January 22, 2013, will mark the 40th anniversary of Roe v. Wade, the landmark US Supreme Court decision that established a woman’s constitutional right to an abortion. While we celebrate that Roe has enabled millions of women to safely decide whether or when to have a(nother) child, in 2013 many women face significant barriers to accessing safe abortion care. The increase in restrictions on abortion services and providers over the last two years is making it more difficult, if not impossible, for many women, and low-income women in particular, to exercise their fundamental right to make decisions about their futures and their families.  

At Ibis Reproductive Health, we conduct original clinical and social science research focused on uncovering gaps in the evidence and identifying new ways to improve women’s reproductive health and choices. We work with advocates, health care providers, and policymakers to use research results to change policies and health care services so that they better meet women’s needs. Some of our recent findings highlight how barriers to accessing abortion harm women; our results also show ways we can improve women’s access to the services they need today, while we continue to fight to eliminate restrictions that do not serve women’s rights or health. 

Restrictions on abortion coverage in publicly-funded health insurance programs make it difficult for many women to obtain care, including women enrolled in Medicaid and in the US military. Our work shows that even the minority of women who are legally entitled to federal Medicaid coverage for their abortion face challenges using their insurance, forcing them to come up with money they do not have—often at great cost to themselves and their families—to pay for their abortion out of pocket. US servicewomen overseas also face significant challenges accessing care. Abortion care is generally not available at military health facilities and is not covered by military insurance, except in limited cases. Women in our studies have reported that a decision to have an abortion can have an impact on a woman’s military career, and the need to request leave from her superiors and travel to undergo the procedure cost time and money, and sometimes lead to breaches of a woman’s confidentiality. We are heartened that the Shaheen Amendment, which extends military insurance coverage of abortion to cases of rape and incest, was included in the recently passed defense bill, but this still leaves many women without access to care.

We have learned from women, providers, and advocates that there are strategies that can help improve women’s access to abortion, even in the face of current restrictions. Many of these strategies are outlined in our Take Action guides. We are working to share these guides, along with our state-specific research summaries, with state coalitions that can use them to protect and expand access to abortion care in their states. We have also conducted research on low-income women’s experiences paying for abortion care after health care reform in Massachusetts. Our findings show that expanding access to insurance that covers a comprehensive range of reproductive health services, including abortion, makes a dramatic difference in the ability of low-income women to access the care they need. As national health reform rolls out across the United States we hope this data will help protect abortion coverage where it exists, and will support the fight to extend insurance coverage for the full range of reproductive health care services to all women. 

We have also worked to identify service delivery innovations that can transform services to better meet women’s needs. Tele-medicine provision of medication abortion is one example of such an advance. By increasing accessibility of medication abortion for rural women, and other women without easy access to a surgical abortion provider, tele-medicine can help to address disparities in access to care. Results from our evaluation of a tele-medicine service in Iowa show that tele-medicine for medication abortion is effective, safe, and highly acceptable among women, and also increased abortion access for women in rural Iowa.

In the current climate of growing legislative and political attacks on abortion, we must continue developing and implementing innovative policy, service delivery, and technological solutions to address the barriers many women in the United States face in accessing high-quality abortion care. On this 40th anniversary of Roe v. Wade, we honor and celebrate women’s legal right to abortion, while we reaffirm our commitment to ensuring that abortion is accessible to women everywhere, and that the promise of the decision is a reality for all of us.