We know what we think about the Hyde Amendment. But what do women who are on Medicaid, the very people who are most affected by Hyde, think about the restrictions it places on their insurance coverage?

Evidence-Based Advocacy is a bi-monthly column seeking to bridge the gap between the research and activist communities. It will profile provocative new abortion research activists may not otherwise be able to access.

September 30th marks the anniversary of the Hyde Amendment, which prevents Medicaid coverage of abortion in most circumstances. When activists and advocates talk about Hyde, we discuss the injustice of health care denial, the importance of grassroots abortion funds, and the stories of people who’ve sacrificed rent, food, and monthly bills in order to pay for an abortion their insurance won’t cover. And rightly so—there’s no denying that the more we talk about the horrific ramifications of the Hyde Amendment and the more awareness we raise, the better. We know what we think about Hyde. But what do women who are on Medicaid, the very people who are most affected by Hyde, think about the restrictions it places on their insurance coverage?

Amanda Dennis of Ibis Reproductive Health interviewed 71 low-income women who had abortions while living in Arizona, Florida, New York, and Oregon, states that represent those operating under Hyde’s restrictions and those that have pro-actively provided Medicaid coverage for abortion. These women ranged from 18 to 35 years old, most reported having some college education, and a majority of them had surgical, first trimester abortions within the past two years. All of them met their state’s Medicaid income qualifications.

Most of the women supported government funding for abortion care; in fact, 82 percent said that they support Medicaid coverage of abortion. When asked about whether funding should be available in specific circumstances, however, they wavered. The interviewees didn’t think abortion should be covered if a woman could not afford another child. Similarly, they didn’t think Medicaid should cover abortion if a woman was not in a relationship with the person with whom she had sex. These views held constant even for women who were themselves in these same circumstances when they had their abortions. For example, a majority of the women cited financial instability as the most salient factor in their personal abortion decision, yet when specifically asked if Medicaid should cover abortion as a result of not being able to afford another child, 40 percent said no. Similarly, women often used disparaging language to talk about people who seek abortions for reasons they don’t approve of, again, even if they themselves had abortions in those circumstances.

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This seems contradictory: why would women who have abortions for financial reasons disapprove of Medicaid coverage of abortion for the exact same reason? Dennis and her colleagues points to abortion stigma, explaining:

“Women said that they did not support coverage in these circumstances because they felt coverage would promote ‘irresponsible’ behavior…these circumstances conjured images of irresponsible, promiscuous, and callous women, which participants sought to distance themselves from in order to view their own abortion decision as consistent with their moral values.”

Dennis and colleagues propose that abortion stigma operates differently for low-income women, as they are battling both abortion stigma and welfare stereotypes. The researchers note that the overlap between stereotypes of women who have abortions and women on welfare are notable—they’re both thought of as irresponsible, lazy, and promiscuous, the exact qualities from which the women in this study were trying to distance themselves. Indeed, the shame associated with welfare reflects an American view that holds individuals accountable for their own poverty rather than recognizing the systemic determinants of poverty and health.

The point of this research is not to suggest that we should keep Hyde in place because low-income women themselves don’t believe that Medicaid should cover abortion in every circumstance. A person’s character, whether upstanding or “irresponsible,” should not determine whether or not they receive insurance coverage. This particular study uncovers just how pervasive abortion stigma is, so much so that even women who need Medicaid to cover abortion because they can’t afford another child don’t believe women like them deserve to have this coverage.

The Hyde Amendment has made it acceptable to debate whether different pregnancy circumstances merit abortion coverage. As we see in this particular study, parsing out who does and doesn’t deserve abortion coverage based on the circumstances of a pregnancy only further embeds stereotypes about people who seek abortions, especially among those who need access to these services (in this case, low-income women). Research like this demonstrates that our work on the Hyde amendment can’t just be at the policy level. Repealing Hyde is not enough—it does not undo the damage of stereotypes associated with people who have abortions. We must advocate for policy change coupled with culture change, in which we both repeal Hyde and challenge the multiple stigmas and stereotypes associated with those who need Medicaid coverage of abortion.

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