An Untold Story of Access: Title X Grantees & Abortion Referrals in Rural America



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I called over 700 Title X grantees in 8 rural states (West Virginia, Kentucky, Iowa, Vermont, Wyoming, North Dakota, Oklahoma and Maine) posing as a pregnant woman seeking abortion services. The goal of this project was to gain a better understanding of the barriers low-income women in rural states face in accessing abortion services. I called Title X clinics because they serve mostly low-income women and they are government funded. While the Title X guidelines state that referrals for abortion services must be given upon request; as a “pregnant woman” requesting those services I was not consistently given the medical information I requested. I received a range of different answers to a simple question. When I was not referred to an abortion provider I was either refused the information I requested (directly, information referral or referral to another provider) or referred to a Crisis Pregnancy Center. Both of these responses pose a serious threat to abortion access and make Title X grantees an unreliable source of medical information for pregnant women. I chose to do this research and write my thesis on the results because I wanted to draw attention to the ways in which increasingly restrictive state legislation, the isolation of abortion services and abortion stigma impact low-income women in rural states. The abortion debate in this country leaves out real women’s experiences with abortion and focuses on legality. But the right to abortion means nothing if its not accessible. Abortion access is fundamental to women’s health care, autonomy, equality and constitutional personhood. My project is part of a larger effort to expand abortion access and bridge the gap between legality and access. My thesis highlights the need for increased training surrounding abortion referral practices at all medical providers beginning with Title X grantees. I emphasize the importance of the incorporation of abortion services into mainstream health care and challenge medical providers and government officials to step up to play their part in promoting access to abortion services.



abortion, Title X, abortion referrals, rural America, low income, pregnant women