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Did Policy Change Work?

Oregon Women Continue to Encounter Delays in Medicaid Coverage for Abortion

Bayla Ostrach

Women in poverty experience greater delays in the process of seeking abortion. Timely access to both safe abortion care and early prenatal care reduces morbidity and mortality among pregnant women. This article examines the impacts of a policy change intended to facilitate poor women's applications for pregnancy-related Medicaid (a federally funded, state-administered health coverage programme for the poorest Americans), in Oregon (Western U.S.). The mixed-methods data from this applied anthropology study demonstrate that though health coverage waiting times grew shorter on average, poor women and the clinic staff who cared for them continued to perceive delays in obtaining Medicaid coverage for abortion. Implementation of the Affordable Care Act in the U.S.A. (aka Obama-care) is now thought to be contributing to a return to greater delays in accessing prenatal care and abortion. More research and advocacy are needed to improve access to reproductive health care through state Medicaid programmes.

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Bayla Ostrach


Abortion law reforms enacted in Spain in 2010 and extended to Catalunya expanded access to abortion. Simultaneously, the autonomous region was affected by economic crisis and austerity, affecting access to care for migrant and marginalised populations. Mixed-method ethnographic data were collected in relation to low-income and immigrant women seeking abortion in two phases: (1) 2012–2013 and (2) early 2016. Data sources included surveys, interviews and participant observation. Data analysis combined descriptive statistics, modified Grounded Theory, thematic analysis and constant comparative methods. Despite public funding of care in a system ostensibly available to all, marginalised people seeking abortion reported reduced access and more barriers to access. Participant experiences with legal, publicly funded abortion revealed bureaucratic difficulties and delays as well as inconsistent and inadequate information. Data on marginalised people's experiences demonstrate that even where abortion is legal and ostensibly available, politico-economic contexts and trends affect their access to abortion and public health care.