10 May, 10 | by BMJ Group
For most of last year, a van covered in anti-abortion slogans has been parked on the corner of Independence Avenue and 3rd Street in Washington DC. Directly in front of it was the US Capitol, home of Congress, and across the street was the main building of the Department of Health and Human Services. The reason for the van’s presence: health reform. In much of Europe, abortion is not even an election issue, let alone a healthcare issue. In the US, healthcare reform can easily get tangled up with abortion.
The reason for this is the Hyde amendment, passed in 1976, three years after the Supreme Court decision that made abortion before 22 weeks legal across America. The Hyde amendment states that no federal funds can be used to pay for elective abortions. The concern among pro-life members of Congress about the most recent reforms was that federal subsidies paid to middle and low income individuals to help them buy insurance could be used to purchase health plans that covered elective abortion, thereby indirectly flouting the Hyde amendment. Led by Bart Stupak, a Democratic member of the House of Representatives from Michigan, this pro-life faction was hard to ignore because a significant number were Democrats and their votes were crucial if reform was going to pass in the absence of any Republican support.
In the end, a compromise was struck through an executive order that reinforced the administration’s commitment to the Hyde amendment. Executive orders signed by the President do not have the force of law but act as a mandate on the executive branch of government. In the face of national compromise, several states are pushing a more activist stance against abortion. As with other social issues such as gay rights, it is America’s southern states that are leading the conservative charge.
Oklahoma’s recent law requiring women to see an ultrasound image of their foetus before undergoing an abortion has been widely reported. Other states, such as Kansas, have similar but less severe pre-abortion counselling laws that insist that women are told about the stage of development and probable features of their foetus prior to undergoing an abortion. Last month, the Kansas Governor vetoed an attempt by the state legislature to ban late term providers of abortions from setting up clinics in Kansas. This followed the murder last year of George Tiller, one of the few late term abortion providers in the US. While legislation failed in Kansas, similar legislation passed in Nebraska, making abortion after 20 weeks illegal. In contrast to all previous legislation that limits abortion based on the age at which a foetus becomes viable, the Nebraska legislation restricts abortion based on a claim that foetuses feel pain after twenty weeks.
Other states restrict abortion rights simply by making it almost impossible to access abortion services in state. Mississippi, for example, has only one clinic and it performs abortions only up to 16 weeks. Missouri, a state with close to six million people, has only two clinics, both of which are located in urban centres, out of reach of much of the state’s rural population.
Among all this bad news, there is a silver lining for the majority of Americans who support choice for women. With nominations to the Supreme Court now in the hands of the Obama administration, the threat of overturning the decision in Roe vs. Wade that legalised abortion has receded. Under the Bush administration, this threat seemed very real. The appointment of one more socially conservative Republican justice to the Supreme Court could have been enough to overturn it.
Vidhya Alakeson is a former Harkness Fellow in Healthcare Policy who was based in Washington DC until last month.