Whose Choice: Learn More

Whose Choice: Learn More

Since 1976, the Hyde Amendment has been used to ban the federal government from spending money on abortion with very few exceptions. This means that low-income women enrolled in Medicaid have been most severely affected with repercussions revealing itself in three principal ways: procedures being delayed, additional financial strains being imposed on already difficult economic situations, and by forcing women to continue unwanted pregnancies.

Take a closer look at the history of the Hyde Amendment and how it has denied more than a million women the right to decide their own futures.

Executive Summary >
Scope of the Investigation and Methods >
How Hyde and Medicaid Work >
Profiles of Women Interviewed for Report >
State Funding for Abortion Under Medicaid >
Hyde's Impact >
Human Rights Framework >
Abortion Funds: Providing Critical Support to Women in Need >
Conclusion >

Recommendations >


Scope of the Investigation and Methods

From October 2009 through February 2010, researchers from the Center for Reproductive Rights (the Center) and the National Network of Abortion Funds (the Network) together conducted 27 interviews for this report. In conducting this research, the Center and the Network sought to collect a broad range of stories highlighting how poor women are adversely affected by the funding restrictions imposed by the Hyde Amendment. These stories are meant to be illustrative of Hyde's impact.

Among those interviewed were 16 women from various regions of the United States whose lives have been affected by the Hyde Amendment. Criteria for participation in the investigation included residence in the District of Columbia or one of the 26 states that do not provide state Medicaid funding for abortion beyond the few exceptions permitted under the Hyde Amendment, being age 18 or over, being eligible for Medicaid (whether or not receiving it), and having sought financial assistance to pay for an abortion within the previous 12 months.

To recruit women, the Center collaborated with independent abortion providers who operate clinics in four locations in Texas; Philadelphia, Pennsylvania; Detroit, Michigan; Atlanta, Georgia; and Shreveport, Louisiana. , In addition, the Network recruited women by issuing a call to its national case manager and member Funds. Funds in Pennsylvania, Texas, Illinois, Georgia, Oregon, and Washington offered referrals, along with the Network's national case manager.

The Center and the Network also interviewed one staff member at each of the collaborating clinics who counsels and supports women in obtaining abortions and, when needed, helps them to secure financial assistance. In addition, we interviewed representatives of three of the Network's member Funds, who offered additional insight into the challenges that women face financing their abortions. (See Box: Abortion Funds: Providing Critical Support to Women in Need.)

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How Hyde and Medicaid Work

"The Hyde Amendment's denial of public funds for medically necessary abortions plainly intrudes upon [women's] constitutionally protected decision, for both by design and effect it serves to coerce indigent pregnant women to bear children that they would otherwise elect not to have." – Justice Brennan, dissenting in Harris v. McRae, the Supreme Court decision finding the Hyde Amendment constitutional

Under the federal Medicaid program, federal and state governments jointly pay for healthcare services for eligible poor and low-income individuals and their families. Medicaid is the largest source of funding for medical and health-related services for low-income and indigent people in the United States. It currently provides health and long-term care services to 60 million individuals, including children and parents, persons with disabilities, and seniors. Medicaid plays a particularly important role for women, and especially women of reproductive age. One in ten women in the United States is covered by Medicaid, and women make up more than two-thirds of adult Medicaid beneficiaries. Thirty-seven percent of women of reproductive age in families with incomes below the federal poverty level rely on Medicaid for healthcare coverage. According to a 2009 Kaiser Family Foundation report, "Medicaid pays for more than four in ten births nationwide, and in several states, covers more than half of total births."

States have the option of whether they want to participate in the federal Medicaid program, and if they do so, they agree to abide by certain program rules. All states have agreed to participate. Eligibility for a state Medicaid program is based on a complicated set of rules and varies tremendously across the country. Coverage is limited to only the poorest households, and yet not all people who are poor qualify for Medicaid.  The recently enacted healthcare reform legislation will expand Medicaid eligibility to all non-elderly adults living at or below 133% of the federal poverty line, thereby providing a safety net for millions of Americans who would otherwise be priced out of the insurance marketplace.

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Profiles of Women Interviewed for this Report

  • Eight of the women were Black/African-American, two were White/Caucasian, two were Hispanic, one was Puerto Rican, one was African-American and Caucasian, one was Caucasian and Indian-American, and one was African- and Cuban-American.
  • Thirteen had one or more children.
  • Three reported being in an abusive relationship leading to their unwanted pregnancy.

Work and School

  • Eight were in school full-time and either working (4), looking for work (2), about to start a job (1), or recently laid off (1).
  • Four worked full-time and were in school full- or part-time.
  • Seven worked part-time, one of whom had several part-time jobs.
  • Two were looking for work.

Enrollment in Public Assistance Programs or Sources of Other Financial Support

  • Eight received food stamps; another said that it was not worth missing work to collect them because they amounted to so little.
    • Three of the eight enrolled in the food stamp program following their abortions.
    • A ninth had a son who was able to obtain food from the federally funded Women, Infants and Children supplemental food program (WIC).
    • A tenth sought her sister's assistance to help the family obtain sufficient food.
  • Four reported enrollment in public assistance.
  • One was enrolled in disability insurance.
  • Two obtained child support.

Medicaid and Health Insurance

  • Eight were enrolled in Medicaid at the time of the abortion.
    • Three of these only met income eligibility standards for Medicaid coverage while pregnant.
  • One had student health insurance.
  • Seven had no insurance at the time of the abortion.
    • One of these enrolled in Medicaid following her abortion.
    • Another had children enrolled in Medicaid.
    • A third was enrolled in Medicaid during a prior pregnancy.

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Hyde's Impact

"There is some sort of assumption out there that women who choose abortion have not yet had a family, not yet gotten married, not yet started their careers. The majority of women who show up for abortion are already mothers, are between the ages of 20 and 24, are already sexually active and have been using birth control. I think it kind of shatters that stereotype of women who choose abortion. These women are our sisters, our mothers, our rulers, our leaders, our teachers, our principals, our rock stars, our political people, they're everywhere.... The question is always what keeps women silent and what is so horrible here in our culture that we have a stigma that surrounds abortion that creates an area where women don't feel as though they can be seen as good, so they choose to not talk about it...." – Vice President of Whole Woman's Health

The Hyde Amendment's restrictions affect low-income women in three principal ways: by causing them to delay procedures, by imposing additional financial strain on their already difficult economic situations and by forcing them to continue unwanted pregnancies.

As of 2006, the average amount women paid for a first-trimester abortion was $413; at 20 weeks, the cost of an abortion was roughly three times as much. The costs continue to rise and vary widely, influenced in part by how far along the pregnancy is, as well as by location and availability of providers. One woman interviewed reported paying over $600 for her abortion performed at 16 weeks, while another woman reported paying over $2,000 for an abortion at 17 weeks, and another was charged $1,510 for an abortion at 20 weeks.

Asked to describe some of the circumstances of the women whom they assist with paying for abortions, clinic counselors reported that many women have one or more children and are single, in school, working low-paying jobs or trying to enter the workforce, not receiving help from their children's father, and working to make ends meet. One counselor reported that 75% or more of her clinic's clients seeking funding assistance are enrolled in Medicaid and their stories include recent job loss, low-income jobs, and more than one child at home with no support from partners. Another said that "the majority [of women] were on birth control, but maintaining birth control was not easily accessible for them-either their prescription ran out or they couldn't afford to get it renewed." Another counselor reported speaking with women who say "‘I need an abortion, because I can't afford another baby. I'm a single mom. I just got back to school, and I can't afford to drop out of school right now. I just got the baby out of Pampers and to have another would cause too many setbacks.'"

The Women's Medical Fund Director stated that many of the women the Fund serves are in precarious living situations. "A lot of women we talk to are virtually homeless. They're not on the street and not in shelters, but they live short-term with family, with friends, with anybody who's willing to take them and their kids in for six months or three months or any amount of time."

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Human Rights Framework

"If there was the reinstatement of Medicaid funding for abortion, low-income women would be able to pursue their dreams, move forward in their lives, and exercise the same right to choose that middle-class women can. Women would be able to turn their lives around. It would just make all the difference for women." – Executive director of the Women's Medical Fund

The Hyde Amendment violates the human rights of poor and low-income women. The restrictions interfere with a woman's right to make fundamental decisions about her body, to access health services necessary to protect her health, and to decide whether and when to have children. The ability to make these decisions without government coercion is integral to women's dignity and equality. The government's failure to respect and ensure these rights violate a woman's right to health, life, equality, information, education, and privacy, as well as freedom from discrimination.

The rights to life, privacy and personal autonomy, and non-discrimination are set forth in two human rights treaties ratified by the United States: the International Covenant on Civil and Political Rights (ICCPR) and the Convention on the Elimination of All Forms of Racial Discrimination (CERD). Treaty ratification confers an international legal obligation on the United States to respect, protect, and fulfill the rights contained in the treaty and to create the conditions necessary to ensure that all persons are able to enjoy rights in practice.

The United States is also a signatory to key human rights treaties that guarantee women's right to reproductive healthcare and equality-among them, the International Covenant on Economic, Social and Cultural Rights (ICESCR) and the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW). The United States has an obligation not to take any action that would defeat the object or purpose of the treaties it has signed.

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