Whose Choice? How the Hyde Amendment Harms Poor Women

“Because of the Hyde Amendment, more than a million women have
been denied the ability to make their own decisions about bringing
a child into the world in the context of their own circumstances and
those of their families.”
– Stephanie Poggi, Executive Director of the National Network of Abortion Funds(1)

What public funding is supposed to provide vs. the hyde amendment

“…by denying poor women the funds to
exercise their constitutionally protected right to choose
to have an abortion, the government both discriminates
against poor women and impermissibly coerces them
to choose to continue a pregnancy”.

“State courts have also criticized restrictions on public
funding for abortion as “antithetical” to the goals of a
state Medicaid program, which is to provide the poor
“with access to medical services comparable to that
enjoyed by more affluent persons.
” By essentially
barring a poor woman from obtaining medically necessary abortion care, restrictions on Medicaid funding” for abortion “subject[ ] the poor woman to significant
health hazards and in some cases to death[,] and
thus clearly contravene the objectives of Medicaid”.

“Medicaid plays a particularly important role for women, and especially women
of reproductive age. One in ten women in the United
States is covered by Medicaid, and women make up
more than two-thirds of adult Medicaid beneficiaries. Thirty-seven percent of women of reproductive age in families with incomes below the federal poverty level rely on Medicaid for healthcare coverage” (18).

Summary: All states have the choice wether to or not participate in Medicaid and all have chosen to do so, therefore must adhere to a specific set of rules for the program. That being said the eligibility requirements for an individual to be covered by the Medicaid varies enourmously from state to state (in virginia..)

Summary: Henry Hyde sponsored a rider to the annual Appropriations Act and the rider has been included in every Appropriations Act since then.

in cases of rape, incest or endangerment a women’s life “or States are required to provide matching funding for cases that fall within these narrow
exceptions. If states choose to provide additional coverage for abortion, they must shoulder the entire cost”.

International Perspectives on Public Funding for Abortion (20)

Summary: Comparing the United States funding policies for abortion to that of other developed nations sheds light on the abnormality of the way this country handles it.

“Twenty-one of the twenty-seven members of the
European Union, an additional five European
nations and Israel provide funding for abortions
through public health insurance or in public health

“In Canada, all provinces provide abortion
coverage at hospitals and many also cover costs
at private abortion clinics… (a canadian) court held that a provincial health
program limiting funding to public hospitals where women were subject to long delays and that excluded services provided by abortion clinics violated
women’s right to liberty and security of the person,
freedom of conscience, and equality”

Sum: Other countries outside of Europe, Canada, and Israel several other countries approach the access to public funding as a fundamental aspect of the right to abortion.

“Mexico City voted to legalize abortion
in April 2007,59 a core element of the legislation
was making abortion both available and accessible
to women, including women who could not afford
to pay for the procedure”

“The Supreme Court of Nepal also recognized that ensuring that abortion is
financially accessible is a necessary component of
the legal guarantee of safe and affordable abortion.
Following a successful lawsuit brought by the Center to legalize abortion, the Supreme Court ordered the government to establish an abortion fund to
ensure that abortions were accessible to poor and
rural women”

“South Africa adopted a similar view when it legalized
abortion. The Choice on Termination of Pregnancy
Act, passed in 1997, both established women’s
right to abortion during the first trimester and
ensured access by providing abortions free of
charge at designated public hospitals and clinics”.

Hyde’s Impact

“There is some sort of assumption out there that women who choose
abortion have not yet had a family, not yet gotten married, not yet
started their careers. The majority of women who show up for
abortion are already mothers, are between the ages of 20 and 24,
are already sexually active and have been using birth control…
These women are our sisters, our mothers, our rulers, our
leaders, our teachers, our principals, our rock stars, our political
people, they’re everywhere…”
– Vice President of Whole Woman’s Health

“The Hyde Amendment’s restrictions affect low-income
women in three principal ways: by causing them to delay procedures, by imposing additional financial strain on their already difficult economic situations and by
forcing them to continue unwanted pregnancies”

Backround of Interviews: From October 2009 through February 2010,
researchers from the Center for Reproductive Rights
(the Center) and the National Network of Abortion Funds
(the Network) together conducted 27 interviews for
this report. In conducting this research, the Center
and the Network sought to collect a broad range of
stories highlighting how poor women are adversely
affected by the funding restrictions imposed by the
Hyde Amendment(15)

“One counselor reported that
75% or more of her clinic’s clients seeking funding
assistance are enrolled in Medicaid and their stories
include recent job loss, low-income jobs, and more
than one child at home with no support from partners.72 Another said that “the majority [of women] were
on birth control, but maintaining birth control was not
easily accessible for them—either their prescription ran
out or they couldn’t afford to get it renewed.”73 Another
counselor reported speaking with women who say “‘I
need an abortion, because I can’t afford another baby.
I’m a single mom. I just got back to school, and I can’t
afford to drop out of school right now. I just got the
baby out of Pampers and to have another would cause
too many setbacks”(22).

“Of the 50 to 70 abortion patients that her clinic sees
weekly, the counselor stated that around five are unable to obtain the money to pay for the abortion” (24).

“On average, it takes them two to three
weeks longer [for poor women] than [for] other women to obtain an abortion
because of the difficulties involved in procuring the
necessary funds”(24) .

“In one study, nearly
60% of Medicaid-eligible women reported that paying
for an abortion created serious hardship.111 Moreover,
studies have found that poor women are often forced
to divert money that they otherwise would have spent
on necessities such as rent, utility bills, food or clothing
for themselves or their children, and that some women
resort to extreme measures such as pawning household
goods, theft, or sex work in order to raise enough money
to pay for an abortion” (28).

“According to a clinic counselor, even if “a funding agency gives them $50 or $200, it
still leaves a huge gap that they are not able to fill”(30)

How funding abortion would actually save federal dollars
“The costs associated with unwanted pregnancies
carried to term are estimated to be four to five
times greater than those of paying for abortions
for women who seek them.The available
data suggests that providing public funds for
women seeking abortion would result in significant cost savings for federal and state governments. The most widely cited study concluded
that using state and federal funds to pay for
abortions would have resulted in medical and
social welfare savings of $435 to $540 million and a net savings to the nation of at least
$339.6 million over the two years following the
study.147 The same study concluded that, for
every dollar spent to pay for abortion, nearly
five dollars are saved in public medical and
welfare expenditures related to babies born
to poor women, including Medicaid expenditures for prenatal care, delivery, and postnatalcare for the mother, as well as newborn care,
neonatal intensive care, pediatric care, food
stamps, and public assistance for the child
during the first two years of life. The study
was replicated with similar results”(34)

Funding under Discrimination states (includes VA)

“accessing Medicaid funding for abortions under the Hyde Amendment restrictions. In the
1990s, the two groups worked to ensure that women would not have to report a rape
to the police in order to obtain Medicaid coverage for abortion. This requirement deters many
women from seeking funding because they have been assaulted by partners, family members, or others whom they know and are afraid of retaliation or reluctant to involve the criminal
justice system; others want to put the experience of sexual assault behind them”(37).

What about states that Fund all medically necessary abortions (non-discrimination states)? (36)

“Seventeen states fund all medically necessary abortions under Medicaid using state funds. In thirteen of these states, state courts have found that the Hyde
restrictions violate state law”(37).

“once a government chooses to
provide funds to assist a constitutionally protected
decision, such as the decision whether to continue
or terminate a pregnancy, “it must do so in a nondiscriminatory fashion, and it certainly cannot withdraw benefits for no reason other than that a woman
chooses to avail herself of a federally granted constitutional right”(37)

Summary: State courts have seen denial of the funding a poor women’s access to abortion as a violation of a women’s right to privacy, which is in turn the right for a pregnant women to choose to terminate a pregnancy.

Summary: the time it takes for enrollment in the medicaid program and access to insurance coverage is an important issue when it comes to women receiving an abortion in an expedient manner.

“Unless state policies address these issues, delays in accessing
Medicaid benefits can undermine women’s ability to get
an abortion or force them to suffer significant delays in
obtaining the procedure” (38).

“Some states, like New York, have programs that facilitate low-income, pregnant
women receiving Medicaid benefits and accessing reproductive healthcare, including abortion. Through the Prenatal Care Assistance Program (PCAP), a pregnant
woman may receive healthcare benefits immediately after applying for Medicaid benefits, and for the following 45 days, without having to wait for an official determination that she is eligible for Medicaid benefits” (38). > presumptively eligible

Human Rights !! Thesis

“If there was the reinstatement of Medicaid funding for abortion,
low-income women would be able to pursue their dreams, move
forward in their lives, and exercise the same right to choose that
middle-class women can. Women would be able to turn their lives
around. It would just make all the difference for women”– Executive director of the Women’s Medical Fund

“The Hyde Amendment violates the human rights of
poor and low-income women. The restrictions interfere
with a woman’s right to make fundamental decisions
about her body, to access health services necessary to
protect her health, and to decide whether and when to
have children. The ability to make these decisions without government coercion is integral to women’s dignity and equality. The government’s failure to respect and
ensure these rights violate a woman’s right to health,
life, equality, information, education, and privacy, as
well as freedom from discrimination”

Argument: The United states International Human Right’s Obligations

“The UN committees that oversee compliance with the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and the International Covenant on Civil and Political Rights (ICCPR) have consistently criticized restrictive abortion laws as a violation of
the right to life.205 In particular, the Committee on the
Elimination of Discrimination against Women (CEDAW
Committee) has expressed concern where women
do not have access to safe abortion services, despite
those services being legal, and has recommended that
governments provide safe abortion services or ensure
access where permitted by law, including recommending that a government provide social security
coverage for abortions or include abortion coverage
in government health services” (43).

“The rights to life, privacy and personal
autonomy, and non-discrimination are set
forth in two human rights treaties ratified by
the United States: the International Covenant
on Civil and Political Rights (ICCPR)
and the Convention on the Elimination of All Forms of
Racial Discrimination (CERD).Treaty ratification confers an international legal obligation on
the United States to respect, protect, and fulfill the rights contained in the treaty200 and to create the conditions necessary to ensure that all persons are able to enjoy rights in practice. The United States is also a signatory to key human rights treaties that guarantee women’s right to reproductive healthcare and equality—among them, the International
Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on
the Elimination of All Forms of Discrimination against Women (CEDAW). The United States
has an obligation not to take any action that would defeat the object or purpose of the treaties it has signed” (43).

Right to Health

The right to health includes “the right to attain the
highest standard of sexual and reproductive health.”
To fulfill this right, governments must provide access to
“a full range of high quality and affordable healthcare,
including sexual and reproductive services.” This obligation includes a responsibility to make reproductive health facilities, goods, and services economically accessible, and in particular, to ensure that such health services are accessible to marginalized or underserved

Summary of Argument:

Hyde Amendment has imposed funding restrictions that result in some poor women delaying their abortion or continue an unwanted pregnancy, even when their health and economic security is endangered.

“By limiting or denying women’s access to safe and legal abortion care, Medicaid funding restrictions also deny women access to a basic component of reproductive healthcare, thus hindering
enjoyment of the conditions that are necessary for good health”(42).

Right to Equality and Non-discrimination

“Restricting access to abortion, a procedure that only
women need, discriminates against women and their
reproductive freedom. Denying Medicaid funds for
abortion services uniquely discriminates against low-income women and prevents them from realizing the full range of rights to the same extent as men or women of greater means”(43).

“The international human rights community recognizes
a governmental responsibility to ensure that all people,
without distinction as to race, national or ethnic origin,
or color, have the right to “public health [and] medical
care.” The right to non-discrimination in health includes equal access to reproductive health services for women of color. Thus, the Committee on the Elimination of Racial Discrimination has called on governments to report on measures taken to eradicate gender-related
racial discrimination in the area of reproductive and
sexual health, and specifically urged the United
States to adopt special measures to address persistent
racial disparities in reproductive healthcare”(43).

“The removal of those restrictions constitutes one measure that would contribute to addressing the significant race disparities in reproductive healthcare by facilitating equal access to abortion”(44).

Right to Self-determination

“Self-determination in decision-making is also inherent in the right to health. The Committee on Economic, Social and Cultural Rights has stated that reproductive health means “that women… have the freedom to decide if and when to reproduce and the right to be informed and to have access to safe, effective, affordable, and acceptable methods of family planning of their choice as well as the right of access to appropriate healthcare services.” The CEDAW Committee has stated that respect for women’s human rights requires governments to “refrain from obstructing action taken by women in pursuit of their health goals”(44).

“By interfering with poor and low-income women’s decision-making on whether to continue a pregnancy, and placing financial obstacles in the path of women who
seek to protect their health and access an essential reproductive health service, the government’s restriction on federal Medicaid funding for abortion contravenes
women’s right to reproductive self-determination”(44).

“Hyde Amendment offers the United States a critical
opportunity to restore women’s equality and make
reproductive rights meaningful for all women irrespective of economic status. Free from the restrictions of Hyde, women throughout the country would be
empowered to make decisions regarding what is best
for themselves and their families”(45)

Final Notes

“In most states, Medicaid
covers pregnant women with incomes between 133
and 185% of the federal poverty level—in other words,
annual incomes between $24,352 and $33,874 for
a family of three”(46).

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