Last year, I was a volunteer case manager for the DC Abortion Fund (DCAF), which meant that for a week every quarter, I would take calls from people in the D.C. area who needed financial assistance in order to obtain an abortion. I would give patients advice for how to raise the funds they needed, refer them to local clinics and other resources, and if necessary, help close any remaining funding gap. Initially, I signed up to do this work because I wanted to contribute in a real way to an issue that is important to me. I wanted to go beyond signing petitions and sending out enraged tweets. It was an intense and rewarding experience. I didn’t realize how much I would learn about how choice and money (and privilege in general) intersect in our country.

In DC, the cheapest abortion you can get is about $300. That may seem affordable to some, but to those who are living paycheck to paycheck (or to those who don’t even have a paycheck), it can be insurmountable. And the further along a pregnancy is, the higher that cost climbs. If enough time goes by, an abortion can cost thousands of dollars. When it comes to reproductive choice in America, unless you have money, you don’t have much of a choice. There are many factors causing this.

When it comes to reproductive choice in America, unless you have money, you don’t have much of a choice.

Lack of insurance coverage

You might be wondering why people don’t just use their medical insurance for their abortion. Well, 10 states have laws in effect restricting insurance coverage of abortion in all private insurance plans written in the state, including those that are offered through the health insurance exchanges established under the Affordable Care Act. Twenty-five states restrict abortion coverage in plans offered through insurance exchanges. Twenty-one states restrict abortion coverage in plans that insure public employees. I could go on.

I personally tried to find out whether or not abortion is covered by my private insurance plan. I couldn’t find any mention of abortion on the website, even when I searched for it. So even if an insurance plan does cover abortion, it might be too difficult for a patient to figure that out.

Medicaid restrictions

Speaking of insurance, many low-income people rely on Medicaid for their health insurance. In fact, it’s often their only option. But did you know that in many states (and in Washington, DC), patients are not allowed to use Medicaid to cover abortion? Only 15 states accept Medicaid for abortion coverage. You can thank the Hyde Amendment for that. Many of the patients that I spoke to had Medicaid and were shocked to find out that it couldn’t help them in their current circumstance.

Paying up front

For most medical procedures, you wouldn’t expect to have to pay in cash before you’re allowed to get your procedure. Yes, some big items (like an MRI or CT scan) need to be approved by your insurance company before they can be done. But for other medical appointments, you can expect to be billed later, or pay in installments. This is not the case for abortion. Clinics like Planned Parenthood require payment at the time of the procedure in order to keep costs down, so they can afford to continue to provide services to patients. Many people need time to save up the money needed to cover their abortion, but this can often make their situation worse. The longer it takes to raise the money, the more expensive the procedure becomes, and so on… It can seem like an impossible situation to be in.

Do you ever find yourself with at least $300-600 to spare? I know that just a couple years ago, I would have had a really hard time fronting that kind of cash, even in an emergency. And I wouldn’t have been alone; 46% of Americans wouldn’t be able to cover an unexpected $400 expense.

Having dependents

Many of the women who turn to the DC Abortion Fund already have children. In fact 59% of American women obtaining abortions are mothers. When you already have children to care for, money can be even tighter. Sometimes, it can be a matter of paying for rent or paying for an abortion.

Traveling for care

Over the past few years, many clinics have had to shut down due to Targeted Regulation of Abortion Providers (TRAP) laws. These laws regulate things like corridor width, procedure room size, hospital admitting privileges, etc. Since many clinics can’t afford to comply with these regulations, they end up having to close down. How does this affect women financially? Often, in large states like Virginia and Texas, women have to drive hundreds of miles to a clinic that provides abortion. Not only is this an inconvenience, but it requires a car (or public transportation), gas money, accommodations, taking time off from work, and finding child care. Some states also require a 72-hour waiting period after the first clinic visit, so patients either have to stay near the clinic for at least 3 days, or they have to make the trip twice.

Financial insecurity

Obviously, all of the issues above relate to financial insecurity. In fact, most TRAP laws (and other related restrictions) rely on financial insecurity as a way to prevent abortions from being obtained. The goal is to make it all but impossible to get the desired medical care. Many people who call organizations like DC Abortion Fund are unemployed or underemployed. They are living paycheck to paycheck. They often don’t have friends or family who are capable of helping them financially. Remember, nearly half of this country is financially insecure in the face of an emergency.

And don’t forget, abortion is a really dicey subject in our country. Even if a patient had family or friends with money to spare, they might be afraid or ashamed to ask. We are taught that abortion is a selfish and immoral choice to make. I’m a pro-choice activist, yet I know I might still struggle going to my family in this kind of situation.

Reproductive choice and health is one of the main reasons I am so passionate about financial freedom. It is why I want to help women to take control of their finances, prepare for the future, and achieve their dreams. I want women to live the lives that they want and deserve to live. No one should feel like they have no options. Socioeconomic status should not take away the fundamental right to decide if and when you want to have children.

If you want to volunteer with or donate to an abortion fund near you, check out the National Network of Abortion Funds. Other great organizations are Planned Parenthood, the Center for Reproductive Rights, and NARAL Pro-Choice America.

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