Liberating abortion, p.17
Liberating Abortion, page 17
But it’s not solely capitalism; it’s how we consume these tragic stories without indicting the system. In the time since Roe was overturned, we have seen writers and journalists clamoring to cover a story about someone who has died from an unsafe abortion. They have opined about why those stories are not plastered all over the front pages of every newspaper. For us, the situation is complicated. Those who died deserve not to have their death—their stories—exploited and mangled for political gain. They deserve to have their memories live on with those who loved them, not flattened to make a point about the barriers to abortion that we already know about. It’s frustrating to witness reporters salivate over the potential story of a dead person, rather than elevate the stories of those who are living and indicting the injustice of our system with their voices. But, most important, we have seen people die from unsafe abortions simply because of who they were and where they lived, and those stories have been mangled and misrepresented. The lessons were not learned the first time, so why are reporters begging for more stories of martyrs murdered by the system rather than illuminating and advocating for changes to a flawed system that has been in place for decades?
Whiteness is one reason. As we mentioned, Sara Clarke Kaplan argues that, although for years there was public discussion about the recriminalization of abortion and how it would harm communities of color and low-income people, after the Dobbs decision, reporting focused mainly on medical implications and ignored race, making the stories synonymous with whiteness. She also pointed out that the narrative painted these cases and the criminalization of abortion as unprecedented reproductive coercion, despite the centuries-long history of the United States applying that same coercion to communities of color. It is painful that people’s allegiance to whiteness does not allow them to empathize with people of color experiencing systemic barriers leading to their death. We shouldn’t have to lose another Rosie to act; Rosie’s death should have been enough.
If we were ever going to learn anything from Rosie’s death, it should have been that the racist, classist systems, rooted in capitalism, that make it possible for abortions to be denied in the first place need to be dismantled. That includes the health insurance system that grants corporations and governments the authority over what health care is and isn’t covered, and the medical system that gives doctors the power to turn patients in desperate need away because of how much money isn’t in their bank account. It’s the Medicaid system that plays Russian roulette with lives, determining who receives care based on legislators’ whims and budgets. Until those systems are completely rebuilt with the people who need abortions at the center, they will never, ever meet the needs of Black and Brown folks in this country.
The Creation of Medicaid
The effort to create a federal health insurance program for all began in the 1930s but lost steam after World War II, when President Harry S. Truman asked Congress for legislation to establish public insurance. President Truman had to abandon the idea after he faced fierce opposition to his plan, which included fearmongering about the idea of “socialized medicine.” But advocates continued to retool the idea in response to growing needs among people age sixty-five and older in the United States and reintroduced it in the 1960s. (The population swiftly rose from 3 million in 1900 to 12 million in 1950 and was in need of increased health care services, but many had a hard time affording health care due to rising costs.) Congress invited testimony from key advocacy groups; their testimony highlighted how the private insurance industry was leaving behind this older population, whom insurers considered a “bad risk” for their financial investment.
Medicaid is a means-tested federal health insurance program for low-income families. The Medicaid program’s structure was based on a previous program, Medical Assistance for the Aged, established by the Kerr-Mills Act of 1960. The program provided federal funds to states that participated voluntarily to expand health care coverage available to elderly people in the United States who had too much money to qualify for public assistance but not enough to cover their medical expenses. But the program had limited success in enrolling people due to the social stigma of being poor and needing government assistance, and states with large populations of Black people rejected participation because it might better those people’s lives. This stigma would impact the Medicaid program as well.
After much debate, two programs were created: Medicare and Medicaid. President Lyndon B. Johnson signed the law creating these programs as part of the Social Security Amendments of 1965, one week prior to signing the Voting Rights Act. Both were monumental pieces of legislation that were products of the civil rights movement’s attempt to right the status of Black people. Medicare became the federal health insurance program for elderly people and eventually some disabled people, while Medicaid insured low-income people in the United States. Because the structure of the public insurance program provides states with flexibility over how they comply with the federal standards to administer the program, state Medicaid programs vary significantly. Ultimately, states get to decide who is covered, what services are covered beyond some basic care, the models for health care delivery, and the reimbursement structure for doctors and hospitals. Reimbursement is slow and rates are notoriously low, sometimes not even covering the cost of the procedure; thus some providers won’t even accept Medicaid insurance, which limits where low-income people can receive health care.
The rot in the Medicaid program is due to its original structure. The program’s setup allowed politicians to control the health care access of low-income people in the United States, whom they chastised for their family size, poor health outcomes, and low incomes based on racist assumptions, and therefore the program perpetuated the very issues it was created to eradicate. Even though white people are enrolled in Medicaid, the overwhelming image of Medicaid enrollees conjured by politicians and media is of people of color—in particular, Black women. This is similar for welfare benefits; Black women are the controlling image, yet white people are overwhelmingly the beneficiaries. That’s by design. Using anti-Blackness and racism—along with fatphobia, classism, ableism, and xenophobia—politicians have been able to denigrate Medicaid as an “entitlement program,” casting those who are enrolled in it as nontaxpaying and undeserving people and thus experiencing less pushback when legislators enact cuts to the programs. The overt racism allowed politicians to create a system that decides who is and is not worthy of “free” health care from the government.
Racist pro-poverty lawmakers are then able to use Medicaid funding as a weapon to wield against populations they do not like or who do not support these politicians at their own discretion, particularly in states with large concentrations of low-income people and people of color. Herein lies the problem: states with large populations of Black folks tended to not participate in the program, making the public benefits program inaccessible to the people who needed it most. The idea of Black and Brown people receiving any sort of support or compensation from the government was portrayed with disdain, and lawmakers knew that the Medicaid program was a specific vehicle they could weaponize.
This was a tried-and-true tactic. In her 2020 book Taking Children: A History of American Terror, Laura Briggs, gender studies scholar at the University of Massachusetts Amherst, writes that states sought “to punish the most impoverished Black households for the NAACP’s desegregation work” in the 1950s and 1960s, including the 1954 Brown v. Board of Education decision. Immediately after that decision, southern states such as Mississippi used “suitable home” requirements to cut Black women and children off welfare rolls. Mississippi also used common-law marriages, which were more prevalent among Black and low-income communities, as a tool to cut welfare rolls, by decrying these marriages as “an illicit relationship or promiscuity.” This effectively cut Black children from welfare programs because they were considered illegitimate in the state’s eyes. For example, Mississippi cut nearly 8,400 mostly Black children off welfare rolls “because they or a sibling were illegitimate.”
In the 1960s, the image of welfare recipients underwent a transformation. Prior to this period, white widows were the larger share of welfare recipients, in part due to the intentional exclusion of Black mothers. Therefore the conjured image of a public assistance recipient was of a deserving white widow who was a single parent due to loss, emphasizing her white womanhood as a badge of innocence. Similarly, the New Deal’s Aid to Families with Dependent Children program excluded Black mothers, on the grounds that “blacks needed less to live on than whites.” Black parents were shut out of support. Already unable to earn the same wage as white people or men, Black women were further financially disadvantaged because they could not receive welfare benefits on account of their race. Following successful organizing by the National Welfare Rights Organization, more Black families enrolled in social service programs after previously being excluded. Benefits increased to women-led households, and the image of welfare recipients was transformed to one of a dishonorable and immoral single Black mother. Black women’s reproduction and caregiving were weaponized against them and expanded to women of color overall, building on systems of discrimination. These women were blamed for having children but were also locked out of services when they tried to plan and space their pregnancies. Segregation was a feature of the US health care system.
Codifying Abortion Stigma
Lawmakers introduced and passed Title X in 1970 at a time of inequitable access to contraception, with women reporting that they were having more children than they wanted. Title X (read “Title 10”—it’s a Roman numeral) grants are federal funds directed to health clinics for them to provide affordable reproductive health services for low-income patients. To this day, Title X funds contraception and other preventive health care services, including cancer screenings and treatment for sexually transmitted infections. However, lawmakers included in the legislation a ban on abortion, which prevents the health clinics receiving Title X funds from using those moneys to provide abortions. To add to the confusion, presidential administrations control how Title X is regulated, so the program’s rules have vacillated based on who is sitting in the White House. Under the Trump administration, for example, Title X clinics could not refer their patients for abortions or even provide abortions in the same building as they provided Title X services, which contributed to a decline in the number of providers in the network, further marginalizing people with low incomes for being poor. The Kaiser Family Foundation reported that these regulations “led to a withdrawal of almost a third of the sites from the Title X network.”
Although Title X marked the first time in history that congressional lawmakers would legislatively separate abortion from other health care services, it was far from the last. In many ways, Title X set a precedent for how lawmakers would go on to prevent people from accessing abortion care, even beyond the United States’ borders, without enacting a total abortion ban. Conservatives would follow this same strategy again shortly after the Roe v. Wade ruling by passing the Helms Amendment to the Foreign Assistance Act in December 1973. The Helms Amendment prevented US funding that goes to other countries for a broad range of health care programs and services, such as HIV and AIDS prevention and treatment, from being used for abortions. Specifically, this policy prohibits US funds from being used for the “performance of abortion as a method of family planning” or to “motivate or coerce any person to practice abortions.” Despite protests from the Nixon administration’s US Agency for International Development (USAID) that the Helms Amendment “was at odds with the fundamental philosophy of US population assistance policy, because of its seemingly imperialistic and hypocritical overtones,” the president signed the policy into law on December 17, 1973. In essence, the wealthiest nation in the world was telling other countries that it would help expand access to reproductive health care, but only if they adopted its antiabortion ideology, despite mounting evidence that abortion bans are deadly. But as we would come to see with the Hyde Amendment, the harm inflicted on the most marginalized in our society didn’t matter to those seeking to maintain their power and ability to control the lives of others through capitalist systems and structures.
Congresswoman Barbara Lee’s Abortions
In the early 1960s, fifteen-year-old Barbara Jean Tutt discovered she was pregnant. She knew little about how her own body worked and had previously become pregnant by her boyfriend, Carl, whom she immediately married, she wrote in her 2008 memoir Renegade for Peace and Justice: Congresswoman Barbara Lee Speaks for Me; however, the first pregnancy had ended in a miscarriage. “Whatever your decision is, it’s nobody’s business,” her mother told Barbara. With this second pregnancy, Barbara decided to have an abortion. Given that abortion was illegal nationwide, she had to find connections to a clinic. Her mother’s friend and former co-worker suggested a reputable clinic for a safe abortion in Juárez, Mexico, just across the border from El Paso, Texas, where Barbara was raised. The family had recently moved to the San Fernando Valley, so Barbara got on a plane and flew to El Paso for care. Her mother’s friend, who was Latina, took Barbara to a doctor the friend knew to get the procedure. In her memoir, Barbara wrote that the woman had all sorts of connections and that if it weren’t for her, Barbara would not have known how to get a safe abortion. When Barbara and her mother’s friend arrived, it was late in the evening. Barbara wrote that the “relatively clean and safe” clinic was not one that she would have any other medical procedure in but was better than the unsafe options others had gone to. In a 2022 NBC News interview, she described the room where the abortion was performed as dark, with the only lights shining down onto the bed. She wrote in her memoir about her vague memories of the Mexican abortion provider giving her an “unbearably painful procedure” that allowed her to finish high school and graduate from college. “I could have been put in jail and criminalized just like now,” she told us in a phone interview. She also could have died before becoming a congresswoman, because as she explained, septic abortions, like Rosie’s, were a leading cause of death among Black women before Roe. Barbara’s own abortion experiences led her to become a tireless advocate for abortion policies supporting Black and Brown women.
She has also found a renewed passion in her advocacy with sharing her abortion stories. Although she wrote about her abortion in her memoir, she didn’t share the story much until it became clear that the Supreme Court was going to overturn Roe. In September 2021, days after Texas’s Senate Bill 8 (SB8)—a law that banned abortion after six weeks but also allowed private citizens to enforce the law and collect a $10,000 reward for doing so—went into effect, Congresswoman Lee joined fellow members of Congress, Representatives Cori Bush and Pramila Jayapal, in a House committee hearing to share their own abortion stories. It was a historic first for the legislative body and a critical hearing for all to see. “Women around the country need to understand their members of Congress who see them and who have been in this fight a long time,” she told us. “I felt like it was the time to talk about it so other people would understand that they are not alone . . . and that there are those of us who look like them who are fighting for reproductive justice and the right for them to make our own decisions about our own bodies.”
A decade later, President Ronald Reagan would bolster the Helms Amendment by implementing the notorious Mexico City Policy. Named after the location where the policy was announced at the 1984 United Nations International Conference on Population, the Mexico City Policy blocked overseas groups receiving US funds from using their grant funding, including non-US funds, for abortion services or referrals. The policy has been revoked by every Democratic president and reenacted by every Republican one, causing chaos for nongovernmental organizations seeking to provide the world’s poorest communities with family planning services and reproductive health care.
These two policies have contributed to a rise in unsafe abortions in developing countries. Unsafe abortions result in 13 percent of global maternal deaths and account for one of every four cases of pregnancy-related death. In countries in Africa and Central and South America, the majority of abortions pose great risk. Although this is very much a US problem, it’s become a global tragedy as antiabortion lawmakers in the US seek to control the reproductive lives of anyone who is poor or of color, and definitely those who are both. The United States continues to export its segregated health care system to other countries through policies rife with abortion stigma, causing countless deaths and unsafe pregnancy conditions for millions of people. Anti-Blackness and abortion stigma are always at the core.
Protesters holding placards reading “Legal abortion si yes” and “Free legal abortion” during a mass demonstration against New York State abortion laws, in the Manhattan borough of New York City, March 28, 1970.
