First Person

I Gave Up My “Poor People” Foods. But I’m Keeping Soda.

When my two childhood best friends and I were kids, we would toast two pieces of bread, spread butter across them, and coat them in cinnamon sugar to curb our hunger if we were between grocery trips and our parents didn’t have much in the house. We also ate cheap ramen noodles, plain pasta with butter, canned tuna, bologna sandwiches, Celeste $1 frozen pizzas, McDonald’s value menu sandwiches, and we drank a lot of soda.

I’m no longer poor like I was growing up, and I generally have more meal options; even at my brokest moments in the last five years, I’ve been able to afford a basic meal at Panera Bread. I’ve since given up a lot of the poverty foods that I grew up with, mostly because I find other options tastier and, like many millennials, I’m more willing to spend my money on food than my parents were. When I first tried sushi in 2008, I loved it enough to work it into my shopping list occasionally despite the high price; I’d rather have one serving of sushi than eight Celeste pizzas for the same price. But I still drink at least two cans of Coca-Cola every day, and I’m not planning to stop anytime soon.

Soda, like the other inexpensive foods that many poor people rely on, is frequently demonized. It’s often cited as a health risk for weight gain, which is a fatphobic tactic that ignores the fact that being overweight is not directly linked to health problems. And alternatives to soda that many people suggest, such as fruit juice, often contain the same amount of sugar and calories as soft drinks.

Still, these attitudes persist. Soda is taxed in over 35 countries and seven U.S. cities, and these taxes continue increasing; Washington, D.C. is currently considering raising taxes on sugary drinks. I’m often told by well-meaning friends and family about the amount of sugar and calories in the soda I drink.

After the second or third time I laugh off my soda habit by opening another can in the face of a dissenter, they usually get the picture and chalk it up to one of my quirks. I’m very privileged to be able to do that: I’m white, thin, and no longer live in poverty. When I was living on cereal and cinnamon toast, it was harder to rebuke people’s comments about what I ate; I had no choice. If I didn’t eat that one dollar chicken sandwich, I wasn’t going to eat dinner that night. If I let the sugary cereals expire, it was valuable money wasted. Growing up, I didn’t even have enough money to maintain a diet consisting of foods that don’t cause my disabilities to flare up, which I realized when I finally had the financial freedom to give up red meat in 2011 and stopped experiencing weekly stomach aches.

When you’re poor—especially if you’re also fat, disabled, a person of color, an immigrant, or from another marginalized background—the world feels entitled to share its opinion of every choice you make. What cell phone you use. How you pay your bills. How often you go to the dentist. What foods you put in your grocery cart, and how many of them you have to put back at the end of the trip because you’ve run out of money. Whether you pay for those groceries with SNAP.

Poor people have fewer choices; there are so many things I can do now that I couldn’t do when I was poor. I can spend a few dollars to rent my favorite movie on Amazon Prime, save up enough for a weekend trip to Maine with my best friends, take an Uber or Lyft when my body is in too much pain to walk ten minutes from the train station to my home, and eat sushi with my wife when one of us is craving it.

I’m not planning to give up soda.

Every choice you make when you’re poor is more likely to be criticized by other people (“Why would you buy your sister a birthday gift when you can barely afford groceries?”). These choices also carry more weight: What if you decide to buy her that gift she really wants and then you’re stuck eating rice for weeks? It’s easy to judge poor people’s choices about what to eat and drink because these decisions are so visible, but sometimes getting a vanilla Coke with your Wendy’s chicken sandwich is the best choice you’ve been able to make that week. I remember sitting down with my dad to eat Pizza Hut, knowing he’d recently been injured in an accident at work and was having a hard time making enough to pay our bills. I ate pizza and watched Shameless with him, thinking this might be the last time we’d get to do this for a while if our cable and electricity were shut off. Maybe we could have kept the $10 (plus tip) we spent on pizza, but it wouldn’t have paid our bills. It wouldn’t have helped my dad, an independent contractor cab driver, figure out a way to work when he couldn’t physically drive.

Research shows that escaping poverty requires 20 years with nearly nothing going wrong. I haven’t reached that milestone yet, but I’m better off economically than my parents, a disabled mom on SSDI and a cab driver dad, were when I was a kid. My dad used to choose our meals based on what was on sale; I choose my meals based on what my wife and I are in the mood for. Do we want chicken or fish? Do we want fresh blueberries or frozen vegetables? I rarely eat fast food as a meal anymore (if I do eat it, it’s usually because I’ve been out drinking with my friends and it’s 2 a.m.). But I’m not planning to give up soda. As my wife’s aunt recently joked, I have a glass of Coke in the morning with my breakfast in lieu of coffee or tea.

Nothing tastes as comforting as freshly poured fountain soda with crushed ice. Maybe it’s the nostalgia from my childhood memories of drinking soda and eating pizza on the couch with my mom, who passed away in 2004, as we watched reruns of Seinfeld. Maybe it’s the satisfaction of thinking about haters clutching their pearls as I ingest what they would denounce as pure sugar and empty calories with my fresh salad.

Maybe there’s a kind of power in having enough money to choose any beverage, but still choosing the one that costs $1 any size at McDonald’s. I may not go through the drive-through often anymore, but I always know that it’s there waiting for me, like a crispy slice of cinnamon toast with my best friends on Saturday morning.


First Person

I Ate Lobster On Food Stamps. It Was Delicious.

 I was a food stamp kid for a few years in the early 1990s when my mom started college. I remember the first time we went to the H-E-B grocery store in the South Side of San Antonio with our stamps. We always drove to a store in the next neighborhood over to shop. My mom had worked at the closest H-E-B when she was pregnant with me. People she went to high school with shopped there and so did her former in-laws. There was no way my mom was going to walk into that store with a wad of food stamps. We felt enough shame that we needed the help without adding in other people’s judgement.

It wasn’t like it is today, where people get a debit card nearly indistinguishable from a Visa or Amex. Back then, we were given books of bright red or blue coupons, which were slightly smaller than dollar bills. You weren’t supposed to separate individual stamps from the booklet ahead of time, which meant that you had to stand at the cash register and count them out and sign each one, publicly. She was ashamed that we needed them, and so was I.

Once, when I was in middle school, a kid dropped a red food stamp on the playground, and our gym teacher snatched it up and held it above his head, loudly calling, “Who dropped their food stamp? Can’t go to the store after school and buy yo mamma’s groceries if you don’t have her food stamps!”

No one took it. It wasn’t mine, but I thought about claiming it anyway. It was a dollar. It would buy fruit. You could get a pomegranate for a dollar at the store, and I was on a pomegranate kick.

It is easier to implement cruelty if you don’t think of those you’re being cruel to as good people. If you think of the cruelty as “tough-love” or as teaching people to pull themselves up by their bootstraps, then you don’t see it as cruel at all. To the Trump administration, being poor is a character flaw. It is worthy of shame. A flaw for which they have no problem punishing people for, even children, the elderly, and the disabled.

The first time my family shopped with our food stamps, we bought grapes, Roman Meal bread, cheddar cheese, romaine lettuce instead of iceberg, peaches, and a lot of hamburger. And a lobster and a pound of butter and some lemons. The lobster was on sale since they tended to hang around the tank for a long time at the H-E-B in southeast San Antonio. I remember exactly what we bought, even 30 years later. We feasted that night. I remember cracking open the claw, startled at the creaminess of the flesh, dripping with butter and tart from lemon juice.

Shaming people others them.

To be clear, we weren’t destitute. We were broke and lived off poor people food, like canned butter beans and potatoes stewed in milk and covered in ketchup, and Little Debbie Snack Cakes. My dad rarely paid child support and my mom was working and going to college full-time. We were in the same situation as millions of families now who use SNAP. Food stamps were a step-up to better nutrition, including the one-time lobster.

Most of the kids in my elementary school qualified for food stamps, so most of us also qualified for free or reduced breakfast and lunch. There were separate lines for kids who paid the reduced or free rate. Even knowing that we were all poor, there was still so much stigma and shame attached to using that checkout line. So much that rather than deal with it many of us used the change meant for lunch for vending machine snacks instead, or just didn’t eat. A generation of kids raised on Flamin’ Hot Cheetos and Snickers bars lunches. Eventually, the entire school district was allowed to serve everyone reduced or free lunch since such a large percentage of us qualified, and they removed the separate reduced/free lines. Suddenly there were a lot more kids in the cafeteria and fewer hanging out by the vending machines.

It’s easier to be cruel to someone who you’ve made feel ashamed. Shaming people others them. It creates a divide in their mind between themselves and poor people. It makes it easier to believe that poverty is the result of bad choices and decisions, not a capitalist system that’s out of control. This way, it could never happen to them. People who support SNAP cuts aren’t afraid of poor people, they’re afraid of BEING poor. When my coach was teasing us about food stamps, I imagine that it made him feel better somehow, to feel apart from all the poor kids. Especially since his salary made him food stamp eligible, too.

In my case, my mother graduated from college and went on to become a high school teacher. We moved from the neighborhood I grew up in to across town for a new start. I went to college at seventeen, then culinary school, then graduate school. I married, had a child, and became disabled. Neither of us have gone back on SNAP.

I am a success story because of public assistance, and I am no longer ashamed. Food stamps saved my family when I was young. They save families every single day.


First Person

Chicago’s South Side Was Covered In Candy Houses. Now They’re Dying Out.

Candy houses are quintessential to Chicago summers. Back in the ‘90s, when I was a child, a kid could go to any South Side community and find local homes that doubled as candy stores. They sold sour and hot kosher pickles, fruit chews, chewy sour balls, Flamin’ Hot Cheetos with cheese and, if you really had the money, with cheese and beef. There was so much to choose from, including the lemon and strawberry cookies that no one could name, but everyone remembers.

“I would buy Flamin’ Hots with melted cheese and ground beef and that was like a whole damn meal. We would buy penny candy, lemon and strawberry cookies, snow cones. We would buy anything related to snacks or junk food now that would be a health hazard,” said Val, a Black South Side native who has lived in Chicago her entire life.

A candy house is a business run by a homeowner who sells candy and snacks. But they were also a source of fun for children and income for women in areas of Chicago the media consistently portrays as violent, unhealthy, and poor, and that have suffered due to policies that hurt Black homeownership, exacerbate segregation, and affect food quality.

According to the Racial Justice Project, Black people have access to half as many grocery stores as whites. Many big grocery store chains avoid low-income spaces altogether.

But we had candy houses. They were symbolic to South Siders.

There are no longer as many as there used to be, though. Growing up, there was a candy house across from my elementary school, then called Myra Bradwell, on S. Burnham Ave. Whenever I had the money, my favorite things to purchase were sour candy balls, specifically the blue ones, and dill pickles. The store wasn’t always open, but when it was, there were always children purchasing candy and running to school. It’s gone now.

In 2006, while I was in high school, another candy house existed for about four months in the summer. I used my money from an after-school job and bought tons of candy and chips to eat each day. But that candy house also closed. I knocked on the door, and the woman simply said that she was no longer selling candy, and that was the end of that.

They provided women money without strings attached.

Traditionally, people on the South Side of Chicago purchased their candy from one wholesaler: L&P Foods, located on 7047 S. State St. And despite median Black household income in the ‘90s being just $21,420, money never seemed like a problem when children and candy were involved.  Depending on the candy house, a child could receive candy on credit, an adult would purchase candy for neighborhood children, or other children would purchase candy for their friends.

This was the case with Etholia, 33, a former Auburn Gresham resident, who with $10 in her pocket shared her wealth with other children. “It had to be third grade and I told everybody that they could get something, all my little friends. We spent that money up and I almost got in trouble. When I came home, they asked, ‘Where’s your [money]?’ I was like ‘Oh, I spent it at the candy store,’” she said.

When children and adults purchased candy for other children it was a way to look out for each other. Doing so built a community of trust and brought people together, because the same people buying candy were also looking out to make sure you didn’t get into trouble, that you made it to school, and that you felt safe. Purchasing candy for children was more than a kind act. It was built on a foundation of Black traditions of acceptance and care.

And the houses were about more than just community building. Economically, they were important to Black ownership, and Black women were the center of the business.

“As far as I knew [it was] women. I never knew any men running it. Also, their older kids too,” Val said. “It was clear that many of those women were much older, and they didn’t have the sort of income that we have now, so candy houses were a way for them to get extra money.” In Chicago in 2016, only 2 percent of businesses were Black-owned despite Black people being 17 percent of the population.

Not only did these businesses provide extra income for necessities, they provided women money without strings attached.

“[My grandmother] loves money. I admired the hustle in her and that was her way to make extra income, because my grandmother was a [stay at home mom]… so she never really had income of her own,” La’Shon, a fourth generation South Side native, said.

The young relatives of these women also received a benefit, because children of candy house owners received automatic “cool” points from their peers.

“It gave me some type of extra street cred because my house was the candy house. If your house was the candy house, it put you on another level because your house was the house,” La’Shon said.

There is no single reason why candy houses are no longer as widespread. But among them are candy house owners growing older and retiring, safety concerns in Chicago’s enclaves due to the small population of violent offenders, and the ease of internet shopping.

“We have different type of community now. A lot of people who were not a part of the community infiltrated the community and made [corner stores] that really were the antithesis to those candy stores,” Val said. “[Illinois] started cracking down on people having businesses in their home, so people would actually get in trouble for it.”

“I think now everybody doesn’t live by the code, which is ‘don’t snitch when it comes to that.’ People are scared of getting shut down,” Etholia said.

The rise of internet commerce has also played a role in making candy houses a thing of the past. “The internet,” La’Shon said. “It’s definitely the major reason. I couldn’t tell you where a candy house is today… and I can go on the internet and buy chews, Frooties, and all those unique candies that I couldn’t find anywhere else. I can go on the internet and buy it now.”

With so many changes in communities and technology, these Black-owned businesses may never see their former glory. However, what will never change was that they built community and long-lasting memories that bonded communities together.

“Just knowing that we grew up in a time where you had a community, you had people that you could go to, you had people you could talk to, you had places where you could get fresh air and run around and be silly and be a kid,” Val said. “And I don’t necessarily think that a lot of times we think about Black children being children and that was the moment we were not held to this inhumane standard. It makes me think how wonderful it was to at least have some form of childhood and think about happy experiences.”



Minimum Wage Increases Are Great. But Only If Workers Actually Get Them.

New Year’s Day 2020 made history for workers, as minimum wage increases went into effect in 47 states, cities, and counties.

But when cities and states take action to raise wages, they often ignore a pretty obvious problem: across most of the country, employers routinely skirt paying the minimum wage, overtime wages, or contractually promised wages, with little fear of facing consequences.

When the Broken Laws study surveyed 4,387 workers in 2008 across Los Angeles, Chicago, and New York in low-wage industries like hospitality and domestic care, they found that 44 percent had been paid less than the law required within the past year. In 2017, the Economic Policy Institute estimated that employers steal $15 billion annually from workers by paying less than the minimum wage.

Two basic facts add up to create an environment where wage thieves operate with impunity. The first is that most wage thieves will never be caught. Workers often fear retaliation for speaking up or don’t have the resources they’d need to file a complaint or bring a lawsuit. And only a handful of local or state wage theft enforcement agencies have demonstrated an effective strategy for tracking down wage thieves, explaining why in places like Houston, Texas, and Charlotte, North Carolina, a typical year might only bring a single successful wage theft prosecution.

The second is that even when wage thieves are caught, our legal system protects business owners at the expense of workers: wealthy individuals and profitable companies get ample opportunity to claim they just don’t have the money to pay workers what they’re owed. A 15-state investigation by Politico found that workers who won their wage theft lawsuits only ultimately recovered 59 percent of the money that judges or juries had agreed they’d been owed. In New York City, ten delivery workers won a $700,000 wage theft ruling against the restaurant Indus Valley — although these workers started their complaint in 2008 and won their lawsuit before a federal judge in 2014, they say they’ve collected only about 15 percent of what they’re owed.

These are both solvable problems if we’re willing to change a legal and economic system that stacks the deck against working people.

Catching Wage Thieves In the Act

Workers know complaining about unpaid or underpaid hours can mean risking their jobs or getting shunted into a less favorable schedule. According to a 2019 report by the National Employment Law Project, 45 states lack one or more of the provisions of an effective anti-retaliation law.

Undocumented workers are especially vulnerable to retaliation. Speaking about undocumented workers in Houston, Texas, Josef Buenker, a private employment lawyer, said, “I can’t count the number of times workers have told us that that it’s an overt threat used against them, [when bosses say] ‘I’m going to report you to ICE, what are you going to do about it?’” He added, “We regularly meet with people who want to pursue their claim, but then they go home and think about it and decide not to because they’re concerned about their immigration status.” As long as the threat of deportation can be used against workers, wage theft will persist. Aggressive deportation policies undermine labor conditions for both immigrants and for their U.S.-born coworkers, whose bargaining power is undermined by their bosses’ ability to exploit those without papers.

The cost of going to court is another key consideration. Some workers are able to find free legal counsel from a local legal services agency, but these agencies are stretched thin, forced to choose between helping people in poverty avoid eviction, fight wrongful debt collection lawsuits, win wage theft cases, and gain protection from domestic violence. A worker making more than $15,000 per year is often totally ineligible for legal services aid.

Our legal system protects business owners at the expense of workers.

Some legal aid organizations lack the funding to take on wage theft cases at all. In Charlotte, North Carolina, for example, there are two organizations providing civil representation to low-income workers, the Charlotte Center for Legal Advocacy and Legal Aid of North Carolina, explained Ken Schorr, Charlotte Center for Legal Advocacy’s executive director, and he noted that neither organization will represent low-income workers in court for wage theft cases. Schorr explained, “The majority of our funding is grant-based for particular areas.” He added, “We haven’t been able to find funding to do employment law based work such as wage claims.” Our country considers legal representation in civil cases a privilege, not a right — which means many low-wage workers can’t use the court system to hold their employers accountable.

That’s why, as Tallulah Knopp, a staff attorney at Boston’s Volunteer Lawyer Project, points out, it’s so important for states to have clear “fee-shifting” statutes: in many states, when a worker wins a wage theft lawsuit, the employer will have to pay their back wages, but not necessarily their legal fees. A strong “fee-shifting” statute, like Massachusetts’, sets a standard where, if a worker wins their case, their employer pays the legal fees, instead of the worker having to pay the lawyer out of their recovered damages. That encourages private lawyers to come to the table on behalf of workers, Knopp explains. In a state like Texas, where filing fees are $400, and many attorneys bill at $100 per hour or more, there’s no real way to get your wages back if you’re owed just $500. That’s why Knopp and Nick Wertsch, of Texas’ Workers Defense Project, both point to fee-shifting statutes as a critical part of fighting wage theft.

But Jennifer Lee, associate professor at Temple Law School, argues that relying on workers to come forward against their bosses can’t solve wage theft by itself, even in the presence of fee-shifting.

As Lee explains, the information barriers and risks for workers to report their own wage theft remain high, even when states try to protect workers from retaliation. “The number of workers who are suffering violations versus the number of people who come forward is miniscule,” says Lee.

After investigating 141 state and local anti-wage-theft laws, she concluded that we can’t rely on workers to file complaints or lawsuits: while a worker’s “private right of action” can be part of the solution, we also need strong wage theft enforcement agencies that don’t just react to workers’ complaints, but are on the lookout for abuse.

Funding is part of the problem in some cities and states, says Lee, but she also points to cities whose enforcement agencies are dramatically underutilized. Many agencies, Lee says, wait for workers to file complaints, rather than entering the community to inform workers of their rights, and to find bad actors.

The most promising approach, says Lee, is collaboration between government agencies and workers’ centers. Although workers in the industries susceptible to wage theft often aren’t unionized, many are organized through local worker’s centers like the Domestic Worker & Day Laborer Center of Chicago and Houston’s Fe y Justicia. “Agencies aren’t always in the best position to identify which workplaces have issues or to build trust with workers,” says Lee, adding that worker’s centers are often more embedded in the community. The cooperation of worker’s centers gathers useful information about labor conditions and can encourage more workers to come forward. Lee pointed to Seattle as an example of a city that has effectively partnered with local community groups — their Office of Labor Standards selected ten community organizations to receive $1 million contracts to provide education and outreach to workers. Reporting by the Philadelphia Enquirer found that, in 2018, Seattle’s Office of Labor Standards received 10 times the number of wage theft questions and complaints than Philadelphia received, a larger city that lacked such a strategy.

Making Them Pay the Bill 

But even once wage theft is brought to light, workers don’t always get paid. Across the country, nominally “successful” wage theft lawsuits often result in empty judgments: just because a judge or jury agreed that a worker experienced wage theft, it doesn’t always mean that the worker will be able to collect her back wages.

A report by the National Center for Law and Economic Justice found at least $125 million in unpaid wage theft judgments and orders within New York City alone. Carmela Huang, a supervising attorney at New York City’s Legal Aid Society, says “it’s just far too easy for employers to transfer their assets.” As an example, Huang explains, a restaurant owner faced with a high-dollar wage theft lawsuit will recruit a friend to create a new corporation and transfer the restaurant to the new corporation. That makes the original corporation facing the lawsuit nominally unable to pay its wage debts. “For more than a decade employer-side attorneys have been advising clients on how to hide their assets — it is definitely a part of the practice to advise clients on how to make themselves judgment-proof,” says Huang. That’s why the Legal Aid Society called on New York Governor Andrew Cuomo to sign the SWEAT Act, which would have allowed workers to place a lien on their employers’ assets while wage theft litigation was ongoing, stopping bad companies from using suspicious transfers to hide assets. Cuomo vetoed the SWEAT Act on January 2.

Our country arrests 1.5 million people for burglary and larceny per year — but workers facing stolen wages are routinely deprived of justice. Businesses can dial 911 and expect the cops to show up to arrest a shoplifter, while millions of Americans work for poverty wages, as victims of theft from their employers, with little hope of recourse. To end wage theft, we should lift the threat of deportation, guarantee workers access to the legal system, build strong wage theft enforcement agencies, and close the loopholes that allow employers to shirk responsibility to pay owed wages.


First Person

Laws Aren’t The Only Barrier To Abortion Access. So Is Cost.

When thinking of abortion access challenges in the United States, waiting periods, mandatory ultrasounds, biased pre-abortion counseling, bans on federal and some state funding, and a dwindling number of independent clinics come to mind. These challenges delay abortion care, increase medical risks, and especially hurt minors. After navigating extreme restrictions and logistical needs to get to the clinic, another problem may arise for some patients: additional fees, which can range from $50-250 (on top of an average cost of $500 for a first trimester abortion), for factors entirely out of the patient’s control, such as having a negative blood type, being over a certain weight, or having a twin pregnancy. Although additional fees are common among various medical procedures, the lack of public and private coverage for abortion costs makes them difficult for some to afford — especially in places where the rate of uninsured people is high.

I have firsthand experience with one: Rhogam. Like 15 percent of the population, I lack the Rhesus factor in my blood, which means I have a negative blood type. If your partner has a positive blood type (or if their blood type is unknown), the fetus can inherit their factor, causing problems with the pregnancy. Pregnant people in this position can be given an injection of rho(D) immune globulin, such as Rhogam, to create antibodies that desensitize our physiological response if our blood comes into contact with the fetus’ blood, should it be Rhesus positive. Without the injection, it could be problematic for not only the health of the pregnant person and developing pregnancy, but the development of future pregnancies. Normally, Rhogam isn’t given during pregnancy until the 28th week, but abortion providers still routinely provide it at earlier gestations.

I had the privilege of using insurance when I delivered my two children, including one through a cesarean section. Unexpected fees weren’t something I anticipated when I needed an abortion while living uninsured — and I live in Texas, where in 2017 a bill passed prohibiting insurance plans from providing coverage for abortion unless the pregnant person has a separate premium they’ve purchased specifically for abortion. And for most people, Medicaid won’t cover it, either. I learned I’d need to pay $100 because of my blood type, on top of $450 for a surgical abortion. My local abortion fund helped, but it wasn’t enough for me to afford Rhogam and sedation. So I experienced my surgical abortion completely aware, which wasn’t comfortable for me. Nor what I wanted, since medical settings give me anxiety.

Some clinics have taken measures to address the challenges of added fees. And abortion funds, such as the Mississippi Reproductive Freedom Fund, also provide financial assistance. Some abortion providers combine what would typically be additional costs with the price of the abortion, or try to be up front about these fees on their websites. But not everyone has access to the internet, or if they do, it isn’t always easy to find accurate information. Crisis pregnancy centers often use similar names to trick people, who may not realize they’re on a site that isn’t legitimate. So it isn’t unusual for us to learn — for the first time — that we have to pay hundreds of dollars upon visiting the clinic.

“We’ve had patients who choose our clinic specifically because we don’t charge for Rhogam,” one clinic told me. Other clinics may waive the fee for those who need help paying for it, when resources are available to do so. “We received a grant that allowed us to provide our patients with financial assistance for things, and at the time we decided to use it on Rhogam, so people wouldn’t have to miss their appointment over an unexpected thing,” another clinic said. “We recognize the hardship this creates for many people, especially when a lot of people have no idea what their blood type is to begin with.”

Our right to choose means nothing if we can’t access it.

The extra cost of Rhogam increased the time one patient needed to pay back a loan they took out on their car in order to afford the procedure. “I had to travel to a different state because it was closer than the clinic where I lived. I had the money from a loan I took out already, but when I found out I’d need to pay $100 more because of my blood type — in addition to the barriers I was already facing — I realized I’d be stuck in this cycle of debt longer than I hoped for,” they said.

I also spoke with Desiree — whose name has been changed to protect her privacy. “I remember standing at the window and being told it would be an extra $100 because of my blood type. It had already taken me weeks to get the $400, and I needed an abortion a few days before rent was due. I had to step aside and really think about what this could mean for my living situation,” she said, since she’d already needed assistance from a local abortion fund.

Laurie Bertram Roberts, co-founder and executive director of the Mississippi Reproductive Freedom Fund, told TalkPoverty: “We hear from many callers that struggle more because of these extra costs. It’s already hard as it is to raise hundreds of dollars for the procedure, especially for our callers who are experiencing homelessness and other barriers related to accessing abortion.”

This issue also affects those who don’t have a negative blood type. “I wasn’t even Rh-negative, but the clinic I went to gives everyone Rhogam,” said another patient. She said the additional cost caused her to drive home on “fumes,” because she had to use her last $50 that was originally intended for gas after driving out of town for her abortion.

When it comes to the extra cost associated with Rhogam, fortunately, things are changing. In Contraception Journal, the National Abortion Federation (NAF) recognized last year that testing for the Rhesus factor in abortion care has become a barrier. They refer to Dutch guidelines, which say the injection is unnecessary for pregnancies less than eight weeks — and Sweden also recommends against the injection for early medical abortion.

NAF recently updated its recommendations regarding when Rhogam is required. They no longer recommend it for early abortions less than eight weeks, most of which are medical abortions and account for two thirds of the abortions performed in the U.S., according to the Guttmacher Institute. Now, people with a negative blood type — who find out about their pregnancy early on — may have the ability to forego Rhogam at NAF-member clinics. Some experts say it isn’t necessary for a first pregnancy at all.

Dr. Alice Mark, NAF’s Medical Director, told TalkPoverty: “We know giving the Rhogam injection at 28 weeks decreases the risk of sensitization, but what we don’t know is that any intervention before that has any impact on the outcomes…The studies [on sensitization] use methods that are outdated, and we were doing this intervention without knowing whether or not it benefited patients.” They drew heavily on data from Europe, where not providing Rhogam early in gestation has “no appreciable impact.”

Dr. Mark stressed that some clinics may want to follow American Congress of Obstetricians and Gynecologists (ACOG) recommendations to protect their patients, and that’s not wrong. “But because we’ve made this change, it’s been taken to ACOG to be discussed on their committees,” said Dr. Mark.

One clinic I spoke with told TalkPoverty that, “We’re going to follow the [NAF] recommendations, and we should be updating the guidelines in the next month. All of our physicians are really excited to follow these guidelines — there’s a lot of research on it. It’s an extra barrier for patients.” Patients are also growing more aware. “I didn’t need it because I’m less than eight weeks,” said one person I spoke with before her abortion.

This isn’t the fault of clinics. It is the result of the systemic issues related to extreme abortion restrictions. After all, paying for abortion could be a lot easier if there wasn’t a federal ban on public funding. Independent clinics perform the majority of abortions in the U.S., but they receive absolutely no support from our government. Use of state dollars for Medicaid reimbursements for abortions is highly restricted in Texas and a number of other states, so while some providers may combine these additional fees in the cost of the abortion, it’s inevitable not all would be able to in order to sustain the operation of the clinic. In eleven states, including Texas, most people can’t use their private health insurance for their abortion, either.

And with providers across the country facing closures due to medically unnecessary restrictions, accessing a clinic becomes less of a reality for many even without these additional costs. Next month, Missouri will give a final ruling in the case of the state’s only abortion provider shutting down. Six states currently have only one clinic, and Missouri could be the first with zero. In Texas, we have the most cities more than 100 miles away from an abortion clinic. For some of us, there is no choice: we’re forced to continue a pregnancy we don’t feel ready for.

Because even though we have a legal right to have an abortion, lawmakers continue to remind us that our right to choose means nothing if we can’t access it.