What does this have to do with abortion? Intersectionality and reproductive freedom

Trigger Warning: discusses infertility and police violence

Reproductive Freedom in Washington Today

We have been active as an abortion rights advocacy organization in Washington since 1975. In 1991, following decades of activism, we helped pass the Freedom of Choice Act, which codified Roe v. Wade into state law¹. This enshrined the legal right to abortion in Washington state but, as is the case with Roe nationally, it was meant to be the floor not the ceiling – the foundation on which more abortion and reproductive rights can be built.

Decades later, reproductive healthcare is still not equitable in Washington state because of an uneven distribution of resources and services across the state, bias within healthcare and insurance systems, and insufficient representation and focus on intersectional issues within the reproductive freedom movement. With escalating abortion bans in states across the country and the likely end of national abortion protection this summer, we must invest in Washington as a sanctuary state for truly equitable abortion and reproductive healthcare for all.

So, today, still as an abortion rights advocacy organization, Pro-Choice Washington looks at how a person’s social and political identities relate to reproductive healthcare and abortion access. As a result, we focus our energy and resources on passing legislation that increases access to affordable, timely, and quality abortion and reproductive healthcare, reduces the burden of out-of-pocket costs for reproductive health services, and builds a more equitable Washington that protects people’s rights and safety. This means that we also work closely with partners who protect our democracy and our communities by improving health equity, voting justice, and police accountability. We do this precisely because our vision is a future where (1) every person in Washington state has (2) equitable access to the reproductive healthcare options they need (3) to thrive.

Support Legislation & Reproductive Freedom

At first glance, our ‘Support Legislation’ looks like it falls outside of traditional abortion rights advocacy. In some ways it does, because we are lucky enough to live in a state where activists worked hard to enshrine the right to abortion into state law. We are not facing an abortion ban like our friends in Idaho, Texas, Ohio, Missouri, Oklahoma, and Florida, and abortion is generally accessible in our state. But only for a portion of our population. It is for this reason that we look beyond basic legal protections to unlock the broader barriers to reproductive healthcare that make it impossible to achieve our vision. To dive into what we mean by this, I am going to walk through a few of our support legislation in 2022 and how they relate to protecting and promoting reproductive freedom in Washington state.

1. “Every Person“: Health Equity for Immigrants

We believe that every person in Washington state, regardless of income level, zip code, gender identity, race, immigration status, or type of employment deserves access to reproductive healthcare services. And the past few years have demonstrated that immigrant communities and people of color in Washington state need better access to healthcare services and insurance coverage. An estimated 49 percent of undocumented Washingtonians are uninsured, compared to seven percent of the overall population², so, we are working with partners to ensure that immigrant communities have equitable state-funded healthcare coverage. This builds upon previous wins by Pro-Choice Washington activists and partners to expand insurance coverage to include the full range of contraceptives and abortions, addressing bias and disparities in reproductive healthcare, and expanding post-partum Medicaid coverage. To live up to our vision of every person in Washington, we need to continue to unlock insurance barriers to access.

2. “Equitable Access to Reproductive Healthcare Options“: Fertility Treatments

Reproductive freedom includes the full range of a person’s reproductive healthcare needs. While some people become pregnant without medical intervention, in vitro fertilization (IVF), egg and embryo freezing, intrauterine insemination (IUI), and surrogacy are all legitimate healthcare procedures that help people start a family in Washington state. However, the out-of-pocket cost of fertility treatments for those struggling to become or stay pregnant can be insurmountable without personal means or insurance coverage (or both). A single round of IVF costs on average $12,000-$17,000³.

Often the biggest barrier to IVF and other fertility treatments is the out-of-pocket cost, which especially impacts fertility care for people of color and LGBTQ+ patients⁴. While an estimated 20 percent of Black women may experience infertility (roughly double the nationwide estimate), only 8 percent seek medical assistance to become pregnant compared to 15 percent of white women⁵. LGBTQ+ patients who require medical assistance to start a family can face discrimination and medically unnecessary requirements from Washington insurance carriers. Some insurance carriers require people to prove their own infertility through intercourse before covering IVF or IUI services⁶. Obviously, this is deeply biased and medically unnecessary. If we believe in the full range of reproductive healthcare, then we need to continue advocating for sufficient and unbiased insurance coverage for fertility treatments for all people.

3. “To Thrive“: Voting Rights & Police Accountability

As a grassroots advocacy organization, we strongly believe in the democratic process and the importance of safeguarding the right and ability of every person to participate in the voting process. Elected leaders can only reflect community needs if strong systems are in place to ensure that representative lawmakers can be elected and that historically sidelined groups, like young people, people of color, and previously incarcerated folks, can fully exercise their right to vote. Ranked-choice voting, for example, creates the opportunity for progressive leaders to represent their constituents and to allow voters to exercise real choice, leading to higher voter participation⁷. Washington voters overwhelmingly believe in the right to abortion care, so we must lend our voice to advance freer and more representative elections to bring in outspoken abortion rights champions.

We also believe in bodily autonomy and the right to a healthy and safe family. As SisterSong articulates, reproductive justice work includes ending police violence because it takes away Black children and pulls apart Black families. Police brutality is among the biggest threats to healthy and safe Black families in America⁸. In addition, increased stress and trauma of structural racism for Black parents and families in America is linked with higher infant and maternal mortality rates – Black women are four times more likely to die from pregnancy-related causes than white women⁹. In Washington state, we have seen several police injuries and killings of community members leading to protective policies passed in 2021. There has been a decline in police violence in Washington since 2021¹⁰, so, these protections need to be strengthened, not rolled back, in order to ensure that the voices of families and communities impacted by police violence are heard, and to protect reproductive freedom and justice in Washington state.

Conclusion

If we truly believe in a future where every person in Washington state has equitable access to the reproductive healthcare options they need to thrive, then we have a responsibility and a clear mandate to support – as part of our agenda – the partners (listed below) who are leading this work every day. Abortion access does not exist in a vacuum, and we are lucky enough in Washington to be able to look beyond basic legal rights and work on tackling these complex intersectional barriers to care.

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