Choice Requires Access: Abortion and the Democratic Debate

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Former Housing and Urban Development Secretary Julian Castro speaks during the first Democratic primary debate in Miami. 

The 2020 Democratic presidential candidates agree that a woman’s right to reproductive health care, including abortion, is a no-brainer. But without policies that make access to reproductive care possible, that belief does little.

Few candidates mentioned reproductive freedom and choice at last week’s debates, when speaking about their health care plans. On the second night the discussion was brief, with only Senators Bernie Sanders and Kirsten Gillibrand speaking about access to reproductive health care. But the night prior, former San Antonio Mayor Julián Castro made his progressive position known. 

“I don’t believe in just reproductive freedom, I believe in reproductive justice,” he said. 

Castro’s use of reproductive justice addresses an issue progressive advocates have long sought to make mainstream: Abortion and women’s reproductive health care is about access to that care as much as it is about the legality of that careReproductive justice emphasizes the connection between access and choice, that one cannot happen without the other. The paradigm of pro-choice can exclude marginalized communities. If Democrats want to demonstrate pro-choice acumen and their support for reproductive rights, they need to develop intersectional policies that address the access problem,

The term reproductive justice originated in 1994, coined by Women of African Descent for Reproductive Justice. To them, the discussion of reproductive rights solely through a pro-choice versus pro-life debate mainly represented the experiences of white, wealthy women. The barriers women of color, indigenous communities and trans people faced were ignored. In their framework, published as a response to President Bill Clinton’s universal health care plan, the group argued that “to be truly universal, benefits must be provided regardless of income, health or employment status, age or location.” They also advocated that the plan include anti-discriminatory provisions “to ensure the protection of all women of color, the elderly, the poor and those with disabilities,” and that it not “discriminate on the basis of sexual orientation.” 

A member of the group, Loretta Ross, who is also a leading scholar and advocate, is a co-founder of SisterSong, a multi-ethnic Reproductive Justice collective. Her intersectional work emphasizes the need to transform the pro-choice movement into a reproductive justice movement that addresses inherent social inequalities. SisterSong also developed education and training programs dedicated to reshaping the national discussion on abortion and mobilized a network of reproductive justice advocates to improve current policies. 

When asked if his health-care plan would cover abortion, Castro added,  “[J]ust because a woman, or let's also not forget someone in the trans community, a transfemale is poor, doesn’t mean they shouldn't have the right to exercise that right to choose.” Castro, who served as secretary of Housing and Urban Development from, later said that he misspoke: He should have said transmale. 

Castro’s diction represents a needed push to go beyond siloed policy proposals, especially for marginalized communities. (Castro was the only candidate to mention transgender issues specifically.) After Wednesday’s debate, he went further, explaining that he wants to continue to learn and use his platform to advance the goals of reproductive justice. 

An intersectional approach to health care policy is essential to eliminating historical barriers to the ability to choose. The stubborn racial wealth gap is just one among a host of challenges that make it harder for a black woman to get an abortion. People of color are less likely to receive preventive care and have lower insurance coverage rates at all ages. Health care deserts often overlap significantly with predominately black counties. 

The transgender community also struggles to access needed care. A 2015 survey showed that 29 percent of transgender people live in poverty. Transgender people face discrimination in seeking medical care, and subsequently may choose to avoid it. Transportation, cost of care and insurance, as well as discrimination make it harder for members of these communities to even make a choice.

The discussion of reproductive rights in the debates indicated support for the right to choose, but did not always address accessing that choice. Over the course of both nights, Sanders, Gillibrand, O’Rourke, Inslee, Warren, Castro, and to some extent Klobuchar all voiced support for reproductive freedom as part of comprehensive health care. Warren, too, emphasized access, saying, “I would make certain that every woman has access to the full range of reproductive health care services” including abortion. Castro also homed in on access to health care for everyone, including the transgender community, as central to any discussion about reproductive health care.  

Democrats have pushed left on abortion this cycle. “I believe that reproductive rights are human rights, they are civil rights, and they are nonnegotiable,” Senator Kirsten Gillibrand, who has made women’s issues center to her campaign, told The Atlantic. Even Joe Biden has moved away from his position of limiting federal funding on abortion. Nearly all the 2020 candidates support repealing the Hyde Amendment, which bans federal funding for abortions. But the term reproductive justice has yet to go mainstream. Even Castro seems not to have used the term before this debate. 

The comment may also signal a shifting discussion in a Democratic Party where, although abortion access is part of the party platform, pro-choice Democrats often struggle with including pro-life Democrats in the same party. But the issue has grown more urgent. As Republicans have gained control over more state legislatures, abortion accessibility has decreased dramatically. Six states have only one abortion clinic. In Missouri, the last clinic recently was forced to implement a state rule mandating a medically unnecessary internal pelvic exam before patients could receive an abortion. Across the country, access to reproductive medical care is evaporating, and marginalized communities who face historic barriers are left with no good choices or no choice at all. 

Even as a sound bite, Castro’s remark matters. Addressing historic inequities and stopping the Republican mission to block access to reproductive health care is essential. One way to do that is to change the way we talk about this issue.

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