Have We Really Come That Far? API Women and Abortion 40 Years After Roe

January 24, 2013

By: Christine Poquiz, Reproductive Justice Fellow

A few years ago, I spent a summer working in rural Uganda, providing reproductive healthcare education and access to women. Contraception availability was limited. As difficult as access to contraception was, abortion was largely out of the question because it was illegal. That didn’t mean it didn’t happen, just that safe, legal abortion procedures weren’t available. The situation was a lot like the United States pre-Roe v. Wade, when desperate women would take matters into their own hands or trust someone with questionable abilities. Unfortunately, one woman I worked with ended up going to an unqualified, illegal abortion provider and the procedure went wrong. She bled to death.

When I began reproductive health care advocacy domestically, I thought that, because abortion was legal here, women wouldn’t have the same struggles they would in poverty-stricken sub-Saharan Africa. I quickly learned that, although Roe was on the books, in many areas it is just as difficult to obtain a safe, affordable, legal procedure.

States make it extremely difficult for women, primarily low income women, to obtain an abortion. Many states have enacted 24 hour waiting periods, ultrasound requirements, and parental notification laws, all designed to make it harder for women to receive abortion care. One of the most egregious obstacles is the ban on using public insurance coverage to pay for an abortion procedure.

The Hyde Amendment, which bans federal funds from being used for abortion, is of particular concern for me because it affects API women. Over 70% of Medicaid enrollees are women, including 6% of Asian Pacific Islander (API) women.[1] These numbers are significantly higher for poorer API subgroups; 19% of Southeast Asians, for example, rely on Medicaid.[2] Further, certain API subgroups experience high rates of unintended pregnancy[3] and use of abortion care.[4] Low-income women who receive their healthcare through Medicaid cannot obtain an abortion if they need one through their Medicaid benefits. The average cost of a first-trimester abortion is $490.[5] That is significant. Women are deciding whether to pay their rent, buy food for their family, or to obtain this procedure. Worse, the costs go up tremendously after 16 weeks. Between 18-35% of Medicaid eligible women reported that they would have had an abortion if funding had been available, but instead carried their pregnancies to term.[6]

Medicaid covers the pregnancy costs if a woman decides to carry the pregnancy to full term but will not cover the costs of an abortion. An abortion is still pregnancy-related care, and I believe all pregnancy-related care should be covered.

Another grievance I have is the exclusion of immigrant women from Medicaid. There is a 5-year waiting period[7] after naturalization until they can become eligible for Medicaid. States may offer Medicaid coverage for reproductive health care services to immigrants but they must do so at their own cost. As of 2009 there were more than 10.6 million API immigrants in the United States and over half, 52% are API women.[8] Currently, less than half of states opt to use their own funds to provide any coverage during the waiting period.[9] This means that many low-income, immigrant API women are still waiting for Roe to mean something.

The legal right to decide whether to have an abortion is diminished when the procedure is unattainable for so many women. We can and should be able to use our health insurance, which may be Medicaid for many women, to cover the procedures we need. Requiring women to pay for this one procedure out of pocket takes away their ability to care for their health and families. I’ve seen first-hand what pre-Roe looks like. In that way, the U.S. is not that different from places where abortion is still illegal, like some countries in Africa.

[1]NAT’L ASIAN PAC. AM. WOMEN’S FORUM, FACTS ABOUT HEALTH COVERAGE AND ASIAN PACIFIC ISLANDERS (Apr. 2008) available at http://napawf.org/wp-content/uploads/2009/10/Health-Coverage-and-API-Women-Factsheet.pdf.

[2] ASIAN PAC. ISLANDER AM. HEALTH FORUM, WHY PROTECTING MEDICAID MATTERS FOR ASIAN AMERICANS, NATIVE HAWAIIANS AND PACIFIC ISLANDERS (Oct. 2011) available at http://www.apiahf.org/sites/default/files/PA-factsheet1007-2011.pdf.

[3] NAT’L ASIAN PAC. AM. WOMEN’S FORUM, RECLAIMING CHOICE, BROADENING THE MOVEMENT: SEXUAL AND REPRODUCTIVE JUSTICE AND ASIAN PACIFIC AMERICAN WOMEN 5 (2005) available at http://napawf.org/wp-content/uploads/2009/working/pdfs/NAPAWF_Reclaiming_Choice.pdf.

[4] Id.

[5] Rachel K Jones and Kathryn Kooistra, Abortion incidence and access to services in the United States, 2008, 43 PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH, 41, 41–50. (2011).

[6] NAT’L ASIAN PAC. AM. WOMEN’T FORUM, FACTS ABOUT THE HYDE AMENDMENT: 30 YEARS IS ENOUGH (Jan. 2008) available at http://napawf.org/wp-content/uploads/2009/11/factsheet_hydeamendment_updated.pdf.

[7] Id.

[8] Asian Immigrants in the United States, MIGRATION POLICY INSTITUTE, http://www.migrationinformation.org/USfocus/display.cfm?ID=841#14 (last visited Jan. 22, 2013).

[9] Supra note 6