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Protestors outside EMW Women's Surgical Center in Louisville

October 1, 2013

Access Denied

Kentucky ranks among the most restrictive in the country regarding access to abortion, particularly for low-income and rural women

On Market Street in downtown Louisville every Saturday morning, outside of the last remaining full-time abortion clinic in Kentucky, the culture wars remain in effect and in high gear.

By 6:30 a.m., anti-abortion protesters have beaten the sunrise to form a column on the sidewalk just outside the front door, as clinic escorts wearing orange vests form a human wall at the property line.

Within an hour, female clients and their companions walk two by two down the sidewalk from their cars to the clinic, flanked by escorts, as protesters — called “chasers” by the escorts — follow closely within inches and try to convince or shame the women into changing their minds.

“We’d love to open our homes, our lives to you,” pleads Andrew King of Immanuel Baptist Church, wearing a yellow vest similar to escorts that — not coincidentally — often confuses clients. A woman named Mary — infamous among the regular escorts as the most violent and hateful chaser — shoves her way in between a client and an escort, then feigns indignation, “Give the client some space!” The client shakes her head with a mix of amusement and disgust.

A line of clients and their companions wait outside the front door of the clinic before it opens, as Patrick Eddington — a regular nicknamed “the screaming preacher” by the escorts — unloads a torrent of shame upon them from five feet away.

“What has this child done to you to kill it?” Eddington shouts. “Do you kick little children when you’re on the street? You’re demented!”

The same scene plays out on a smaller scale in front of EMW Women’s Surgical Center from Tuesday to Friday, but this is the typical Saturday morning that has played out in front of the clinic for 20 years.

The physical and verbal intimidation outside the clinic is far from the only obstacle women in Kentucky face when attempting to access a medical procedure that has been legal for 40 years.

Throughout the past several years, many states around the country where the Republican Party has gained power have passed new laws severely restricting abortion access. Such legislation has closed more than 50 clinics over the past three years, with 10 closing this summer in Texas and North Carolina.

Though Kentucky is the only Southern state to (narrowly) avoid passing such laws targeting abortion in recent years, the state already ranks among the most restrictive in the country regarding access to abortion, as women face legal, financial, geographical and informational barriers to reproductive health care, particularly low-income and rural women.

As poor as such access is in Kentucky, it could soon become much worse. The Democratic majority in the state House has barely held off further restrictions in recent years, but anti-abortion activists are optimistic that Republicans have a good chance of taking back the majority in the 2014 election and pushing through their legislative wish list.

Despite the perilous environment, pro-choice activists aren’t surrendering, and they’re not waiting for legislators to suddenly have an epiphany. Grassroots volunteers and organizations, both old and new, are doing their part to make sure Kentucky women maintain their reproductive rights, no matter their income, region or age.

 

Following the Supreme Court’s Roe vs. Wade decision in 1973, abortion services became available throughout Kentucky by the late-1970s, with a total of 17 providers performing roughly 13,000 abortions per year, at a rate of 15 per 1,000 women of reproductive age.

But subsequent state and federal laws have facilitated a dramatic decrease in these numbers and abortion access in Kentucky. In Congress, the Hyde Amendment of 1976 prohibited federal money from being spent on abortion — with current exemptions for rape, incest and life of the mother — most notably for low-income women on Medicaid. Starting in the late-1980s, a series of Supreme Court rulings gave state governments greater ability to enact restrictive legislation that was previous blocked by the courts. By the early 2000s, Kentucky had enacted a plethora of laws doing just that.

Not only is there the federal ban on Medicaid paying for abortion, but Kentucky is one of 33 states that prohibits state funds for that purpose as well, which includes publicly owned hospitals. Additionally, a 1978 state law prohibits any private insurance company from covering abortion, which will extend to policies purchased through the new health insurance exchange under the Affordable Care Act.

Kentucky law also places the following restrictions that have been upheld in court: 1) Hospitals with emergency room services are prohibited from offering sexual assault victims counseling or referrals for abortion, 2) females under the age of 18 may not receive an abortion unless they receive the written consent of one parent or secure a court order from a judge, and 3) abortion providers are subject to a licensure scheme that is not required by physicians offering other services, often called TRAP laws — targeting regulation of abortion providers.

These laws factored into the evaporation of abortion providers throughout Kentucky by the 2000s, as there is now just one full-time clinic in Louisville and one part-time in Lexington, with three doctors alternating between each. This means that 98 percent of Kentuckians live in counties with no provider, which makes up 77 percent of the population.

With no private insurance coverage or public assistance, many low-income women simply cannot afford an abortion. Prices range from $650 early in the first trimester (up to 12 weeks), to more than $2,000 late in the second trimester, the latter only available at the Louisville clinic and limited to 22 weeks.

There are also added expenses beyond the procedure to factor in, especially for women living in rural parts of the state. Besides taking at least a day off of work, many women must travel multiple hours and pay for overnight lodging, as well as their companion who must accompany them to the clinic. A majority of the women who have an abortion in Kentucky already have children, meaning childcare must be arranged, as well.

This collection of barriers to access has likely played a significant role in the dramatic decrease of abortions in Kentucky throughout the last two decades, despite unintended pregnancies remaining relatively static. According to the most recent figures, there are roughly 4,000 abortions per year in Kentucky, with an abortion rate that ranks the third lowest in the country, one-fourth the national average and one-third of Kentucky’s abortion rate from the late-’70s. Kentucky’s percentage of unintended pregnancies that result in birth are the third highest in the nation.

While those opposed to abortion celebrate these numbers as a sign of victory, a dedicated group of pro-choice and reproductive justice advocates across Kentucky are not declaring defeat, as they work in the face of existing laws and barriers to insure women are not denied their legal right simply due to their socioeconomic status.

 

From the time of New York legalizing abortion in 1970 to the 1973 Roe vs. Wade decision, abortion was still illegal in Kentucky, with many desperate women continuing to risk their health and life by paying for dangerous back-alley abortions. In response, a group of women in Louisville formed the Problem Pregnancy and Abortion Counseling Project to ensure that women in Kentucky had access to safe abortions.

PPACP volunteers set up a hotline for women with unintended pregnancies seeking information and options, and for those choosing an abortion, facilitated their travel arrangements to New York where they had found a trusted clinic to perform the procedure, helping women without the financial means when enough money was available.

But 40 years after the legalization of abortion in Kentucky, similar volunteer efforts are still needed to help women receive the counseling, finances and travel arrangements to clinics in Louisville, Lexington and out of state.

Volunteers for the Kentucky Support Network — a new program of the Kentucky Health Justice Network nonprofit — are stepping up to take on this task.

The Kentucky Support Network operates a 24/7 information hotline for women with an unintended pregnancy, helping them cut through the red tape of obtaining financial assistance, offering free transportation and lodging, and providing legal and counseling resources. Bree Pearsall, a board member of the Kentucky Health Justice Network, tells LEO that KSN’s work is sadly still necessary due to restrictive state and federal laws, which disproportionately affect low-income women already facing barriers to health care and contraceptive access. “For me, it’s about self-determination, the ability to create the families we want and the lives we want for ourselves,” says Pearsall. “I believe every person should have access to choices to make the best decision for themselves, and we’re really filling a gap that many women face.”

Since beginning this year, KSN has assisted nearly 50 women from 12 counties through the hotline, providing transportation, lodging, babysitting, legal resources and interpreters for immigrants who speak another language. Though KSN was able to offer grants ranging from $50 to $70 to some of the low-income women, most of their financial assistance to callers consisted of helping them connect with state and national organizations that have a long history of offering this service in Kentucky.

Since 1993, the A-Fund has distributed money so that women below the poverty line can afford the procedure. Last year they provided $27,000 to clinics in Kentucky and nearby cities in bordering states, which assisted 300 Kentucky women. The National Network of Abortion Funds also steps in with extra funds for women in special circumstances, though the total financial assistance from all groups rarely covers more than half of the costs.

While the total of available funds is nowhere close to meeting all of the need for women in Kentucky, the General Assembly in Frankfort is on the verge of enacting more restrictive legislation that will only increase the financial burden of women seeking an abortion.

 

Though Kentucky law since 1998 has required “informed consent” before a woman can have an abortion — a 24-hour wait after she has received information about the procedure that is biased against it — court rulings have determined that the information can be transmitted over the phone and by mail, rather than in person. Pro-choice advocates argue that an in-person requirement would disproportionately hurt rural women, who would need to take another day off work and pay for an extra night at a hotel.

Legislation mandating an in-person visit — and a description of the fetus during an ultrasound — has easily passed the Republican-controlled state Senate every session for more than a decade, yet fallen a vote or two short in the House Health and Welfare Committee. Despite a Democratic majority in the House, enough conservative House Democrats support the bill that it would pass easily if cleared through committee, and any gubernatorial veto would be easily overridden.

Supporters of the legislation, such as Kentucky Right to Life and the Catholic Conference of Kentucky, expressed confidence that they had the votes in the House committee this year, though Rep. David Watkins, D-Henderson, apparently switched to a “no” vote at the last second, citing the hateful display women must endure while walking into Louisville’s EMW clinic.

“Go down to the abortion clinic in Louisville ... and see what trauma these ladies have to go through when they enter,” said Watkins in committee. “It’s disgraceful ... Legislators are treading in places where they have no business.”

Derek Selznick, director of the ACLU of Kentucky’s Reproductive Freedom Project, is the point person lobbying House Democrats in a scramble to block the informed consent bill every session. He finds it disheartening that legislators can’t find common ground on methods to decrease abortion, such as increasing access to contraception and implementing proven comprehensive sex education programs in schools.

“Unfortunately, we get stuck in the same fight over how to restrict abortion, how to make it more expensive and inaccessible, rather than doing things we know can decrease unintended pregnancies in a cost effective manner,” Selznick says.

The Guttmacher Institute estimates that births resulting from unintended pregnancies in Kentucky cost taxpayers more than $248 million in 2006, while expanding contraceptive access could save millions of dollars and further decrease the abortion rate.

Such chances for compromise may be further unattainable by 2015 in Kentucky, as the Republicans stand a serious chance of flipping six House seats in the 2014 elections, which would put them in the majority in both chambers.

If the House majority does in fact change, Rep. Mary Lou Marzian, D-Louisville, says she would expect Kentucky to easily pass the most restrictive legislation on abortion of any state in the country. Marzian notes that abortion opponents continue to push this legislation just as low-income Kentucky families are beginning to face steep cuts in kinship care and childcare tax credits on the state level, with the possibility of further cuts to the federal Head Start and SNAP food stamp program.

“If Republicans cared as much about children after they’re born, I might take those Christian Taliban seriously,” Marzian tells LEO. “But God forbid you make your own choice about having a baby. As long as you’re in the womb, you’re OK.”

Marzian doesn’t spare her conservative Democratic colleagues pushing for informed consent either, adding, “Some people in my own party … think that’s a popular way to get elected. It’s just so cynical.”

 

At a Louisville press conference two weeks ago to announce their endorsement of Sen. Mitch McConnell for re-election, the leaders of the National Right to Life and Kentucky Right to Life organizations touted their hopes that Republicans would take full control of Kentucky’s state legislature and follow the lead of states in recent years to further restrict abortion rights.

Both RTL leaders told LEO their ultimate goal is to overturn Roe vs. Wade and make abortion illegal on the federal level, hoping to prosecute doctors who “kill babies,” but not the women who pay for them.

NRTL president Carol Tobias explained that “some women find themselves in very difficult circumstances,” while KRTL executive director Margie Montgomery made her differentiation due to women having “a lack of education” and not having “all the facts about abortion.” Though Planned Parenthood currently doesn’t offer abortion at their two Kentucky clinics, Montgomery said they are “racially motivated” to set up shop in poor, black neighborhoods, “to take advantage of the ignorance.”

The “facts” about abortion that RTL prefers are growing throughout the state with Crisis Pregnancy Centers (CPCs), particularly in rural areas where women’s health clinics have disappeared over the past decade. Kentucky now has 40 CPCs, which discourage abortion by giving out blatantly inaccurate medical information about abortion being dangerous to a woman’s health, as well as discouraging contraceptive use while promoting abstinence until marriage.

While the federal stream of funding that directed millions of dollars to CPCs during the Bush Administration is now gone, a portion of state proceeds from the sale of “Choose Life” license plates currently are distributed among CPCs.

One of the most deceptive CPCs in Kentucky is A Woman’s Choice in Louisville, which operates one office adjoining the EMW abortion clinic and a second across the street, often successfully confusing EMW clients into mistakenly walking in the wrong door.

Members of the Kentucky Religious Coalition for Reproductive Choice — an interfaith organization doing pro-choice activism in the state for four decades — conducted an undercover investigation of A Woman’s Choice last year while posing as clients. Counselors attempted to shame and guilt the women for considering abortion, while also dispensing myths about the procedure causing infertility and depression.

Bree Pearsall of the Kentucky Health Justice Network is also the Kentucky field coordinator for Provide, an organization seeking to train social service workers and medical providers with the skills to give quality referrals to women they serve facing an unintended pregnancy.

“Even if their specific role isn’t working in reproductive health care on a daily basis, it’s bound to come up among your clients and patients,” says Pearsall. “It’s a very common issue that’s faced by women, and we think of those people as community connectors.”

 

Following another tense Saturday morning outside EMW, the Louisville clinic escorts have their ritual gathering over breakfast to debrief and vent about what they had just witnessed. Pat Canon — who has escorted at EMW three to four days a week for over three years and now volunteers for the Kentucky Support Network — says that even though escorting is difficult work that is easy to burn out on, the service they provide is necessary.

“I’m asked, ‘How can you keep on coming back and doing this?’” says Canon, who is frustrated that no one in Metro government fights to enact buffer laws keeping the protesters further away from EMW clients. “And I always answer, ‘Once I’ve seen what’s going on, how could I not come back?’ If the protesters aren’t there, we don’t have to be there.”

Anne — the executive director of EMW who declines to give her last name for security reasons — tells LEO that the clinic protesters aren’t exercising free speech but simply harassing women for the decision to terminate their pregnancy and shaming them for being sexually active. Anne mentions the recent interview given by Pope Francis in which he criticized the Roman Catholic Church for focusing too much on issues like abortion, contraception and gay marriage — adding that she is tempted to put his quote on their front window.

“That’s exactly what we need, somebody who can put a good perspective on what Christianity is all about, whether it’s Catholicism or something else,” says Anne. “There are so many other things we have to do to honor God and be helpful to people in this world. And that sure isn’t what those protesters are doing out there.”

Father Pat Delahanty, executive director of the Catholic Conference of Kentucky, lobbies in Frankfort on a wide range of issues, from fighting poverty to supporting stronger abortion restrictions. He tells LEO that he’ll let Pope Francis’ “nuanced” words speak for himself, but doesn’t outwardly embrace or reject the tactics of EMW protesters.

“I don’t know how to assess the clinic action,” Delahanty says. “I think prayer is good, as is public witness. How that affects the pro-life cause may not be discernible. But if a life is saved or a heart is moved, that is all the better. Those are outcomes we may never know about.”

 

Despite the daunting landscape ahead for pro-choice advocates in Kentucky, there appear to be a few glimmers of hope.

One reason for optimism cited by several advocates to LEO is the merger this summer of the Planned Parenthood affiliates of Indiana and Kentucky into PPINK. Though Planned Parenthood has 26 clinics in Indiana, there are currently only two Kentucky clinics in Louisville and Lexington, which do not offer abortion services. Sources close to the former Planned Parenthood of Kentucky told LEO before news of the merger that expansion into other parts of the state — as well as adding abortion services at existing clinics — is a possibility. A PPINK spokesperson says they are currently conducting a needs assessment for Kentucky through market research that will be completed sometime this month, after which time they will chart their future plans.

Another reason for optimism are new provisions of the Affordable Care Act that provide women with birth control coverage with no co-pay, which could decrease the rate of unintended pregnancies among low-income women. This includes intrauterine devices, which last for three to 10 years and previously cost up to $1,000, and the University of Louisville Physicians OBGYN office will provide these for qualified women who don’t have insurance free of charge.

While groups such as the Kentucky Support Network and A-Fund attempt to expand their efforts to break down barriers to abortion access for low-income and rural women, their ability to provide resources is far exceeded by the need. While legislative barriers remain and might even expand, those groups hope to grow their base of volunteers and fundraising to fill in the gaps to access.

On the political front, a new PAC — Reproductive Rights for Kentucky — formed earlier this year with the single purpose of electing more pro-choice legislators in Frankfort.

One of the advisory board members for Reproductive Rights is Jessica Loving, who was one of the key members of the Problem Pregnancy and Abortion Counseling Project in pre-Roe Kentucky, helping women with the logistics of traveling to New York to have a safe and legal abortion.

While strides have been made in Kentucky since those days, Loving says that the continued barriers to abortion access in Kentucky and the remarkably similar grassroots efforts to overcome this “feel like déjà vu all over again.” However, struggles for rights of any kind do not have an endpoint, therefore women and pro-choice advocates must never become complacent.

“What I’ve learned, as we all do when we become mature, is battles don’t stay won,” says Loving. “Making strides in achieving constitutional rights and securing constitutional rights is a long process.” 

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