Resistance in the US
National Abortion Federation, Washington, DC, USA
In the last several years anti-choice legislators have made restricting abortion access a priority in the United States. We have seen a record number of anti-abortion restrictions being introduced and passed at state and federal levels. These restrictions have made it increasingly difficult for women to access the care that they need and have even forced clinics to close.
In the last year, we have also endured a smear campaign using highly-edited, misleading videos to target and demonise abortion providers. This anti-abortion campaign has led to increased investigations against providers and a dramatic increase in hate speech and internet harassment, death threats, attempted murder and murder targeting providers.
We have been active in fighting back against these attacks, particularly in the courts. NAF immediately sued the individuals and organisations behind the illegal undercover videos in order to protect the safety and security of our members. Earlier this year the Supreme Court heard arguments in Whole Woman's Health v. Hellerstedt - a challenge to Texas abortion restrictions designed to close more than half of the clinics in that state. The outcome of this case could have implications for abortion restrictions throughout the United States.
Policy of the US
Vicky Sapporta, MD, President of NAF (National Abortion Federation),
The Religious Right has grown as a political force in the United States. With widespread
access to the White House, members of Congress and state legislators, they have been
trying to restrict women’s access to abortion care by introducing legislation that would ban
abortion, require parental involvement for minors, reduce public funding, require biased
informed consent and waiting periods, and force clinics to comply with other politically
Abortion providers can play a key role in countering the Religious Right by providing the
medical, scientific and provider perspectives in public policy debates about abortion. NAF,
as the professional association of abortion providers in the United States and Canada, has
successfully brought forward providers and patients to highlight the real-life consequences
of restrictive legislation and regulations. As a result, we have been able to expose and
defeat initiatives supported by the Religious Right to further restrict women’s access to
Vicki Saporta, President and CEO, National Abortion Federation, USA
In the 1990s, obstetrics and gynecology (OB/GYN) residency programs were falling short of their responsibility to train new physicians in abortion care and contraceptive services. Through targeted efforts, organizations addressed this problem with the introduction of a wide range of training opportunities, including newly established residency- and fellowship-based training programs in family planning and abortion care.
Residents receive hands-on training through residency program partnerships with freestanding clinics and private medical practices. Current providers have also partnered with some of these sites to learn abortion techniques, including later abortion procedures to expand their practices. Additionally, providers stay current in abortion practice through continuing medical education (CME) opportunities such as educational conferences and accredited online resources.
Despite the fact that OB/GYN residents have had more training opportunities in the past 15 years, this has not necessarily resulted in increased numbers of clinicians providing abortion care. Efforts are underway to train physicians in other specialties such as family practice, as well as to train advanced practice clinicians. By integrating abortion care into other broader practices, we hope to see an increase in the number of providers who actually go on to offer abortion care.
What happens if society opts out?
Vicki Saporta (United States)
National Abortion Federation (NAF), United States
Abortion has been legal in the United States since the Supreme Court decided Roe v. Wade in 1973. However, during the last thirty-five years, abortion opponents have launched legal, legislative, and judicial challenges that have resulted in more restrictions and obstacles being placed in the way of women seeking abortion care. The most onerous of these restrictions is the lack of public funding for abortion care. In the United States where abortion is legal and safe, access continues to be a challenge especially for low-income women.
In the United States, low-income individuals rely on the government for basic and long-term health care. Medicaid is the joint federal-state program that finances health care for 55 million low-income people. In 2006, 37% of women of reproductive age in families with incomes below the Federal Poverty Line were enrolled in Medicaid, according to the Guttmacher Institute.
When abortion was legalized in 1973, Medicaid covered abortion care without restriction. In 1976, Congress passed a provision to limit federal funding for abortion care. Current law requires coverage of abortion only in cases of rape, incest, and life endangerment; however, it can be very challenging for a woman to actually obtain a publicly-funded abortion even in these limited circumstances. The Guttmacher Institute has found that 20-35% of Medicaid-eligible women who would choose abortion carry their pregnancies to term when public funds are not available.
When society opts out of providing women access to abortion care, the burden is shifted to the private sector. Since 2001, NAF has been operating a modest Patient Assistance Fund through our toll-free Hotline. With limited resources, we were only able to fund the most desperate cases and often had to turn away more women than we were able to help. However, through increased private sector funding, we are now able to subsidize the cost of abortion care for low-income women at or below 150% of the Federal Poverty Level. In order to be eligible for this funding, a woman must live in one of the 35 states or the District of Columbia where Medicaid does not cover abortion except in very limited circumstances, and obtain abortion care at a NAF member clinic. We have received hundreds of letters from women thanking us for helping them obtain abortion care that they otherwise would not have been able to afford.
Low-income women are four times as likely to experience an unplanned pregnancy as higher-income women, according to the Guttmacher Institute. It is incumbent upon us to continue to use the voices of these women to educate the public about the barriers low-income women face when accessing abortion care, and the necessity for public funding. When society opts out, the private sector becomes critical in helping women obtain the abortion care they need.
Empowering providers and patients as advocates
Vicki Saporta National Abortion Federation, Washington, DC, USA - firstname.lastname@example.org
Although abortion has been legal in the United States for 41 years, we continue to see attacks on women's access to abortion care. In the last few years, anti-choice legislators have made restricting abortion access a priority and we have seen a record number of anti-abortion restrictions being introduced and passed at the state and federal levels. The stigma surrounding abortion has also contributed to this hostile political environment and a lack of understanding for abortion providers and women who access abortion care. One of the most effective ways to fight these attacks and work to dispel stigma is to ensure that the voices of providers and patients are included in the public debate about abortion. We have helped women come forward and speak out about their decision to obtain abortion care and to explain how proposed restrictions would have affected their ability to make the decision that was best for them. These stories have been successful in combating political stigma and challenging restrictions. We must continue to help women share their abortion stories. We have also worked to train and mobilize abortion providers to advocate with lawmakers and speak to the media. Abortion providers are invaluable messengers, who can offer expert medical testimony and dispute false claims made by abortion opponents. Abortion providers are also uniquely qualified to discuss the public health consequences of unsafe abortion and the necessity of ensuring that abortion care is safe, legal, and accessible.