Do Low-Income Women Have a Right to Choose?

In March, a 14-year-old girl in foster care walked into a reproductive health clinic in Washington, D.C., seeking an abortion. She was HIV-positive, on dialysis because of kidney failure, and recently had spent time in a psychiatric ward after trying to commit suicide. Even though the girl could not afford the abortion she so badly wanted, she was able to get it thanks to funds provided by private donors.

But for millions of other low-income girls and women seeking abortions, the money hasn't been there. That is the intended result of a 31-year-old law known as the Hyde Amendment, which bars the federal government from funding most abortions through Medicaid. Over the past three decades, states have followed suit: Currently, 33 states ban the use of state funds for abortion except in limited circumstances.

This obscure law poses the single greatest barrier to abortion, reproductive rights advocates say. At an average cost of $370 at 10 weeks gestation (not including attendant expenses related to transportation, accommodation, and child care), abortion is often too expensive for low-income women. More than 7 million women of reproductive age are enrolled in Medicaid, and the average salary for a family of three is $930 a month, according to the Guttmacher Institute. That leaves little extra for anything other than basic necessities like rent, utilities, food, child care, and transportation. Finding the money to cover an unplanned expense like an abortion can be an insurmountable task.

It is impossible to count the number of girls and women who have proceeded with unwanted pregnancies since the ban was enacted three decades ago, but studies conclude that between 18 and 35 percent of women on Medicaid who would have had abortions if government funding were available -- at least 64,000 women a year, according to a conservative estimate -- instead carried their pregnancies to term. The 64,000 figure does not account for women who live in states that do cover abortion but who do not qualify for Medicaid or cannot afford related expenses like transportation and child care.

In terms of sheer numbers, the impact of the ban is far greater than that caused by other restrictions, such as parental consent requirements, mandatory waiting periods and counseling laws, according to Heather Boonstra, a senior public policy associate at the Guttmacher Institute. "Some of the other restrictions are a bother, but there is not the evidence that any of those other restrictions actually mean fewer abortions," Boonstra said.

Recognizing the role public-funding bans have played in reducing the abortion rate, pro-life activists recoiled when Rudy Giuliani, a leading candidate for the Republican party's presidential nomination, told CNN on April 4 that he supported government subsidies of some abortions.

Editors of the National Review were quick to excoriate Giuliani for his perfidy. "We can therefore assume that an America with Giuliani's favored policies would be a country with more abortion -- probably reversing the 15-year trend of decline, including the decline in New York City for which he takes dubious credit," they wrote in an April 6 editorial.

Giuliani has since backpedaled, saying during a May 3 debate among GOP presidential hopefuls that he supports the Hyde Amendment and that public funding decisions should be left to the states.

Despite the tremendous impact of the ban, the effort to overturn it has not landed on the congressional agenda, now set by the Democratic Party, which officially backs abortion rights. Even the most ardent pro-choice advocates are staying mum on the issue, preferring instead a more cautious approach to the explosive topic of abortion now that a friendlier political power finally controls Congress.

This political pragmatism is taking shape in the Prevention First Act, legislation that is aimed at reducing abortion rather than increasing access to it. Pro-choice lawmakers and advocates have rallied around the bill, which would order insurance companies to cover contraceptives and provide more funding for government programs that pay for family planning services, comprehensive sex education, and campaigns to raise awareness about birth control and teen pregnancy.

It is no surprise that Democrats, with their slim margin of power, have crafted their domestic agenda around initiatives that they believe enjoy solid public support, such as bills that would raise the minimum wage and ease laws governing research on embryonic stem cells. When it comes to abortion, pushing pregnancy prevention legislation is indeed a much safer political tack than calling to restore the use of taxpayer dollars to subsidize a procedure that a good portion of the public finds morally repugnant.

Still, some grassroots activists wish Democrats and advocates would strike a bolder tone on the theme of abortion, especially after a dozen years of conservative Republican success in chipping away at access to the procedure. And, they ask, why not make the opening salvo an effort to make abortion accessible to all U.S. women, regardless of their ability to pay for it? That goal, advocates say, cuts to the core of Roe v. Wade, the 1973 Supreme Court decision that legalized abortion and made the procedure available to more than just the wealthy women who could circumvent the law.

"I think the Republicans have done quite a job of making people feel like you can't talk about abortion," said Stephanie Poggi, president of the National Network of Abortion Funds, a non-profit organization in Boston that raises money to help low-income women pay for abortions. "I think it's a huge mistake on our side if we accept that."

With Democrats now in control of Congress, Poggi and her supporters say the time is right to fight to block the amendment, which has been attached to an annual appropriations bill every year since it was first passed in 1976. Perhaps more auspicious, the law's creator and namesake -- former Representative Henry Hyde, an Illinois Republican who carried the torch for the Religious Right during 32 years in office -- retired last year. Sensing an opportunity in Hyde's absence, the National Network for Abortion Funds launched "The Hyde Campaign: 30 Years is Enough" to raise awareness about the effects of the amendment and to lobby Congress and state legislatures to reinstate funding. But the campaign has yet to catch fire in Washington, D.C.

When Kim Gandy, the president of the National Organization for Women, laid out her wish list for the 110th Congress after the November elections, she touched on issues from paid sick leave to inserting gender into hate crimes laws, but did not mention the Hyde Amendment. There is little discussion of the amendment on sites representing NOW or other prominent women's rights organizations.

NARAL Pro-Choice America and the Planned Parenthood Federation of America support public funding for abortion and have both signed on to the Hyde Campaign. But even these national reproductive rights groups have been relatively quiet in calling to repeal the ban, observers say. In its list of priority bills before Congress, NARAL Pro-Choice America leads with the Prevention First Act and goes on to list another six measures that focus on prevention. The Planned Parenthood Federation of America downplays the issue on its Web site.

NARAL Pro-Choice America spokesman Ted Miller said the reason boils down to the political reality on Capitol Hill, and noted that pro-life lawmakers still make up a majority in the House. Democrats, meanwhile, hold a one-seat majority in the Senate, where they are ruled by Harry Reid, a Nevada Democrat who opposes abortion in most cases. And any effort to repeal the law would certainly be opposed by President Bush, who recently vowed to veto any legislation that would expand abortion rights.

"We made significant gains in the 2006 elections, but the composition of Congress still gives an advantage to the anti-choice side," Miller said. "Unfortunately, these numbers mean we have more electoral work to do before we have enough votes to repeal harmful, unfair restrictions like the Hyde Amendment."

But Marlene Fried, a board member of the National Network of Abortion Funds, said Democrats might be surprised if they actively worked to block the ban. Voters -- especially those that comprise the Democratic base -- are motivated by issues of poverty and health care and would support an effort to reinstate public funding for abortion, she asserted. Confronting the issue, rather than shying away from it, would strengthen support for the Democratic Party and the advocates who support its policies on abortion.

But because the Hyde Amendment affects the most marginalized women -- a constituency that votes in low numbers and has little influence on Capitol Hill -- politicians and advocates are under little political pressure to fight it, Fried said. Consequently, neither congressional leaders nor national reproductive rights organizations have prioritized the issue.

"I don't think there's anybody who is an advocate of abortion rights who would say they are against public funding," Fried said. "The issue comes down to, 'Is this a good time or is this a pragmatic time to push for it?' And unfortunately the answer has been 'No.'"

Underlying these political decisions are attitudes about race and class, added Jatrice Martel Gaiter, president of Planned Parenthood of Metropolitan Washington, D.C., a family-planning clinic located four blocks from the White House.

Local grassroots reproductive rights groups and minority rights organizations have been more dedicated to repealing the Hyde Amendment because they are more sensitive than national organizations to the effect of the ban on low-income women, a majority of whom are minorities, Gaiter said. As a result, a divide has arisen among various groups over whether and when to push to restore the use of public money to pay for abortion.

"The Hyde Amendment has been the dirty little secret of the reproductive health movement," she said. "It's been kicked around like a hot potato."