By Julie Zaebst, Senior Policy Advocate, ACLU of Pennsylvania
On a recent day in March, a group of our staff was glued to our phones in anticipation of the Georgia state House vote on a draconian anti-abortion bill. The bill would ban abortion at six weeks gestation — a stage before most people even know they are pregnant. But as this circus was unfolding in Georgia, we were also preparing to spend the day at the Philadelphia Women’s Center, getting an inside look at what it actually means to provide abortion care under the current regime of restrictions and red tape in Pennsylvania.
The Philadelphia Women’s Center is an independent abortion provider that has been providing first- and second-trimester care for more than 45 years. Every day, their staff arrives at work prepared to navigate byzantine laws and regulations that were designed to make their jobs of providing safe, compassionate, and timely abortion care difficult. But despite the politically motivated restrictions, they’ve developed systems to make the experience as seamless as possible for patients.
By the time patients arrive for their appointment, they have already cleared countless hurdles. First, they must locate a provider and get themselves to the office. With more than 85% of counties in Pennsylvania lacking an abortion provider, this is no small feat. The number and locations of abortion providers is not a reflection of the need for care; rather, it is a reflection of the challenges of opening and operating a clinic, a task made more difficult by restrictions the state imposes only on abortion providers and not on other similar healthcare providers.
Of course, patients must arrange time off from school or work for their appointment. For low-income folks, this may mean a day without pay that their family counts on for survival. The majority of patients are already parents, so securing affordable childcare is often another obstacle that they face.
State law imposes a mandatory delay on patients: at least 24 hours before their procedure, they must receive state-directed counseling from a provider. The Philadelphia Women’s Center offers a couple of options to make this process as least burdensome as possible to patients. But if a patient misses their counseling session and they can’t reschedule quickly enough to satisfy the waiting period, they have to cancel their procedure and restart the scheduling process.
Perhaps the biggest barrier of all is the ban on insurance coverage of abortion care. During our visit, we had the chance to read patients’ entries in journals that the center provides in their waiting room. Many of them shared that their decision to get an abortion was driven by financial circumstances — they simply couldn’t afford to raise a child (or, in many cases, another child). According to a study by Guttmacher Institute, 75 percent of the people who received abortion care in 2014 were low-income.
Still, PWC staff must break the news to most of their patients that their insurance will not cover their procedure because state and federal law prohibit Medicaid from covering abortion care in most circumstances.*
Because most patients who are insured through Medicaid must pay out of pocket, some may wind up “chasing the fee,” as one staff member explained to us. A patient may take a few weeks to scrape together the money needed, only to find out that the cost of care has increased because they are now further along in their pregnancy — so they have to go back to the drawing board.
A patient must navigate all these barriers before they even arrive at the center for their procedure. And for some patients, the hurdles are even higher: for incarcerated folks, for instance, or for young people, who must obtain consent from a parent or get a judicial bypass.
When they arrive, patients will likely be greeted by anti-abortion protesters outside the clinic — but also by escorts, who help them make their way inside safely. There, staff will welcome them and prepare them for their procedure.
What we observed during our visit were dedicated, compassionate medical providers doing what they were trained and committed to doing: providing healthcare. The only difference we saw between the Philadelphia Women’s Center and any other healthcare facility? Doctors and patients — those who know best — face politically motivated restrictions and interference.