About 1 in 5 Delaware women get their health care via Medicaid, which has been providing low-income persons access to acute and long-term medical services since 1965. Medicaid is a lifesaver for the conditions it covers, but it does not cover every medical issue — for example, unnecessary cosmetic surgery. As such, it pays for pregnancy care — prenatal visits, management of labor and delivery, postpartum care, etc.
Yet Medicaid funding for abortion is prohibited, as outlined by the federal Hyde Amendment. This 1977 legislative provision barred the use of federal funds for pregnancy termination, except in cases of rape, incest or conditions that are life-threatening to the patient.
For decades, women who rely on Medicaid have had to scrounge for money to seek abortion care. This situation is blatantly discriminatory and unfair, but it doesn’t need to be this way. States are not bound by the Hyde Amendment. Any state can provide funding for this vital reproductive health care if they choose. So far, 14 states and D.C. have decided to do so, but Delaware is not among them.
As a retired OB-GYN physician who has provided a full range of obstetrical and abortion care for 50 years, I can attest that women who find themselves inadvertently pregnant do not fit the stereotype that many would imagine. They almost never fit the picture of a promiscuous teenager who didn’t care to use birth control. They are commonly married women in their 20s and 30s who were using some form of contraception. Nobody thinks having an abortion is a lark. Nobody plans to have an abortion. It is always a difficult and unhappy decision, but one that rightly belongs with the woman, her family and her doctor.
In 1972, before Roe v. Wade, women of means would travel to countries where abortion was legal, or they would obtain surreptitious care at high cost. Others would sometimes seek out “back-alley” care from midwives, doctors or untrained charlatans, who were entirely unregulated and often unsafe. I can remember when hospital wards were filled with these women, suffering from hemorrhaging (bleeding) and sepsis (infection). Some of them required emergency blood transfusions or complex surgeries, and large numbers of them died.
As soon as abortion was legalized in our country, the rates of complications and deaths from these dangerous pregnancy terminations dropped to near zero. Additional advancements, like the medications mifepristone and misoprostol, have made abortion less invasive and more accessible for patients everywhere. When used under the supervision of trained clinicians, these pills are safe and effective for ending pregnancy through the first trimester, which is when the overwhelming majority of procedures are done.
Yet we’re seeing dangerous backslides in reproductive health care these days.
Last year, the Supreme Court vacated Roe v. Wade, mifepristone is currently at risk of being banned nationwide, and many states are passing laws restricting abortion access.
Fortunately, Delaware is not among these regressive states. We have preserved the right for our citizens to make reproductive health care decisions for themselves. However, it is now up to the legislature to determine if the state will also allow funding for those on Medicaid to access all options for care, including abortion services.
In an ideal world, every pregnancy that happens would result in a healthy baby that thrives, and is loved and cherished. In the real world, many pregnancies are indeed joyous events, while others create serious problems. There are many reasons for this. Everyone is unique and has their own story. But, considering policy for the community as a whole, we are better off when every individual, including Medicaid recipients, can decide for themselves whether and when to have the children they want.
Please contact your representative and senator to encourage them to pass legislation so that Medicaid in Delaware will cover the costs of abortion care.
Dr. John J. LaFerla