According to the Guttmacher Institute, roughly 75 percent of those who get abortions are poor or low-income — not necessarily a surprise, given the lack of access to affordable preventative health care and contraception. Unlike most medical procedures, the majority of states don’t cover terminating a pregnancy through Medicaid (with very narrow exceptions), leaving patients to pay for the procedure out of pocket. But for low-income patients — especially in rural areas across the country — finding the funds to pay for an abortion out of pocket is quite literally only half the battle.
The other half? Paying to get to the procedure itself — a task that can cost hundreds of dollars on its own and eat up hours, if not days, of travel time in states that lack usable local public transit systems or mass transportation between rural and urban areas.
Nearly 20 percent of poor people lack their own vehicle, and the same states that pass paternalistic abortion restrictions are also the states least likely to spend infrastructure funding dollars on mass transit, considering it a form of “social welfare” for those too poor to own cars. States like Mississippi, Missouri, or Kentucky, which have just one clinic each, lack usable public transit within their borders, or easy access into major cities from suburbs and rural towns via train, light-rail, or even major bus lines.
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The limited number of abortion clinics — often paired with face to face waiting periods that are anywhere from one to three days apart — and the shortage of transportation infrastructure means that low-income patients without a car are often forced to hire taxies and other car services, rent vehicles, or navigate an expensive bus or train schedule at a time when they are emotionally and in some cases physically vulnerable, too.
“We’ve had patients use Uber to get to [Jackson Women’s Health Organization] in Jackson [Mississippi] from Oxford or Hattiesburg,” Laurie Bertram Roberts, director of the Mississippi Reproductive Freedom Fund, told TalkPoverty. “I didn’t even know you could go that far.” The cost? Around $200 for a 90-mile trip.
The logistical challenges quickly pile up. Alabama — which has three clinics spread throughout the state — has Amtrak, but the route through the state is limited and scheduling is difficult. This makes navigating the transit options a search for the right combination of trains and bus routes — often shuffling the same patient from bus to train and back again. Abortion funds — organizations that offer financial support for those seeking out a pregnancy termination — can offer gas cards, but that still requires patients to have a car to begin with. For those in one-car families, that also means letting another family member or friend into a very private, personal decision, too.
Amanda Reyes, co-founder of the Yellowhammer Fund, an abortion funding and practical support group for pregnant people in Alabama, said for patients outside a city — even just in the exurbs of the cities that do have clinics — renting a car is often the only solution. But for people who are low income and lack not only the funds for renting but also the credit cards, debit cards, or checking accounts needed to rent a car in the first place — about 20 percent of Americans are considered “unbanked or underbanked” — this can be nearly impossible. Because of Alabama’s requirement that patients visit a clinic and then wait 48 hours before returning for a termination, the car is needed for multiple days; the Yellowhammer Fund typically rents cars for a week.
“That’s why we got ourselves a van,” said Roberts. Now, with a van that can get patients from far out cities or towns to the only abortion clinic in Mississippi, Roberts is able to help some patients avoid that extra expense. It’s assistance that no doubt means even more to some local abortion patients who may hire a cab from one of the city’s taxi companies only to have it arrive with “Choose Life” etched into the side of the car’s body, according to Roberts.
Getting to a clinic without a car is a nightmare even when the provider itself is only a 15-minute drive away. Hiring taxis, Uber, or Lyft always means providing a name, and often a home address, to a driver. That can be especially difficult when ride app drivers refuse to serve neighborhoods that are predominately black or even refuse a ride once they realize the client is a person of color, as once happened with one of Roberts’ clients. In St. Louis, where Missouri’s only abortion provider is currently fighting the state to keep its doors open (it was just granted permission to continue operating until early August while it awaits a final decision), getting from a home in the north side of the city to the St. Louis Planned Parenthood can take hours, simply because the busing system exists as a means of keeping neighborhoods segregated from each other, rather than interconnected.
“The bus system is woefully underfunded and not super accessible for most people,” explains Alison Dreith, former executive director of NARAL Pro-Choice Missouri and current deputy director for Hope Clinic in Granite City, Illinois, which is just 10 minutes across the river from St. Louis. “It doesn’t go into North St. Louis, which is primarily a poor, black community. It would take multiple buses and transfers. It’s not just accessible.”
Then there is the more complicated — but not entirely rare — case of the patient who is worried about domestic violence, abuse, or has other safety concerns that make it necessary to hide the entire process from their partners, families, or the person who got them pregnant. “I spent 45 minutes calling every rental car agency in Birmingham,” Reyes told TalkPoverty, explaining the extra steps required to help a patient who was getting an abortion without informing an abusive spouse, and who needed to cover her actions along the way. “She couldn’t take a bus, she needed to rent a car, and she needed to be able to do it using cash so he wouldn’t see a charge for it. To get a car that way, you have to call the day before to see if anything is available.”
Cash-only rental cars often require the cash upfront, in addition to $300 or more in deposits in case of damage or theft. While an abortion at seven weeks would only be around $600, the costs for travel and other support were expected to be nearly three times that amount for Reyes’ client. It is just one of the many ways that a patient can be blocked from obtaining an early abortion and instead require a termination in the second trimester, instead, where the cost of an abortion rises with each additional week of gestation.
Getting the money for an abortion when you are poor and in a conservative state or rural community is only half the battle. Without an adequate public transit infrastructure, those with the ability to afford a termination may become trapped in pregnancies they do not want, simply because they lack the means to make it to their appointments. And the same legislators who have starved off transportation infrastructure in the name of rejecting “social welfare” will then deny those pregnant people any medical assistance, accessible contraception, living wages, childcare or safe housing, all while being the ones who forced them into this impossible situation in the first place.