For people living in poverty, getting an abortion is hard. It’s about to get harder
When Aida Peery decided to get an abortion at 18, she felt scared and confused. It was a few years after the historic Roe V. Wade ruling, the 1973 landmark case protecting a person’s right to an abortion. But Peery was unsure how she could access the procedure.
At the time, her home state of Illinois required unmarried people 18 and under to first obtain parental consent to undergo an abortion. Peery, nervous but committed to her decision, enlisted the help of a family friend to pose as her mother at a clinic in Chicago. She felt like she couldn’t be honest with her family about the situation
“I was scared to talk to my family about it,” Peery said. “They instilled a lot of fear in me.”
Now, amid a historic rollback of reproductive rights led by Republican lawmakers instituting a patchwork of contradictory laws state-to-state, Peery feels the past creeping back up. A recent draft opinion leak from the Supreme Court shows the court is considering overturning Roe v. Wade, the same law that allowed her to get an abortion all those years ago.
Perry, a vendor program associate with Street Sense Media, worries about how low-income people and people experiencing homelessness will be affected in the coming months.
“It’s a woman’s right to choose,” she said.
Nearly half of people who receive abortions live below the federal poverty level, according to the Guttmacher Institute. Another quarter identifies as being “very close” to poverty. Some studies have shown up to 20% of women seeking abortions in metro areas were experiencing homelessness or housing instability.
With close to 15% of D.C.’s population living in poverty, according to the latest census data, the city’s most vulnerable residents will be affected by future reductions in reproductive care access.
Abortions have always been difficult to access
Even though abortions have been legal since 1973, low-income people have consistently struggled to find access to steady health care. Obstacles include cost, knowledge of reproductive health and physical access to providers, according to a study published in the academic journal Health and Social Care in the Community.
“Roe v. Wade was never enough,” Benny Del Castillo, the interim Board President of the DC Abortion Fund, said. “Roe v Wade provided legality into the mix. However, it never guaranteed true access.”
For those who cannot afford the full cost of an abortion, the DC Abortion Fund is an all-volunteer nonprofit that gives grants to pregnant people in the Washington region and to people who travel to the District.
And the variation of state abortion laws adds further challenges, particularly for Washington region residents.
While abortion is legal in D.C. at all stages of pregnancy, including late-stage and third-trimester abortions, Medicaid does not cover the cost of an abortion except in cases of life endangerment, rape or incest. In 2017, a Republican-led House voted to prevent the District from using local tax dollars to subsidize abortion services for low-income women, limiting access to abortions for low-income people.
Abortions are illegal in the third trimester unless the patient’s life or health is endangered in Virginia. Medicaid cannot be used to subsidize an abortion.
In Maryland, abortions after viability (meaning the baby can survive if born) are illegal, but Medicaid can be used to cover the cost of the abortion. Lawmakers in Maryland just voted to expand access, allowing health practitioners other than physicians to perform abortions.
Because people living in deep poverty typically do not have access to health care and insurance, it can be hard to detect a pregnancy and receive an abortion early on, according to Dr. Karen A. Scott, a board-certified OB-GYN and founding CEO and owner of Birthing Cultural Rigor, a science consulting firm.
Often when a person is experiencing homelessness or living in deep poverty, they may also have a harder time being in tune with their body and noticing changes, as well, Scott said. In fact, Leise Gergely, a community advocate with My Sister’s Place, a domestic violence housing and services organization in the District, said she comes across clients who have expressed this idea.
Tracking your period or ovulation just isn’t a priority when you’re dealing with the stress and trauma of homelessness, says Scott. Additionally, pregnancy tests are also costly and not easily accessible to purchase, administer and interpret. People also frequently experience long delays in getting timely appointments or require copays which add additional burdens to obtaining care.
“Some people may not even be aware that they have missed a period because they are concerned about the other determinants of health, like how they will find and secure safety, shelter, food, work and nurturing human attachments,” Scott said. “Those take precedence, so people sometimes are not aware of what’s happening in their body”
This delay has material impacts; it’s harder and more expensive to find places that cater to abortions later on in the pregnancy and in the third trimester, Del Castillo said.
But even an early abortion can be cost-prohibitive: the average price for an abortion during the first trimester ranges from about $400 to $600, depending on the clinic. Late-term abortions can cost upwards of $2,000, according to Planned Parenthood.
People experiencing homelessness – particularly women — also face an outsized threat of sexual assault and trafficking, according to a study by UNANIMA International. Sexual violence and abortions are inextricably linked, Del Castillo explained.
“It’s just another way to really exert power and control over the most marginalized,” she said.
Abortions are common among trafficking survivors, according to a peer-reviewed study by the science journal Annals of Health Law and Life Sciences. More than half of 67 respondents in the study said they had received at least one abortion, and 20 respondents reported receiving multiple abortions.
Society has already taken so many choices from people experiencing violence, poverty and housing instability that limited access to abortion is part of a larger pattern, Gergely said.
“Taking away even more autonomy is bound to wreak even more havoc than they’re already experiencing.”
What the draft leak means for the District and surrounding areas
The District has long been a safe haven for people seeking abortions across the United States. According to federal health data, more than two-thirds of people who obtained an abortion in the District in 2019 traveled from other states.
More people will likely begin traveling to the District and Maryland to receive an abortion if Roe v. Wade is overturned, according to the Planned Parenthood of Metropolitan Washington, D.C.
Thirteen states have “trigger laws” related to abortion in place, meaning it will immediately become illegal in these states if Roe is overturned. In total, 26 states could ban abortions. Several states have also introduced near-total abortion bans. Most recently, the Oklahoma governor signed the most restrictive law on abortion, which bans abortions from the moment of “fertilization.”
This means some people will have to travel hundreds of miles to get an abortion. But for people living below the poverty level, travel is not always a viable option.
“For people facing financial hardships and homelessness, this stroke will be especially hard as patients may have to budget in travel and lodging expenses when seeking care,” Planned Parenthood of Metropolitan Washington, D.C., wrote in an email. “The cost of an abortion shouldn’t prohibit someone from receiving the care they need to have full autonomy over their lives.”
After the draft opinion leak, councilmembers and the District’s non-voting House Del. Eleanor Holmes Norton pointed out that, despite the District’s support for abortions, a Republican-majority Congress could try to restrict D.C.’s access to reproductive care. Because of the District’s lack of statehood, the federal government has ultimate oversight over D.C.’s budget and laws.
“You can bet your life that, if this is the decision, I’m ready to fight,” Holmes Norton said in a news conference on May 3.
Shortly after the draft opinion was leaked, Councilmember Brianne Nadeau introduced legislation that would prohibit the District from cooperating in investigations led by other states into anyone who performs, assists with or receives abortions in D.C. If the bill is passed, the District would essentially become a sanctuary city for people seeking abortions. The bill, titled the Human Rights Sanctuary Amendment Act of 2022, is co-sponsored by nine of 13 councilmembers.
“Here in the District, we have laws that would protect that. But there are many places in the country that don’t, and my legislation would create a sanctuary for people who need that care, and who need access to abortion,” Nadeau said in an interview. “We want to help keep people safe.”
In March, At-large Councilmember Christina Henderson also introduced the Enhancing Reproductive Health Protections Amendment Act of 2022, which clarifies that an individual assisting someone in self-managing their medication-induced abortion would not be penalized. The bill was co-introduced with nine other councilmembers.
Robert White, the chair of the Committee on Government Operations and Facilities, announced in a press release on May 16 that both pieces of legislation will be heard on July 14.
What you can do
If it’s financially viable, you can donate to a local abortion clinic, Del Castillo said, rather than donating to a much larger organization. She also encourages people to talk about abortion access to lessen the stigma around the topic.
If you are seeking financial help to get an abortion, the DC Abortion Fund has a helpline — (202) 452-7464. You can leave a voicemail including your contact information, how many weeks pregnant you are, the date of your doctor’s appointment and whether the fund can you leave a voicemail. After that, a volunteer will be in touch with you about the next steps. There are no requirements and no formal application process.
Akosua Ali, the president of the NAACP Washington, D.C. Branch said she encourages people to get involved with local community efforts and most importantly — to vote.
“Our votes matter now more than ever, and it’s imperative that our infrequent and indifferent voters that really failed to turnout in the midterm elections, really ensure that their voices and their vote carry in our next election,” Ali said.