What Women Do When They Can't Afford an Abortion
By restricting Medicaid coverage, the Hyde Amendment forces low-income women who need an abortion to find a way to come up with money that they just don't have.
Illustration by Vivian Shih
In honor of Planned Parenthood's 100-year anniversary, we're taking an in-depth look at the history and future of reproductive rights. Read more of our coverage here.
When Ariana Menefee found out that she was pregnant seven years ago, she knew immediately that she needed an abortion. "My pregnancy was a surprise. I had no intention of having children at the time," she told me over the phone from her home in Bedford Heights, Ohio.
At that point, she was homeless and putting herself through college; in addition, the person who got her pregnant was, in so many words, not someone with whom she wanted to parent. She was in the process of getting her life back on track—carrying a pregnancy for nine months, giving birth, and then taking care of a baby was not something she could reasonably do while she was living in a shelter, working toward her degree, and already raising two kids. Her decision was easy.
Read more: Talking to My Grandma About Her 12 Abortions
The only problem was everything else: She lacked the money to pay for the full cost of her procedure at eight weeks, which was $390 at the time. Under federal law, Medicaid is not able to cover one cent of abortion care costs. She also faced immense pressure from the people around her, who just didn't respect her choice. "I had several conversations with my classmates about religion, and they were asking me why I was going to do this, [and saying abortion] not a form of birth control. The stigma was so high," Menefee recalled. "But I didn't really care about what they thought about me, what they said to me. It was totally my decision. I needed it."
It would be an understatement to say that the man she'd slept with didn't help, either. On the day of her abortion, he called her right as she was about to be anesthetized. She remembers how he told her that "I was wrong and that God would hate me," and how she responded by hanging up the phone, lying back, and getting her abortion. In the middle of the procedure, she woke up from her sedation and cried. "It was very emotional and very traumatizing," she said, not referring to the abortion itself but rather to the stigma and shame she'd been forced to endure and the barriers she had to go up against, just because she wanted to determine her own future on her own terms.
When I asked her if she felt like getting an abortion was the right call, she simply said, "100 percent."
Since 1976, the Hyde Amendment has acted as an arbitrary wall between low-income women and the life-changing health care that they need. Each year that the Hyde Amendment—which bans the federal funding of abortions, with no exceptions for rape, incest, or threat to the life of the mother—sneaks its way into the federal budget is another year that women who are insured through Medicaid have to struggle to come up with the funds to be able to take control of their reproductive health.
Anti-abortion lawmakers say that the Hyde Amendment "saves unborn lives," but it really just puts living, breathing women at risk. Medicaid is supposed to provide health care for citizens of the United States who cannot afford it, and abortion—a safe and legal medical procedure—should not be excluded from that initiative. Considering that 42 percent of abortions in the United States occur among women living below the federal poverty level, it is blatant economic injustice.
Although some states mandate that Medicaid funds can cover the cost of the procedure, there are millions of women of reproductive age living in 33 states that don't. These women have to come up with the money on their own, in whatever ways they can. Women of color, like Menefee, are impacted the most. In the vacuum that the Hyde Amendment has created, organizations that raise money to help women pay for reproductive care have popped up to fill a need. Menefee was able to get assistance from an abortion fund associated with Preterm, a local Ohio clinic.
She walked into Preterm with $200 in hand for a procedure that cost nearly twice that. "When a woman at the clinic told me how much more I would need to continue, I had a breakdown where I just cried. I told her that I wasn't going to be able to afford this and I told her about my situation. She just said, 'Whatever you could come up with, bring it. I'll schedule your appointment,'" Menefee explained. "I called her later and told her that there was really nothing else I could do and she just said, 'It's OK, come in.' Preterm funded the rest of that abortion, and it was the best thing that ever happened to me. I'm so grateful. If I could ever see that woman again I would just give her a big hug and tell her how much I appreciated it. I didn't realize that it was a blessing then, but now I realize what she had done for me was tremendous."
I need my daughter to have these rights and feel comfortable to make her own decisions.
The clinic is partnered with an advocacy group, New Voices for Reproductive Justice, which started a program called Patients to Advocates in collaboration with NARAL Pro-Choice Ohio and Ohio Religious Coalition for Reproductive Choice. It allows women who have had abortions to become activists and educators for other women, with a focus on women of color. Menefee is now a patient advocate for the organization, and she goes door-to-door canvassing to change the laws that infringe on women's reproductive rights and people's minds about them. "People like to whisper and keep things a secret [when it comes to abortion], and a lot of people don't even know that our rights are being taken away. That's not acceptable. I think that education is so important," she said.
In the years after her abortion, after getting back on her feet, Menefee welcomed the birth of two more children with her partner, who is in the National Coast Guard. Her youngest is a one-year-old girl. "I need my daughter to have these rights and feel comfortable to make her own decisions. This is very important to me now that I have a daughter," she said.
"[The patient advocates] teach as much to each other as much as we teach them," Jasmine Burnett, the director of community organizing at New Voices, said of the program. "I think it's a really holistic way to involve and engage those who have had abortions. The movement is all about saying, It's okay, you're alright. Your decision is yours. You can be anything. Whatever choice you need to make for your life, your body, your circumstance, your family are yours, and no one should control that."
A 2014 study of women seeking abortion care at 30 clinics across the US found that, for more than half, out-of-pocket costs were more than one-third of their monthly paycheck. For Nikki Johnson, that meant she needed to dedicate extra hours to her side job. The clinic covered $275 for her abortion—but she still needed to come up with about $300. "It's very hard to come up with all that money at one time when you're already supporting a family and you're already on a tight budget," she told me. "When you're living check-to-check and you have an unplanned pregnancy, it's definitely a difficult thing for a woman in Ohio."
Johnson had received custody of her sister's kids when she was 25 years old and, overnight, she became a single mother of three. She then got pregnant and had her son, but before her son had turned one, she was pregnant again. "People try to make it seem like women who have abortions are sexually irresponsible, but nothing that we have out here is foolproof. I was taking birth control pills, but having four kids, a little baby, I couldn't remember to take it at the same time every day," she explained.
"I knew couldn't have another baby. I would lose my mind. Literally," she said. "So I kind of scrambled to get that money together, asking family and friends, doing side work. I do hair on the side... and I did a hair special so I could get some more clients in real quick."
The financial barrier is often just one of the hurdles women face: Numerous states have passed medically unnecessary restrictions with the intent of limiting women's abortion access. Ohio's 24-hour waiting period law, for instance, requires women to make two separate trips to the clinic—which means they must take multiple days off work or school and secure transportation or lodging.
"It makes it very difficult when you have to take off work to go in on two separate occasions for your procedure," Johnson said. "You have to wait 24 hours after you've spoken with a counselor, I guess so they can make sure you have time to think out your decision, like you haven't thought out your decision already. Laws that restrict abortion do nothing but add stress."
Another woman I spoke to, Alice Jackson, put the 24-hour-waiting period this way: "It's almost like, 'Oh man I'm going to eat some ice cream,' and then when you go to get the ice cream they tell you, 'You can't get it the flavor you want today. You have to come back.' Except it's not ice cream, it's your body."
For Jackson, having an abortion was a profound experience, and she's now a passionate advocate for women's rights. "It was a growth for me. Who knew my abortion would help me not be afraid to speak my mind?" she said. "My whole life, I got in trouble for saying something; everybody told me, 'Oh, girls aren't supposed to say that.' It was empowering."
The ugly truth is that anti-abortion crusaders—who are mostly white men—are determined to bring these women down. They employ tactics directed at black and poor women, as if legislation like the Hyde Amendment doesn't already provide enough of a distressing obstacle. They stand outside of clinics and hand out pamphlets that say abortion is killing black children and that "the most dangerous place for an African American is in the womb." But really, it's abortion restrictions that are harming black lives.
Now that Johnson works with New Voices, she's fighting back against this misinformation: "A lot of our work is to eliminate abortion stigma and these restrictions that they're putting on abortion just to make it more difficult. These restrictions don't help women," she said. "Anti-abortion groups put out propaganda that says Planned Parenthood is trying to eliminate black people and all this other stuff. They make it seem like you go back there and you're at a butcher shop and they're going to chop your baby up and put it in a bag next to you, which is really ridiculous," she said. "They're instilling hate and lies—but they're 'pro-life,' though." Johnson laughed at the irony of the label, then added, "They hate us."
These woman are resilient, but they shouldn't have to be up against so much; they deserve reproductive justice. Activists are continuing to do the grassroots work that is necessary to make it happen and it's hopeful that presidential nominee Hillary Clinton has promised on the campaign trail to repeal the Hyde Amendment. "Either way that the election goes, you know, it's going to be a fight to repeal Hyde. And whoever is in service of women—in service of our access, our lives, our body's lives and [our] sexuality and families—can be a partner to us in repealing the Hyde Amendment," New Voices director of community organizing Burnett said. "There's rural woman—rural, white poor women, rural women of color—you got urban women of color who cannot afford abortions. It's a fight for all of them."