Back in March of this year, someone unearthed a video of Republican presidential candidate Rudy Giuliani speaking at a 1989 Women's Coalition for Giuliani event and posted it on YouTube. In the video, Giuliani says that he supports public funding for abortions for low-income women, because, in his words, "we cannot deny any woman the right to make her own decision about abortion because she lacks resources." Hysteria, of course, ensued. In a follow-up interview on CNN in April, one breathless interviewer incredulously probed, "So you support taxpayer money, or public funding, for abortion in some cases?" Giuliani hemmed and hawed, emphasizing his abiding hatred for abortion, but essentially maintaining his 1989 position. By May, however, his handlers had clearly taken the reins, and Giuliani was publicly stating his support for the Hyde amendment-the 1976 law that barred federal Medicaid from paying for abortions unless a woman's life was at stake, and that, in essence, overturned Roe v. Wade for poor women in the United States.
I bring this up not to rehash Giuliani's mercurial rhetorical record on reproductive rights, but rather to highlight the fact that public funding for abortion is a now-familiar wedge issue in the anti-abortion lobby's attempt to whittle the core right to abortion down to a near-meaningless sliver. For the anti-abortion crew, public funding for abortion is loosely defined as everything from Planned Parenthood receiving Title X federal family planning grants (so that they can provide women with contraception that might-horror of horrors-prevent unintended pregnancies) to allowing Medicaid to cover abortions for women who can't afford health care. The goal, ostensibly, is to make abortions disappear by making it impossible to get one, but anyone who enjoys regular contact with pregnant women (remember them?) knows that such restrictions are far more effective at discriminating against poor women than reducing the abortion rate.
No group is more intimately aware of this reality than the women – largely volunteers – who operate community-based abortion funds across the country. The National Network of Abortion Funds (NNAF), established in 1993, is made up of 104 such funds, operating in 42 states and the District of Columbia. Every year, the funds help about 20,000 women access the safe abortion services to which they are legally entitled, through a combination of small grants, counseling, advocacy, childcare, transportation, and temporary lodging. The women who operate the funds are driven by a dual commitment to reproductive rights and economic justice, based on a firm understanding that the core right to abortion is meaningless if millions of women cannot access that right.
The volunteers who staff the funds are keenly aware of the barriers faced even by women who meet the state's stringent requirements for assistance. For example, in 33 states, Medicaid only covers abortions when a pregnant woman's life is in "imminent" danger, or when the pregnancy is a result of rape or incest. Despite this legal framework, Carol Cohan, executive director of the Florida-based Women's Emergency Network and a NNAF board member, reports, "Medicaid virtually never covers abortion, even when mandated to do so by law. We funded a case a few months ago for a woman suffering from multiple organ failure whose pregnancy would have killed her. She had both Medicaid (because she is poor) and Medicare (because she is disabled). Both refused to cover."
Cases like the one Cohan describes are far from isolated. A blog run by the Austin-based Lilith Fund catalogs the experiences of women seeking the Fund's services, many of whom qualify for Medicaid assistance under both federal and Texas law, but few of whom ever receive the financial support to which they are legally entitled. Across the 33 states where Medicaid should technically cover abortions under the narrow circumstances described above, NNAF reports that the program only pays for 1% of all procedures, in a clear violation of federal law. Funds like the Women's Emergency Network and Lilith are left to pick up the slack.
Even in the 17 states where Medicaid covers abortions, there are plenty of women who still struggle to come up with the money for an abortion-because they aren't eligible for Medicaid, because they don't have health insurance, or because their health insurance won't cover the procedure. Abortion opponents may frame the denial of public funding for abortions as every taxpayer's right, but those who work at abortion funds know that when pregnant women lack the disposable incomes to pay for a procedure that can cost anywhere from a few hundred to a few thousand dollars, they wind up with less money for things like food and housing – or they are forced to give birth to babies that they don't want and can't afford. After all, if you don't have the money for an abortion, how on earth are you going to support a child?
Many women who are on public assistance face a double bind: Medicaid won't cover the cost of an abortion, but the "family caps" established in the 1990s as part of welfare reform deny additional support to women who have another child while on welfare. Add to this the stringent working requirements ushered in by welfare reform, which, coupled with the lack of maternity leave and affordable childcare, make the prospect of having another child difficult for many women to imagine. As Kathryn Burton, president of the New Hampshire Fund for Choice (NHFFC) observes, "Our society is set up to hinder women in whatever decision they make, whether it be to avoid, to terminate or to continue the pregnancy…any decision a woman makes is fraught with politics and obstacles." Cohan has a similar response: "I find it inconceivable that the same legislators who could pass the welfare laws of 1996 could say to women, ‘We're going to prevent you from having an abortion, and when you have this baby-or these several babies-we're going to limit the services you can access as punishment for having these babies.' " Inconceivable but true. And, as Joanne Richards of the Lilith Fund points out, increasingly prevalent abstinence-only programs and crisis pregnancy centers (funded by your, ahem, tax dollars) are not only denying women access to the means to prevent future or further pregnancies, they are also spreading dangerous misinformation about the risk associated with abortion.
In a landscape like this, it's hard not to get frustrated with the systemic injustices that seem to greet women at every turn. But working directly with pregnant women also helps activists like Burton reconnect on a regular basis with the roots of their commitment to reproductive justice:
Working at a clinic or a fund, you quickly realize you are dealing with real women who are at a major juncture in their life. It goes beyond whether they want to continue their pregnancy or not. It goes to the heart of the debate. These women are deciding what trajectory their life is going to take on all facets. They are making decisions based on their current families, their future families, careers, financial resources, support networks, relationships and much more.
Brianna Boggs, who serves as board president of the Eastern Massachusetts Abortion Fund (EMA), describes a similar moment. EMA, like most funds across the country, will make small grants to help pay for a procedure, but cannot cover the full cost for any one woman. Instead, Boggs and her colleagues work with women individually to figure out how to raise the money themselves-mapping the resources in their lives, brainstorming ways of generating income, breaking down the problem into manageable steps. For Boggs, it is through this process that the transformative nature of the work begins to emerge. She reflects,
I love feminist theory, and it's all very interesting until you get to this crisis moment where you realize, theory's awesome, but what are you actually doing to materially improve women's lives? What are you doing? You can talk all day, but there are poor women who don't have access to the things that they need in the world. This is materially improving the lives of women who are living in poverty, who are living in crisis, this is the moment that you can absolutely change a woman's life, you can help her change her own life, if this is the right choice for her.
At the national level, NNAF's campaign to overturn the Hyde amendment-a first step toward improving the lives of women living in poverty-continues to gain momentum. "It's a really exciting time," says Boggs. "It's time to introduce that conversation that it is not appropriate for the federal government to limit funding this way. It's not taking full responsibility for the fact that women deserve a full range of health care. I think that this goes far beyond the right to access abortion, I think that this is about every person having dignity."
Still, on the subject of national advocacy, Boggs stays grounded. "Policy work and legislative work-all of that is incredibly, incredibly important," she acknowledges. "And a lot of it means absolutely nothing to the woman who says, ‘I don't have $800 by Friday.' " Until that woman has a space and a voice in our national abortion conversation (instead of these guys), we can expect more backsliding on the public funding issue by candidates on both sides of the political spectrum. Meanwhile, the phones will keep ringing in the 104 abortion funds across the country, where women's lives continue to unfold.