Eliminating the Hyde Amendment Would Be a Big Win for Abortion Care in the South

In 1973, the U.S. Supreme Court handed down its landmark decision in the case of Roe v. Wade, declaring that the right to an abortion was protected under the Due Process Clause of the 14th Amendment. Although the ruling was an enormous victory for the pro-choice movement, it soon became clear that the fight for abortion access for all was far from over.

In 1976, U.S. Rep. Henry Hyde, an Illinois Republican and outspoken abortion opponent, introduced to Congress a budget amendment that bans federal funds including Medicaid from being used to pay for abortion. It went into effect the following year and has been inserted into every federal budget since. The Hyde Amendment has drastically limited the ability of people, particularly the poor and people of color, to access abortion care. According to the Guttmacher Institute, 52% of women impacted by the policy are women of color. The Biden administration excluded the Hyde Amendment from its 2022 budget proposal, which, if passed by Congress, would end the ban on federally funded abortions and greatly reduce financial barriers to accessing abortion care, particularly for people in marginalized communities.

Oriaku Njoku is the co-founder and executive director of the Atlanta-based abortion fund Access Reproductive Care-Southeast, which helps people in Alabama, Florida, Georgia, Mississippi, South Carolina, and Tennessee — states with restrictive abortion laws — pay for and access abortion care. In 2018, Njoku wrote an essay for Facing South about the devastating impacts the Hyde Amendment has had on the Southerners she assists as a part of the fund’s work. Facing South recently had a chance to talk with Njoku about the history of ARC-Southeast, her reaction to the Hyde Amendment’s exclusion from Biden’s budget proposal, her work with with the women of color-led abortion justice coalition All Above All, and her vision for the future of reproductive justice in the U.S. South. The interview has been lightly edited for clarity.

Jessica Agbemavor: How did you come to co-found Access Reproductive Care-Southeast?

Oriaku Njoku: The co-founders and I were all working at Atlanta Women’s Center, which is an abortion clinic here in Atlanta, Georgia. We were doing various things. All of us were always on the phone as phone advocates; we also did some financial advocacy, so that would be helping folks trying to figure out where the funding is coming from, scheduling appointments, doing all these things to support folks. It was very interesting because when I applied to be a phone advocate, I remember being like, well it’s in Buckhead (a well-to-do Atlanta neighborhood), I’ve been working at this massage place answering phones. I feel like they’re transferable skills — I talk to rich white ladies everyday, so this is not gonna be much of a difference. The very first clinic date, everyone who came into the clinic outside of the clinic administrator was a person of color. Majority of those people were Black. So over the first three months of working there, I just remember being like, “Y’all, we have to show up for our folks, Southerners, in a more meaningful way,” because having our people cross state lines from all over the region trying to figure out how to get an appointment because they have a partner who changed their mind, or they couldn’t find childcare and they have nowhere to stay, these barriers should not be what keeps people from getting what they want or need. So at that time, I was like, “We should start an abortion fund.” It was not just this light undertaking in hindsight, you know? But we were like, we know this is what our folks need, so how do we make that happen? That’s really how it got started. It was just this idea, and being in it and seeing that the need was there.

How was ARC-Southeast different from the organizations that were working on reproductive health issues?

One thing that we knew we didn’t want was for this to be a reproductive health organization or a reproductive rights organization. We really wanted this to be a reproductive justice organization, because I believe reproductive justice is inherently intersectional. When we’re talking about the issues that impact people in our communities every single day, it’s not just falling on this choice binary, as far as, you can choose to be a parent or not to be a parent. That is one component, but there are also so many other issues that affect our communities every day, and influence how and why we make the decisions that we make. So, recognizing that reproductive justice is not just about the health aspect, but it takes into account environmental justice, racial justice, economic justice, all of these things come together to influence our decision making process, We wanted to start an organization where the focus was specifically abortion access, which was something that was different.

A lot of times we hear that a conversation of reproductive justice is not just about abortion. For us, reproductive justice is absolutely about abortion — and, in the spirit of abundance, it’s about all of these other things that impact us every single day. For us, we wanted to make sure that we’re specifically focusing on the direct service piece, eliminating barriers to abortion access through funding and logistical support. But we also knew that there needs to be some sort of cultural shift around how we even just talk about abortion, especially in communities of color. So thinking about what is required to not only fund abortion, but build power at the same time, in order for our communities and people to feel empowered, and be fully educated about how to advocate for themselves, advocate for our bodies, for our families, and to speak about against the reproductive oppression we see literally every single day in multiple ways. I feel like that was what was slightly different about us, the focus on the direct service piece, while being a reproductive justice organization.

How have you seen the political climate for reproductive justice change in the time you’ve been with the organization, particularly in the South, and how has that affected your work?

Well, here’s the interesting part. Nationally, there’s this conversation about a post-Roe reality and what we’re coming up against and what the fear is, especially seeing legislation coming through every single session. Every single year there’s something different. But the reality is that this fear nationally that people have is actually our lived experiences here in the South every single day. We’re living in that political climate, living in these political times where it’s constantly changing, living in an area where there are huge disparities based on if you’re Black and brown when accessing health care at large. Adding abortion on to that is just another obstacle. Living in a place where there’s a digital divide if you live in a rural area — that is what determines essentially what you have access to. That is the climate that we live and work in. And so, in that regard, I feel like definitely in the last year, especially with the racial uprisings and the global pandemic, it was essentially like this reckoning that happened where people actually started to see and listen to what we have been talking about over the last six years that we’ve been around.

As far as a drastic change in the political climate, it’s been pretty consistent as far as the various types of oppression we’ve been experiencing. But, there’s definitely a new lens that people have, as far as being able to make those connections as to why we do need to have some level of change, structural change, in our community. Of course with the last administration, it was definitely more difficult. It felt like more conservative folks felt more emboldened to just try anything because they knew that they were being supported — they knew that they weren’t going to get any of that pushback. That is something that has changed over time.

Would you say that the political climate has changed both in good and bad ways?

I don’t want to necessarily say it’s good and bad. But it’s definitely been affirming in a way, to know that people are starting to understand and see, feel called to then do something about it. So, it’s good, even though it’s a really crappy situation that we’re in.

Several years ago you wrote an essay for Facing South about the Hyde Amendment — which has banned the use of federal funds including Medicaid for abortion since 1976 — and how it has directly impacted the ability of Southerners to access abortion care. What was your reaction to hearing that President Biden submitted a budget proposal to Congress that excludes the provision?

Initially, my reaction was: “It’s about time!” I’m always so fascinated about the Hyde Amendment. This is something that I didn’t know until I started working in the movement. The Hyde Amendment isn’t even a law, it’s something done every single year, regardless of who’s been in office. We’ve had conservative folks, we’ve had liberal folks, moderate folks, everything in between for the last 40 years, and there’s been a choice to include the Hyde Amendment in the budget. And every single year, they could have just not included it, and it would have expanded health care access to so many people. So yeah, it’s about time. What will happen after this is unclear. What will happen if next year they decide to add it back to the budget? I don’t know. What will happen if there is a change in who’s leading this country? That could also change. So yes, this is a great and amazing first step. Once we start having this conversation on how this was affecting various people, whether you’re in the military, whether you’re an Indigenous Native person in this country, whether you’re on Medicaid, how has getting rid of this improved our lives, how has it improved access to care — I think will be really exciting to see how the conversation develops over time. The general sentiment was it’s about time, thank y’all for doing what y’all need to do.

Let’s imagine that the Hyde Amendment was eliminated permanently. What would that mean for the work that you do and the communities you serve?

Oh my goodness, it’s huge. It’s huge. When thinking about the number of callers that we have that are actually on Medicaid, there’s definitely an opportunity to expand health care access to so many people who end up reaching out and calling the ARC-Southeast healthline. The other part of that is when we see Medicaid expansion as far as folks being able to use their Medicaid to pay for an abortion in other states — one of the key things about that is the implementation and what that actually looks like. So making sure that all of these clinics that are providing abortion access actually then get paid on time, that reimbursement rates are where they need to be to make it even worthwhile for them to be able to even continue to provide this care — that’s the next step of consideration of things that need to happen.

About 43% of the folks that we support at ARC-Southeast are on Medicaid, and 44% of people that we support don’t have Medicaid at all. So, 87% of the folks who call our healthline are either on Medicaid or uninsured. So when thinking about what the Hyde Amendment can do for all of those people — as far as making it steps closer to accessing abortion care when it comes to paying for it — is huge. But also, even though folks will be able to use their insurance to pay for their abortion care, there are still so many other barriers logistically that come into play. So yes, that will possibly help on the funding side. But there are also going to be other barriers that still need to be eliminated in order for people to get the appointment. So yes, you can have all the money to pay for your abortion, but what if you don’t have childcare, if you don’t have somewhere to stay, if you don’t have gas money to travel to get your abortion? For instance, Mississippi only has one abortion provider in the entire state, so if you live in a part of the state where you actually have to cross state lines, you’re still gonna need funding to do that. So I feel like there’s a lot of other things that may come into play, as far as, being able to access abortion. But that funding piece ends up being quite a big barrier for a lot of folks as far as being able to get an abortion. So, it’s optimistic, but it’s also like, this is a first step and there is so much work to be done still.

The progress toward eliminating the Hyde Amendment comes at a time when abortion rights are under unprecedented assault in the states and at the U.S. Supreme Court. Are you optimistic or pessimistic about the possibility of achieving greater reproductive justice in America?

I am so optimistic about what is going to happen, and the reason I can be optimistic is because I know our people. Being in communities, being a Black first-generation Nigerian American queer femme living here in the South, there are so many things even personally that could keep me from living fully as I am, and one of the things that I keep going back to is this doesn’t actually have to be this way. We do this work to make sure that we receive some level of reproductive justice in our lifetime — it’s not just because I’ve drank some Kool-Aid and I’m like, “I believe!” It’s because history has shown us that Black and brown communities consistently will do whatever we need to do to make sure that our material conditions are being met. Our folks will always come together to make sure that we have what we need. When thinking about this, regardless of Roe, the courts are not going to determine our destiny. That can’t be the end-all, be-all of how we choose, as communities, to make sure that we have everything we need to thrive. Especially living in a region, in a country where these systems were never intended for people like me to thrive, I can’t keep relying and counting on the court to be this savior.

So, I am optimistic. I feel like even last year, it wasn’t just a reckoning for white folks in this country, but it was for us to be like, “Oh yeah, we can stand up and we can fight for what we know is right. We can make sure that we have what we need because it’s not going to be coming from anyone else.” So I do believe that we can achieve some level of reproductive justice in our lifetime. I’m not doing this just for future generations, even though yes, we want to make sure that our folks in the future don’t have to go through the same things we did. But, we deserve to live in those spaces and sustainable environments as well. We deserve to have our human rights and bodily autonomy. That’s why I end up being so optimistic. I’m also in love with reproductive justice and what it’s done for me personally, so when I think about what is possible, I can’t be pessimistic. I can’t be.

What do you believe it will take to achieve equal access to abortion for all Americans, outside of ensuring that abortion is legal in all 50 states?

That’s such a big question, and such a beautiful and dreamy question. It could look different for so many people, but I just imagine when we’re in that place where reproductive justice is achieved. It’s something that I like to do, especially with our staff. I’m like, “Let’s just imagine we’re there. Let’s imagine that reproductive justice is a thing, we’re here, we’ve done it, we don’t have to work through those remaining barriers because all the unmet needs are being met. What does that look like, and what do we have to do to meet and sustain that?” There’s a range of things where people are not only making a living wage, but they’re making a thriving wage. Where if they need to pay for their abortion, they can. Or if abortions are completely free, making sure that the folks providing abortions, whether they are traditional or nontraditional, are being adequately compensated for the work that they do because they also deserve to live and thrive. Making sure that we live in communities where there aren’t food deserts. And when people decide to have children and decide to create their families, they have access to clean water and food, housing, and education. There’s a full range of contraceptive options. And not what we think is sexy, not what we think y’all need based on some scientific calculation, but you can actually decide what you want on your own terms.

There won’t be any criminalization of abortion or criminalization of our bodies, so if you decide to do a self-managed abortion at home or go to a clinic, or if you decide to go pick up Plan B, whatever it is, just having that full range of options, and being able to decide what you do with that information without any bias, or shame, fear, or stigma associated with that. I feel like that gets us much closer to that liberatory space where we have all the things that we need, and we feel informed to make those decisions without questioning, without any sort of pessimism or negativity creating an additional barrier to living your best life. That’s just such a dreamy vision. It’s something that I’m like, “I want that now. I want it now for all of us.”

Are there any other thoughts you would like to share?

The reason the Hyde Amendment and this conversation is happening the way it is right now is because of the work and love for communities that Black and brown folks have had. The All Above All Coalition has done so much work to get rid of the Hyde Amendment and advocate for a clean budget. I’m so proud that ARC-Southeast is also a part of that organization. But also, that work could not have been done without the blood, sweat, and tears of Black and brown women in the reproductive justice movement. As hard as it has been, it’s still worth it, and this is just one step of many to make sure that our folks get what they need. So huge shout out to All Above All, and all of the organizations that made this magic happen. I remember the first All Above All thing that I did was the first advocacy day I had in D.C. and met John Lewis. Knowing that we’ve had champions from the South who are like, “Yes, we see how this is tied into all of the other issues,” whether it’s civil rights or human rights — knowing that there’s a lot of people in leadership who believed in this work that are here or not here with us. It’s been a long time coming.