Saturday, Sep 6, 2008
Rights in New York are, at least by comparison, rights indeed. Here, abortion is available to 24 weeks, covered by Medicaid, and subject to few legal restrictions. On NARAL's state-by-state abortion access "report card," New York gets an A.
Our neighbors to the southwest, by contrast, get an F. A predominant number of Haven patients are from Pennsylvania, where women seeking abortions (unavailable in 75 percent of the state's counties) are required to undergo what abortion-rights advocates call "biased counseling": a state-sanctioned lecture about their "unborn child." Abortion advocates blame such restrictions for complicating and delaying an act that is hardly simple to begin with. Especially for low-income women, actually getting an abortion is rarely a simple two-step process of 1) making a decision, and 2) making an appointment. By the time one 41-year-old Guatemalan native came to terms with her choice, which went against her faith and that of her mother, whom she lived with and cared for, plus the fact that her longtime boyfriend left when she revealed the pregnancy, she was too far along to get an abortion at home in Rhode Island. She took the bus to New York; health complications kept her in Haven homes -- lying to her family and employer about what she was doing -- for two nights.
Pennsylvania and Rhode Island aren't the only problem states. Counseling is also required in Delaware, Maine and Massachusetts, as is adult (or judicial) consent for minors seeking abortions. Some clinics perform abortions only one day a week; some "clinics" are not clinics at all, but rather anti-abortion outfits dissembling themselves through sleight of ad. Because of such detours and roadblocks -- often requiring travel to multiple appointments, missed work and pay, and extra child care -- women frequently find themselves in their second trimester before they know it.
Quite a few women get there literally before they know it; they simply do not realize they're pregnant. Many are the unlucky embodiments of their birth control's "failure rate"; others experience first-trimester bleeding and assume it's a period. Last November, Haven hosted a 21-weeks-pregnant woman from upstate who'd had a tubal ligation. (Ultrasounds are also not 100 percent consistent or accurate; a second exam may show a woman to be further along than she was initially told.)
Even women with planned pregnancies can get caught in the same tangle of restrictions. "You can't do amniocentesis until 15 weeks, when you're already in your second trimester," says Sue McPhee, spokeswoman for the Family Planning Association of Maine. If major "fetal distress" is discovered (that is, severe enough to warrant termination), there's still a problem. "There are no physicians that I'm aware of at this time who perform second-trimester abortions in this state," she says. "When something goes really wrong with a very wanted pregnancy, on top of that trauma, you're being sent out of state."
Confusion over a traumatic decision -- and the isolation that often comes with it -- can also make time tick by. We recently hosted a 23-year-old woman from El Salvador, now living in Long Island, who already had one toddler daughter she'd conceived on purpose with her long-term boyfriend. (She specifically consented to let me interview her for this article.) They got pregnant again as a result, she says, of skipping one day on her birth control patch. She had her heart set on getting her GED; she couldn't imagine dividing her time between that and two children. But her boyfriend thought differently. "From the beginning he said no," she says, and informed her he'd leave if she went through with it. "If he doesn't want to talk about it, I'll have to make the decision myself," she resolved. And she meant it. Her English is minimal (I speak Spanish); her entire world is made up of other Salvadorans -- all of whom are against abortion. Tormented and isolated, she told no one. "I didn't feel supported by anybody," she says. When she finally made up her mind, she was 16 weeks pregnant: too far along for any local clinic. She dropped her child off with a younger cousin, telling her where she was going only at the last minute, and got on the train to the city. She told me she had no idea if her boyfriend would be there when she got home.
Medicaid paid for that young woman's abortion. But generally, money is a -- if not the -- major obstacle to abortion. "Low-income or uninsured women have to take extraordinary measures to terminate a pregnancy," says McPhee. Up to about 10 weeks of pregnancy, clinic abortions cost approximately $350, going up to about $650 at 16 weeks and over $1,000 after 20; for a doctor's office, tack on a couple hundred more. While the higher number of providers in New York City -- that is, competition -- keeps costs here relatively low, a late abortion can cost up to $2,000. According to the National Network of Abortion Funds, even the cost of a first-trimester abortion may be more than a family on public assistance receives in one month. Nationally, 62 percent of women come up with the full fee; the remainder pay a reduced fee or are covered by Medicaid or private insurance. Maine, New Hampshire and Rhode Island (among others) prohibit public funding for abortion except in cases of rape or incest. "Many women have to decide among paying rent, feeding their children or having an abortion," says a social worker at a clinic that works closely with Haven, pointing out that since the procedure's cost goes up over time, even as they save they wind up "chasing the fee." (If a woman shows up without enough cash for the procedure, the clinic works the phones, calling organizations such as the New York Abortion Access Fund for emergency financial assistance.)
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