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Commentary discusses Hyde Amendment's 'emotional and cultural' toll

In a Rewire commentary, columnist Steph Herold discusses the "emotional and cultural effect" of the Hyde Amendment, "a sneaky rider" that restricts Medicaid as well as other government insurance programs from covering abortion care.

She explains that beyond "poor health outcomes," especially for women of color and low-income individuals, the amendment "contributes to a culture rife with abortion stigma." She writes that Hyde has allowed "people with power and authority, like lawmakers, to invent an artificial divide between abortion and all other forms of health care." According to Herold, "Abortion is the only medical service singled out by the government as not required to be covered by Medicaid or private insurance." In turn, "[t]his deliberate marginalization of abortion makes it seem like there's something different about abortion, that it's not like other forms of health care, despite abortion being one of the safest and most common services a person can have," she writes.

Moreover, the amendment has "made it acceptable for lawmakers and the public to debate reasons for seeking an abortion." Specifically, Herold highlights the significance of the law's "'acceptable' clause," which "promotes a core component of abortion stigma -- labeling certain abortions as worthy of public funds and public support, and others as unworthy and shameful." In addition, Herold notes that Hyde promotes "institutional-level stigma" around abortion care, "in which a public system (such as Medicaid) and the actors within it reinforce the stereotyping, labels, and discrimination that contribute to the stigma."

According to Herold, the "mandate that some reasons for abortion are socially sanctioned through Medicaid coverage, while others are not, negatively affects people's experiences when accessing abortion." For instance, Herold notes, "It's possible that having to ask family, friends, and strangers to help pay for an abortion may strain relationships and even place people in danger."

Yet "[t]he obvious cultural implication of the Hyde Amendment is the emotional effect it has on people enrolled in Medicaid, people who are trying to make ends meet," Herold continues. She draws attention to the experience of rape survivors with Medicaid coverage, noting that Hyde "causes trauma for people who need to go through the arduous, painful task of 'proving' that they are the victim of rape in order to be eligible for insurance coverage of their abortion." She adds that Hyde also "may contribute to increased internalized stigma for people seeking abortions."

Citing a recent study, Herold adds that "very few, if any" television depictions of abortion "made reference to a character's financial situation as a reason for choosing abortion." However, the findings are "in stark contrast to reality," Herold explains, pointing to research that shows about three-quarters of women seeking abortion care "cite their economic circumstances as a top reason." Herold states, "By refusing to show TV characters who wrestle with the limitations that poverty places on reproductive decision-making, popular narratives ignore the lives of many women who have abortions, another cultural ramification made possible by the Hyde Amendment."

Further, Herold draws attention to a 2012 study that found that women with Medicaid coverage who had received abortion care "expressed overwhelming support for Medicaid covering abortion," but "used disparaging language to talk about people needing abortions in certain circumstances, even situations that mirrored their own." Herold writes, "The Hyde Amendment reinforces the stigma associated with both abortion and poverty, ... which for women of color is also compounded by systemic racism, exemplified by poor access to high-quality health care in neighborhoods with a majority of people of color, and health-care professionals treating women of color in a way that could jeopardize their health."

Herold also highlights efforts to end Hyde as the amendment nears its 40th anniversary this month. For instance, she spotlights the work of All* Above All, "a coalition led by women of color and reproductive justice advocates, [that] is playing a pivotal role by introducing pro-active abortion access legislation and encouraging elected officials to come out against" Hyde. In addition, Herold notes "a shift in how we think and talk about abortion thanks to countless storytellers and advocates joining force." She points to a recent poll that found that the majority of voters in eleven states agreed with the statement: "'However we feel about abortion, politicians should not be allowed to deny a woman's health coverage for it just because she's poor.'"

Noting how Hyde "has woven abortion stigma into the fabric of how we think and talk about abortion in the United States," Herold concludes, "To remedy that, we need to focus both on repealing Hyde and also creating deep-seated cultur[al] change to eradicate abortion stigma" (Herold, Rewire, 9/20).