“Everyone thinks of Massachusetts as such a liberal place, but I don’t think they realize how big the stigma is even here.”
Those words were spoken by Alice, who will begin her third year at the University of Massachusetts Amherst this fall. Now 21, Alice chose to get an abortion when she was 19 and became pregnant with her boyfriend during her senior year in high school.
Alice, who agreed to speak with the Advocate only if we changed her name, was surprised to learn how many people she thought she could trust, wound up negatively judging her for her decision.
“I think of myself as an open person but not about this anymore,” she said. “There have been several times where I was open about my experience in what I thought was a safe space and I got some kind of backlash. So, I’ve learned to keep quiet about it.”
Rachel, a 30-year-old from the Pioneer Valley, also agreed to speak to the Advocate about her abortion under the condition that we change her name. She said her parents still do not know she got an abortion in 2010.
“I kept it from people in my family, not because they’re super religious or anything, I just think it’s a generational gap in understanding abortion. It would have shocked them and made them sad,” she said.
It is unsurprising both Alice and Rachel decided to remain anonymous when speaking about their experiences — abortion is both a deeply personal and highly politicized topic. And while they faced challenges, their abortions were relatively straightforward in comparison to others in the state.
Massachusetts does not have some of the barriers to getting an abortion that other states have — state Medicare funds can be used for abortion, and state law does not require a licensed doctor to perform the procedure (meaning licensed nurses can perform them before 13 weeks). However, abortions remain difficult to afford for the poor, and Massachusetts still has a state law that requires those under 18 to have parental permission, or a judicial bypass (meaning permission from a judge) in order to get an abortion.
And as both Rachel and Alice discovered, social stigma still remains a large factor.
“I was lucky.” Alice said. “I know that. If I had been in even a slightly different situation this entire process could have been basically impossible.”
Prohibitive Costs
Abortion, defined under federal law as “the spontaneous or artificially induced expulsion of an embryo or fetus,” has been a controversial issue for centuries in the United States. Even since Roe v. Wade, the 1973 Supreme Court decision that legalized abortion on a national level, debates about abortion restrictions and access remain rampant.
And the debate largely affects the poor.
According to the Guttmacher Institute, a reproductive rights research organization that keeps national statistics regarding abortion and reproductive health care, 75 percent of women seeking abortions are either at or below the poverty line, meaning that most women seeking abortions may face some sort of financial or logistical barrier. Abortions typically cost between $500 and $800, according to the Guttmacher institute.
Economic insecurity is one of the biggest obstacles to abortion access, said *Nina Haddad who is a staff member at National Network of Abortion Funds (NNAF) and is a board member of the Eastern Massachusetts Abortion Fund. The NNAF provides monetary and logstical support to those seeking abortions.
Insurance companies in Massachusetts don’t always cover the full cost of an abortion. Economically insecure people are much more likely to be uninsured or to have less expensive and less extensive insurance programs, which are also less likely to cover the abortion cost.
For Rachel, who had her abortion performed at Planned Parenthood in Springfield, paying was not a problem. Alice, who was a teenager when she had her abortion explained that she and her boyfriend originally wanted to pay for the procedure themselves, to keep it private from their parents. However, Alice said, “When I called [Planned Parenthood] they told me it would be $600. Me and my boyfriend obviously couldn’t afford that.” Instead Alice decided to tell her parents so their insurance could help cover the cost. Though Alice was initially hesitant to tell her parents, she said that ultimately they helped her find transportation, made sure the cost was covered by her insurance, and provided her support.
She said she was aware of how difficult the process would have been had she been economically disadvantaged and did not have the support of her family to help her pay and provide her transportation.
For Rachel, who chose not to tell her parents, both Tapestry Health in Northampton and Planned Parenthood in Springfield helped walk her through the process over the phone.
“There was never any doubt in my mind that I was getting an abortion, because I don’t want kids — ever,” Rachel said.
Rachel said she was very grateful to be living in Western Massachusetts when she had her procedure. “I’ve heard of how people in Texas might have to drive two or three hours. My friend in Ireland had to go to a different country to get an abortion, but you know at Planned Parenthood [in Springfield] there weren’t even any protestors.”
While Rachel was thankful for Massachusetts’ limited support of women’s rights, and both Rachel and Alice did not face many logistical issues obtaining an abortion, many other women in Massachusetts are not so fortunate.
For someone who does not have insurance or whose insurance cannot cover this cost, getting an abortion can be extremely challenging. In addition, economically insecure people often face other barriers like finding transportation to the clinic, and getting time off from work, and child care during their procedure, Haddad said.
The Tiller Fund, an organization with the National Network of Abortion Funds, keeps statistics on the demographics of women to whom they provide assistance. Over 33 percent of people seeking assistance from the NNAF nationwide were on some sort of public assistance.
Haddad said that this issue is as relevant as ever in Massachusetts, where these numbers remain similar to national averages.
“Disadvantaged people aren’t really free to make a decision about having a family on their own terms,” she said. “The people who are already experiencing racial and economic inequality just don’t have equal access to abortion care. Even if the law says they do, that’s simply not how it plays out.”
To that point, more than twice the number of women seeking assistance with abortion costs were black than white — 50 percent compared with 24 percent, according to the Guttmacher institute. Nationally, while only 11 percent of abortion-seekers are teenagers, the age group makes up the 22 percent of NNAF applicants.
Too Young to Choose
Another abortion access challenge in Massachusetts is the law that restricts abortions for minors. This law, which was passed in the early 1980s, states that any minor seeking to have an abortion must either have parental permission or permission from a judge. This came about because of a 1979 Supreme Court ruling that said minors do not need to have parental consent to have an abortion. After this ruling some states got rid of any consent laws surrounding minors and abortion, while others, like Massachusetts, put the judicial bypass system into effect. This system puts a difficult hurdle in front of teens who face the possibility of abuse, being thrown out, or other forms of retribution from their parents due to their getting an abortion.
While some nearby states, like New Hampshire, have parental notification laws and similar restrictions, others including Vermont, New York, and Connecticut do not.
Alice, who was 19 at the time of her abortion, was forced to tell her parents due to a different law that has since been overturned.
Up until 2016 insurance providers in Massachusetts were not required to keep information on sensitive procedures — including abortions — from other members of an insurance plan.
Alice was on her parents’ insurance plan in 2015 when she sought to have an abortion, and her insurance company’s policy was to inform the policyholder.
“I didn’t want to tell my mom or my family,” Alice said. “I was already so confused and upset about the whole thing I didn’t want to have to deal with my mom being upset and worried about me. … I didn’t want to share it until I was emotionally ready.”
Alice was fortunate in that her mother and family were supportive of her decision. Not all families are.
According to Jamie Sabino, an expert on abortion law and member of the Coalition of Choice, a group primarily based out of Boston that seeks to end restrictive abortion laws, the remaining parental consent law on the books is extremely problematic.
The law states that a pregnant teen who cannot tell her parents about her intended abortion will be referred to a lawyer by Planned Parenthood to receive a judicial bypass, meaning that a judge signs off on the abortion. The teen is expected to go to court, explain her situation and wait for the judge’s answer.
“For many teens even the idea of calling a lawyer is terrifying,” Sabino said.
She added that teens have to find a ride to the courthouse with someone they can trust not to tell their parents. These court dates happen during school hours so a teen usually has to figure out how to get out of school without her parents knowing.
Sometimes a teen, thinking she can trust a school official, will tell that person only to have the official inform her parents, Sabino said.
“We have kids delaying their abortion, having to skip school, hitchhiking. We have stories of kids borrowing cars when they have no license, or kids getting lost on the way to court and having to do it again,” she said.
Even if a teen does make it to the courthouse, she still faces the challenge of having to tell a judge the most intimate details of her life.
“We make them jump through all these hoops and we treat them like criminals,” Sabino said. “These are the kids we should have the most empathy for because they have to do this without their parents support.”
Rachel, who was an adult when she had her abortion, strongly agreed that the parental consent law should be repealed.
“It horrifies me to think of some teenager who doesn’t know what to do, being without parental support, and being forced to go in front of this guy in robes asking permission to do something with her body,” she said. “There shouldn’t be roadblocks [for minors]. … Anyone who doesn’t want to have a baby or be pregnant shouldn’t have to have a baby or be pregnant, its that simple.”
Even after going through the judicial bypass process the minor has to find a way to get to her abortion provider, and a way to pay for it. Sabino explained that often teens end up going out of state. Sabino said that since abortion providers are less common in Western Massachusetts, and it is often easier for teens to get to less restrictive states like New York and Vermont, teens in Western Massachusetts in particular often choose to go out of state.
Sabino explained that the law does not impact the number of teens getting abortions. In addition, one third of teens getting abortions choose not to tell their parents. This statistic remains the same in states with age restrictive laws and states without, suggesting that the law has no effect on if teens decide to tell their parents.
“If a kid is not going to tell their parents, they’re not going to tell their parents,” Sabino said.
In addition this law does not affect the number of teens getting abortions.
The number of teen abortions remained constant before and after the law went into effect. Sabino said since 1981 there have been 25,000 cases of minors seeking a judicial bypass. Of those 17 were denied, and of those 17 decisions, 15 were overturned in a couple of days by a judge at a superior Court or by appeals Court. Only one denial was upheld for unknown reasons.
Essentially this law produces no effect besides making it more difficult and more dangerous for minors to seek abortions, according to Sabino. She said that in her profession she often hears people talking about how hard it was for women to get abortions before Roe v. Wade, when women would have to go out of state to get abortions, or go to the judge and ask permission. She said “no one realizes that for teens this is essentially how it still is.”
The Shame Game
The amorphous and pervasive issue of social stigma still remains for those who seek abortions, even in Massachusetts — as both Rachel and Alice learned.
“What surprises me most is how much people think they are entitled to an opinion about me and who I am based on what I do with my body. Abortion is treated as this big political question when in reality it is a personal question for each individual person to answer,” Alice said. “It should be a private issue for each woman and there should be the resources there to make it be a private issue for each woman.”
Alice also said that she has had multiple uncomfortable encounters with fellow students at UMass regarding her abortion.
“I got in a big fight with a boy I knew vaguely because he didn’t agree with abortion, and he said he didn’t like anyone that had one. We would talk about it in class a lot and most of the time I would learn to keep my mouth shut,” she said.
Rachel agreed that there is still a lot of stigma around abortion, and said she believed most of that comes from people who are older. Modern communication also exacerbates the issue, she said.
“The world is so connected via the internet. Like, if I make it publicly known that I had an abortion, I could be getting hate mail from across the country, and that thought alone makes me realize how much of a taboo it still is,” she said.
Rachel also said that she thinks the way pregnancy and abortion is portrayed in the media can be very problematic, and doesn’t fit her experience.
“I think in pop culture there are two acceptable story lines when someone is pregnant: you either have the baby or you have an abortion but you feel really bad about it, and I didn’t feel really bad about. I don’t have the belief in the humanity of a fetus. Going through it confirmed what I had thought before, that it is just cells, it’s just a biological thing,” she said.
She explained that even the friends who know she has had an abortion often question her about her choice not to have children, assuming that if she were to get pregnant again she would not have an abortion.
“There’s this idea that women should want to have children, or have to have children, and if you don’t when you’re 23 you should when you’re 30,” she said.
Rachel said she is not a woman who wants to have children, and while she certainly hopes she never has to go through the abortion process again, she would do so if faced with another pregnancy.
Laura Suttenfield, who disagrees with abortion, nevertheless agrees that the stigma against women who find themselves considering them is a major problem.
An organizer with the Pro-Life Young Adults of Pioneer Valley group, a discussion group that meets periodically in Northampton to discuss anti-abortion arguments, Suttenfield said that she started this group because “the pro-life voices that I see are not my own voice.”
She is in favor of a more compassionate approach to anti-choice advocacy where women are not shamed for their pregnancy and are given options to help support them, she said.
Suttenfield said that she believes that all human life, no matter how early on, has a consciousness and therefore should not be terminated, but she said her approach is to focus on supporting women — particularly those in poverty — who are the majority of those seeking abortions.
“To me that speaks of a broken economic system; that speaks of a bigger problem that’s not going to be solved by ending a life,” she said.
Suttenfield believes that the focus should be on finding economically disadvantaged women ways to care for a child, and not ways to pay for an abortion.
While her ultimate goal is to make abortion illegal, she said if it was outlawed tomorrow it wouldn’t necessarily be a good thing.
Suttenfield explained that she believes the political system and the economic system are deeply flawed and that this is what largely contributes to women needing abortions.
Nina Haddad of NNAF said that because of negative backlash against women who get abortions, it is often important to keep the procedure private.
“I don’t think anyone could argue that there is no more stigma around abortion,” she said. “An intent to have an abortion can endanger people emotionally and physically if the wrong person finds out, including parents and partners.”
A Reluctant Legislature
Both Haddad and Sabino said progress in expanding abortion access can be difficult in Massachusetts because people do not realize what the restrictions still are in the state. Sabino also said that lawmakers are often hesitant to directly address abortion rights.
The underage law remains an extremely tough law to combat, according to Sabino. She said that no parental consent law has ever been revoked in the United States, and so far it doesn’t look like Massachusetts will buck the trend.
“Not a single bill [to mitigate the impact of this law] has ever come out of committee in Massachusetts,” she said, adding that she has been fighting this law since it went into effect in 1981. “Lawmakers don’t like talking about sex and they don’t like talking about abortion.”
At the same time, Sabino still sees potential that change will come to this law.
“There is currently a bill in the Legislature to reduce the age to under 16 instead of under 18,” she said. “This change would get rid of 80 percent of the cases.”
According to Sabino and the Coalition of Choice, half of teens seeking a judicial bypass are 17 and 30 percent are 16.
Meanwhile, most people remain ignorant of the law, Sabino said. She believes that is why it still persists.
State Rep. Solomon Goldstein-Rose, (D-Amherst), said that while he thought there would be “a lot of support in the Legislature” for a bill to lower the age of abortion consent, his focus would be on “getting at the root of the problem through more comprehensive sex-ed and better access to contraception for everyone.”
He said those measures would help make the debate about the age for parental consent less relevant because fewer teenagers would be having unintended pregnancies.
Goldstein-Rose said that “as we react to the Trump administration’s proposed policies and Congress’ healthcare debates, broader bills such as [the contraceptive access bill] are going to be high priorities.”
Access to contraceptives, however, would unlikely have changed things for Rachel or Alice: They were both on the pill when they got pregnant.
Some progress was made through the Massachusetts PATCH (Protecting Access to Confidential Health Care) Act, a state bill that was passed in 2016. This act states that when multiple people are on the same insurance plan, health care information is only shared with the patient and no other member of the health plan. This legislation means that in the future women like Alice could keep their choice private until they are ready to share.
While many issues concerning abortion access are swept under the rug at a legislative level, organizations like NNAF continue to work on behalf of those who need abortions in Massachusetts.
*The network’s main goal is “redistribute resources to those who have been historically and presently denied those resources,” Haddad said, but sometimes the agency has to turn people away without services.
“This is why we are building power and organizing to end harmful regulations like the Hyde Amendment,” said Jenni Kotting, communications director for the National Network of Abortion Funds, referring to an amendment that bars federal funds from paying for an abortion unless the mother’s life is in danger.
Haddad explained that the network has been growing in the last few years, and got a further boost since the last presidential election.
“Especially after the change in the White House, we’ve received so much support and love,” she said, adding that the organization exceeded their fundraising goal this year.
For both Alice and Rachel, the process of getting an abortion did not involve financial legal and logistical challenges. But even so, they have both faced issues of stigmatization felt pressure to keep their procedures secret.
“We need to stop pretending like Massachusetts is the beacon on liberal thought and tolerance, there is still a lot of hate here and a lot of work to be done,” Alice said. “The stigma around abortion is so intense, and I think we need to start having the abortion conversation more compassionately and more frequently.”
Christin Howard can be reached at christinhowa@umass.edu.
Editor’s Note, Aug. 11, 2017: *The original article contained several errors that have been corrected. These inaccuracies were Nina Haddad’s title, an estimate on how often insurance companies cover the full cost of an abortion, the ability of the National Network of Abortion Funds to provide financial support to all people requesting services, and a claim that the National Network of Abortion Funds is expanding its volunteer program. We deeply regret these errors.
