An Anti-Poverty Agenda That Excludes Access to Reproductive Healthcare is Woefully Incomplete

I've written extensively in this column about anti-poverty policy. I've underscored the importance of minimum wages, work supports including child care and wage subsidies, SNAP (food stamps), housing and health care. I've often stressed the critical role for criminal justice reform. I never shut up about the benefits of full employment.

But I've never said a word about reproductive rights.

I have long supported such rights. And I've long recognized the decline in teenage pregnancy, particularly among poor girls, as an important advance for social policy (see Belle Sawhill's work on access to contraception and its positive impacts on child/parent outcomes). But I've failed to connect the dots between access to comprehensive reproductive health care, including abortion, and economic security.

Thankfully, those dots are compellingly connected in this report from last year, "Two Sides of the Same Coin, Integrating Economic and Reproductive Justice." If you're thinking the connection should be obvious, I agree. Having a child is much more than an economic event, but it's also very much that, invoking significant direct costs and opportunity costs (and benefits too, of course). Thus, the inability to control such costs due to lack of access to reproductive health care is a potentially poverty-inducing problem for low-income women and their families (and 69 percent of those who seek abortions are low-income). Conversely, increasing use of the birth control pill, for example, has been found to significantly reduce the gender pay gap.

I was particularly struck by the findings from a research project in progress called the Turnaway Study, a longitudinal study which follows women who sought but did not get abortions, comparing their outcomes to economically similar women who were able to access abortion services. This type of quasi-experimental study design is a good way at getting closer to causal impacts versus correlations.

A key finding from the Turnaway Study in the economic security space is that relative to women who were able to get the abortion they sought, women denied an abortion were three times more likely to be poor. A year after they were turned away, these women were 10 percent less likely to be working full-time (58 versus 48 percent), and 76 percent of them received public assistance, compared to 44 percent of women who were able to access abortion.

These findings match up to the facts as to why women seek abortions. It's not often because they don't want to have kids; 60 percent of women who have abortions are raising children; of those turned away, 29 percent cited their need to focus on their other kids as the reason they were seeking an abortion. Once again, it's often economics: "Women typically cite multiple interrelated reasons for seeking an abortion, but the most common theme that arose in the Turnaway Study was not feeling financially prepared (40 percent), meaning that they had general financial concerns, were unemployed or underemployed, were uninsured or could not get welfare, or did not want government assistance."

Another reason why it's so essential for progressives to add reproductive access to our anti-poverty agenda is that public policy is pushing hard in the wrong direction, making abortions more costly and harder to find. Along with the publicized attack on Planned Parenthood, many states are making it harder for clinics that serve low-income women to stay open, such that abortion seekers stuck in those areas now face potentially high travel costs. In addition, restrictions on both public (Medicaid) and private insurance translate into significant out-of-pocket expenses. More than half of the women in the Turnaway Study (56 percent) who got abortions spent more than a third of their monthly income for the procedure and for travel.

As I was working on this piece, I happened to read an article about the restrictive Texas abortion case to be heard this week in the Supreme Court. The article told the story of an administrative assistant from Texas who, because of the state's aggressive attack on abortion access, had to take out a payday loan to fly to California to be able to schedule an abortion. As she herself noted, "I took out a payday loan, and it put me in debt for a little bit. But I think about women in the Panhandle or the [Rio Grande] Valley. Can they get on a plane, fly 1,500 miles away and get an abortion? No."

In other words, this is not some hypothetical problem. It's real and it's happening every day, which is why the "Two Sides" report concludes the following:

Anyone who wishes to advance the economic security of women and their families will not be able to do so effectively without integrating access to reproductive health care into a proactive policy agenda to achieve economic equality for women.

I think that's absolutely right. That means pushing back on state and federal laws that limit access and increase costs, including insurance restrictions, like the Hyde Amendment. It means protecting the advances we've made under health reform regarding contraceptive coverage. It means fully funding and supporting family planning initiatives through Title X, including Planned Parenthood.

For low-income women to be able to take control of their economic lives, they must be able to access affordable, comprehensive reproductive health, including contraception and abortion. An anti-poverty agenda that fails to recognize that reality is woefully incomplete.