The nomination of Brett Kavanaugh to the Supreme Court and threat to Roe v. Wade is cause for considerable concern for the future of legal abortion in the United States.
But we don’t have to imagine what could happen in a post-Roe America. There are many current policies that already push abortion out of reach.
For example, the 42-year-old Hyde Amendment bars Medicaid coverage of abortion except in limited circumstances. This is a substantial barrier for low-income women since the out-of-pocket cost of an abortion is more than one-third of the monthly income for about half of patients, forcing them to forgo other essentials, such as rent and utilities. Restricting Medicaid coverage forces one in four poor women seeking an abortion to carry an unwanted pregnancy to term.
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This matters from a public health perspective. Abortion is considerably safer than childbirth. Research clearly shows that being unable to obtain an abortion leads to pregnancy complications such as eclampsia and hemorrhage, higher rates of infant death, domestic violence and adverse socioeconomic consequences.
Most low-income women who are unable to obtain an abortion will raise the child and will need public services to thrive.
Fortunately, California, along with 16 other states, has stepped in to provide this important insurance coverage for abortion. That also creates opportunities for our public health leaders to take bold action to implement a 21st century public health approach to abortion in California.
This could include taking steps to increase local access to abortion care. It could mean ensuring that Medi-Cal covers the latest innovations in abortion care. California officials could step into leadership roles in national organizations to bring the most recent evidence to colleagues in other state or local health departments and to communicating the public health importance of Medicaid coverage of abortion.
Concern about a post-Roe environment is timely. But rather than worry about the future, Californians who value the health and well-being of women and their children can take action now.