The right to an abortion evokes strong emotions among its opponents and its supporters. What should not be tolerable to either is an unequal health care system that denies services to those who cannot pay for them.
But that is the system we have with abortion. It is one of only a few procedures that is highly restricted by MaineCare, the state’s insurance program for the poor. Regardless of one’s opinion on abortion, it is legal and the U.S. Supreme Court ruled in 1973 that women have a constitutional right to obtain an abortion. Extending that right only to women with money is wrong. It may also be unconstitutional.
On Tuesday, the ACLU of Maine, on behalf Maine’s three abortion providers, filed suit against the Maine Department of Health and Human Services to overturn a 1981 rule, updated in 2010, that prohibits the use of state funds for abortion, except in cases of rape or incest or if the life of the mother is in danger. A similar prohibition, the Hyde Amendment, bars the use of federal funds for abortions except in these instances. Most states have similar restrictions, though they have been overturned in 13 states, including Massachusetts and Connecticut, by lawsuits similar to the one filed in Maine. Four states — Maryland, New York, Hawaii and Washington — cover abortion voluntarily.
Pregnancy-related care and infant care are covered by MaineCare.
Maine’s prohibition violates the state constitution’s guarantee of “liberty, safety and equality,” the providers say in their complaint, filed in the Cumberland County Superior Court. It also puts poor women at risk of complications from delayed abortions and unintended pregnancies.
In Maine, nearly half of all pregnancies are unintended. In 2010, half of the state’s unintended pregnancies were carried to term, and 28 percent ended with abortions. The remainder ended with miscarriages, according to the Guttmacher Institute.
The rate of unintended pregnancies is higher among women who are low income or unmarried. Women who experience unintended pregnancies are more likely to have mental health problems, have less stable romantic relationships and are more likely to experience physical abuse, the Brookings Institution reported in 2011. Children born from these unintended pregnancies are at greater risk of negative physical- and mental-health outcomes and are more likely to drop out of high school and engage in delinquent behavior as teenagers.
In addition, unintended pregnancies in Maine cost the federal and state governments $58.2 million in 2010, Guttmacher found.
Women intent on ending their pregnancies will find a way, even if it means selling heirlooms or borrowing money or traveling great distances. Worse, women will induce their own abortions. A Texas study calculated that at least 100,000 and as many as 240,000 women in that state have tried to end their pregnancies on their own. Increasing restrictions on abortions has resulted in the closure of half the clinics that provided them in Texas. When asked what self-induced abortion methods they were familiar with, women mentioned herbs and getting punched in the abdomen, along with the drug misoprostol, which is used to induce abortion.
These sobering numbers show that laws restricting access to reproductive health care increase risks for women, especially the poor, have real and horrific consequences.
Even those who strongly oppose abortion should agree that the basic level of health care available to women should not differ based on how much money they earn.