Guttmacher Institute study showed that abortion rates among low-income women increased during 1994-2000, while the overall abortion rate decreased.
Instead of trying to control women’s reproductive capacity based on stereotypes, policies should promote health access and economic and educational opportunities for women.
Punitive Treatment of Pregnant Women
Other policies granting fetuses separate identities from pregnant women place particular burdens on low-income women. According to the National Advocates for Pregnant Women, low-income women disproportionately are drug tested, reported, and prosecuted by authorities for endangering their fetuses. Women of color are especially targeted, even with little evidence that they are more likely to use drugs or consume alcohol during pregnancy than white women. Rather than focusing on providing health care, these policies seek to penalize pregnant women without offering viable alternatives. Ironically, appropriate drug and alcohol treatment programs are seriously lacking.
In another example of politics trumping common sense, federal funds are available for fetuses – under the State Child Health Insurance Program – yet these same funds are not available for postpartum care, family planning, or any services that are not directly related to the fetus.
Religious Restrictions in Health Care
Low-income women also have been disproportionately affected by the merger wave that has seen Catholic hospitals grow to five out of the top ten largest health care systems. These institutions are often the only providers in low-income communities, yet they apply the Ethical and Religious Directives for Catholic Health Services to all patients, regardless of the patients’ religion. The Directives prohibit or limit virtually all reproductive health services, such as contraceptive services and supplies (including emergency contraception and sterilization), fertility services, and HIV/AIDS prevention. Catholic HMOs impose similar restrictions on their Medicaid enrollees, a practice allowed by Federal legislation passed in 1997.
Furthermore, a Merger Watch study found that religious hospitals and entities, while denying reproductive health services, receive almost all of their funding from public sources and private insurance with little or no funds coming from churches or religious organizations. Despite their non-profit status, the same study found that these institutions do not necessarily provide any more charity care than other non-profits or, in some cases, for-profits.
The current administration’s faith-based initiatives supporting religious-based entities’ participation in publicly financed programs will only result in more of the same.
Building Broad-Based Support
The inclusive message of the march is a hopeful sign of broad-based coalition building with diverse communities. Addressing abortion access in the context of equally pressing reproductive health needs is critical to secure and promote reproductive health and sexuality rights for all.
Lourdes Rivera is managing attorney of the National Health Law Program, Inc= in Los Angeles, Calif.
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