Requirement: “The mainstream pro-choice movement … has focused primarily on restrictions on abortion..” (Fried 184). Why is this problematic and for whom is it problematic? Your response should include race and class as categories of analysis.
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CTJ Description:
The Critical Thinking Journal (CTJ) assignment is designed to enhance critical reading
skills and to aid in the development of analytical thought and writing. To these ends,
the CTJ will ask you to draw connections between course readings, identify points of
similarity or disagreement, and to consider the implications of concepts and theories
discussed in the readings. In sum, the CTJ assignment will challenge you to think
beyond what you are given.
Requirement:
“The mainstream pro-choice movement … has focused primarily on restrictions on
abortion..” (Fried 184).
Why is this problematic and for whom is it problematic? Your response should include
race and class as categories of analysis.
Your response should be 450 to 500 words and make sure all 3 assigned readings are
clearly present in your CTJ response (either direct quotes or paraphrased ideas).
•
Gerber Fried (2000) “Abortion in the United States: Barriers to Access”
Use in text citations for direct quotes (MLA or APA format) & paraphrased ideas. Do
not include a list of works cited.
The President and Fellows of Harvard College
Harvard School of Public Health/François-Xavier Bagnoud Center for Health and Human
Rights
Abortion in the United States: Barriers to Access
Author(s): Marlene Gerber Fried
Source: Health and Human Rights, Vol. 4, No. 2, Reproductive and Sexual Rights (2000), pp.
174-194
Published by: The President and Fellows of Harvard College on behalf of Harvard School of
Public Health/François-Xavier Bagnoud Center for Health and Human Rights
Stable URL: http://www.jstor.org/stable/4065200
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Abstract
The legalization of abortion in the United States has brought a dramat-
ic improvement in women’s health and reductions in maternal and
infant mortality. For young women, low-income women, and women of
color, however, access to abortion has been increasingly restricted. This
article describes the obstacles to abortion access, including lack of federal funding; restrictive laws, encompassing those requiring parental
consent or notification for a minor seeking an abortion, as weil as those
attempting to ban a certain procedure; stigmatization and marginalization of abortion; decreasing abortion services; and a shortage of
providers. The article connects the erosions in rights relating to abortion
to policies undermining poor women’s rights in relation to having children.
La l?galisation de l’avortement aux ?tats-Unis a contribu? ? une am?lioration importante de la sant? de la femme et ? la r?duction de la mor-
talit? maternelle et infantile. Toutefois, pour les femmes jeunes, les
femmes ? faibles revenus et les femmes de couleur, l’acc?s ? l’avortement est de plus en plus restreint. Cet article d?crit les obstacles ? l’ac-
c?s ? l’avortement, notamment le manque de fonds du gouvernement
f?d?ral, les lois restrictives, dont celles qui exigent le consentement
parental ou la notification pour une personne mineure d?sirant avorter,
de m?me que les lois visant ? interdire une certaine proc?dure, la stigmatisation et la marginalisation de l’avortement, la diminution des
services d’avortement et le manque de prestataires. L’article relie l’?rosion des droits relatifs ? l’avortement aux politiques minant le droit des
femmes se rapportant ? la procr?ation.
La legalizaci?n del aborto en los Estados Unidos ha resultado en mejo-
ras espectaculares en la salud de la mujer y en la reduccion de las tasas
de mortalidad de madres y e infantil. Sin embargo para las mujeres
j?venes, mujeres de bajo ingresos, y las mujeres de color, el acceso al
aborto se encuentra cada vez m?s limitado. Este articulo describe los
obst?culos que existen para llegar a obtener un aborto, incluyendo la
falta de financiamiento publico; las leyes restrictivas, aquellas que
requieren el consentimiento de los padres, o su notificaci?n, para
menores de edad que buscan el aborto, y las que intentan prohibir ciertos procedimientos; la estigmatizaci?n y la marginalizaci?n del aborto;
la cantidad decreciente de servicios de aborto; y la escasez de provee-
dores. El articulo muestra el enlace entre el desgaste de los derechos al
aborto y las politicas que debilitan paulatinamente los derechos de
mujeres sin recursos con respecto a tener hijos.
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ABORTION IN THE UNITED STATES:
Barriers to Access
Marlene Gerber Fried
Assessing the current status of rights relating to
abortion in the U.S. is a complex matter. From a public
health perspective, if one looks at the statistics comparing
maternal mortality in the U.S. to countries in which abortion remains illegal and unsafe, the situation in the U.S.
looks extremely positive. Abortion has been legal since
1973, and it is widespread: there are between 1.2 and 1.4
million abortions annually.l There is virtually no mortality
from abortion, and the complication rate for first-trimester
abortion is about the same as for tonsillectomy. This is a
dramatic improvement from maternal deaths in the era
before legalization. While we cannot know the exact numbers because the cause of death was not always recorded
(even today, studies find that 23-60% of maternal deaths are
not recorded as such), we do know (from statistics based on
death certificates) that there were 1407 deaths from induced
abortion in 1940.2 That number fell during the 1940s to
200-300 per year. It rose again in the 1950s and ’60s and fell
sharply after 1970, when the first state legalized abortion.
From 1970 to 1980, legal abortion is estimated to have prevented 1500 pregnancy-related deaths and thousands of
other complications. The availability of safe abortion also
accounts for much of the decline in infant mortality.3
Focusing on abortion experiences, however, especially
those of young and low-income women, presents a very different picture-one in which reproductive options are
Marlene Gerber Fried is the director of the Civil Liberties and Public
Policy Program at Hampshire College and a professor of philosophy. She
is also the board president of the National Network of Abortion Funds.
Please address correspondence to the author at CLPP, Hampshire
College, Amherst, MA 01002, USA or to [email protected].
Copyright C 2000 by the President and Fellows of Harvard College.
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severely curtailed. The 28-year effort to restrict and ultimately to recriminalize abortion has had a devastating
impact on many women’s lives. The recent case of a 14year-old girl in Arizona, 24 weeks pregnant, possibly as a
result of rape, makes this all too clear.4 Her case became a
political football. As a child in foster care in a state in which
abortion after 20 weeks is prohibited by law, she had to
receive a court order from her state’s Supreme Court allowing her to go out of state to have an abortion. This young girl
had to travel 1000 miles away, amid a flurry of anti-choice
protests in both her home state and Kansas, where she went
to obtain the abortion. Her case was leaked to the press even
though it is against the law to release confidential information about children who are in the custody of the state.
Anti-choice forces followed her to Kansas, where they lined
the sidewalk outside the clinic in an effort to “persuade”
her not to have an abortion. Sadly, a “normal” day for an
abortion patient all too often requires running a gauntlet of
protestors, having her confidential medical information
made public, traveling long distances, and passing through
metal detectors to see her doctor.
Looking at the experience of abortion providers, we
may see the extent to which fear and danger permeate their
work. In September 1999, clinics in the U.S. and doctors
who perform abortions received an alert warning that
extremists had proclaimed September 19 “Anti-Abortion
Day.”5 A web site with links to the most extreme and violent parts of the movement encouraged anti-choice activists
to “celebrate” anti-abortion day “appropriately.” Such
threats must be taken seriously: to date, there have been
seven murders, and over 80% of clinics have experienced
threats and harassment.5 Abortion in the U.S. is literally
under siege. Providers operate under constant threat, and
many clinics have become secured fortresses. A “normal”
workday for providers includes wearing a bullet-proof vest,
checking for bombs, and being constantly aware of who is
around them. There is no other medical service for which
the dangers to the provider are much greater than those to
the patient. There is no other medical service for which violence statistics must be collected.
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This article will give a picture of abortion in the U.S. at
the end of the 2Oth century from the vantage point of those
women who bear the brunt of restricted access. This analysis is informed by the author’s 20 years of activism, most
recently in the National Network of Abortion Funds, a
growing network of 67 grassroots groups throughout the
U.S. who raise money for women who want abortions but
cannot afford them. For tens of thousands of women in the
U.S. annually, the lack of access to abortion remains a key
obstacle to fully exercising their reproductive rights.
Although one cannot deny the substantial gains made in
women’s health and mortality reduction since the legalization of abortion, access remains an issue, as it was in the
U.S. before abortion was legalized, and as it still is for millions of women living in countries where abortion is illegal
or severely restricted. The barriers to access that will be discussed here-from economic constraints to the relentless
efforts by anti-choice forces to deny women access-are not
unique to the U.S. They are pervasive throughout the world,
regardless of the legal status of abortion. Nevertheless, one
should not conclude from this that legality is unimportant.
Activists worldwide have learned that the legalization of
abortion is necessary but not sufficient to insure the availability of safe abortion to all women who seek it. Women’s
health advocates are continuing to work against legal
restrictions and for funding, training of health prof essionals,
and access to the full range of safe abortion methods.
While battles over abortion tend to dominate reproductive rights politics in the U.S., many U.S. advocacy groups,
especially those organized by women of color, have a broader agenda. Like their counterparts in developing countries,
they see abortion as part of a larger struggle for all the conditions that will make women’s reproductive and sexual
freedom a reality.
Legal but Inaccessible
There is an extreme dissonance between the wide avail-
ability of abortion and its inaccessibility to women on the
social and economic margins. Legal abortion is one of the
safest surgical procedures in the U.S. today, and it is relaHEALTH
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tively inexpensive compared to other surgical procedures.
At the same time, it remains out of reach for thousands of
women each year who find that the expense, location, and
shortage of services, burdensome legal restrictions, and antiabortion threats and violence create daunting barriers.
Abortion Funds get calls from women all over the U.S.-
women in prison, young women, women who have been
raped, “undocumented” women, and women with few economic resources. The organization repeatedly hears of the
desperation of girls and women like the 1 7-year-old with one
child who drank a bottle of rubbing alcohol to cause a miscarriage and the 14-year-old who asked her boyfriend to kick
her in the stomach and push her down the stairs.7 For these
women it is as if abortion had never been legalized.
While violence and harassment pose the most visible
threat, access to abortion has been even more systematically eroded by other strategies. Since legalization in 1973,
there has been a sustained effort by anti-choice forces to
undermine these rights. As a result, abortion access, especially for low-income women, women of color, and young
women, has become dangerously limited by restrictive legislation, judicial decisions, and relentless anti-abortion
activity, both legal and illegal. Abortion providers are marginalized within the medical profession, and women who
have abortions are stigmatized, stereotyped as selfish, or
portrayed as hapless victims incapable of making their own
decisions. The experience of abortion continues to be
marked by silence and isolation despite the 35 million legal
abortions in the U.S. since 1973 and millions of illegal abortions prior to that time.
In addition to the direct attacks on clinics and
providers, abortion access has been undermined primarily
through the denial of public funding for abortion, restrictive
legislation such as mandatory waiting periods and parental
consent laws that impose burdens on women and on clinics,
a shortage of services, and a lack of training for new
providers.
Funding
Within the system of privatized health care in the U.S.,
a large majority of abortions must be paid for by the patients
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2
themselves. About one third of women lack employmentlinked health insurance. One third of private plans do not
cover abortion services or cover them only for certain medical indications. At least 37 million Americans have no
health care coverage at all, including nine million women of
childbearing age.8 And abortion coverage is prohibited by
Medicaid, the publicly funded federal program that covers
“necessary medical services” for low-income people.9
Abortion is the only reproductive health care service that is
not covered by Medicaid. In effect, these policies deny lowincome women equal access to abortion.
The restrictions on funding came soon after legalization. Federal Medicaid covered abortion from the late 1960s,
when state-level abortion laws began to be liberalized, until
1977, four years after Roe v. Wade made abortion legal
nationwide. Each year since then, the U.S. Congress has
passed different versions of the Hyde Amendment, which
prohibits federal funding of abortion. Initially, the only
exception was for cases of endangerment of the life of the
pregnant woman. In 1993, exceptions for rape and incest
were added, but only after a long battle. Most states have
followed these federal precedents, but even this minimal
“liberalization” had to be fought out in court when several
states refused to comply.10
The impact of the Hyde Amendment has been devastating. Between 1973 and 1977, the federal government
paid for about one third of all abortions. Now it pays for
virtually none. Since the average cost of a first-trimester
abortion is $296 (nearly two thirds the amount of the average maximum monthly welfare payment for a family of
three), some welfare recipients cannot afford abortions at
all.” It is estimated that 20-35% of women eligible for
Medicaid who have wanted abortions have instead carried
their pregnancies to term because funding has been
unavailable.12 Others are forced to divert money from food,
rent, and utilities in order to pay for their abortion. Even
when women have been able to raise the money, the time
needed to search for funding makes it more likely that they
will need a more costly and difficult second-trimester procedure. It is estimated that one in five Medicaid-eligible
women who have had second-trimester abortions would
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have had first-trimester abortions if the lack of public
funds had not resulted in delays.13
One recent example underscores the rigidity of the federal standard. A Medicaid recipient with a life-threatening
heart condition sought an abortion in the first trimester of
pregnancy.14 The hospital where she received treatment for
her heart condition refused to perform the abortion on the
grounds that the chance that she would die from the pregnancy was less than 50%. Ultimately, she had to be transported by ambulance to another state at a cost of thousands
of dollars, raised by grassroots Abortion Funds.
These restrictions also deny abortion access to Native
American women, who rely on the government-funded
Indian Health Service for their medical care; federal employees and their dependents; federal prisoners; Peace Corps volunteers; and military personnel and their dependents.
Decreasing Services
Abortion services are severely limited despite the facts
that (1) abortion is legal, (2) there are 40,000 obstetriciangynecologists (ob-gyns) practicing in the U.S., (3) abortion is
the most common obstetrical surgical procedure women
undergo (at 1992 rates, about 43 % of U.S. women will have
an abortion during their lives) and the most commonly per-
formed surgical procedure in the U.S., and (4) excellent surgical and medical methods of abortion exist.15 The number
of abortion providers in hospitals, clinics, and physicians’
offices, however, has declined since the 1980s, and services
are very unevenly distributed. Nine in ten abortion
providers are now located in metropolitan areas; across the
United States, about one-third fewer counties have an abortion provider now than in the late 1970s.16 Ninety-four percent of non-metropolitan counties have no services, and
85% of rural women live in these underserved counties.
One quarter of women who have abortions travel more than
50 miles from home to obtain them.’7 Yet the provider
shortage has only come to public attention in the last few
years, although it represents a major threat to safe and legal
access to abortion.
As older physicians retire, few medical students are
being trained in abortion techniques to take their place.
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2
Almost half of graduating residents in obstetrics-gynecology
have never performed a first-trimester abortion. Many hospitals do so few abortions that they cannot even qualify as
appropriate training sites.18
Anti-abortion violence and harassment aimed at clinics, doctors, and clinic workers contribute to this situation.
Clinics and providers have been targets of violence since the
early 1980s. Thus far, 1993 was the peak year for anti-choice
violence, but levels remain unacceptably high. Acts of vio-
lence have included death threats, stalking, arson, bomb
threats, invasions, blockades, and chemical attacks with
mater …
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