By Michelle Oberman

This is bad news. Since the Trump administration finalized a gag rule banning organizations that get money through Title X from providing or referring patients for abortions, Planned Parenthood has withdrawn from Title X. This sort of rule will seriously impact low-income women, because all Planned Parenthood centers will be barred from getting funding that helps provide affordable contraception, STI testing, and other services in addition to abortions. In Her Body, Our Laws: On the Front Lines of the Abortion War, from El Salvador to Oklahoma, Michelle Oberman has written about the damning hurtles and obstacles poor women face when dealing with an unplanned pregnancy or seeking reproductive health care. This excerpt shows what their reality looks like.

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None of the laws Oklahoma passed were new. They simply passed every measure enacted by other pro-life states, along with the occasional model bill drafted by Americans United for Life.

The laws cover a broad range of issues. Some of the laws, such as a ban on sex-selective abortion, are plainly symbolic. Women seeking abortions in Oklahoma, as in other states, need not provide a reason for terminating their pregnancies. There is no way to enforce this provision.

Other laws have had a direct impact on the delivery of reproductive health care in the state. For example, one state law forbids the use of public funds or facilities for the provision of abortion services. This law bars doctors at the University of Oklahoma hospital—the state’s leading health-care center—from providing abortions for any reasons other than rape, incest, or medical necessity. The ban’s most dramatic consequences are seen in cases involving poor women, who learn, typically halfway through their pregnancies, that their fetuses have severe anomalies.

Consider what happens when a poor woman finds out that her fetus has trisomy 18, a condition that causes severe developmental delays due to an extra chromosome. As anomalies go, it’s fairly common—one in 2,500 pregnancies, and one in 6,000 births. Most of the time, the woman miscarries. For those who survive, life is precarious and profoundly limited. Only 10 percent will reach their first birthday. Those who live require full-time, institutionalized care.

Yet unless this pregnant woman has money to pay for a private abortion—which by mid-trimester, when these anomalies typically are discovered, will cost thousands, rather than hundreds, of dollars—she must continue her pregnancy.

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At the national level, there’s a bitter dispute about whether restrictive abortion laws lead to lower rates of abortion. Since 2008, abortion rates have been declining all over the country. The leading pro-life economist says this decline proves the laws are working to deter women from having abortions. The pro-choice economists respond that he’s wrong, because abortion is declining throughout the country, including in states without pro-life laws.

For our purposes, though, the question is not necessarily how often or how much the laws deter abortion. What we want to know is how the law might tip the balance away from abortion.

Sociologist Sarah Roberts has undertaken a deep inquiry into how abortion restrictions affect women’s actual decisions. After Utah enacted a seventy-two-hour waiting period, one of the longest in the country, Roberts surveyed five hundred women who sought abortions in Utah. Her study found that the waiting period had an impact on women’s decisions, but in a surprisingly indirect manner:

The 72 hour waiting period and two-visit requirement did not prevent women from having abortions, but it did burden women with financial costs, logistical hassles, and extended periods of dwelling on decisions they had already made. The wait also led some women to worry that they would not be able to obtain abortion drugs, and pushed at least one beyond the clinic’s gestational limits for abortion.

Roberts found no evidence suggesting that the three-day waiting period led women to change their minds about abortion. But it is clear that the law had an impact on the woman contemplating abortion: it increased the costs of having an abortion.

Laws restricting abortion by banning insurance coverage or requiring waiting periods don’t target any particular set of pregnant women. The laws are neutral on their face. Yet poor women disproportionately feel the impact of these laws.

Take, for example, a hypothetical low-income single mother in Wisconsin. In recent years, that state enacted a law requiring a twenty-four-hour waiting period, and another law banning the use of telemedicine by abortion providers. The state has only three abortion providers, all in Madison or Milwaukee. The abortion procedure itself costs, on average, $593. For a single mother in rural Wisconsin, though, the actual costs are much higher. To the cost of the procedure, she must add the costs triggered by the waiting period and the distance she must travel. Gas, lodging, child care, and missed work add up, so that in the end, an abortion actually costs her $1,380.

In the end, abortion laws aim to nudge women away from abortion by raising the costs of getting one. And the women most likely to be nudged away from abortion because of the costs are those who are poor. Ironically, and to my mind most cruelly, these are the same women who were nudged toward abortion because of the high costs of motherhood.

Our policies on both ends of the scale leave poor mothers so constrained by their options that it is hard, in good faith, to see either motherhood or abortion as a “choice.”

About the Author 

Michelle Oberman is the Katharine and George Alexander Professor of Law at Santa Clara University School of Law and an internationally recognized scholar on the legal and ethical issues surrounding adolescence, pregnancy, and motherhood. She works at the intersection of public health and criminal law, focusing on domestic and international issues affecting women’s reproductive health. Her book When Mothers Kill (2008) won the Outstanding Book Award from the Academy of Criminal Justice Sciences. She is also the author of Her Body, Our Laws: On the Front Lines of the Abortion War, from El Salvador to Oklahoma.