The Prochoice Case Against Free Abortion

Access to abortion care is a vital aspect of comprehensive health care for women of reproductive age. Lack of access to abortion services leads to later term abortions that come with an increase in the risk of health complications like unmanageable pain or bleeding. Lack of access also opens the door for disreputable individuals to offer clandestine abortion services, which often lead to dangerous and deadly side effects.

Socioeconomic factors affecting abortion access are exacerbated by state-enacted, targeted regulation of abortion providers, or TRAP laws. TRAP laws are laws passed that apply only to abortion providers, which are often passed under the guise of protecting women’s health, while serving only to reduce the number of freestanding abortion clinics in a state, thus reducing access.

However, the primary and most immediate barrier to abortion care for many women is purely economic: the cost of an abortion. The cost for a surgical abortion in the first trimester ranges from $300 – $950. The cost for a medical abortion very early in pregnancy using an abortifacient like mifepristone costs $300 – $800. The price goes up week-per-week as a pregnancy progresses.

When I was a student working my way through college, taking the minimum student loans, and scraping by each month, raising an extra $600 in just a couple of weeks while still paying the rent and feeding myself would have been almost impossible! I’d have had to pick up extra shifts beyond the 30 hours a week I was already working. I think it would have taken me 5 or 6 weeks to earn the money. If I was diligent and found out I was pregnant at 6 weeks*, by the time I’d raised the money, made an appointment, and traversed the needlessly obligatory waiting period, the pregnancy could have progressed into the second trimester – and the price would have progressed right with it. And so I paint the picture of the unforgiving situation of chasing the cost of an abortion.

Because of this impact that cost chasing has on poor women, some prochoice activists advocate “abortion – free, on demand”. Other reproductive health care professionals advocate for increases and expansion of Medicaid coverage to pay for medically necessary as well as elective abortions for poorer Americans. But I, as a Prochoice activist, cannot fully support these position. To explain, I’ll break this motto up into two parts.

Abortion on demand!

When was the last time you walked into a doctor’s office who you’d never met, shook his or her hand and said “I want you to perform procedure X – which requires sedation, maybe a narcotic prescription, and possibly follow up – on me today.” I highly doubt you’d get what you want without an in-depth consultation at the least. Abortion in the first trimester is a minor procedure. But a patient history, pregnancy testing, and consultation is important for patient wellbeing for even minor procedures. Many states, including mine, have enacted a compulsory waiting period between the first appointment with an abortion care professional and the abortion being performed. However, a 24-hour waiting period may not be necessary (and is certainly not effective) for ensuring patient wellbeing.

Waiting periods are just another barrier. Decisions about patient care should be left to the doctor and the patient, without unwarranted intervention by the government. Compulsory waiting periods without careful consideration of and compensation for the burden such waiting periods would have on women with no childcare arrangements,  lacking private transportation or needing to travel great distances to access an abortion pose an undue burden.

Another aspect of abortions “on demand” is allowing abortion at any stage of pregnancy for any reason. Not many people support this position. The United States Supreme Court ruled in Roe v. Wade that a state’s vested interest in the wellbeing of a fetus cannot override the interests of a pregnant woman until such time the fetus could be viable outside the womb – variably 22 – 24 weeks into pregnancy. Most states criminalize third trimester abortions, with exception for when the life of the mother is in danger. (One marked exception is Maryland, which has no such laws on the books and is home to one of the very few late-term abortion providers in the country.)

Though the antichoice movement would have one believe otherwise, the majority of prochoice activists support restrictions on third trimester abortions with exceptions for serious or life-threatening health circumstances and when lethal fetal anomalies are confirmed.

Abortion – for free?

Health care costs money. Many people disagree with the notion of health care as a civil right. Personally, I reject the philosophy that some lives are worth more than others if they have enough money. In my view, some fundamental level of health care is indeed a civil right. As health care costs money, a threshold exists where the obligation to protect the common wellbeing ends and a personal agenda of wellbeing begins.

There will be an estimated 56.9 million Americans enrolled in Medicaid in 2013**. In most states, Medicaid covers an abortion if it is a medically necessary health care procedure. But the majority abortions are arguably not medically necessary. The question in the case of non-medically indicated health care procedures becomes – who is obligated to fund your life? Is the government supposed to take care of you?

Under the Constitution, our government provides vital services for the indigent and those that cannot care for themselves. This does not mean the government (the people) should pay for laser eye surgery because a Medicaid recipient is burdened by wearing glasses. As another analogy, this also does not mean the government is obligated to pay for tubal ligation or vasectomy. Likewise, an elective, non-medically indicated medical procedure does not fall under the financial obligation of our government (the people) to protect the welfare and national security of our country.

The government does (the people do) , however, pay or free contraception access (and in some cases, tubal ligation sterilization procedures) for Medicaid recipients and other qualified persons. This is because our government (the people) takes advice from the medical industry and the experience of our and other countries, which shows that in the long term it is in our best interest to prevent disease and unintended pregnancy rather than fight the symptoms.

Contraception access and comprehensive sex education prevent unplanned pregnancies. Offering elective abortion for free is not a preventative measure, and does nothing to prevent future unplanned pregnancies. A switch from a curative health care system to a preventative health care system is the single most important step the people (the government) can take toward protecting the common welfare of our country.

Offering abortion for free could have additional indirect consequences. If there is no consequence (cost) for needing an abortion, then there is no incentive for preventing unplanned pregnancy in the first place. Sure, there is always the desire to prevent the more uncomfortable symptoms of pregnancy. But if abortion were free, there would be no issue with pregnancy symptoms, because as soon as a woman found out she was unwelcomely pregnant, she could just jaunt right over, have an abortion within a day or two, and rid herself of the symptoms. Studies have shown money to be an effective incentive for eliciting many good behaviors – good grades and weight management for example. Why should avoiding pregnancy be any different?

Bad behavior with no consequences is no bad behavior at all. Personally, I worked quite well to make sure I never ended up pregnant unexpectedly. Neglecting contraceptive measures, getting pregnant, and then footing the people with your unnecessary medical bill is bad behavior. We should all be tasked with assuming a measure of personal responsibility when it comes to our health care. And when we choose to practice safe (or not) sex, we have accepted not only the protection, but also the risk that our chosen contraception method will fail. This is a calculated risk, one for which we should all be prepared to pay.

*More commonly, women discover they are pregnant at between 6 and 12 weeks.

**U.S. Department of Health and Human Services, “Fiscal Year 2013 Budget in Brief, Strengthening Health and Opportunity for All Americans,” http://www.hhs.gov/budget/fy2013/budget-brief-fy2013.pdf

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Author: NuclearGrrl

Nuclear engineer, afro queen, black mamba, feminist, clinic escort, beer aficionado and all around spectacular human being.

9 thoughts on “The Prochoice Case Against Free Abortion”

  1. If there is no consequence (cost) for needing an abortion, then there is no incentive for preventing unplanned pregnancy in the first place.

    But cost is not the only consequence of abortion. The procedure itself is not a walk (or “jaunt”) in the park. A surgical abortion is invasive and can be painful and upsetting. A medical abortion can also be incredibly painful. Not having to have an abortion in the first place is absolutely an incentive for “good behavior.”

    If cost were truly the only thing keeping people “responsible,” then rich women, for whom a few hundred dollars was chump change, would be having abortions all the time. But they aren’t, because if your choice is between “abortion” and “don’t get pregnant in the first place,” you’re going to choose the latter every single time, regardless of your financial situation.

  2. So you think it’s a fair trade-off, that poor women be forced to carry unwanted pregnancies to term just so there’s an extra disincentive to get pregnant?

    I absolutely understand that we don’t want to encourage women to treat abortions as a form of birth control. But as Anna points out above, no one does! Imagine the suffering caused to a woman who is forced to carry a pregnancy to term simply because she cannot afford an abortion. She may well be working the kind of job where taking time off at the end of the pregnancy is impossible. She may already have children who she is struggling to support. Presenting this as a reasonable consequence for “bad behaviour” (which doesn’t sound like a pro-choice position to me!) is frankly inhumane.

    In addition to that, pregnancies do not always occur because of neglecting contraception (even then, the consequence you suggest – forced birth – is wildly disproportionate). They occur because of rape. They occur because no contraception is 100% reliable even if used 100% perfectly. They sometimes occur because they are wanted, and then a change of circumstances (losing a job, losing another child, discovering that a spouse is unfaithful or abusive) means that continuing the pregnancy is no longer desirable. Or do you advocate free abortion only in cases where the woman was sufficiently virtuous about how she got pregnant? Again, that’s not exactly a pro-choice position.

    1. At no point did I imply that a woman who does not wish to be pregnant should be forced to carry to term. My opinion is that the government (the people) shouldn’t be footed with the medical bill unless there is a medical reason the abortion is necessary, as recommended by her doctor, and the person is indigent.
      Not taking care of oneself is bad behavior. If one does not want to get pregnant, or does not want to get a woman pregnant, having sex without any contraceptive measure is bad for ones health – i.e., bad behavior. The likelihood of getting pregnant while using contraceptives is very low; but it does happen. That still does not mean the government should foot the bill. That is a risk every person should be willing to deal with without needing the government to prop one up.

      1. Yet a woman who is too poor to afford an abortion, when abortion is not free, IS forced to carry the pregnancy to term. What do you think happens to pregnant women who can’t afford abortions? They find cheaper illegal options, or they carry the pregnancy to term. Because there is no other option. Because they are forced to.

        It’s a bit like saying “abortion should be legal, but an abortion should cost $1million.” Well, that’s the same as being illegal for almost all but the tiniest fraction of the population. You have the average price of abortions in your blog; that’s about as unaffordable for women living in poverty as $1million abortion is for the average person.

        This isn’t pro-choice. This is wealthy people being allowed to do what they want, and the poor can suffer.

      2. That is your opinion. However, poor women manage to afford these “$1 million” abortions every day without the government’s aid. Our government is not (and shouldn’t be) beholden to supply every health care whim it’s people can manage.

  3. I agree with Anna, and would also like to point out that many women who want abortions are not pregnant because they didn’t try hard enough not to be. Contraceptive sabotage (http://en.wikipedia.org/wiki/Birth_control_sabotage) is a real thing, as well as pregnancy from rape, pregnancy from sexual abuse, and pregnancy because the woman didn’t understand how to use contraceptives effectively–and this is a real problem when many, MANY women don’t have access to comprehensive sex ed.

    1. Our grave deficiencies in educating teens about sexual health issues inexcusable. Additionally, I focused on cases not stemming from abuse or attacks for a reason.

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