Family planning, abortion and welfare reform.
The difficulties the poor encounter in obtaining the means to control their childbearing are a critical case in point. The ability to make decisions about whether and when to have a child is not only a basic right of all Americans, it is a fundamental prerequisite to taking charge of one's life. The overwhelming majority of poor women want to make responsible choices about childbearing, (1) yet society has been unwilling to ensure them access to comprehensive family planning services and, as a fall-back position, abortions, that would enable them to do so. Congress, for example, has failed to provide adequate support for the national network of family planning clinics that is the primary source of contraceptive services for poor and low-income women, particularly teenagers; instead, it has allowed funding for these clinics to drop drastically since 1980. (2) Furthermore, by funding prenatal care and delivery services for Medicaid-eligible women while withholding funding for abortion except under the narrowest of circumstances, Congress for nearly two decades has supported a policy that encourages a poor pregnant woman to have a baby, even when that woman concludes that she is not in a position to raise a child and wants to terminate her pregnancy. (3)
These policies are counterproductive and costly, both for the individuals involved and for the country as a whole. They undermine the ability of the poor to make voluntary, responsible choices about their lives, and they cost American taxpayers millions of dollars annually in medical and social welfare expenses for families of women who were denied access to family planning and abortion services that would have enabled them to avoid unplanned pregnancies and unwanted births in the first place. (4) While these policies have never made sense, their reconsideration has become more urgent in light of welfare-reform proposals that would impose harsh penalties on women based on their reproductive behavior.
Few would disagree that our nation's welfare system is dysfunctional, and that policies enacted by Congress over the years, including those cited above, have had the unintended effect of actually undermining the program's goal of helping individuals make the transition from dependency to self-sufficiency. Yet, the importance of access to reproductive health care as a first step to avoiding welfare dependency is being lost in the rush to enact measures that appear designed simply to force women from the welfare rolls, rather than to help them move out of poverty, which, after all, should be the overriding objective of any reform effort.
Reduction of adolescent pregnancies and out-of-wedlock births is a principal, stated goal of current welfare-reform proposals. In their current form, however, these proposals would attempt to achieve this goal largely by punishing women for bearing children. Some, for example, would "cap" benefits so that a mother could not receive additional benefits for having a child while on welfare. Others would deny benefits altogether to unmarried teenage mothers under age 18 and allow states to deny benefits to unwed mothers aged 18-20. Still others would deny welfare benefits, as well as food stamps and public housing, to unmarried mothers up to age 25. If women are too destitute to care for their children as a consequence of these policies, the answer, according to some proposals, is government-funded and operated orphanages.(5)
Remarkably, not one of the current reform proposals seeks to help women avoid these dire circumstances by ensuring that they have access to comprehensive family planning and abortion services. Moreover, the Republicans' "Contract With America" would revive the "gag rule," thereby preventing poor women from receiving even information about abortion.(6) If these "reforms" became law, the federal government would be in a truly indefensible position: It would use tax monies, as a matter of public policy, to encourage women on Medicaid who become pregnant to have the baby, even when they conclude they cannot afford to raise a child, and then punish those women who give birth by limiting or denying welfare benefits for the child, or even removing the child to an orphanage.
Family Planning and Abortion Services
No one would argue that family planning and abortion services alone are the key to reforming welfare. Nevertheless, their provision on a purely voluntary basis is a simple, cost-effective strategy that would "empower" poor women and, at the same time, have a positive impact on unplanned childbearing and its consequences.
Every dollar spent on publicly subsidized family planning services, for example, saves $4.40 that would otherwise be spent to provide medical care, welfare benefits and other social services to women who by law would be eligible for such services if they became pregnant and gave birth.(7) Yet, Congress has not reauthorized Title X of the Public Health Service Act, the only federal program with the principal purpose of providing family planning services, since 1985. (8) (Although unauthorized programs can still be funded, Congress signals a lack of commitment to a program when it opts to make funding decisions on a year-to-year rather than a more permanent basis.) In addition, it allowed the program's funding to decline by 72% between 1980 and 1992, when inflation is taken into account. Overall funding for family planning services from all public sources decreased 27% during the period. (9)
In spite of sharply curtailed funding, publicly funded family planning services prevent an average of 1.2 million unintended pregnancies, including 509,000 unintended births and 516,000 additional abortions, each year.  Not all poor and low-income women who need subsidized family planning services are reached, however, and the decline in funding has forced family planning clinics to cut back or eliminate efforts to recruit patients, especially those who are hardest to reach, and to conduct education campaigns to improve contraceptive practice.
Undeniably, the use of public funds to pay for abortion has always been controversial. The federal government stopped funding most abortions under Medicaid in 1978; its policy was upheld in 1980 by the United States Supreme Court, which ruled that the federal Constitution permits the federal government and the states to use public funds to encourage poor women who are faced with an unplanned pregnancy to choose childbirth over abortion by covering the costs of prenatal care and delivery but not abortion. However, even some of the justices who supported the decision on constitutional grounds questioned whether a restriction on abortion coverage for Medicaid-eligible women was "wise social policy."(1) Moreover, several states subsequently ruled that such a policy violated poor women's equal protection rights under their respective state constitutions. (12) In addition, cost-benefit studies have shown that extending coverage for abortions to Medicaid-eligible women who want to terminate their pregnancies would save taxpayers more than $600 million in medical and social welfare expenditures over a two-year period. (13)
Hopes were high in 1994 that Congress would rectify the inequity in Medicaid coverage of pregnancy-related services and ensure poor and low-income women access to contraceptive services by enacting comprehensive health care reform that incorporated a package of benefits that included family planning and abortion services for all Americans. That effort failed, and while some state legislatures may continue to focus on health care reform, the prospects for comprehensive reform at the national level in the near future appear extremely dim.
With attention now turned to welfare reform, the overriding question is whether society genuinely wants to help women and their families move out of poverty and become self-sufficient, or whether it simply wants to blame them for their problems and force them and their children off the welfare rolls at any cost. The answer will become clearer when Congress takes up various welfare-reform proposals early in 1995. Will Congress continue to allow funding for family planning programs to languish at the same time it decries the high rates of unintended pregnancy and out-of-wedlock births, especially among teenagers? Will Congress adopt a cap or prohibition on welfare benefits, yet continue to support a policy that encourages--indeed, in some cases essentially forces--women who would be harmed by such restrictions to continue unwanted pregnancies and to give birth by providing free prenatal care and maternity care services but not abortion? Or, will Congress put aside the finger pointing and punitive approaches and adopt policies that give poor women a real chance to take responsibility for their lives?
Purpose of Report
This report examines the reproductive behavior of poor and low-income women and the individual and societal consequences of denying these women Medicaid or other insurance coverage for abortions. It focuses on abortion rather than family planning services because the relationship between access to abortion and poverty and welfare receives less attention, either because the connection is not made or because people are uncomfortable talking about it.
The information presented here comes from a variety of published reports and from special tabulations of data from surveys conducted by The Alan Guttmacher Institute (AGI) and by the federal government. In addition, in the spring of 1994, AGI convened two focus groups of poor women, one in Atlanta and one in Philadelphia, with the assistance of the National Black Women's Health Project and the Kensington Welfare Rights Union. The purpose was to gain insights into the realities of living in poverty and of trying to obtain contraceptive care and to pay for an abortion in the absence of publicly subsidized services.
The report begins by discussing the impact of poverty on women and analyzing the background characteristics of poor and low-income women. It then compares rates of contraceptive use, contraceptive failure and nonuse, and unintended pregnancy among poor, low-income and higher income women. It examines how lower income women resolve an unintended pregnancy and the reasons why those who terminate their pregnancies decide to do so. The report explores the difficulties faced by poor and low-income women, especially those on welfare, in obtaining an abortion in the absence of Medicaid funding. It also looks at the financial implications for the states and the federal government of restoring public funding for abortions for poor women. In conclusion, the report discusses how current proposals to reform the welfare system are unlikely to succeed in reducing adolescent pregnancies and out-of-wedlock births if Congress continues to ignore the importance of access to family planning and abortion services for women striv ing to take control of their lives and lift themselves out of poverty.
Notes to Text
(1.) AGI, 1994a; AGI, 1994b.
Eighty percent of poor women at risk of an unplanned pregnancy use contraceptives. Poor women who have abortions often do so in order to stay in school, to keep a job or to avoid giving birth to a child they feel they are not in a position to raise properly.
(2.) AGI, 1993, p.3; Daley and Gold, 1993, p.248.
(3.) Daley and Gold, 1993, p. 250.
(4.) Forrest and Singh, 1990, p. 13; sources to Table 1, columns 13 and 15.
(5.) Congressional Quarterly, 1994, pp. 3371-3372.
(6.) Congressional Quarterly, 1994, p. 3371.
(7.) Forrest and Singh, 1990, p. 13.
(8.) AGI, 1993, p.3.
(9.) Daley and Gold, 1993, p. 248.
(10.) Forrest and Singh, 1990, p. 13.
(11.) Harris v. McRae, 1980.
(12.) Courts in California, Connecticut, Idaho, Massachusetts, Minnesota, New Jersey and Vermont have ruled that under the state constitution Medicaid must treat abortion and prenatal care equally. A similar ruling was issued in December 1994 in Illinois; at press time, litigation in the case was continuing.
(13.) Torres, et al., 1986; sources for Table 1, columns 13 and 15.
Alan Guttmacher Institute (AGI), Abortions and the Poor: Private Morality, Public Responsibility, New York, 1979.
-----, "Title X Family Planning Clinic Network," unpublished memorandum, New York, Sept. 16, 1992.
-----, "Even as Politics Improve, Challenges Facing Family Planning Providers Mount," Washington Memo, Jan. 12,1993, pp. 3-4.
-----, tabulations of data from the 1988 National Survey of Family Growth, 1994a.
-----, tabulations of data from the 1987 AGI Survey of Reasons Women Have Abortions, 1994b.
-----, unpublished findings from focus groups conducted with poor women in Atlanta and Philadelphia, Apr.20 and May 12, 1994c.
-----, tabulations of data from the March 1992 Current Population Survey, 1994d.
-----, tabulations of data from the 1987 AGI Abortion Patient Survey, 1994e.
-----, tabulations of data from the 1988 National Maternal and Infant Health Survey, 1994f.
-----, tabulations of data from the 1993 AGI Abortion Provider Survey, 1994g.
-----, data from a special tabulation of the 1990 U.S. Census, 1994h.
-----, Sex and America's Teenagers, New York, 1994i.
Althaus, F.A., and S.K. Henshaw, "The Effect of Mandatory Delay Laws on Abortion Patients and Providers," Family Planning Perspectives, 26:228-231,233,1994.
American Political Network, Inc., "New Mexico: Dept. 'Greatly' Expands State Abortion Funding," The Abortion Report, Nov.29, 1994.
Bachrach, CA., K.S. Stolley and K.A. London, "Relinquishment of Premarital Births: Evidence from National Survey Data," Family Planning Perspectives, 24:2732,1992.
Bane, M.J., and D.T. Ellwood, Welfare Realities: From Rhetoric to Reform, Harvard University Press, Cambridge, Mass., 1994.
Bennett, W.J., and P. Wehner, "End Welfare for Single Women Having Children," USA Today, Feb. 1,1994.
Center for Reproductive Law and Policy, "Federal Court Blocks Pennsylvania Medicaid Restrictions," Reproductive Freedom News, Sept.23, 1994.
Centers for Disease Control (CDC), "Effects of Restricting Federal Funds for Abortion--Texas," Morbidity and Mortality Weekly Report, 29:253255, 1980.
Chapin, J., American College of Obstetricians and Gynecologists, personal communication to J.D. Forrest, June 23, 1993.
CHOICE, "An Unacceptable Burden: The Effects of Pennsylvania's Restrictions on Medical Assistance-Funded Abortions," Philadelphia, Sept. 10, 1993.
C.K v. Shalala, "Brief in Support of Plaintiffs' Motion for Preliminary Injunction," Docket No. 935354 (NHP), Civil Action, (D.N.J., Apr.26, 1994).
CNN/USA Today/Gallup Poll, "The New Republican Mandate," Nov. 28-29,1994.
Congressional Quarterly, "House GOP Offers Descriptions of Bills to Enact 'Contract'," Nov. 19, 1994, pp. 3366-3379.
Crepps, J., Center for Reproductive Law and Policy, "Status of Funding for Abortion for Pregnant Women Eligible for Medicaid through Expanded Eligibility," memorandum to P. Donovan, Nov. 7, 1994.
Daley, D., and R.B. Gold, "Public Funding for Contraceptive, Sterilization and Abortion Services, Fiscal Year 1992," Family Planning Perspectives, 25:244-251,1993.
Donovan, P., "The People Vote on Abortion Funding: Colorado and Washington," Family Planning Perspectives, 17:155-159, 1985.
-----, "Family Planning Clinics: Facing Higher Costs and Sicker Ptients, "Family Planning Perspectives, 23:198-203, 1991.
-----, Our Daughters' Decisions: The Conflict in State Law on Abortion and Other Issues, AGI, New York, 1992.
-----, "The Restoration of Abortion Services at Cook County Hospital," Family Planning Perspectives, 25:227-231, 1993.
Forrest, J.D., "Timing of Reproductive Life Stages," Obstetrics and Gynecology, 82:105-111, 1993.
-----, "Epidemiology of Unintended Pregnancy and Contraceptive Use," American Journal of Obstetrics and Gynecology, 170:1485-1489, 1994.
-----, and S. Singh, "Public Sector Savings Resulting from Expenditures for Contraceptive Services," Family Planning Perspectives, 22:6-15, 1990.
Forste, R., L. Tedrow and K. Tanfer, "Sterilization Among Currently Married Men in the United States, 1991," paper presented at the annual meeting of the Population Association of America, Miami, May 5-7, 1994.
Frost, J.J., "The Availability and Accessibility of the Contraceptive Implant from Family Planning Agencies in the United States, 1991-1992," Family Planning Perspectives, 26:4-10, 1994.
Gold, R.B., "After the Hyde Amendment: Public Funding for Abortion in FY 1978," Family Planning Perspectives, 12:131-134,1980.
-----, AGI, unpublished memorandum to J. Rosoff, Mar. 7, 1994.
Hadley, K., Minnesota Housing Finance, personal communication to P. Donovan, June 30,1994.
Harlap, S., K. Kost and J.D. Forrest, Preventing Pregnancy, Protecting Health, AGI, New York, 1991.
Harris, L., "A Survey of Public Attitudes Toward Planned Parenthood and the Supreme Court Decision in Rust v. Sullivan," Louis Harris and Associates, June 1991, Study 912043.
Harris v. McRae, 448 U.S. 297(1980).
Henshaw, S.K., "The Accessibility of Abortion Services in the United States," Family Planning Perspectives, 23:246-252,263,1991.
-----, "Abortion Trends in 1987 and 1988: Age and Race," Family Planning Perspectives, 24:85-86, 96,1992.
-----, and J. Silverman, "The Characteristics and Prior Contraceptive Use of U.S. Abortion Patients," Family Planning Perspectives, 20:158-168,1988.
-----, and A. Torres, "Family Planning Agencies: Services, Policies and Funding," Family Planning Perspectives, 26:52-59,82, 1994.
-----, and J. Van Vort, "Abortion Services in the United States, 1991 and 1992," Family Planning Perspectives, 26:100-106, 112, 1994.
-----, and L.S. Wallisch, "The Medicaid Cutoff and Abortion Services for the Poor," Family Planning Perspectives, 16:170-180,1984.
Jones, E.F., et al., "Unintended Pregnancy, Contraceptive Practice and Family Planning Services in Developed Countries," Family Planning Perspectives, 20:53-67,1988.
-----, and J.D. Forrest, "Contraceptive Failure Rates Based on the 1988 NSFG," Family Planning Perspectives, 24:12-19, 1992.
Kolbert, K., Center for Reproductive Law and Policy, personal communication to P. Donovan, July 20, 1994.
Kost, K.L. and J.D. Forrest, "Intention Status of U.S. Births in 1988: Differences by Mothers' Socioeconomic and Demographic Characteristics," forthcoming, Family Planning Perspectives, January/February 1995.
Maherv. Roe, 432 U.S. 464 (1977).
Minnesota Department of Human Services, "A Market Basket Evaluation of the AFDC Standard of Need: A Report to the 1991 Legislature," St. Paul, Dec. 15,1990.
Moore, K.A., "Facts At a Glance," Child Trends, Washington, D.C., Dec. 1993.
Mosher, W.D., "Contraceptive Practice in the United States, 1982-1988," Family Planning Perspectives, 22:198-205,1990.
Murray, C., "The Coming White Underclass," Wall Street Journal, Oct. 29,1993.
National Governors' Association, "State Coverage of Pregnant Women and Children--July 1994," MCH Update, Washington, D.C., Aug. 1994.
National Network of Abortion Funds, "Summary of Fund Profiles," Hadley, Mass., May 7, 1994.
New York Times, "The Harm in Family Welfare Caps," June 9, 1994.
Omnibus Budget Reconciliation Act (OBRA) of 1987.
Omnibus Budget Reconciliation Act (OBRA) of 1989.
Richard Day Research, Inc., "The Chicago Metro Survey: Attitudes Toward Abortion and Family Issues," Sept. 22-Oct. 2,1994.
Silverman, J., A. Torres and J.D. Forrest, "Barriers to Contraceptive Services," Family Planning Perspectives, 19:94-102,1987.
Standard of Need Advisory Committee, "Report to the Commissioner of Human Services," N.J., Oct. 1990.
Tietze, C., and S.K. Henshaw, Induced Abortion. A World Review, 1986, AGI, New York, 1986.
Torres, A., and J.D. Forrest, "Why Do Women Have Abortions?" Family Planning Perspectives, 20:169-176, 1988.
-----, et al., "Public Benefits and Costs of Government Funding for Abortion," Family Planning Perspectives, 18:111-118,1986.
Trussell, J., etal., "The Impact of Restricting Medicaid Financing for Abortion," Family Planning Perspectives, 12:120-130,1980.
U.S. Bureau of the Census, "Characteristics of the Low-Income Population, 1970," Current Population Reports, Series P-60, No. 81, 1971.
-----,"Poverty in the United States: 1992," Current Population Reports, Series P-60, No. 185,1993.
U.S. Department of Health and Human Services, "Federal Percentages and Federal Medical Assistance Percentages, Effective October 1, 1994 September 30,1995 (Fiscal Year 1995)," Federal Register, 58:66363, 1993.
-----,"Annual Update of the HHS Poverty Guide-lines," Federal Register, 59:6277-6278, 1994.
U.S. Department of Housing and Urban Development, "Schedule B-Fair Market Rents for Existing Housing," Federal Register, 58:51415-51469,1993.
U.S. General Accounting Office, Families on Welfare: Sharp Rise in Never-Married Women Reflects Societal Trend, GAO/HEHS-94-92, Washington, D.C., May 31,1994.
U.S. House of Representatives, Overview of Entitlement Programs: 1994 Green Book, Washington, D.C., July 15,1994.
RELATED ARTICLE: Definitions:
* Poor, low-income, lower income, higher income
In this report, poor is defined as having an annual family income below the federal poverty LeveL--the amount of income determined by the government to be needed to support a minimum standard of living. In 1994, the poverty level was $7,360 for a single person, $9,840 for a two-person family $12,320 for a family of three and $14,800 for a family of four. Low income is defined as between 100%-199% of the poverty level. For a single person, this would range from $7,360 to $14,719, for a three-person family, if would range between $12,320 and $24,639. Lower income refers collectivety to women who are poor or low-income. Higher income is defined as 200% of poverty and above. For a single person, this is $14,720 or more; for a family of three, it is $24,640 or more.
* Race and ethnicity
Race and ethnicity are cross-classified to create three major categories: black non-Hispanic, Hispanic, and while non-Hispanic and other non-Hispanic. Throughout this report, the three labels have been condensed to "back," 'Hispanic' and 'White." Unfortunately, most surveys are not large enough to provide reliable data for smaller groups, such as Asians or Native Americans. For this reason, these groups are included in the third category.
AFOC, or Aid to Families with Dependent Children, is the program commonly referred to as welfare (although there are other welfare programs). AFDC provides cash assistance to needy children and their indigent adult caretakers, who in the vast majority of cases are their mothers. In addition, AFDC families automatically qualify for Medicaid, and most are eligible for food stamps. Although funded jointly by the states and the federal government, AFDC is administered by the states; each state sets its own income eligibility ceiling and level of benefits. As a result, ceilings and benefit levels vary widely. The eligibility ceiling for a family of three, for example, ranges from an annual income of $1,968 in Alabama to $11,076 in Alaska, and the maximum monthly benefit ranges from $120 in Mississippi to $928 in Alaska.
Medicaid/s the federal-state program that pays for medical care for indigent individuals. Like AFDC, it is administered by the states and there is great variation in both eligibility and benefits. AFDC recipients automatically qualify for Medicaid. So do pregnant women and children under age six whose family incomes are below 133% of the poverty level. In addition, states have the option to extend Medicaid benefits to the "medically needy"--individuals whose incomes are below poverty but above the income ceiling for AFDC or who otherwise do not meet the conditions of AFDC eligibility, such as having children and being unmarried. Currently, 35 states and the District of Columbia cover the medically needy, although the income eligibility ceiling varies from state to state. Also, federal law permits states to extend coverage to pregnant women with incomes as high as 185% of poverty; however, coverage for pregnant women ends 60 days after the woman gives birth (except in South Carolina and Rhode Island, which ext end Medicaid coverage for family planning services for 2426 months postpartum). Since 1978, the federal government and most states have denied Medicaid coverage for abortions, except in very limited circumstances.
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|Title Annotation:||welfare reform needs family planning provisions|
|Publication:||The Politics of Blame: Family Planning, Abortion and the Poor|
|Article Type:||Topic Overview|
|Date:||Jan 1, 1995|
|Next Article:||Women and poverty.|