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Abortion Access How does socioeconomic status impact access to reproductive health care?

Overview

Since the legalization of abortions in the United States in 1973, anti-choice politicians have sought to limit access to reproductive health care through Targeted Restrictions on Abortion Providers (TRAP). The enforcement of TRAP laws place women of lower socioeconomic status at a greater disadvantage accessing abortion clinics. Laws, such as mandatory waiting periods and the Hyde Amendment, create logistical and financial challenges for women seeking abortions. Ultimately a women's decision to obtain an abortion remains largely unchanged by these policies.

History

Roe v. Wade

In 1973, following the Supreme Court ruling in Roe v. Wade, abortion became legal in the United States. The case outlined the role that state governments are allowed to take in while implementing abortion laws during each trimester of pregnancy. Based on the decision, during the first trimester, states are not allowed to place restrictions on abortions. During the second trimester, states have the ability to enforce restrictions relating to maternal health. In the last trimester, states are allowed to ban abortions as long as there are exceptions for circumstances when pregnancy becomes life threatening.

Planned Parenthood of Southeastern Pennsylvania V. Casey

The Supreme Court case of Planned Parenthood v. Casey addressed the legality of state enforced abortion laws. In 1992, the case discussed three Pennsylvania laws- the requirement for pregnant individuals seeking an abortion to wait 24 hours prior to their procedure, minors to receive parental consent or obtain a judge's permission, and wives to notify their husband about their decision to have an abortion. Of these laws only one was deemed as invalid, the mandatory husband consent. This case set the precedent for more laws limiting access to abortion clinics to be passed across the United States.

Introduction to TRAP Laws

TRAP Laws are Targeted Restrictions on Abortion Providers. Influenced by Planned Parenthood v. Casey, the laws regulating abortion clinics are designed to limit access to reproductive health care. The laws are often justified by claiming they protect a pregnant individual's safety, yet they are recognizably designed to create difficulty, as shown by parental consent laws. The consent laws portray a minor as not mature enough to make an insightful decision because they require a parent's permission, but mature enough to become a parent. Other TRAP Laws include regulations on the grass length outside of clinics, the hallway width and janitor closet size inside clinics, and the requirement for physicians to have admitting privileges to a hospital within a certain distance of the clinic. TRAP Laws harmfully force clinics to close, creating difficulty accessing reproductive health care. In the period between 2011 and 2017, 33 abortion clinics closed in the Midwest and 50 closed in the South. Currently there are six states-Kentucky, Mississippi, Missouri, North Dakota, South Dakota, and West Virginia- with only one abortion clinic.

The video discusses the personal impact of TRAP Laws, specifically mandatory waiting periods, on patients and introduces the disadvantage it places on individuals of lower socioeconomic statuses.

Waiting Periods

25 states in the US have laws requiring mandatory waiting periods. This means an individual seeking an abortion must visit the abortion clinic twice. The first appointment consists of a counseling session and the second appointment occurs 18-72 hours later, depending on the state, and contains the abortion procedure.

Impact of TRAP Laws by Socioeconomic Status

One study of 379 Arizona women who received an abortion prior to the implementation of the 24 hour waiting period addressed the difficulties posed in accessing abortions and the additional disadvantages that the two visit requirement would cause.

  • Of the people 100% below the federal poverty line (FPL), transportation cost accounted for 40% of their total cost, while transportation accounted for 28.7% of the total cost for those 100-199% FPL and 16.2% for those ≥200% FPL.
  • The average time traveled was 58 minutes. 10% traveled more than 2 hours. The average time traveled was about 30 minutes more for people below 100% FPL line than those ≥200% FPL
  • 1/2 of the women reported that in order to pay for their abortion, they experienced delays paying their other expenses, like rent, bills, and food. Women above the FPL were more likely to report not requiring any assistance to pay for their abortion. Women below the FPL were more likely to report greater difficulty.
  • Lower income women experienced greater delays in obtaining an abortion due to not knowing they were pregnant, not knowing where to find a clinic, and difficulty preparing to pay for travel costs, childcare, and taking time off work. It is also noteworthy that abortion price increases as gestational time increases.
  • Although women above FPL tended to miss work at a higher rate, lower income women expressed delays in obtaining appointments at a higher rate due to difficulty taking time off of work.
  • When asked about the emotional aspects of a 24 hour waiting period, lower income women expressed at a greater percentage that it would have a negative effect, while higher income women expressed it would have no effect. The different reactions based on income level displays the greater challenge that accessing reproductive health care presents for women of lower socioeconomic status than women of higher socioeconomic status.

The 24 hour waiting period significantly impacts lower income women due to the appointment payments and additional costs. Women of lower socioeconomic statuses are found to travel greater distances, experience greater tradeoffs in other expenses in order to pay for their appointments, higher chances of delays in making abortion appointments, and therefore, express a negative outlook towards the two visit requirement.

TRAP Laws have forced clinics to close, causing 87% of counties in the United States to lack an abortion provider. The map above shows the percent of women and travel distance by region.

72 Hour Waiting Period

Utah was the first state to enforce a 72 hour waiting period. This time length extends over several days, creates logistical challenges, and has the potential to push women into greater restrictions. In a Utah study surrounding the 72 hour waiting period, women were interviewed and asked about their experience.

  • Women expressed that logistical and cost concerns were the hardest aspects of the 72 hour waiting period and two visit requirement.
  • A woman commonly finds out that she is pregnant at 4-7 weeks. In Utah abortion is banned at 21 weeks. The average number of days waited between visits is 8 days, further lengthening the limited time available to legally receive an abortion.
  • Expenses relating to the first appointment were on average over 40 dollars. Expenses relating to the second visit, not including the abortion, were on average over 100 dollars.
  • One woman explained her struggle, “[I] get paid every week, but every time I think I have enough money, it all gets taken out in taxes, so I'm just under the amount I need. Every time I try to make an appointment, something else comes up that I have to pay.”
  • One woman described the difficulty paying for her abortion, “I knew the longer it took, the more money it would cost….We are living paycheck to paycheck as it is, and if I [had] gone one week sooner, it would have been $100 less.”

A waiting period as long as 72 hours can force someone to exceed the gestational limit and no longer be applicable for an abortion. Women in the second trimester of pregnancy also have greater struggles accessing abortions. During the study, one woman believed she was earlier in her pregnancy than she was in actuality, making her unable to receive an abortion because she was past the legal time. Another woman was pushed over the gestational limit due to the wait resulting from the two visit requirement. As a result, the 72 hour waiting period increases the expenses of receiving an abortion by delaying the procedure, targeting those of lower socioeconomic statuses and creating added financial difficulty.

Financial Struggle

The average cost of an abortion is 500-2,000 dollars which is a large sum of money to pay, especially without financial support. For lower income women in particular, who live pay check to pay check, or generally do not have extra money to spare, the waiting period poses a challenge to not only pay for their abortion but also the two appointments, travel, childcare, and other expenses. Financial support through the government would offer help to meet the demands of the waiting periods by covering the cost of the abortion. However, the Hyde Amendment, made in 1976, bans the use of federal money to cover abortion, meaning lower income women, who are enrolled in Medicaid, cannot use that as a means to cover their abortion cost. Once again women of lower socioeconomic statuses are specifically placed at a disadvantage due to the restrictive abortion laws set in place by the federal government.

Impact on the Decision to have an Abortion

The waiting period requirements are rationalized as allowing women greater opportunity to consider their decision. However, the two visit requirement seldom alters the women's choice and generally creates additional hardship and stress while accessing the abortion.

In response to the Tennessee 24 hour waiting period, a survey was conducted of over 300 women.

  • 7 in 10 women expressed that there was no benefit in waiting.
  • 59% of women expressed hat they decided on having an abortion within 24 hours after confirming their pregnancy.
  • When asked about a benefit of the waiting period, 75% of the women said they were unable to name one.
  • Prior to the wait, 46% of women expected to have one or more problems before the second visit. After the second appointment, 64% of women reported experiencing problems including nausea/physical discomfort, mental anguish, greater need to make excuses for absences, greater transportation expenses.
  • The cost associated with the additional expenses of the waiting period and two visit requirement were greater than the women initially anticipated.

Additional surveys further support the lack of significance that waiting periods have on a woman's decision to receive an abortion.

  • A national survey in 2008 recorded that 92% of patients who had an abortion knew they wanted to receive an abortion prior to making their appointment. This means a 24 hour waiting period does not change the minds of those seeking an abortion.
  • In Arizona, women were questioned about how they would prefer visits, either having the counseling session on the same day as the abortion, or having two appointments, 88% preferred one day, while 12% preferred two days.
  • When clinics are not required to enforce waiting periods, 1-13% of women do not have an abortion, showing uncertainty in their decision. In Utah 8% of women became less certain about receiving an abortion after a 72 hour waiting period.
  • For low income women, their cost increased by 48% due to a second visit while the cost for higher income women increased by 14%
  • 7% of 7,022 women, ages 18-49, from a study by the KnowledgePanel reported having attempted a self managed abortion (SMA). Their reasoning behind an SMA was due to the diminishing access to abortion as a result of the various restrictions as well as the clinic being too expensive.

Because women generally express that mandatory waiting periods are not beneficial and do not cause a significant change in certainty, when comparing the outcome of waiting periods to no waiting periods, it is important to recognize the falsehood of the justification for the laws. It also causes women to seek unsafe abortions because they are unable to access clinics. Instead of supporting a woman's choice, like the laws claim to do, they only establish greater struggle, especially for women of lower socioeconomic status, as they are forced to take on additional expenses in order to obtain their abortion.

Sources

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Images

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  5. Supreme Court Building Supreme Court Law Court. pixabay, pixabay.com/photos/supreme-court-building-supreme-court-1209701/.
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