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CALIFORNIA STATE UNIVERSITY, NORTHRIDGE Socioeconomic CALIFORNIA STATE UNIVERSITY, NORTHRIDGE Socioeconomic Disparities in Abortion Among Young and Low-Income Women in the United States: A Public Policy Approach and its Impact on Reproductive Health Legislation A graduate project submitted in partial fulfillment of the requirements For the degree of Master of Public Administration, Health Administration By Alannah Smith August 2019 The graduate project of Alannah Smith is approved: ___________________________________ ___________________________ Dr. David Powell Date ______________________________________ ______________________________ Dr. Frankline Augustin Date ___________________________________ ___________________________ Dr. Kyusuk Chung, Chair Date California State University, Northridge ii Table of Contents Signature Page ii Abstract iv Introduction 1 Statement of Purpose 3 Background 4 Abortion rights and Roe v Wade 4 The Helms Amendment 4 Title X and Medicaid Expansions for women with low-income 5 The Hyde Amendment 7 Conceptual Framework 9 Methodology 12 Findings/Analysis 13 Need for Reproductive Care 13 Economic Outcomes for Women who are denied abortions 14 Disparities in Unintended Pregnancies related to Contraceptive Use 15 Lack of knowledge with Abortion laws and services 16 The Impact of the Affordable Care Act on young and low-income women 17 Trump Administration blocks funds for Planned Parenthood 19 Future Direction of Young and Low-Income Women’s Healthcare Access 22 Conclusion 24 References 25 iii Abstract Socioeconomic Disparities in Abortion Among Young and Low-Income Women in the United States: A Public Policy Approach and its Impact on Reproductive Health Legislation By Alannah Smith Master of Public Administration, Health Administration Abortion in the United States is the most common medical procedure undergone by young women between the ages of 15 and 44 (Jones, Zolna, Henshaw, & Finer, 2008). This paper aimed to analyze peer-reviewed journal articles on the disparities in abortion rates in the United States with low-income women and create a better understanding of the economic and social factors that underlie them. The literature review provided information regarding disparities in abortion, and how the need for reproductive healthcare is important and necessary for women, although some still finding it difficult to obtain affordable healthcare coverage due to their socioeconomic status. It has been shown that women who have low income and are unmarried are likely to have abortions, and also have a difficult time receiving medical care. Therefore, all women’s health care providers should work to ensure that all forms of birth control are available to women, and if not, innovate ways to provide access, making sure that health insurance companies cover women’s preventive care services with no out-of-pocket costs, and improve access to abortion care ensuring that all women are able to make the decision that is best for them. Although there are disparities in abortion with low-income women, abortion will continue iv to be an important component of women’s health care, especially with new developments in technology and practice. Keywords: abortion, disparities, healthcare v Introduction Though abortion has become integrated into women’s healthcare and a safe and common medical procedure in the United States, it was once considered a common law crime. Abortion laws in the United States affected most states, resulting in the passage of Roe v Wade, which was a landmark decision of the US Supreme Court that provided a right to privacy that protects a pregnant woman’s liberty to choose whether or not to have an abortion. Abortion rights for women have always been controversial, particularly for low-income women. There are substantial disparities in abortion rates in the United States, with low-income women having higher rates of abortions than others (Dehlendorf, Harris, & Weitz, 2013). Disparities in abortion have led women in disadvantaged communities to experience significant health burdens and fundamental hardships. To address the disparities in abortion, there is a need to help women achieve their personal fertility desires. For a woman with an unintended pregnancy who desires an abortion, being able to obtain this procedure in a timely and safe manner is, in fact, a desirable outcome (Dehlendorf, Harris, & Weitz, 2013). The disparities in abortion exploit low-income women and women of color and result in more women experiencing later abortions. Health care providers and insurers can help to provide and improve access to abortion that would enable women to have greater control over the timing of the abortion and reduce the number of clinic visits. Healthcare organizations should strive to provide the best quality of care for all women in the United States. Typically, healthcare in the United States can be viewed as being very expensive. Medicaid coverage plays a significant role in the relationship between healthcare and low-income women because it provides the access and affordability women need during pregnancy (Alan Guttmacher Institute, 2004). Understanding the disparities in abortion amongst 1 the increased population of low-income women can help provide assistance with women obtain Medicaid health coverage and establish the underlying factors affecting healthcare quality. Healthcare organizations including its providers and insurers must realize the hardships that low- income women face, and understand that a lack of knowledge of abortion laws and services can impede access to abortion services as well as medical routine services in a timely manner. So, we can pose the question: what are the factors that are associated with disparities in abortion rates, and how do we address them? This research project will focus on the following topics: - Disparities in abortion rates - Factors associated with disparities in abortion rates - Economic outcomes for women who are denied abortions - Ways to improve access to abortion services - Potential effects legislation has on family planning services 2 Statement of Purpose The purpose of this research project is to analyze and understand the socioeconomic disparities in abortion in a comprehensive manner and what important positive factors women can create to make the best decisions about childbearing for themselves. This research project will outline the underlying influences on disparities in abortion, and examine how we can address them while focusing on the structural factors including economic disadvantage and lack of access of family planning. To identify these structural factors, this research project will analyze the differences in discrimination in healthcare. This would inform policy decisions to improve access to quality prenatal care for all women of any socioeconomic status. Restricting abortion and limiting access will have no effect on the factors that will be outlined in this research project, but recognizing the importance of women’s reproductive health are essential to meeting the reproductive health care needs for low-income women. In the healthcare field, managed care systems have become a great influence for low- income women and continues to aim to reduce costs through in-network providers. Medical insurance coverage has always been an important obstacle The Affordable Care Act has the potential to decrease the financial barriers and continues to provide assistance for low-income women (Dehlendorf, Harris, & Weitz, 2013). In addition to the Affordable Care Act, Federal Title X Funding helps ensure that women have access to basic preventive reproductive healthcare. With a growing number of unintended pregnancies, the impact of Title X gives women more control if or when they have children, their health, and economic security. With the help of Medicaid, young and low-income women can have affordable and accessible healthcare coverage to meet all of their needs, including abortion services. 3 Background Abortion Rights and Roe v Wade Abortion rates have been declining since the early nineties among adults and adolescents, but remain high among minorities and the poor. Before the legalization of abortion, the medical procedure had been performed for thousands of years even though hospitals were not common and the physicians had basic medical education (National Abortion Federation, 2019). Between the 1880s and 1973, many women died or suffered serious medical problems during abortions or going to physicians whose methods were undeveloped for the medical procedure (National Abortion Federation, 2019). On the other hand, some women were able to obtain safer, although still illegal, abortions from private doctors. Although abortions remained common, doctors had to stop performing the procedure because they were facing more scrutiny from their peers and hospital administrators. The right to have an abortion in all states was available to American women in 1973, which ignited the passage of Roe v Wade. It made it possible for women to receive safe and legal abortions from well-trained medical physicians, and a right of a woman and her doctor to make that decision without state interference. As women of color do have a higher percentage in abortion rates, we have to focus on the issue of how to improve all women’s health outcomes, as well as women’s ability to make life decisions about their reproductive health. The Helms Amendment The Helms Amendment, passed in 1973 and also known as the Foreign Assistance Act, limits the use of US foreign assistance for abortion. The amendment states that “no
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