On June 24, 2022, reproductive health care in the United States was dealt a major blow when the U.S. Supreme Court overturned the landmark Roe v. Wade decision and removed federal protection for abortion. Now states have the power to ban abortion outright, which will increase inequities that already plague the health care system and our society. Although abortion restrictions will negatively affect the health and well-being of all pregnant people and their families, those most affected by this changing landscape will include low-income women and members of marginalized racial and ethnic groups. Dobbs will thus perpetuate and exacerbate health inequity, which has a long history in the United States.
去年6月24日的Dobbs裁決將聯邦法律所保證的婦女墮胎權利下放給各州。美國社會的衛生保健系統本來就不平等，現在低收入邊緣族裔的孕婦和家人受到這一裁決更大的衝擊。
Specially designed to limit access to abortion by low-income and other vulnerable women, the Hyde Amendment, passed on September 30, 1976, banned federal Medicaid funding for the procedure. Unfortunately, women of reproductive age with incomes below the federal poverty level (FPL) face a number of barriers to contraceptive use, including the cost of highly effective methods. As a result, low-income women are more than five times as likely to report an unintended pregnancy as women living at or above the FPL. Because of this higher rate of unintended pregnancy, women who are struggling financially have a greater need for abortion. Not surprisingly, patients who undergo an abortion in the United States have been disproportionately low-income.
1976年9月30日海德修正案通過，專門禁止聯邦醫療補助計劃(Medicaid)為低收入婦女提供墮胎服務的資金。不幸的是，這些婦女沒錢使用某些昂貴的避孕工具，因而她們比較多地意外懷孕，更多地需要墮胎。
Medicaid is an important and growing source of health coverage for low-income women in the United States. In 2010, under the Affordable Care Act, states had the option to expand Medicaid eligibility to all people with incomes below 138% of the FPL, effectively eliminating the requirement for many low-income women to get pregnant in order to become eligible. To date, 40 states and the District of Columbia have adopted Medicaid expansion; residents of the remaining 10 states lack the protection of expanded coverage. In the states where it was implemented, Medicaid expansion substantially reduced the number of uninsured women of reproductive age and provided more people access to primary and gynecologic care before pregnancy. Medicaid expansion in Oregon, a state that funds abortion care under Medicaid, not only increased access to abortion services but also the receipt of medication abortion, which most likely increased safety and reduced financial burdens for low-income people. This historic policy change also reduced racial, ethnic, and rural health disparities in health care access and utilization.
2010年奧巴馬醫保計劃允許各州擴大Medicaid輔助範圍。40個州採納了，減少了沒有醫保的育齡婦女數目。然而還有10個州至今沒有採納。
In 2019, half of U.S. women living below the FPL were insured by Medicaid. Medicaid coverage rates were higher in certain groups, including women who described their health as fair or poor, women from marginalized racial or ethnic groups, and single mothers. Approximately two thirds of adult women enrolled in Medicaid are in their reproductive years and are potentially at risk for an unintended pregnancy. For many low-income people, however, federal and state funding restrictions created substantial financial and other barriers to accessing abortion services even before Dobbs. Notably, the Hyde Amendment greatly disadvantaged low-income people by blocking use of federal Medicaid funds for abortion services except in cases of rape or incest or to save the pregnant person’s life. In 32 states, Medicaid programs adhere to the strict guidelines of the Hyde Amendment, making it difficult for low-income people to access abortion services in these states. 即使在羅訴韋德裁決沒推翻之前，採納Medicaid擴大計劃的州有32個嚴格執行海德修正案，讓他們的貧困婦女很難得到所需要的墮胎服務。
Before the fall of Roe, Medicaid coverage could determine whether women in some states did or did not receive abortion services. Since the implementation of the post-Dobbs abortion bans, abortion care is even more restricted in entire regions of the country. Access to abortion services under Medicaid will continue to vary by place of residence and depend on the confluence of restrictions or bans on abortion care and Medicaid policies currently in effect within each state. In the new landscape, obtaining abortion services has become even more challenging for low-income women in most of the country, despite the fact that most states have expanded Medicaid coverage. 在Dobbs裁決之後，那些本來就嚴格限制墮胎的州，依靠Medicaid醫保服務的貧困婦女就更難了。
After Dobbs, complete or partial bans on abortion went into effect in more than a dozen states, forcing people in those states to travel to other states to access abortion care. More than a third of women of reproductive age now live more than an hour from an abortion facility and will probably face additional barriers, including costs for travel and child care and the need to take time off from work. Regrettably, people who already had poorer-than-average access pre-Dobbs face even greater health burdens and risks. For example, members of marginalized racial and ethnic groups that face disproportionate burdens of pregnancy-related mortality are more likely than other groups to have to travel longer distances to get an abortion post-Dobbs. 她們有的需要到外州去墮胎，有的需要請假和跑很遠的路，導致(自然流產而來不及處置的)孕婦死亡數量增加。
As a result of the overturning of Roe, a substantial proportion of people who want abortion services will not have access to them and will end up carrying their pregnancies to term. For decades, research has demonstrated that abortion bans most severely affect low-income women and marginalized racial and ethnic groups that already struggle with barriers to accessing health care, including abortion. The economic, educational, and physical and mental health consequences of being denied a wanted abortion have been thoroughly documented in the landmark Turnaway Study. Thanks to nearly 50 years of legal abortion practice, we now have a robust body of research on the safety and efficacy of abortion and the impact of abortion restrictions on people’s socioeconomic circumstances, health, and well-being. 限制安全有效的墮胎決定會影響人們，尤其是低收入群組的社會經濟狀況、身體健康、和一般生活福祉。
Innovative strategies, such as telemedicine for medication abortion services, can improve access to abortion care. Self-managed, at home, medication abortions are safe, effective, and acceptable to many patients. In states where abortions are legal that are bordered by states where abortions are banned, telemedicine could mean the difference between patients being able to simply drive across the state line, in order to be physically in the state providing care, and having to drive to a clinic that could be hundreds of miles away. In addition, Planned Parenthood affiliates have plans to launch mobile services and to open clinics along state borders where abortion is illegal in one state but legal in the other. These clinics could bring needed abortion and contraceptive care closer to people in rural communities, who would otherwise have to drive long distances. Finally, marginalized women and communities, for whom Roe was never enough, are leading grassroots efforts for just and equitable abortion care that builds on decades of advocacy and support. 為了幫助這些地方低收入婦女的需要，有人發起遠程望診和開藥指導服務，周邊墮胎合法的州在邊界地區設立機動服務站，在反墮胎的貧困社區建立草根運動為婦女申張正義。
The fall of Roe amplified the effects of racist structures on poor women from marginalized racial and ethnic communities facing unintended pregnancy. Policies to ensure comprehensive access to abortion have the potential to address the effects of systems of oppression. National and local groups such as All Above All5 are advocating for reproductive and comprehensive abortion justice. In addition, the majority of American voters who believe that abortion should be available and accessible to all are making their voices heard. Voices and actions supporting abortion access will only continue to grow as a formidable force for change. This growing segment of the population has the opportunity to implement comprehensive approaches to lifting up low-income and marginalized women from societal neglect to the center of societal care. Centering women from historically marginalized groups in efforts to ensure affordable, available, and accessible abortion care can foster innovative policies and practices. We hope such bold efforts will lead to transformative change to create a truly equitable society in which all people can thrive.
支持墮胎的民眾越來越多，他們有機會有機會實施綜合方法，將低收入和邊緣化的婦女從社會忽視中轉變到受到社會關懷的位置。確保婦女得到負擔得起、實用的墮胎護理，可以促進創新的政策和做法，以創造一個真正公平的社會，讓所有人--無論男女貧富--都能茁壯成長。
下圖是美國各州限制/保護墮胎服務的情況(情況隨各州新政策的出現不斷變化)。
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