When push comes to shove, if a woman wants to terminate her pregnancy but can't either access services or afford the procedure, the right afforded to her under Roe is not enough.  While having the right is still important and meaningful, for too many women-- particularly young women, immigrant women, and women of color-- this right is not experienced in practice. 

Public policies as well as social and economic barriers inhibit reproductive justice and, as advocates, we must remember looking forward that we still have a great many battles left to win.  

One issue is access.  Many states have laws regulating and restricting abortion.  38 states require an abortion to be performed by a liscensed physician in spite of the simple nature of a first trimester procedure; 43 states allow medical institutions to refuse to perform abortions; 36 states prohibit abortion after a specified gestational period, though generally with exceptions for the women's life and health; and 14 states have banned surgical intact dialation and evacuation (D&E) procedures, know in political discourse as "partial-birth" abortions, under the protection of the federal Partial-Birth Abortion Ban Act. 

Laws concerning mandatory counseling and waiting periods and parental involvement are often particularly harmful.  17 states mandate that a woman receive counseling prior to an abortion that includes information on at least one of the following issues: the supposed link between abortion and breast cancer (6 states), the ability of a fetus to feel pain (8 states), the long-term mental health consequences of abortion (7 states), or the availability of ultrasounds (6 states). 

While counseling around reproductive health care is essential in order to ensure that patients are able to make informed and educated decisions regarding their own health and well-being, state mandates on the content of the counseling women receive around abortion, often unfounded in medical literature, provides women with less than accurate information and undermines the health professionals role in determining appropriate medical counseling and care for their patients.

24 states require a woman seeking an abortion to wait a specified period of time, usually 24 hours, between receiving counseling and going through with the procedure.  6 states have laws that are so restrictive that they force women to make two separate trips to the clinic.  In other cases, abortion providers are often left to counsel patients over the phone on their own time in order to meet the state's regulations and still make it possible for women to receive the care they need without losing their jobs for missing more than one day of work.

34 states require parental involvement in some way, shape, or form in a minor's decision to have an abortion.  22 states require one or both parents to consent to the procedure, 10 require that one or both parents be notified, and 2 require both.  While the majority of states (rightly) allow minors to freely consent to contraceptive services, pre-natal care, adoption, and medical care for a child, only 3 states and the District of Colombia explicitly allow minors to consent to abortion services. 

So, if you are under 18 you are still old enough to consent to pre-natal care for a pregnancy, to carry that pregnancy to term and give birth, to choose between keeping a child or placing him or her for adoption, and to make medical decisions regarding that child's care all on your own, but you are not old enough to soundly decide that you would like to terminate that same pregnancy.

All this for the most common minor procedure performed in the United States.

In addition to restrictive policies, women often face social pressures, stigmas, and fears when considering the termination of a pregnancy.  Some are victims of relationship violence and fear their partners' reaction to their decision  Some are undocumented immigrants and fear persecution when accessing care.  Some young women under 18 fear both the stigma associated with teenage pregnancy and the response of their parents or guardians if they require their consent. 

Many women are still unaware of the options available to them.  Since 1996, Congress has spent more than $1.5 billion dollars on ineffective abstinence-only education programs, which have allowed many young people to grow into adulthood without the information they need to make informed decisions regarding their sexual health.  As I learned when giving a presentation to a ninth grade classroom in the Rio Grande Valley, far too many young people are still under the impression that abortion is illegal in the U.S.  And, I guess, how would they know any different living under the last 8 years of the Bush Administration?

But even where women do have access, still another issue is cost.  The Hyde Amendment still bans any federal funding from going towards abortion provision in the United States or abroad.  While 17 states put up their own Medicaid funds to cover all or most medically necessary abortions, ultimately, low-income women on Medicaid can access pre-natal care through their medical coverage, but not voluntary abortion services.  For those women lucky enough to have private health insurance, 4 states restrict abortion coverage by private health insurance plans to cases where the women's life would be in danger if the pregnancy were carried to term.

Many local organizations, like the DC Abortion Fund, work to fill this void by making grants and no-interest loans to women who cannot afford the full cost of an abortion.  But since the recent economic collapse, the number of requests received by the fund on a monthly basis have nearly doubled, a trend that is unlikely unique to the District.

It is clear that more needs to be done.  We all need to work together to challenge state bans and restrictions, to repeal the Hyde Amendment, and to spread awareness in our communities.  Until issues of reproductive choice are truly addressed in the context of these broader political and social issues, our nation will continue to fail women who face the greatest barriers to accessing their reproductive rights and miss the opportunity to build a coalition of support within the framework of reproductive justice.