PROVIDENCE — Dr. Beth Cronin had a patient come into her practice recently with an unplanned pregnancy. The couple already had children, and were not in any financial position to have another, but could not afford to pay for an abortion, which can cost hundreds or even thousands of dollars.
“So now we have people — like this patient — that are stuck,” Cronin told the Globe Wednesday. “This is a time-sensitive procedure. But they don’t have a choice since they can’t put up the funds immediately.”
Though Rhode Island passed the Reproductive Privacy Act in 2019, protecting the right to an abortion in the state, the law doesn’t make it much easier to terminate a pregnancy.
Abortions in Rhode Island can start around $600, and go up to $5,000 or more, depending on if there are any complications. Some organizations — like Planned Parenthood, the National Abortion Federation, and Women’s Health & Education Fund — have a fund that helps cover costs for those who can’t pay. But those limited funds can’t pay for everyone. And they don’t cover lost wages, transportation, child care, or other expenses besides the cost of the procedure.
Abortion is currently not covered by public health insurance in Rhode Island, so the 315,000 low-income residents who are on Medicaid have to pay for abortion care out of pocket. Representative Liana Cassar and Senator Bridget Valverde recently re-introduced the Equality in Abortion Coverage Act, which would allow abortions to be covered by the state’s Medicaid program. Governor Daniel J. McKee says he fully supports it, but there’s a chance the bill could get stuck in committee — for the second year in a row — leaving residents on Medicaid without abortion care coverage.
“Patients face a number of barriers in accessing abortion care. It’s true throughout the country. And Rhode Island is no exception,” said Dr. Ben Brown, an OBGYN at Women and Infants Hospital who is a professor at The Warren Alpert Medical School of Brown University. “These barriers to abortion care disproportionately affect those who are non-English-speaking patients, patients of color, and low-income patients.”
If a woman does not have a car, or does not live in Providence, it may be difficult to even get to an abortion clinic, advocates say. There are only two clinics in the state — at Planned Parenthood and at Women and Infants Hospital — that perform elective surgical abortions, said Jocelyn Foye, the director of The Womxn Project. Both are located in Providence. Other clinics may provide pills that can terminate a pregnancy, but those clinics are also in the greater Providence area, Foye said.
“People see us as such a small state, so why would we need abortion clinics elsewhere? But they aren’t thinking of the poorest communities, where many times, there’s a lack of public transportation,” said Faye.
“Even in our tiny little state, we don’t have great public transit,” said Cronin, who is also chair of the Rhode Island section of the American College of Obstetricians and Gynecologists. “And you don’t want to throw someone on the bus after getting anesthesia. It’s not safe. We don’t even discharge people from the hospital if they are alone because of the risks.”
Certain populations face other risks when trying to access abortion services, said Lucy Rios, the interim executive director of the Rhode Island Coalition Against Domestic Violence.
“We know that domestic violence victims can be impregnated by their abusers against their will, and we know some abusers will force victims to stop taking birth control,” said Rios. “These are situations where these victims are not in control already.”
When they attempt to make decisions to take control of their own bodies, she added, abuse can get worse, and an already difficult situation could become even less stable.
Many victims are fearful of using their own medical insurance because the abuser, especially if they control the household’s finances, could find out they had an abortion through insurance invoices or other paperwork that is mailed home.
“If they have to rely on someone to bring them to a clinic because of a lack of public transit, it becomes even harder,” she said. In many cases, these victims have been isolated and don’t have a trusted support system they can turn to.
If the US Supreme court overturns Roe v. Wade, the 1973 landmark decision protecting women’s right to an abortion, abortions could quickly be banned in at least 22 states. Advocates say they are already preparing for more pregnant people to travel to Rhode Island and other states to safely terminate their pregnancies. Dr. Brown said the clinic at Women and Infants is preparing for it, and keeping their facility fully staffed and “ready to be of service to our patients.” Yet, at the same time, he worries that many of these patients coming through will not be able to seek follow-up or emergency care back home.
“In case anything goes wrong, or there’s an emergency where a patient needs to seek emergency care, I’m worried they won’t feel safe going to their local hospital. Will they get turned in by a health care worker or provider?” asked Brown. “I really worry that laws that make abortion illegal really threaten the relationship between patients and their health care providers. And ultimately lead to crises that could have been prevented.”
“The number of abortions are never going to stop,” said Foye. “People are going to travel for them. And already, it’s difficult for some Rhode Islanders to get one. It’s time we start thinking about adding clinics in these communities, and expanding access.”