September 30 marks the 40th year since the inception of the Hyde Amendment, a sneaky rider that Congress members attach to appropriations bills every year. Hyde enables the federal government to skirt its responsibility to protect the health and well-being of its constituents by withholding Medicaid coverage of abortion.

Simply put, Hyde is a bad policy and leads to poor health outcomes, especially for women of color and people who are struggling to make ends meet. But what kind of emotional and cultural effect has Hyde had over the last 40 years?

The Hyde Amendment undoubtedly contributes to a culture rife with abortion stigma. One way to enshrine abortion stigma is for people with power and authority, like lawmakers, to invent an artificial divide between abortion and all other forms of health care. This is exactly what Hyde accomplishes.

Abortion is the only medical service singled out by the government as not required to be covered by Medicaid or private insurance. This deliberate marginalization of abortion makes it seem like there’s something different about abortion, that it’s not like other forms of health care, despite abortion being one of the safest and most common services a person can have. Yet the Hyde Amendment gives power to the politicians who would rather punish people for being sexually active than ensure they have access to reproductive health care.

By extension, the Hyde Amendment made it acceptable for lawmakers and the public to debate reasons for seeking an abortion. Hyde enshrined into law the idea that there are precious few “acceptable” reasons for providing insurance coverage of abortion: The pregnancy is a result of rape, incest, or a threat to the person’s life. This “acceptable” clause promotes a core component of abortion stigma—labeling certain abortions as worthy of public funds and public support, and others as unworthy and shameful.

Another example of the Hyde Amendment’s cultural effect is the way it affects the people who are often responsible for enforcing it: Medicaid employees. One 2012 study performed “mystery shopper” calls to Medicaid offices in 17 states and found that staff were “confused” about abortion coverage policies, and were not able to provide accurate information about whether the policy covered abortion and under what circumstances. This is what stigma scholars call institutional-level stigma, in which a public system (such as Medicaid) and the actors within it reinforce the stereotyping, labels, and discrimination that contribute to the stigma.

This mandate that some reasons for abortion are socially sanctioned through Medicaid coverage, while others are not, negatively affects people’s experiences when accessing abortion. Having to overcome financial and logistical barriers (such as mandatory waiting periods) to access an abortion inflicts a high emotional toll on people seeking health care. It’s possible that having to ask family, friends, and strangers to help pay for an abortion may strain relationships and even place people in danger.

The most obvious cultural implication of the Hyde Amendment is the emotional effect it has on people enrolled in Medicaid, people who are trying to make ends meet. The Hyde Amendment causes trauma for people who need to go through the arduous, painful task of “proving” that they are the victim of rape in order to be eligible for insurance coverage of their abortion. In addition to causing emotional harm, the Hyde Amendment may contribute to increased internalized stigma for people seeking abortions.

It should come as no surprise, then, that a recent study found that of all abortion plotlines on TV, very few, if any, made reference to a character’s financial situation as a reason for choosing abortion. This is in stark contrast to reality, where 73 percent of abortion patients cite their economic circumstances as a top reason for abortion. By refusing to show TV characters who wrestle with the limitations that poverty places on reproductive decision-making, popular narratives ignore the lives of many women who have abortions, another cultural ramification made possible by the Hyde Amendment.

In a different 2012 study, researchers interviewed more than 70 women on Medicaid who’d had an abortion, and they expressed overwhelming support for Medicaid covering abortion. At the same time, they used disparaging language to talk about people needing abortions in certain circumstances, even situations that mirrored their own. The Hyde Amendment reinforces the stigma associated with both abortion and poverty, which for women of color is also compounded by systemic racism, exemplified by poor access to high-quality health care in neighborhoods with a majority of people of color, and health-care professionals treating women of color in a way that could jeopardize their health, among many other factors.

So what is being done to stop Hyde’s damaging effects on our culture? Luckily, on this 40th unhappy anniversary of Hyde’s passage, we’re closer to a repeal than ever been before. All* Above All, a coalition led by women of color and reproductive justice advocates, is playing a pivotal role by introducing pro-active abortion access legislation and encouraging elected officials to come out against the Hyde Amendment. We have seen, for the first time, both Democratic Party presidential candidates come out against the Hyde Amendment, with its repeal now in the Democratic Party’s platform. We are seeing a shift in how we think and talk about abortion thanks to countless storytellers and advocates joining forces. And a recent poll found that the majority of the voters in battleground states agree with the statement: “However we feel about abortion, politicians should not be allowed to deny a woman’s health coverage for it just because she’s poor.”

Yet we must be vigilant—the Hyde Amendment may be a budget rider, but its effect reverberates beyond the policy realm. During the last 40 years, the Hyde Amendment has woven abortion stigma into the fabric of how we think and talk about abortion in the United States. To remedy that, we need to focus both on repealing Hyde and also creating deep-seated culture change to eradicate abortion stigma.

You can join the movement to repeal Hyde by taking action with All* Above All, and you can contribute to culture change around abortion by listening to people who’ve had abortions; learning how to become a good ally; and standing up to people who have negative attitudes, behaviors, and beliefs about abortion wherever you see them—at your kitchen table, in your classroom, or in the news. It’ll take all of us working together to overcome the personal, political, and cultural effects of the Hyde Amendment.