TALKING ABOUT ABORTION

 

Abortion was a polarizing issue a century ago during the progressive era, and it remains so. In fact, you may have a firm perspective on whether abortion should be legal always, in certain circumstances, or never.

Modern perspectives on abortion have been influenced by the pivotal Roe v. Wade case. In 1973, the U.S. Supreme Court deemed a state’s banning of abortions unconstitutional. How did that case affect the nation and social work practice? How has it continued to inform public and private discussions about women’s rights?

For this Discussion, you examine the Roe v. Wade case and its effects.

 

• Explain how the landmark ruling of Roe v. Wade affected women’s right to an abortion.
• Reflect on the benefits and challenges for women talking about abortion.

   Name at least one benefit and one challenge.

• Explain how you would support a client whose perspective on abortion differs from yours.

vidoes

References

 

• Stern, M.J., & Axinn, J. (2018). Social Welfare: A History of American Response to Need (9th ed.). Boston, MA: Pearson Education. 

  Chapter 5, “Progress and Reform: 1900-1930” (pp. 115-147)

• Ely, G. E., & Dulmus, C. N. (2010). Abortion policy and vulnerable women in the United States: A call for social work policy practice Links to an external site.. Journal of Human Behavior in the Social Environment, 20(5), 658–671.
• Garrow, D. J. (2014). How Roe v. Wade was written Links to an external site.. Washington & Lee Law Review, 71(2), 893–924.
• Smith, A. (2005). Beyond pro-choice versus pro-life: Women of color and reproductive justice Links to an external site.. NWSA Journal, 17(1), 119–140.
• Exhale Links to an external site.. (n.d.). Retrieved December 21, 2016, from https://exhaleprovoice.org

 Baker, A. (2015, May).

Aspen Baker: A better way to talk about abortion Links to an external site.

[Video file]. Retrieved from http://www.ted.com/talks/aspen_baker_a_better_way_to_talk_about_abortion#t-646750 

 Gates, M. (2012, April).

Melinda Gates: Let’s put birth control back on the agenda Links to an external site.

[Video file]. Retrieved from http://www.ted.com/talks/melinda_gates_let_s_put_birth_control_back_on_the_agenda 

Reproduced with permission of the copyright owner. Further reproduction prohibited without
permission.

Journal of Human Behavior in the Social Environment, 20:

658

–671, 2010

Copyright © Taylor & Francis Group, LLC

ISSN: 1091-1359 print/1540-3556 online

DOI: 10.1080/10911351003749177

Abortion Policy and Vulnerable Women
in the United States:

A Call for Social Work Policy Practice

GRETCHEN E. ELY
College of Social Work, University of Kentucky, Lexington, Kentucky

CATHERINE N. DULMUS
School of Social Work, Buffalo Center for Social Research, University at Buffalo,

Buffalo, New York

Repressive abortion policy in the United States creates undue

burdens for groups of vulnerable women, including adolescents,

women of color, women living in rural areas, and women with

economic disadvantages. Repressive abortion policy creates a two-

tiered system of access to reproductive health care that is a par-

ticular disadvantage to vulnerable women. In this study, current

policy is discussed with examples of such policies outlined in three

areas: insurance coverage and Medicaid restrictions, mandatory

waiting periods, and mandated state counseling. Social workers’

role in policy practice is emphasized in regard to advocacy and

abortion policy.

KEYWORDS Abortion policy, abortion access, vulnerable women,

undue burdens, forced pregnancy, policy practice

Lack of access to abortion is arguably the most important barrier to economic
and social equality for women in the United States (U.S.). Legal access to
abortion ensures that women will not be forced to continue pregnancies
against their will, which is necessary if women are to enjoy a level of
human rights equal to those afforded to men. Elective abortion in the U.S.
was decriminalized in 1973 in the landmark Supreme Court case Roe v.

Wade and, in 1992, the Planned Parenthood v. Casey court case upheld the

Address correspondence to Gretchen E. Ely, College of Social Work, University of
Kentucky, 639 Patterson Office Tower, Lexington, KY 40506, USA. E-mail: gretchen.ely@

uky.edu

658

Abortion Policy 659

right to abortion while also allowing individual states to enact restrictions
as long as they did not create an ‘‘undue burden’’ to the women seek-
ing the service (Harper, Henderson, & Darney, 2005). Despite the court’s
ruling that states could not create ‘‘undue burdens’’ for women seeking
abortions, current public policy efforts consistently seek to restrict access
to abortion in ways that do create undue burdens to women, especially
vulnerable groups of women. Thus, much of the current abortion policy
in the U.S. essentially violates the law yet is overlooked owing to a moral
agenda present in many lawmakers. Examples of such policies include the
imposition of parental notification laws, mandatory waiting periods, and
mandatory state-scripted counseling (Kaplan, 1998). These abortion policies
reflect a punitive ideology and a moral perspective rather than evidence-
based science (Fried, 2006). Though laws that impede access to safe, legal
abortion reflect a moral preference that is shared by a few, they infringe on
the reproductive rights of all women and acutely affect groups of vulnerable
women.

Social policy has not historically been a helpful or positive force in
the quest for women’s reproductive rights, especially in the U.S. (Ruhl,
2002). This becomes evident when one examines the list of historical and
present social policies that curtail reproductive freedom and define the con-
text in which women may exercise their reproductive choices (Ruhl). In the
U.S., laws governing abortion in particular are frequently irrational, as they
are based on the notion that the fetus, from the moment of conception,
has individual rights and obligations that are equal to or surpass those
of the pregnant woman (Ruhl). Laws limiting access to abortion violate
the basic principles of the separation of church and state (Fried, 2006),
yet are passed and implemented without regard to their unconstitutional-
ity. Such public policy flourishes under the assumptions that the fetus and
the pregnant woman have conflicting interests, that the pregnant woman
cannot be relied upon to act responsibly when confronted with the condi-
tion of pregnancy, and further allows no consideration for the innumer-
able problems associated with birth, pregnancy, and childrearing in less
than ideal social and economic conditions (Ruhl). Furthermore, regarding
the notion of self-sacrifice for the benefits of one’s offspring, parents have
the right to refuse to donate organs, blood, or other body parts to a sick
child, whereas pregnant women are expected to undergo heroic measures
to carry a child to term, even if such measures are against their will (Cook,
Dickens, & Bliss, 1999; Ruhl). Thus, under current abortion laws in the
U.S., the pregnant woman, considered an autonomous subject under the
law the day before becoming pregnant, no longer enjoys a status that can
be associated with autonomous personhood once a pregnancy occurs. In
fact, in the cases of pregnant women in the U.S., neither the pregnant
woman nor the fetus can be defined as having the status of personhood
(Ruhl), yet laws restricting reproductive autonomy elevate the fetus to the

660 G. E. Ely and C. N. Dulmus

status of personhood above the status of the pregnant woman. Laws that
decrease access to abortion do not in fact increase the autonomy of the
fetus, even though this is how such laws are often framed to garner public
support. Rather, they are punitive and explicitly coercive attempts to control
women in situations wherein they cannot be trusted to control themselves
(Ruhl).

Attempts to make abortion illegal across the U.S. in a post-Roe v. Wade

culture have failed. Thus, repressive policy efforts have focused, recently
in particular, on chipping away at abortion rights and limiting access to
the procedure by any means possible. Such efforts have mostly resulted
in unfairly limiting the reproductive rights of vulnerable groups of women
rather than reducing abortion rates in the population as a whole. Historically,
white women of middle- to upper-class means have enjoyed the highest
levels of reproductive autonomy, even before modern abortion procedures
were deemed legally accessible, which is still the case today. Prior to abor-
tion’s being decriminalized in the U.S., well-to-do women could seek safe
abortions through private physicians or by traveling abroad to developed
nations where abortion was safe and legal (National Abortion Federation,
2009a). Conversely, more economically disenfranchised women seeking ac-
cess to abortion were subjected to illegal and unsafe procedures or forced
into childbearing against their will (National Abortion Federation, 2009b).
Unfortunately, modern disparities in reproductive rights related to abortion
access are similar to the disparities that existed before the modern legalization
of abortion.

In principle, all women in the U.S. gained equal access to abortion ser-
vices with the 1973 Supreme Court decision (Harper et al., 2005). However,
despite residing in the land of the free, where the constitution provides
equality for all citizens, different groups of women enjoy vastly different
levels of reproductive rights based on factors beyond their control, such
as economic class, race, and age. Such differentials are created through
the passage and enforcement of public policy aimed at regulating abor-
tion while violating separation of church and state. This creates a two-
tiered system of abortion access for women in the U.S. Women who fall
into the ‘‘upper tier’’ enjoy higher levels of reproductive autonomy in the
area of abortion rights, as policy efforts such as mandatory counseling and
mandatory waiting periods create more of an inconvenience for this group
than an undue burden. Women falling into the ‘‘lower tier’’ are subjected
to limited and sometimes nonexistent reproductive autonomy in the area of
abortion rights, as repressive abortion policy creates serious undue burdens
for women in these groups by limiting physical access to the services, by
making the costs of services prohibitive, and by creating a social stigma
surrounding abortion that challenges the self-trust and overall trust (McLeod,
2002) that women must have to confidently exercise sound reproductive
choices.

Abortion Policy 661

ABORTION AND VULNERABLE GROUPS OF WOMEN

Adolescents younger than age 18 experience difficulty in accessing abor-
tion owing to prohibitive costs and legal restrictions resulting from parental
involvement laws (American Civil Liberties Union, 2001). As approximately
80% of counties in the U.S. have no abortion provider (Finer & Henshaw,
2003), women living in rural communities are significantly less likely than
women in urban areas to have direct access to family planning services that
include abortion. Women with incomes below 200% of the poverty level find
themselves at a great disadvantage when it comes to accessing and affording
both family planning and abortion services (Jones, Darroch, & Henshaw,
2002). Women of color are also among the groups of adult women who
are most harmed by the politicization of abortion policy (Fried, 2006), as
they reportedly access abortion services at higher rates than other groups of
women, yet often face multiple problems related to access to reproductive
freedom, such as poverty and other economic disadvantages. Owing to the
limited access these women particularly have to abortion, the reproductive
freedom and human rights of women who fall into one, or more, of these
categories are severely threatened.

Adolescent Women

Fifty percent of adolescent women in the U.S. have intercourse by age 17
(Center for Reproductive Rights, 2004), yet do not have the autonomy under
the law to access abortion services in response to unwanted pregnancy often
associated with adolescent involvement in sexual activity. Adolescent women
are engaging in the same sexual intercourse as adult women, frequently with
adult men older than the age of 18. Furthermore, the legal age for consenting
to sexual activity in most states is actually lower than the age of adulthood.
For example, in Kentucky, the state law dictates that the age of consent to
sexual activity is set at 16, whereas a person in this same state is not a legal
adult until age 18 (Governor’s Office of Child Abuse and Domestic Violence,
2009). This creates a legal conundrum in which a young woman at age 16 can
legally consent to sexual intercourse but cannot give her informed consent
for abortion without parental permission should an unwanted pregnancy
occur. Despite the fact that the same type of activity creates identical needs
for abortion access in women both below and above age 18, one group
of women has legal autonomy to access abortion services while the other
group does not. Such disparity of access to abortion could detrimentally alter
an adolescent’s life course. This disparity is allowed to occur even though
our society is doing little to provide effective, evidence-based sex education
designed to prevent the need for abortion in the first place. Young women
are among the vulnerable groups most harmed by current conservative policy
efforts to limit access to abortion (Fried, 2006).

662 G. E. Ely and C. N. Dulmus

It can be argued that lack of life experience, lack of sex education, and
lack of knowledge about one’s body contribute to adolescent women’s being
especially vulnerable to the negative effects of early sexual activity. The most
obvious of these effects is unwanted pregnancy. The unintended pregnancy
rate in 2001 was 104 per 1,000 women ages 15 to 44, which represents about
5% of women having experienced an unplanned pregnancy in 2001; almost
half (48%) of these pregnancies ended in abortion, and the highest rates
of unplanned pregnancies occurred among women aged 19 and younger
(Finer & Henshaw, 2006). Adult women have three legal options to choose
in regard to resolving unwanted pregnancy: giving birth and raising the child,
giving birth and placing the child for adoption, and abortion. They do not
have to involve another person when making any of these three choices.
However, adolescent women are not granted the autonomy necessary to
choose from all three of these options in most states. Though adolescents
do not need parental permission to engage in sexual intercourse, become
pregnant unintentionally, give birth to a child, parent a child or place a child
for adoption, they often need parental permission to terminate an unwanted
pregnancy.

In the U.S., 32 states currently restrict adolescent access to abortion
through parental involvement laws that either require permission for an
abortion from one or both parents or require that one or both parents
be informed prior to an adolescent’s having an abortion (Adler, Ozer, &
Tschann, 2003). All except four of the states with parental involvement laws
allow for a judicial bypass of parental involvement (Adler et al.). Judicial
bypasses can be requested if adolescents can prove that they are capable of
giving their own informed consent and that requesting parental involvement
would put them at risk for problems such as physical violence or being
forced from their homes (Adler et al.; Boonstra & Nash, 2000). In theory,
this option is available to offset the limitations of parental involvement laws,
yet there is no guarantee that a judge will grant judicial bypasses, as hearings
may not be scheduled in a timely manner, and family court judges hearing
these cases may not be supportive of abortion. The delay created for an
adolescent seeking a judicial bypass for her abortion naturally leads to a delay
in being able to get the abortion, thus resulting in later-term abortions. This
is problematic because earlier-term abortions are less costly and less risky
and involve less fetal development (Harper et al., 2005; National Abortion
Federation, 2009).

Laws requiring the involvement of a third party in an abortion decision
have been denounced for their potential to negatively affect health and
infringe on the human rights of women (Cook et al., 1999). Many national
professional organizations that provide social and medical services to ado-
lescents take a stand against parental involvement laws related to adolescent
abortion. For example, The National Association of Social Workers (NASW)
and the American Psychological Association (APA) do not support parental

Abortion Policy 663

involvement policies related to adolescent access to abortion (Adler et al.,
2003; National Association of Social Workers [NASW], 2006). Furthermore, in
a survey of 668 physician members of the Society of Adolescent Medicine,
96% reported that abortion should be available for pregnant adolescents in
at least some circumstances, and 69% supported that abortion should be
an option for adolescents in all circumstances (Miller, Miller, & Koenigs,
1998).

Vulnerable Groups of Adult Women

Early and unwanted childbearing accounts for a significant amount of illness
experienced by women, especially lower-income women (Global Health
Council, 2009; United Nations, 1995). Despite evidence that most Americans
favor access to safe and legal abortion services, low-income women, rural
women, and women of color often have virtually no access to abortion
services in the U.S. (Montanez, 1998). Lower-income women experience
more unplanned pregnancies, likely owing to limited access to and knowl-
edge of contraceptive options; thus, they tend to have more abortions when
compared to women of higher incomes (Harper et al., 2005). In 2000, the
rate of abortion for lower-income women was 44 per 1,000, an increase
in rates from 1990, compared to 10 per 1,000 in high-income women, a
decrease in rates from 1990 (Harper et al.). Because of the need for abortion
services experienced by lower-income women and the economic and social
burdens that result from childbearing in less than idea economic situations,
it is essential that access to abortion be increased and maintained. Women
who want to choose abortion but who experience burdens regarding access
may end up carrying pregnancies to term against their will.

African American women experience the highest rate of unplanned
pregnancy compared with other racial groups, with the rates of abortion at 49
per 1,000 for African American women, 33 per 1,000 for Latinas, 31 per 1,000
for Asian women, and 13 per 1,000 for white women (Harper et al., 2005).
An in-depth analysis of reproductive rights and health in South Carolina
and Florida indicates that access to abortion is limited most severely for
African American and Hispanic women in those states, although poor access
to abortion for all women in those states was also reported (McGovern, 2007).

Abortion is least likely to be available in rural areas. Because of a decline
in the availability of abortion physicians and an increase in illegal policies
that create undue operating barriers for clinics, 87% of U.S. counties had no
abortion provider in 2000, despite that more than one-third of the population
of women ages 15 to 44 lived in these counties (Finer & Henshaw, 2003;
Harper et al., 2005). Approximately one-fourth of women seeking abortion
services travel a distance of 50 miles or more to access the service (Harper
et al.; Henshaw & Finer, 2003). Results from one study indicate that women
living in rural areas in Washington State almost universally had to travel

664 G. E. Ely and C. N. Dulmus

outside their home counties to access abortion services, resulting in later-
term abortions with greater risks to the health of the women (Dobie et.
al., 1999). Results from this study also reveal a decrease in abortion rates
in rural areas, suggesting that lack of access to providers contributes to
women’s carrying pregnancies to term that they might otherwise choose
to terminate.

Many vulnerable women fall into more than one of the vulnerable
groups mentioned earlier, thus further decreasing their access to abortion
services. For example, women of color and women living in rural areas
are also often women with economic disadvantages. The more burdens
experienced by these vulnerable groups of women related to their ability
to access abortion services, the more likely that they will end up hav-
ing no reproductive autonomy at all, leaving them with childbearing as
their only reproductive choice. Forced childbearing has documented neg-
ative effects on both mothers and children (David, 2006; Russo, Horn &
Schwartz, 1992) and is certainly not consistent with human rights afforded
other groups of people both in the U.S. and other parts of the industrialized
world.

REPRESSIVE POLICIES IN THREE AREAS

Illegal policies that attack access to abortion result in undue burdens to
accessing services and adversely affect the aforementioned groups of women
who are already vulnerable to other types of social and economic oppression
(Fried, 2006; Harper et al., 2005; McGovern, 2007). Policies in the following
three areas particularly impede access to abortion for all women but acutely
affect women in the vulnerable groups mentioned earlier.

Insurance Coverage and Medicaid Restrictions

One who chooses an abortion almost always has to pay for it out of pocket,
as most states do not allow for public funding, Medicaid support, or even
private insurance coverage for elective abortions, so the high cost of abortion
services alone severely limits access for vulnerable groups of women (Harper
et al., 2005; Montanez, 1998). States such as Kentucky do not allow Medi-
caid coverage of elective abortion and also will not allow private insurance
to cover the procedure (National Abortion Federation, 2009b). The Hyde
Amendment of 1977 mandates that state Medicaid programs cannot cover
elective abortion services, although it requires coverage in cases of threat to
the life of the mother, rape, and incest. Currently, all states are in compliance
with Hyde Amendment regulations, sometimes owing to court order, except
South Dakota, which has illegally skirted these requirements altogether and
now allows Medicaid coverage for abortions only in cases wherein the

Abortion Policy 665

life of the mother in endangered (Center for Reproductive Rights, 2004;
Harper et al., 2005; National Abortion Federation, 2009b). What is rarely
discussed is that one usually must file a police report to be eligible for
coverage for rape or incest, a process that many victims do not have the
stamina to proceed through, as paperwork is burdensome and rehashing
the crimes can be humiliating and debilitating. Even after taking time to
file these labor-intensive reports, coverage for abortion under Medicaid is
almost always denied (Poggi, 2005). It is also difficult for physicians to
diagnose with certainty that a condition endangers the life of the mother
in absolute terms, as medical science is not exact, and many women are
told such things as they ‘‘might’’ be at risk. Thus, requirements for Medicaid
funding are not met, and vulnerable women are left having to pay out of
pocket for a prohibitively expensive procedure that they need for physical
or emotional health reasons. Evidence suggests that poor women often
pay for abortions with money that was supposed to be used for food or
rent; they have trouble getting money together, resulting in later-term and
more costly abortions; or they cannot afford the abortion and are left only
with the option of forced pregnancy (Henshaw et al., 2009; Henshaw &
Finer, 2003). Estimates indicate that as many as one of three women on
Medicaid would choose abortion if coverage were provided but instead
continue a pregnancy to term against their will, as they feel it is their
only choice (Henshaw et. al., 2009; Henshaw & Finer). Such restrictions
illegally create undue burdens for women seeking abortion for health-related
reasons and for victims seeking abortions, and they produce unwanted
children.

Mandatory Waiting Periods

Mandatory waiting periods create economic burdens for poor and rural
women and implicitly question whether women can be trusted or trust
themselves to decide how to resolve an unwanted pregnancy. Thirty-three
states require that a woman must receive counseling before an abortion
can be performed (Guttmacher Institute, 2009) despite the lack of empirical
evidence that such counseling is necessary or beneficial to potential patients.
Twenty-four states require up to a 24-hour waiting period between pre-
abortion counseling and being able to access the procedure, and seven states
require that the counseling be in person and take place before the official
waiting period begins, thus creating a need for at least two trips to the
clinic before the procedure can be accessed (Guttmacher Institute). These
requirements undermine the decision-making capacities of pregnant women
and create undue burdens for rural women who must travel long distances
to seek services and then must either spend money to stay overnight during
the waiting period or spend money to travel to and from the clinic twice for
the same purpose (Guttmacher Institute).

666 G. E. Ely and C. N. Dulmus

Mandatory State-Scripted Counseling

Closely related to mandatory waiting periods are policies requiring manda-
tory state-scripted counseling. Mandated counseling can be understood as
part of a larger societal and political climate that seeks to punish women
who get abortions and take away their confidence in their moral ability
to know the best means by which to control the size of their families (Ely,
2007). Thirty-two states require that counseling take place before an abortion
can be performed (Guttmacher Institute, 2009). Such legislation has created
undue burdens for both patients and service providers (Henshaw, 1995).
Almost all states direct that women be given specific scripted information,
with 23 states requiring that the state health agency, not the clinic where
services are actually obtained, develop the materials (Guttmacher Institute).
Such materials are often designed to discourage abortion and sometimes
include pictures of fetuses at various stages of development, information
about the unsubstantiated link between abortion and breast cancer, infor-
mation that the fetus feels pain (unsubstantiated) along with the option of
administering anesthesia to the fetus, and information on the unsubstantiated
psychological effects of abortion (Guttmacher Institute). In an analysis of
state abortion counseling laws, Richardson and Nash (2006) found that state
counseling laws disregard the basic principles of informed consent in favor of
a politicized antiabortion goal, and counselors are often required to distribute
misleading information and materials. Moreover, though it is required that
this information be communicated before the procedure can be performed,
the antiabortion agenda of the state law does not have to be disclosed,
the laws disregard the well-being of the patient in favor of antiabortion
political goals, the laws are punitive and demeaning to women, and such
laws undermine self-trust as they create and sustain the negative stigma
associated with abortion (Richardson & Nash).

IMPLICATIONS

Forced pregnancy can be described as a state of denial of abortion services
when pregnancy termination is desired (Cook et al., 1999). Reproductive
freedom cannot exist in a society wherein forced pregnancy is not only
allowed to occur but is promoted by biased, unjust, or illegal social policy.
Universal access to safe, legal elective abortion services regardless of age or
socioeconomic status all but eliminates the possibility of forced pregnancy.
Practices of forced pregnancy are discriminatory based on gender, as there
is no other case wherein a parent is forced to provide their bodily resources,
such as bone marrow or organ donation, to serve a born child (Cook et al.).
Parental involvement laws that limit adolescent access to abortion can result
in cases of forced pregnancy. Even judicial bypass laws do not ensure

Abortion Policy 667

that forced pregnancies do not occur. Lack of access to public funding for
abortion makes abortion unaffordable for many women who would other-
wise resolve their unwanted pregnancies via termination, thus resulting in
forced pregnancy. Mandatory waiting periods create burdens for women by
requiring multiple trips to the clinic that often make the abortion financially
unobtainable, also resulting in forced pregnancies. Both mandatory waiting
periods and mandatory counseling laws push a pro-birth agenda and are
designed so that women will question their trust in their own decision-
making capacity, thus resulting in some women’s carrying pregnancies to
term that they would have chosen to terminate if given access to abortion
services. Forced pregnancy is a condition associated with theocratic and
dictatorial governments in countries where women lack access to social
equality. However, such practices are not in line with American values of
freedom and self-determination, and the end results of forced pregnancy
are not beneficial to vulnerable women, to children, or to our society as a
whole.

The policies mentioned earlier take away the autonomy of vulnerable
groups of women, thereby creating a two-tiered system of access to repro-
ductive health in which women who are not members of these vulnerable
groups have more freedom to resolve unwanted pregnancies than do women
who are members of the vulnerable groups. These policies are allowed to
flourish because they are not being met with the resistance required to
impede their implementation. It is critical that the social work profession
take the lead in policy practice that targets the repeal and elimination of the
repressive policies mentioned heretofore.

RECOMMENDATIONS FOR SOCIAL WORK

POLICY PRACTICE

Social work is a profession with a historical commitment to advocacy that is
not paralleled by any other profession (Reamer, 1991; Lundy & van Wormer,
2007; Van Voorhis & Hostetter, 2006). Repeal of regressive reproductive
health policies can be accomplished through social workers engaged in
competent policy practice, yet professional interest in advocacy related to
this topic is not prevalent in the social work field. Because social justice is
the foundation of the social work profession (Weiss, Gal, & Katan, 2006),
social workers in all areas of practice should be concerned with these issues,
regardless of their personal opinions related to abortion. Jansson’s (2007)
definition of policy practice includes a call for efforts to change policies in
a variety of settings by establishing new ones, improving existing ones, or
defeating the unjust policy efforts of others. Clearly, in regard to abortion
policy in the U.S., competent policy practice is needed in all three of the
areas. Jansson views policy practice as integral to the social work profession,

668 G. E. Ely and C. N. Dulmus

with the ultimate goal being the achievement of social justice. Women in
the U.S. cannot achieve social justice while the aforementioned repressive
abortion policies are in place. Competent social work policy practice in the
area of abortion policy is the only way to change this. Perhaps the most
compelling argument for policy practice in this area lies in the NASW (2008)
policy statement on Family Planning and Reproductive Choice (pp. 144–
151), which states that social work as a profession supports access to safe
and legal reproductive health services for everyone, including abortion and
without government interference. By using this policy statement as a guide,
social workers can implement policy practice strategies that seek to defeat
anti-abortion legislation when it is introduced, eliminate the existing policies
that restrict access to abortion, and establish new policies that focus on
socially just reproductive freedom for all women that includes safe, legal
access to elective abortion services. Though the need for policy practice in
this area is great, one needs to look only to the dearth of published social
work scholarship in the area of abortion related policy analysis and research
to get a feel for the current lack of commitment by our profession to this
critical social justice issue.

Admittedly, this call for policy practice is a lofty professional goal,
especially in the current climate wherein social workers seem to be less and
less involved in seeking social change despite the fact that social justice is the
central mission of the social work profession (Weiss et al., 2006). Advocates
for women’s rights have been insisting on abortion policy reform for decades,
yet social work is the only human service profession with a professional
policy statement indicating the support of access to abortion services as an
important component of social justice. McGovern (2007) suggests that policy
practitioners throughout the U.S. replicate a model that was introduced in
Florida and South Carolina in 2003. Under the McGovern model, advocacy
was implemented by identifying and bringing together a diverse set of health
care professionals, academics, and activists who formed coalitions to work
together and to develop advocacy strategies in support of policies that would
enhance rather than detract from access to reproductive health care, thus
improving access to abortion for all women, especially those in the identified
vulnerable groups. Social workers should be taking the lead in such efforts
in all states, now.

The simplest steps toward advocacy could make a difference in re-
productive health policy in the U.S. Social worker participation in e-mail
campaigns is the easiest way to influence modern social policy reform.
E-mailing state and federal lawmakers to voice lack of support of oppressive
abortion policy, to insist on reform, and to support access to abortion is a
strong way to begin to reshape the landscape of abortion policy in the U.S.
Social workers can sign up for e-mail alerts via advocacy sites that work
toward reforming abortion policy and thus participate in e-mail campaigns
by simply responding to e-mails generated from the advocacy Web site.

Abortion Policy 669

Though such an approach to advocacy is simple, it takes a professional
commitment to generate the interest in using personal time to address this
issue. A profession wide commitment to abortion policy reform is going to
be required if abortion policy is to be made just in this country.

Another way for social workers to advocate is to take time to call
lawmakers directly. Though this approach may seem old-fashioned and/or
time-consuming, in fact it takes only a few minutes to call the lawmaker and
make your position on a certain bill or proposal known to his or her aid. Aids
do take time to compile lists of those who call in favor of and in opposition
to certain policies, and such lists are presented directly to lawmakers who do
consider the opinions of constituents when deciding how to vote on various
bills. This is an effective way to reach lawmakers who are concerned about
both the issues at hand and pleasing the constituency well enough to get
reelected.

Social workers can also make a career out of advocacy in this area by
seeking employment in organizations that advocate for socially just abortion
policy, such as Planned Parenthood or the American Civil Liberties Union.
Social workers are uniquely trained to apply the concepts of social justice
advocacy to abortion policy reform.

An organized effort to repeal the Hyde Amendment of 1977 is essential
if the ‘‘two-tiered’’ system of access to reproductive health care is to be
eliminated. The advocacy efforts outlined earlier must be geared toward the
Hyde Amendment in particular. A profession-wide commitment to the repeal
of this policy is required to address this issue. Forced pregnancy will continue
in the U.S. as long as the Hyde Amendment remains intact.

Educational programs in social work bear the responsibility of empha-
sizing to their students the responsibility of this profession to actively engage
in social justice advocacy as a whole, especially in this area. During matricula-
tion, students must be made aware of the NASW position in support of access
to abortion and the historical professional commitment and expectation for
advancing socially just policy reform in this and other sensitive areas.

In conclusion, the power to choose whether to bear children is the
fundamental premise of reproductive freedom (Finer & Henshaw, 2006). To
experience reproductive freedom, one must be in full control of oneself and
one’s relationship and be able to make good decisions that one considers
beneficial for both self and family (Andrews & Boyle, 2003) without govern-
ment interference. By working to reform U.S. abortion policy, social work
policy practitioners would be working toward social justice for all women
and for children, including those in vulnerable groups. Social work must
take the lead in policy practice in this area because the current state of
access to abortion for vulnerable groups of women in the U.S. is dismal. The
profession of social work is grounded in concepts of social justice, and its
policy statement in this area specifically outlines the importance of access to
abortion as a human right for women. Social workers can no longer ignore

670 G. E. Ely and C. N. Dulmus

their obligation to seek social justice through policy practice in this area as
the need is great and the time is now.

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