Insurance Assurance?

When I worked at an abortion clinic we had a laundry list of questions we asked clients when making their appointment. The standard question went like this, “do you have Medicaid, military status, or private insurance?” We spend a lot of time in this blog or in other abortion’y type news sources discussing Medicaid, abortion funds, and clients’ all-around inability to pay. But what about those who have private insurance? It was very common for women to be surprised that private insurance was an option, mainly because abortion is so completely stigmatized and compartmentalized that no one assumes it would be covered by their policy; abortion has become so moralized and fraught that we forget it is a medical procedure that deserves coverage just like an appendectomy or cardiac bypass.

Quick and dirty: Private insurance that is employer-based (as it currently stands) can and often covers “elective termination.” However, an employer can restrict this coverage and many do (back in my clinic days: Walmart and Cracker Barrel to name a few). When an employer-based policy DOES offer coverage, there is often a deductible (can be up to a few hundred dollars) or there is a co-pay (usually no more than $100, but can depend what type of facility the procedure is done in). Usually it is much cheaper to use private insurance than to pay out of pocket. However, we had a slew of clients who didn’t want to use their insurance. Sometimes they were afraid their employer would find out. Sometimes I think they just did not want any sort of official record of their abortion.

We should take a few steps back though, because using private insurance is never as simple as swiping a card. In fact, some of the smaller insurance companies we worked with were near impossible to nail down in terms of the costs that a client would have for a deductible and/or co-pay. Or, in the case of employers that only provided coverage for rape, incest, or fetal anomalies, it could take weeks before we got approval or even just a basic response for what a client needed to pay up-front. We would urge clients to call their insurance companies themselves and find out the fees but ultimately someone from our clinic needed to call and confirm the costs, which resulted in endless hours on the phone and bickering with insurance companies over whether or not someone was covered. And yes, we did sometimes encounter the lovely insurance company reps that were easy-breezy to work with and who supported abortion and you never felt like they were rolling their eyes or begrudgingly giving you info that you were legally entitled to.

I’m bringing this up because myself and a few close people in my life have recently tried to navigate the world of private insurance and come up against some significant barriers. I’ve been given three of four different quotes on costs from different sources and I’m still not entirely sure I paid the correct amount for a procedure I had. A friend received bills for services he assumed were covered because at the time of care he called his insurance company to confirm. Now, I like to think that I’m pretty literate when it comes to health insurance, yet I have become so frustrated with receiving care and the confusion over costs that it makes me want to ignore my health altogether just to avoid this HOT MESS that we call health insurance coverage.

Moving forward as we continue to fight for universal health care we must recognize that access to insurance is not enough. There needs to be education around how to navigate the system and also health insurance literacy so that all consumers maximize their benefits. Insurance companies are businesses and they are not incentivized to throw any of us a bone, in fact they will do everything they can to take advantage of us who don’t know how to use our benefits.

How Do You Pass a Budget? Strike Down Abortion Funding.

As I'm sure you all know, Congress has been having some troubles passing a 2011 budget, going through many stop-gap measures to prevent a shutdown. The last of these was on April 8, and it went to just about the very last minute. What you all may not know is that last year DC enacted Medicaid funding for elective abortion (yay!). In its infinite wisdom, Congress decided it was within its purview and necessary to stop that Medicaid funding with the passage of the last stop gap measure to prevent the government shut down as well as making it permanent in the 2011 budget this past week.

A few questions come to mind. Why do you need to play with the budget like that, tacking on extra measures? Why do you need to play with women's lives like that? Low income women deserve to exercise their right to safe, legal, abortion like rich, middle class, and women with insurance coverage do? And exactly how is it in your purview to change DC law - passed by officials ELECTED BY THE PEOPLE OF DC?

It's an abomination that Congress thinks it's ok to rip away funding people rely on. I understand that we have a deficit, and that the debt ceiling continues to rise. What I don't understand is why taking programs to help the most disenfranchised, vulnerable citizens of this country is a good way to reduce the deficit. Perhaps we should take away tax loopholes that enable giant companies to avoid paying as much in taxes as possible. Punishing poor people is not the answer.

As someone with friends in DC and has lived in DC, it pisses me off that Congress gets to yay/nay decisions made by the DC city council and mayor. DC residents have no voting member in Congress or the Senate, yet Congress and the Senate get to make decisions on how DC's local tax dollars are spent. How ridiculous is that? DC residents need to get angry, get active, and get involved in the campaign to gain DC voting rights. It also wouldn't hurt for all of us with voting members of Congress and the Senate to write a letter/make a phone call/send an e-mail and tell our representatives how taxation without representation goes against what we claim to be about in this country.

I guess this means that helping low income women access reproductive health care falls back to the hands of volunteers. As we've mentioned before, the National Network of Abortion Funds is having a kick ass bowl-a-thon as a great way to energize the masses to donate to their favorite local abortion fund. I implore you, dear readers, to donate. Please help do the work that Congress is unwilling to do. Tell John Boehner that you won't let his uncaring, narrow minded views affect women having access to safe, legal abortion care.

Injuring and insulting women: legislative edition (Or, "Hereafter Known As The No-Good-Reason Act")

You need to know about this. Chris Smith, along with several other congressmen (many of them newly elected), feel that our representatives' first priority in the new Congress ought to be the passage of "insult plus injury"-style anti-abortion legislation. Enter the "No Taxpayer Funding for Abortion Act." I want to discuss two especially stupid provisions, which this column summarizes nicely.

The tax credits that are encouraging small businesses to provide insurance for their workers could not be used to buy policies that cover abortions. People with their own policies who have enough expenses to claim an income tax deduction could not deduct either the premiums for policies that cover abortion or the cost of an abortion. People who use tax-preferred savings accounts to pay medical costs could not use the money to pay for an abortion without paying taxes on it.

I mean, this is purely symbolic for the legislators, and purely punitive for people who need an abortion! Republicans are going after tax deductions? Breezing right past that irony, let's consider: Does the fact that I can deduct my spending on medicine or a doctor's visit from my "taxable income" make me more likely to spend on those things? Not really, it just makes it slightly easier on me to afford the things I need without taking extra money from me at tax-time as though I had spent those dollars on "fun" stuff.

At my current income I don't actually have to pay federal income tax (shocker), but assume the default 20% bracket applied -- if I get to subtract, say, $500 spent on a first-trimester abortion from my total taxable income, I'll save $100 come April 15. Not enough to make me decide to have an abortion, and not enough to make me decide against an abortion if Chris Smith bans that deduction.

Another example, going further afield to tax credits, which really are a significant chunk of money credited to you directly (not just deducted from your taxable income base): if I have dependent minor children I can get $1000 taken off my owed taxes each year. Has that affected my decision to have or not have a child? Would it affect yours? Probably not; people decide to have children because they are ready to and want to, not because someone's giving them a coupon on it.

I know taxes are a drag, so we don't have to keep discussing, but you see the gist: this ban's purpose can't logically be to make people less likely to choose abortions -- it's only to injure them for it by taking out an extra $100 of their taxes (or more, depending on their income bracket), and to insult them by refusing to acknowledge that their abortion counts as a health-related expenditure. (Just like tampons and pads and menstrual cups don't count, either. Just like breast pumps don't count, either. I discern a fucking pattern.)

The Smith bill also would take certain restrictions on federal financing for abortions that now must be renewed every year and make them permanent. It would allow federal financing of abortions in cases of "forcible" rape but not statutory or coerced rape, and in cases where a woman is in danger of death from her pregnancy but not of other serious health damage. It would free states from having to provide abortions in such emergency cases.

FYI, as Sady Doyle notes, "70% of rapes are 'non-forcible.' Rapists consciously seek out people and situations where they’ll have to use a minimum amount of 'force'."

Currently I work in a state that doesn't provide any of its own funds for abortion coverage but supposedly abides by federally-funded Medicaid's mandate to cover abortions in cases where a pregnancy resulted from rape. Even the old-timers at my work say that they have never seen Medicaid cover a procedure, even when the rape was "forcible" (all rape is forcible, obvi, since that's the opposite of consensual, but by this Smith really means there must also be beating), even when prosecution occurred, even when the pregnancy was DNA-matched to the perpetrator. Many clinics don't bother trying to bill Medicaid anymore, so the state is passively stripping women of even the limited rights they supposedly have. Abortion patients whose pregnancies are a result of rape, even patients who do have Medicaid, overwhelmingly are already paying for their own abortion care (and often struggling to do so). And women who can't pay for their own abortion care overwhelmingly are already bearing their rapists' children. Doesn't that warm your Republican heart*? (Oh, a few Democrats too!)

So this provision, too, isn't going to prevent women from choosing abortion. If the federal government reverses decades of painstaking progress in legal thought, jurisprudence, and goddamn human rights, it isn't going to make women who were raped but just not beaten too feel that they deserve to remain pregnant any more than they did before. It's just going to bring written law more in line with the outrageous reality of states already not understanding rape or supporting rape survivors; add to the stigma of patients who choose abortion outside of the few 'acceptable' reasons (e.g. "I can understand it in cases of rape, but this wasn't even 'real rape'"); and in the process possibly fuck up criminal justice even worse than it's already fucked up.

Sorry, y'all: every time I tell myself I'll try not to rant, something comes up that just makes my brain start bleeding out my eyeballs.


*Update: also h/t Sady, these dudes aren't even in touch with their own supporters - in a November poll, "71% of American voters who voted for a Republican candidate opposed the Smith bill."

Update 2: Sorry, I should have included a What You Can Do!  The same post I linked above provides a handy-dandy link to your representatives' contact page and helpful hints (for a sample call, see rabbleprochoice):

Click on this, and it should take you to a page where you can find out exactly who your rep is, and what their contact information is. Look that person up on Wikipedia, to get a sense of who they are, if you don’t already know. Then, CALL THEM. Be polite; be professional; do not threaten or use violent or abusive language under any circumstances. Explain to them that their constituents don’t support this bill, explain how and why it’s a bad bill, and let them know that if they support or fail to oppose this bill, they can expect that to impact them in a very bad way when it comes to the matter of keeping their jobs.

Maybe you should ask, "Why did we make her wait so long?"

I'd wanted to write a good solid post expanding on my last one -- about why some women "wait so long" to have an abortion -- and connecting the dots to social justice. It is Martin Luther King day, after all, and while we ought to be carrying his goals of racial and economic justice in our minds every day, it always helps to describe the links aloud. But: I've been getting sick this weekend and today I woke up with puffy eyes and that underwater feeling in my head and it's making me feel dizzy. I'm going to limit this to my research summaries, because you're smart and insightful enough to connect the dots yourself, and because I can't see my keyboard very well. 

*

In 2008 researchers at ANSIRH published an unusual study of delay in obtaining abortion care [PDF]. For purposes of analysis, they divided the process into three stages -- between the first missed period and the first pregnancy test; between the first pregnancy test and the first call to an abortion provider; and between that first call and actually having the abortion -- and then identified the circumstances that were closely associated with longer time for each stage. The factors associated with delay varied based on stage. In the first stage, significant delay before the pregnancy test occurred for women who were obese, weren't sure of the date of their last period, were assessed as being in denial about pregnancy or "afraid of an abortion," abused drugs or alcohol, or had had a second-trimester abortion in the past. (A lot of these seem logical, don't they?) 

However, these were not significantly associated with delay in the second stage; rather, women had a longer stage 2 if they had had trouble obtaining MediCal (California's health insurance for low-income residents, which includes coverage for in-state abortion care), and if they had "had difficulty with their decision to terminate this pregnancy." In the third stage, delay in having the abortion itself was associated with (again) having had a second-trimester abortion in the past; having been initially referred to some other clinic than the study site; having an unsupportive partner; and having had difficulty coming up with the money to pay for an abortion. 

So logistical barriers emerge in stage 2 and 3, and especially economic ones. Social/emotional barriers are still present, but different from in stage 1. (Understandably you might delay your call to the clinic if you're having a hard time deciding what to do with your pregnancy; you might try to reconcile a reticent partner to your decision before you head to the appointment -- or your partner might be actively trying to prevent you from getting there!) 

(Additional interesting findings from the last stage: what shortened the time between calling a clinic and having an abortion? (1) Nausea and vomiting [heh, shocker]; (2) having had “difficulty deciding” to seek an abortion. That is, if a woman struggled with her decision, she was likely to have a longer time than other women between taking a pregnancy test and calling a clinic, and a shorter time than other women between calling a clinic and having an abortion.) 

*

From several of the same California researchers, a 2006 multivariate logistic regression study: "Delays in suspecting and testing for pregnancy cumulatively caused 58% of second-trimester patients to miss the opportunity to have a first-trimester abortion. Women presenting in the second trimester experienced significantly more delaying factors, with logistical delays occurring significantly more frequently for these women (63.3% versus 30.4%). Factors associated with second-trimester abortion were delay in obtaining state insurance, difficulty locating a provider, initial referral elsewhere, and uncertainty about last menstrual period." Interestingly, second-trimester abortion was associated with both having had a prior second-trimester abortion and never having had an abortion before. 

*

In 2006 the Guttmacher Institute published a study on timing and reasons for delay [PDF] as well. They broke the process into more steps, and measured median time for each. 

-From the last menstrual period to suspecting pregnancy: 33 days (which makes sense if you imagine the average 28-day cycle then add about a week for your first missed period); it was a week longer for minors than for adults (which also makes sense if you consider how irregular most young people's cycles are)

-From suspecting pregnancy to confirming pregnancy (pregnancy test or sonogram): 4 days

-From confirming the pregnancy to deciding to have an abortion: zero days

-From deciding to have an abortion to first attempting to obtain abortion services (calling to make an appointment): 2 days

-From first attempting to obtain abortion services to obtaining the abortion: 7 days

...So that's 48 days right there (and that's just adding up medians, meaning half of women have a longer delay in each of these steps), yet I think somehow a lot of people hear "seven weeks" and think that's a really long time to "wait." I saw an actual published writer write that abortions should only be legal up til six weeks because "forty-two days is plenty of time to decide to have an abortion." Reality to actual published writer, please come in. 

58% of women reported that they would have rather had the abortion sooner, and these women were asked about the reasons for the delay they experienced (women could give multiple reasons). Most commonly, these respondents said: 

-It took a long time to find out about the pregnancy: 36%

-It took a long time to decide to have an abortion: 39%

It took a long time to make arrangements: 59%. Poor women were about twice as likely to be delayed by difficulties in making arrangement. (This includes money, referrals, appointments, transportation, judicial bypass for minors, legally required waiting periods, etc.) 

Patients mentioned a lot of other reasons, including:

-As partial response to Frances Kissling's question, 0.2% stated they found out late about a fetal anomaly (but this isn't broken up by trimester or week; I still think the later abortion patients she was asking about would give this response more often). 

-Only 2% said they "didn't think it was important to have it earlier." (Granted, this doesn't include possible similar answers from the 41% of women who didn't say they'd have rather had the abortion earlier, but I imagine a lot of those 41% had theirs quite early. I wish I could see a full data set on this.) 

I highly recommend reading the rest of this article because it has a section on qualitative findings from in-depth interviews that I just couldn't do justice here. Among other things, it shares the words of women who "knew right away" that they were decided on seeking an abortion, and of  women who found it a "hard decision" and took longer to feel firm in their choice.** 

*

What about demographic characteristics? Poor women with no insurance coverage for abortion, black women, and young women are likely to have later abortions than other women. However, being poor and lacking insurance coverage disproportionately co-occur with being black and being young. In some studies, each of these effects persists even after controlling for the others; in other studies, they confound one another and only the poverty/insurance effect remains significant. 

I think you can guess what I was going to say about all that. To make a long story short: justice in healthcare access must include attention to reproductive matters. If you care about making a more just society, please express support for public funding for contraception and abortion; donate to your local abortion fund; work to reduce stigma against both abortion and pregnancy; combat racist, ageist and classist stereotypes of appropriate motherhood; and learn about domestic violence and sexual assault prevention. 

**If you want to read more about abortion decision-making, here are some articles to try [unfortunately a few only give the abstract for free]: 

2010: Kjelsvik M. Pregnant and ambivalent. First-time pregnant women’s experience of the decision-making process related to completing or terminating pregnancy – a phenomenological study. 

2005: Finer LB et al. Reasons US women have abortions: quantitative and qualitative perspectives.

1985: Faria G, Barrett E, Goodman LM. Women and abortion: attitudes, social networks, decision-making.

1984: Friedlander ML, Kaul TJ, Stimel CA. Abortion: predicting the complexity of the decision-making process. 

(And if anyone can find the following in English, let me know:) 

1999: Tornbom M et al. Decision-making about unwanted pregnancy.

1990: Ytterstad TS, Tollan A. The decision process in induced abortion. 

Education Sunday.

I decided to post an excerpt from a paper I wrote. In case you didn't know the specifics, now you do.

On March 24, 2010, President Obama issued an Executive Order that prohibits the use of federal funds for abortion services (except in cases of rape, incest or life endangerment of the woman).[1] This provision continues the ban on federal funding of abortion that was set in place more than 30 years ago by the Hyde Amendment. Proponents of the Hyde Amendment assert that it is their democratic right as policy leaders, to express their opinion and be able to exert their beliefs in the health care debate.

Currently, six million women of reproductive age obtain health care coverage through the Medicaid system.[2] Federal bands on funding for abortion services have severely restricted access to safe abortion care for thousands of low-income women who depend on the government for their health care. Poor women especially, are unable to exercise their constitutional right to choose abortion when public funding is restricted. An estimated 18-35% of Medicaid-eligible women carry their pregnancy to term because they cannot afford an abortion.[3] While Medicaid does not allow federal funding for abortion, it does provide funding for childbirth.[4] Medicaid insures one-fifth of the nation’s children and pays for one-third of all childbirths.[5]

Under current health care policy, the federal government is willing to pay for some of poor women’s reproductive health but not all. In turn, the Hyde Amendment is negatively impacting poor women’s lives on the basis of policy leaders moral and ethical beliefs about abortion. Should Congress members and policy leaders be able to put their moral beliefs above the health and well being of its citizens? Low-income women often face serious hardship when trying to raise funds for abortion services. Many women use money they should have spent on rent, food, bills and clothing for their children. A significant amount of women resort to pawning household items, and some resort to theft and prostitution in a desperate attempt to have a legal, medical procedure.[6] The 1983 AGI study found that Medicaid-eligible women wait on average 2-3 weeks longer than women with economic means to have an abortion. As a woman gets farther along in her pregnancy, the cost of the abortion starts to rise, and it becomes more difficult to raise the necessary funds, creating a vicious cycle.

The Hyde Amendment is a discriminatory policy that targets poor women, who are disproportionately women of color. Women who are not covered under the Nation’s Medicaid system, are either not enrolled in the program, undocumented citizens, or not eligible under the Federal Poverty Income Guidelines. Women who can afford to pay for an abortion on their own, ranging from approximately $300-$500 for a first trimester procedure, are mostly unaffected by the Hyde Amendment’s restrictive policy. An estimated 18-35% of Medicaid-eligible women carry their pregnancy to term because they cannot afford an abortion.[7] There is a huge disparity between impoverished women and middle/upper class women. In 1983, AGI researchers found that “nearly 60% of Medicaid recipients said that paying for an abortion caused serious hardship, compared with only 26% of non-Medicaid-eligible women.”[8] Although Roe v Wade gave women the constitutional right to have an abortion, they are unable to exercise this right when access and affordability of services is denied. The Hyde Amendment makes real reproductive “choice” a privilege for those that can afford it, rather than a constitutional right guaranteed by the Supreme Court.[9]

---

[1] Raising Women’s Voices. (March 30, 2010). Health Reform and Reproductive Health: Positive and Negative Effects. Available: http://www.raisingwomensvoices.net/storage/RWV%20on%20Health%20Reform%20and%20Reproductive%20HealthFINAL3.30.10.pdf.

[2] Boonstra, H., A. Sonfield. “Rights without Access: Revisiting Public Funding of Abortion for Poor Women.” The Guttmacher Report on Public Policy. April 2000: 8-11.

[3] Fried, M. (2007) “Hyde Amendment: The Opening Wedge to Abolish Abortion.” New Politics. 11(2): 82-85.

[4] Annas, G. J. “Abortion Politics and Health Insurance Reform.” The New England Journal of Medicine. December 31, 2009: 2589-2591.

[5] Weil, Alan, "There's Something About Medicaid," Health Affairs (Jan/Feb 2003).

[6] Boonstra, H., A. Sonfield. “Rights without Access: Revisiting Public Funding of Abortion for Poor Women.” The Guttmacher Report on Public Policy. April 2000: 8-11.

[7] Fried, M. (2007) “Hyde Amendment: The Opening Wedge to Abolish Abortion.” New Politics. 11(2): 82-85.

[8] Fried, M. (2007) “Hyde Amendment: The Opening Wedge to Abolish Abortion.” New Politics. 11(2): 82-85.

[9] Boonstra, H., A. Sonfield. “Rights without Access: Revisiting Public Funding of Abortion for Poor Women.” The Guttmacher Report on Public Policy. April 2000: 8-11.

The purse strings are so close, yet so far: Abortion coverage and DC sovereignty

Yellow = no lifesaving needle-exchange programs. White = go for it!

I used to live and work in Washington, DC, a place where you'd think people are powerful and have the ability to make important decisions. But the city of the District of Columbia is not the same as what people call "Washington" when they are thinking of Congress and the White House and the Supreme Court and, you know, the halls of power.

Not everyone knows that the residents of DC do not have a single vote in Congress. (They have one non-voting delegate in the House of Representatives, Eleanor Holmes Norton.) Also, not everyone knows that until 1973, DC did not even have an elected mayor or city council, but was directly administered by federally-appointed commissioners -- and Congress can take away that privilege at any time. Congress also has the power to decide how the District can and cannot spend its own income, i.e. money raised from city taxes. Of course, if DC were a state, this would all be very unconstitutional, but the Constitution dictates that the District of Columbia be governed in this way.

It might seem very arcane or very trivial -- why would senators and House reps from other parts of the country care to get involved in someone else's city budget issues, and if they did would their decisions really be so bad for residents anyway? Unfortunately, the residents of DC do indeed feel the repercussions of this lack of sovereignty, repercussions which often hit the poorest among us the hardest.

Every year, Congress writes and passes a new federal budget. And every year, members of Congress use DC as a place to make cheap political statements about where they "stand" on "issues." A timely example: since the late 1990s, DC was prohibited from using its own money to pay for needle exchange programs to combat the spread of HIV, while several of the "real" states were supporting such programs using not just their own funds but federally-allocated funds as well! Basically, conservatives scored political points with their constituents back home using citizens who are politically impotent and thus expendable; meanwhile, the Washington Post reports that "At least 3 percent of District residents have HIV or AIDS, a total that far surpasses the 1 percent threshold that constitutes a 'generalized and severe' epidemic".

In 2007, Congress finally reversed that ban, but now the House is considering a bill with an amendment that restricts where DC can locate needle exchange sites: they cannot be "within 1,000 feet of a public or private day care center, elementary school, vocational school, secondary school, college, junior college, university, public swimming pool, park, playground, video arcade or youth center." The image you see at the top of this post is a map [pdf] 0f what those restrictions would look like: in the white parts it's OK to provide clean needles in exchange for used ones, but not in the yellow parts. (And, um, the blue is water.) How many people can that possibly reach?

OK, so what does this have to do with abortioneering?? As you might guess by now, abortion is another favorite controversy to take out on the residents of DC. Until 1988, the District was using some of its own funds to include abortion coverage as a Medicaid benefit. Since that year (with a brief break 1994-96), Congress has prohibited the District from spending any of its own revenue to pay for abortions, despite the fact that its residents and city council clearly appear to favor it. Again, conservatives scored political points with their constituents back home using citizens who are politically impotent and thus expendable. This year it appears that the Democratic majority in Congress may finally reverse that position and allow DC the choice to resume covering some abortions, and the city probably will choose to do so.

When I worked in DC, most of my clients were on Medicaid, and the vast majority of those were not from jurisdictions that allocated funds for abortion care. They were on Medicaid because their government acknowledged they were too poor to afford health care, but they were going to have to afford an abortion all on their own. Yet abortion care is a part of health care, and we don't suddenly get richer when we have an unwanted pregnancy! It broke and still breaks my heart to know that so many of my neighbors are getting screwed over by people who go to work just a couple blocks or a couple miles away from them.

Living in the nation's capital, you constantly pass monuments, walk right by the White House, and see other stuff that should make you feel like huge decisions are being made in your backyard; yet all that proximity never gets you any closer to meeting those decisionmakers or participating in those decisions. In fact, aside from the euphoria of Election Day and Inauguration, I doubt any of my clients ever thought about the federal government. So maybe it's no wonder that Congresspersons are making terrible decisions about the drug addicts, pregnant women, gay couples and cancer patients of DC as though the latter lived in some tiny shit village thousands of miles away that no one expected Congresspersons to care about in the first place: they don't feel any closer to the residents of their host city than their hosts do to them.

Yes, Congress legally can do all these things. But it still feels like your landlord showed up at your door, set up camp in your nicest bedroom, then went around to all the other rooms and shat on the carpets. Don't forget rent is due on the first.




EDIT: Also, don't you love it when the House minority leader posts a "Statement of Republican Policy" on the party's more-or-less official site for Congressional workings (hosted at a .gov address) and it's got typos and bad logic and unflattering cut-n-paste aesthetics and everything?!

and now i'm pregnant....

I was raped...4 weeks ago, 2 months ago, in August or July, it was a while back and now I’m pregnant.

I'm really sorry you went through that. Do you want the Number to the Rape and Incest National Network hotline number?

Are there any family members you have told about your situation?

No.

Is there anyone you feel comfortable telling?

No. My mom kicked me out when she found out I was trying to get an abortion.

Are you able to explain to her what happen to you?

No she doesn't believe me.

Can you lie to anyone to get money?

No.

I want to help you figure this out but you will have to find a way to scrape together the money if you want to get an abortion.

These words seem completely illogical given the circumstance. When someone is raped they don’t need to be reminded they are responsible for handling the outcomes of this violation. Often that is my role. I have to acknowledge that this situation is not their fault. But, it will not go away unless they find a way to make the appointment, get the money, make the numerous phone calls, find the ride and someone who will go with them, and do whatever else is needed to coordinate services that should be accessible no matter what the cause of the pregnancy.

I've been raped before. I did not have to worry about being pregnant or obtaining an abortion after. I felt lost, confused, hurt, and a deep emotional and physical pain. The months after I was violated are a blur of emotions. I was no longer present in my body. Sometimes it’s hard for me to understand how women are 5 or 6 months pregnant and didn’t realize it. Each time is not necessarily a result of rape. However, I believe this is a result of dissociation from one's body for a variety of reasons often related to some form of violation.

It’s hard to hear women's rape stories. I have a fear that their story could happen to me. Even when a woman shares the most difficult of stories with me I have to be the stern yet supportive voice on the other end of the phone saying, "You have got to get this money in order to get an abortion."

Often times, women do not offer their stories of rape for any number of reasons. When I ask them, "What about the man involved in your pregnancy, can he give you any money?" the story spills out of them. Sometimes they become angry I asked such a seemingly senseless question given their circumstances. Other times, they are searching for a listening ear and someone who will let them cry or yell or be sad, or just be ok with the realization that this is really happening.

Women are left physically and emotionally scarred when assaulted and when it results in pregnancy they are also left with the responsibility of making a choice about what to do about that pregnancy. Then they have to find the means to handle their choice to have an abortion or carry to term. When an abortion is out of reach there really is not much choice involved in the matter. In many states Medicaid will cover abortion in the cases of rape and incest. Most often to use Medicaid in these circumstances a woman needs to have reported the assault with in 24 hours and have obtained a rape kit at a hospital. Sixty percent of rapes are not reported to the police. This means that a huge number of women who are pregnant as a result of rape did not report the rape and many of the women who do report it do not necessarily do so in the 24 hour window required for Medicaid to cover abortion care.

Personally, I spent the first year after being assaulted in denial that what happened was rape. When the person who assaults you is someone you know or even love it becomes more difficult to recognize that this person violated you and it was not ok. Seventy-three percent of rape victims know their assailant. As women tell their stories it is clear they usually know the man who violated their body. It was their father, a nineteen-year-old cousin, a man at my cousin’s wedding, my best friend who committed suicide when he realized what he had done, a friend of a friend at a party, my brother’s best friend, my neighbor, a man I was dating who left me for dead afterwards. When a woman’s assailant is someone she knows intimately, reporting rape may be even more difficult and even dangerous.

Abortion is a service that should be available to anyone who wants or needs it. The financial hardship, logistical difficulties, and social stigma involved in obtaining an abortion are violations of women’s rights. As someone who is a rape survivor I must desensitize myself in order to help women navigate through all of these challenges to obtain care. These obstacles create an environment that makes it even harder for a rape survivor to heal both mentally and physically.

The right to choose?

What does it mean to have the right to choose? You hear this phrase thrown about like having “the right” is the end all. Don’t get me wrong, I believe strongly in having this right. But what is this right if you can’t exercise it? What does it mean, if you can’t afford to exercise it?

In the last post I made, I did a spotlight on a particular abortion fund. I want to take this time to talk about abortion funds more generally, what they do, and how all of us can support funds in our local areas. There are some small, local and a few national abortion funds scattered across the US, part of the National Network of Abortion Funds (NNAF). These funds are run by volunteers, with their own day jobs, who spend many of their evenings and weekends fundraising, working hard to help poor women exercise their right to choose.

For some women, it is hard enough just to find a clinic near them that does abortions. They may not own a car or have reliable public transportation, so they have to find a ride. Maybe they have kids and have to find childcare because some clinics are not able to accommodate small children in the waiting rooms. Then they make an appointment and find out the cost that could be or seem completely out of their reach. Unlike other countries, we do not have universal health care that covers abortion; so many women are uninsured or have insurance that doesn’t cover abortion. In some states Medicaid does cover the cost of an elective abortion, but even then some women have to jump through hoops to get on it and have to hope they can get on the right kind (I believe there are states where certain types of Medicaid do cover and certain types do not cover elective abortion). Then there are women who have the Medicaid or get the money together, only to find out they are further along than they thought and have to travel out-of-state (where their Medicaid will not cover them, and they have to get travel expenses together as well). I can only imagine how personally devastating all these barriers must seem.

Luckily there are individuals out there like the volunteers of these local funds, who will answer questions, brainstorm, and do what they can to fundraise. They do this work for women they do not know and will never meet, but they do it because they believe that every woman, no matter her financial circumstances, should have the right to choose. She should have access to the same health care that those of us who are lucky enough to have insurance coverage or various resources, have.

If you are interested in learning more about donating to or volunteering for a fund in your area, please go to the NNAF website. By donating to one of these funds you can make a huge impact on women’s lives all over the country and where you live.