Too many women in the United States today face unnecessary barriers when seeking abortion care. Throughout the U.S., there can be a shortage of providers willing to provide abortions and a declining number of hospitals that provide abortion services, which can make it extremely difficult for women to obtain care, especially in rural areas.
Low-income women and women in diverse communities are more adversely affected by limited access. For example, low-income women often lack the funds necessary for an abortion, which can delay their care.
State governments continue to impose restrictive legislation on women seeking abortion care, such as mandatory waiting periods and biased counseling.
> Women in Diverse Communities
> Shortage of Abortion Providers
> Restrictive Legislation
> Funding for Abortion
> Declining Number of Hospitals Providing Abortion
Although barriers to abortion access affect all women, women of color, low-income women, and immigrant populations face unique obstacles. Minority women's access to equal and adequate reproductive health care is affected by many things, including discrimination, language barriers, and socioeconomic factors.
The U.S. is home to a growing population of ethnic and immigrant populations. The 2000 census data indicates that Latino, African-American, Asian/Pacific Islander and Native American populations will grow substantially by the year 2050. As the percentages of people of color in the United States continue to increase, we recognize that when women of color attempt to obtain any type of health care, they may face overt and subconscious discrimination by providers.
In 2001, NAF invited individuals who have worked to increase access to comprehensive reproductive heath care to address the unique barriers faced by women of color, low-income women and immigrant women. The consortium report, Increasing Access to Abortion for Women in Diverse Communities (PDF file, 3.6 MB), includes recommendations to increase access for marginalized women.
In 2003, NAF held a full-day cultural
competency seminar led by experts on cultural and linguistic competence
to train reproductive health care providers and activists about how to
develop a culturally competent workplace and to provide strategies for
addressing the concerns and specific needs of women of color, low-income
women, and immigrant women. Developing Cultural Competence in
Reproductive Health Care: Understanding Every Woman (PDF file, 2.3 MB) is a
report of the key recommendations identified by participants.
For additional information on the unique obstacles facing women from diverse communities, read the NARAL Pro-Choice America Foundation's publication The Reproductive Rights & Health of Women of Color.
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In 1973 the Supreme Court struck down state laws that criminalized abortion. Doctors working in hospital emergency rooms and ob-gyn units before the legalization of abortion knew first-hand about the medical devastation that women suffered as a result of self-induced abortions or illegal back alley abortions performed by unlicensed practitioners. Today, many of those doctors are retiring. The younger clinicians replacing them have little direct experience with the consequences of illegal abortions and the public health benefits of ensuring that safe abortions remain available.
In 1995, the Accreditation Council for Graduate Medical Education (ACGME), the agency responsible for accrediting medical residency programs, took steps to address the lack of abortion training in ob-gyn residency programs. After several months of reworking drafts, the ACGME in July 1995 adopted a requirement that all ob-gyn residency programs must provide access to experience with induced abortion. The standard includes the exclusion that "No program or resident with religious or moral objection shall be required to provide training in or to perform induced abortion." While some argue that the new standard lacked the strength of previous drafts, Congress further weakened its power by passing legislation that ensured that any residency training program that loses ACGME accreditation because they fail to provide or arrange for abortion training will still be considered accredited and remain eligible for federal funding or other benefits or services.1
NAF's 1998 survey Abortion Training in U.S. Obstetrics and Gynecology Residency Programs, 1998 (PDF file, 167K) revealed that training in first trimester abortion techniques is a routine part of residency training in 46% of America's ob-gyn residency programs. About 34% offer this training only as an elective, and 7% provide no opportunity at all for residents to learn to do safe first trimester abortions.2 The results from the NAF survey showed an increase in the availability of routine training in first trimester abortion from just 12% of ob-gyn residency programs in 1992 to 46% in 1998.3 While there is reason to be cautious in interpreting the results of the 1998 study, some of the observed increase in abortion training opportunities may be due to the ACGME requirement which took effect in the timeframe between the two surveys.
More still needs to be done in requiring ob-gyn residency programs to offer abortion training because doctors who do not receive training are not in a position to provide the full range of reproductive health care that their patients will need.
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National polling consistently shows that the majority of Americans support a woman's right to choose abortion. Many legislators, however, are committed to bringing an end to legal abortion and have passed state laws that have drastically diminished access to abortion. These include:
- Parental Consent or Notification Laws which are now enforced in half of the 50 states can violate the privacy of young women by forcing them to involve their parents in their decisions, even when that may endanger their lives or health. As a result, some women travel to other states that do not require parental involvement. Others have resorted to illegal abortions rather than comply with a legal requirement that puts them in jeopardy.
- Mandatory Waiting Periods require women to wait for up to 24 hours between a state mandated counseling appointment and their abortion. Many of these laws require the counseling be done in person rather than on the phone. These laws imply that women come to abortion clinics without having seriously considered their options. As a result, a woman's abortion is often delayed much longer than 24 hours, particularly if she has to take time off from work, arrange for child care, travel a long way, and perhaps stay overnight in a distant city. These factors can significantly increase the cost as well.
- Biased Counseling Laws require that clinic personnel lead their patients through detailed, state mandated "scripts" that promote childbearing. Abortion providers have long been at the forefront of developing and delivering sound and effective options counseling to their patients. These coercive scripts are incompatible with the goal of true informed consent because they contain information that is designed to frighten and dissuade women from having abortions.
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The cost of a first trimester abortion has increased only slightly since 1973, but many women still cannot afford an abortion. The Hyde Amendment denies federal Medicaid funding for abortions except in cases of rape, incest or life endangerment, and most states have similar laws restricting financial help to women who need abortions. More than two-thirds of women must initially pay for their abortions themselves - only 14% of abortions are paid for with a state's public funds,4 and only 13% are covered by a woman's private insurance at the time of her abortion.5 A small number of women may be reimbursed by insurance after their abortion.
Too many women who need abortions must wait while they raise funds, postponing their abortions until later in their pregnancies, when the costs increase. For women who struggle to make ends meet or do not have insurance that covers abortion, the legal right to have an abortion does not guarantee that they will have access.
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Today, about 95% of women who need abortions have them in clinics or in private doctor's offices where costs can be kept low without increasing health risks.
This trend represents a significant shift away from hospital provided abortion care, which was far more common in the early years after the laws criminalizing abortion were struck down. A study by the Guttmacher Institute identified that only 603 hospitals out of 5,801 provided abortions in 2001. This has serious implications for abortion access. Women in rural areas where there are no abortion clinics, and low-income women who depend on hospital emergency services for medical care, are left unserved when hospitals do not provide abortions. Additionally, when hospitals do not offer abortions, the young physicians they train have no opportunity to learn to provide safe abortions.
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- 42 USCA § 238n, Abortion-related discrimination in governmental activities regarding training and licensing of physicians.
- Almeling, R, Tews L, and Dudley S. Abortion training in U.S. obstetrics and gynecology residency programs, 1998. Family Planning Perspectives, 2000, 32(6):268-271 & 320.
- MacKay, HT and MacKay AP. Abortion training in obstetrics and gynecology residency programs in the United States, 1991-1992. Family Planning Perspectives, 1995, 27:112-115
- Guttmacher Institute. Facts in Brief: Induced Abortion. January 2003.
- Henshaw, SK, and Finer, LB. The accessibility of abortion services in the United States, 2001. Perspectives on Sexual and Reproductive Health, 2003, 35(1):16-24.
Statistical information in this fact sheet is based on research by The Guttmacher Institute and other members of the National Abortion Federation.