On May 2, 1927, the Supreme Court decided that the state-sanctioned forced sterilization of people with disabilities in public institutions is constitutional. Ninety-seven years later, the horrific precedent set in Buck v. Bell remains the law of the land. Due to ableism, sexism, racism, and other mutually reinforcing systems of oppression, people with disabilities face innumerable barriers to sexual and reproductive health equity. These include refusals of care and other health care discrimination, Medicaid eligibility and service gaps, reproductive coercion, and accessibility barriers. In this blog post series, the National Health Law Program highlights current barriers and opportunities for change.
Too often, people with disabilities, who make up over a quarter of the U.S. adult population are left out of conversations about abortion access. Personal liberty, bodily autonomy, and self-determination are core values of the disability rights movement. Self-determination includes an individual’s right to choose whether or not they become a parent, which is undermined by threats to abortion access. People with disabilities deserve the right to self-determination over their bodies, including through access to abortion. People with disabilities may have different reproductive needs, and be disproportionately harmed by restrictions on abortion. For example, people with disabilities are more likely than people without disabilities to experience maternal morbidities (e.g., preeclampsia). Disabled people also have an 11 times higher risk of maternal death. Pregnancy can also complicate treatment options for those with chronic health conditions because the best available medications or treatments may not be safe for them during pregnancy.
Abortion is essential health care, yet oppressive policies like the Hyde Amendment place abortion access out of reach for many people with disabilities. Since 1976, this Congressional appropriations bill rider has barred the use of federal funds for abortion except in cases of rape, incest, or life endangerment. This means Hyde functions as a de facto abortion ban for many Medicaid and Medicare enrollees who cannot afford to cover the cost of the abortion and related costs, such as childcare and travel. This particularly harms people with disabilities who disproportionately get their health insurance coverage through Medicaid, because they face economic insecurity and because other health insurers fail to meet their needs.
Insurance coverage through Medicaid is crucial to achieve equitable access to abortion because its costs can be devastating to the economic stability of the pregnant person and may cause them to forgo the abortion altogether. According to the Turnaway Study, which looks at the consequences of abortion denials, people who are denied abortions are four times more likely to live below the FPL. For a disabled person with a low income, it might be impossible for them to afford travel to another state to receive an abortion, resulting in the possible continuation of a pregnancy that may place their life or health at risk.
Barriers to abortion access for disabled people have only grown since the Supreme Court overturned the constitutional right to abortion in the Dobbs v. Jackson Women’s Health Organization ruling, as many states have implemented total or near total bans on abortion. Furthermore, ongoing litigation continues to stoke confusion over whether abortions are permissible in the narrow life endangerment exceptions. This has caused a chilling effect on providers who are referring people for out-of-state abortion care or are waiting until people’s conditions deteriorate so that the abortion can be considered a medical emergency. This has unique implications for disabled people who may be unable to easily travel long distances, especially if they have a physical disability.
The Dobbs decision has also undermined access to care for people with disabilities and chronic health conditions. For example, a pregnant woman in Kentucky was unable to obtain an abortion after being diagnosed with cervical cancer and underwent a less effective treatment plan because the standard treatment, high dose radiation, is unsuitable for pregnant patients. Similarly, in the wake of Dobbs, people have been denied access to prescription medications needed to treat chronic conditions such as rheumatoid arthritis, certain cancers, and psoriasis, because the medications are conflated with abortion.
Abortions restrictions such as the Hyde Amendment prevent meaningful access to abortions for disabled people. Congress must mandate Medicaid abortion coverage in all circumstances through legislation like the Equal Access to Abortion Coverage in Health Insurance (EACH) Act in order to bring us closer to health care equity for people with disabilities.
