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How Medicare for All Moves Us Towards Reproductive Justice

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By Rafael Torres

Why is it that Americans, particularly women, still have to fight for reproductive justice, almost 50 years after Roe v Wade? Access to health care, the recent overturning of Roe v Wade, and the language of choice all contribute to the inadequacies of our reproductive health care system in America. However, these aren’t problems that can’t be readily fixed. I believe that legislation and political activism can help solve these issues. In this piece, I propose Medicare for all as a possible solution to alleviate the inequality in access to health care among all American women, regardless of circumstance. Furthermore, I argue that forming partnerships between organizations seeking to advance reproductive justice in America is another path towards reproductive justice.

As Amanda Willis said in a protest in Luzerne County, Pennsylvania, “If a uterus shot bullets, you wouldn’t regulate it.” Amanda highlights the irony in American politics: the same politicians who cite ‘big government’ as their motive for rejecting gun control are often the same ones who want the government to have a say in what people do with their own bodies. Between January 2011 and May 2019, 479 abortion restrictions were enacted in 33 states, which works out to be about one-third of the total abortion restrictions enacted since the 1973 Roe v Wade decision. This unprecedented spike in abortion restriction particularly affects poor and low-income women of color, exposing the severe lack of reproductive justice. In a country that constructs “rights” in terms of individual choice, activists fighting for women’s right to choose are asking us to consider a different perspective: reproductive justice.

According to Atlanta-based organization SisterSong, reproductive justice can be defined as when all people have the necessary power and resources to make decisions about their body, sexuality, and reproduction. A broader concept than reproductive choice, reproductive justice includes not only the right to choose to have (or not have) children, but also the conditions under which one raises them.

I want to make a very important distinction: reproductive justice does not focus only on women. Rather, reproductive and sexual justice encompass men and those who do not conform to the gender binary, including intersex people and transgenered folks. Critical to this concept is the notion that both power and resources are necessary to realize reproductive justice. In stark contrast 26 million people are estimated to be uninsured in the United States. Without access to health insurance, people do not have the resources or power to make decisions about their body, a reality cleverly concealed by the neoliberal ideology of “choice.” Choice narratives fall well short of the vision of reproductive justice and ignore the fact that many Americans, particularly those covered by Medicaid, do not have equal access to health care.

Supporting the notion that access to reproductive care has important health ramifications, a synthesis of existing research by Epsey, Dennis and Landy (2019) shows that access to full-spectrum reproductive healthcare in the US reduces morbidity and mortality, as well as empowers women (Epsey, Dennis, Landy, 2019). Importantly, Epsey, Dennis, and Landy (2019) also show that these poorer health outcomes are exacerbated among groups with less access to healthcare, and especially low-income women, women of color, and young people. This review demonstrates the intertwined relationship between access to health care and reproductive justice. An exclusive healthcare system severely compromises the possibility of reproductive justice in America.

In another review, Dennis et al. (2009) find that where women live in the US is strongly associated with reproductive health outcomes. This is impacted in part by the presence or absence of parental involvement laws: laws that state one or more parent must approve or be notified before their minor daughter can legally have an abortion. Dennis et al. (2009) found that the most significant impact of parental involvement in abortion laws was an increase in people pursuing abortions in states that do not have these laws. In other words, such laws don’t prevent abortion, they simply increase the burden on women who want one. Traveling to a different state to get an abortion requires time and money, revealing again the illusion of “choice” discourse: travel is not a choice for poor and working minors. When people are forced to cross state lines to make decisions about their own bodies, there is no reproductive justice in America. There is only choice for those who have the resources necessary to exercise “choice,” creating a two-tiered system: those who can afford to control their own bodies, and those who cannot.

How might we realize reproductive justice in America? As a starting point, congress should pass a universal healthcare bill. The most well-known bill in public discussion is Senator Bernie Sanders’ Medicare for All, which has won over the Democratic party, as well as a majority of Republicans. This single-payer system would cover all people in the United States, regardless of citizenship and sexual orientation or identity, fixing the problem of access to health care. Importantly, Senator Sanders has noted that Medicare for All would cover abortions, and eliminate the Hyde amendment, which prohibits Medicare from funding most abortions, predominantly affecting low-income women. In addition to benefiting all Americans, women in particular would no longer have to worry about the cost of abortions and other forms of reproductive care, dampening the impact of socioeconomic status on reproductive inequality. But reproductive justice doesn’t end and begin with abortion. Medicare for all would provide healthcare to families that previously might have not been able to afford it, alleviating their anxieties surrounding access. In short, Medicare For All would move America towards reproductive justice for all.

That being said, Medicare for all isn’t a silver bullet. More has to be done to come closer to reproductive justice. Even if we had universal access to healthcare, some people can no longer legally obtain abortions due to the recent overturning of Roe. Legislators have been calling for a codification of Roe v Wade into law for years now. Now more than ever is the time to stand up for reproductive justice.

There are already movements on the ground that are leading the fight in the courts and in the court of public opinion, rooted in the critical feminism and sisterhood of women of color. For example, SisterSong partnered with the ACLU to challenge Georgia’s abortion ban, which would ban abortion as early as six weeks, before many women even know they are pregnant. As of November 2022, the abortion ban was allowed to continue. Nonetheless, partnering with organizations as a means to reach reproductive justice should continue!

Reform isn’t achieved through incrementalism. FDR didn’t save the country from the great depression through half-measures, he did it by working with partners to fundamentally change the system which created the problems of its day. Today, the system that hinders the possibility of reproductive justice in the US is characterized by an ideology of choice, a lack of access to healthcare, and restrictive state-by-state abortion laws. Universal healthcare would be a critical step towards realizing reproductive justice as the status quo.

Rafael Torres is an M2 at UICOMR.