Access to Abortion as a Health Disparities Issue

A recent Guttmacher piece reported that from 2000 to 2008, abortion rates in the United States declined – except among poor women, who “accounted for 42% of all abortions in 2008, and their abortion rate increased 18% between 2000 and 2008, from 44.4 to 52.2 abortions per 1,000 women aged 15–44.”

A commentary in the May issue of the Journal of Health Care for the Poor and Underserved focuses on the barriers faced by poor and minority women in obtaining abortions and other reproductive health care. The authors call not just for better access to services to prevent unintended pregnancy, but for increased access to abortion itself.

In Access to Abortion Services: A Neglected Health Disparity, authors Christine Dehlendorf and Tracy Weitz identify the Hyde amendment, provisions of and legislative reactions to the Affordable Care Act, lack of insurance coverage, waiting periods, the lack of providers in 87% of U.S. counties, TRAP laws, limits on who can perform the procedure, and medical liability coverage as specific barriers that effectively reduce poor women’s access to abortion.

They make the following compelling and provocative argument for increased access to abortion services as a treatment for the condition of unintended pregnancy:

Poor and minority women experience both greater need for and reduced access to abortion services than their White and more affluent counterparts, and have negative health and social consequences as a result. With other chronic conditions with similar disparities—such as diabetes and HIV—there is the recognition that it is necessary not only to work to prevent the onset of the disease but also to ensure access to and eliminate disparities in health care services for whom prevention is not successful. No one would argue, for example, that individuals diagnosed with diabetes should be denied access to diabetes-related care because they did not adhere to diabetes prevention strategies such as exercise and improved nutrition. In contrast, governmental health agencies invested in women’s reproductive health and health disparities have addressed only prevention of unintended pregnancy, thereby ignoring the need for access to abortion care as one option for treatment of this condition.

They then call for actions to address disparities in access and focus attention on abortion itself, not just prevention of unwanted pregnancies:

We propose that a new public policy approach would address the issue of undesired fertility as a condition requiring not only prevention but also treatment. This approach allows consideration of access to all reproductive health services, including abortion, as a health disparities issue. Concrete steps which governmental health agencies could institute with this altered perspective on abortion disparities include removing the exclusion of health care coverage for abortion in both the private and the public sectors. Further, health care regulations which specifically target abortion facilities should be eliminated, and trained providers should be allowed to provide these services without barriers associated with licensure or medical liability insurance.

I would agree that discussions of reproductive care can sometimes have a more limited focus on prevention, which can be seen as more palatable to a broader set of people. Dehlendorf and Weitz remind us that access to abortion itself is just as important. While I think there are plenty of pro-choice folks who agree with the authors, it’s not very often that I see this position laid out so explicitly, and I appreciated the authors’ directness. While the article is not freely available, I wanted to point to it as a resource for advocates and suggest getting a copy through a library or otherwise.