My mother and I came for the salted caramel budino. That, and I like that the restaurant uses one big ice cube for their Old Fashioned. It’s the type of place that requires an Open Table reservation two months in advance. My mother and I entered the narrow space on a whim, with the knowledge that we’d likely turn around and go to a less popular, less packed restaurant with no salted caramel budino and no good ice, but there they were: two vacant bar stools. It was one of those gifts from the universe, like having just enough milk or just enough toilet paper or just enough gas or just enough of really anything.

As we waited for our dessert – layers of Oreo cookies, caramel pudding, crème fraiche whipped cream, and sea salt served in a trendy mason jar – my mother said she had something to tell me. Shoulders back and glint in her eye, she looked like a child moments away from blurting out a big secret. 

And here it was: My mother, who had recently begun working at a prominent city hospital, had officially signed the paperwork exempting her from assisting on abortion procedures. She was so proud of her decision. I sat staring into my Old Fashioned.

In theory, I support my mother’s right to religious freedom and her right to refuse participating in any activity opposing her religious beliefs. In theory, I believe no nurse should assist in abortion operations if they are morally opposed to the procedure. But in practice it’s so much more complicated when my mother and I are on two different sides of an issue, especially when she delivers the news with this expectant expression, as if we’d high five over it. As if I’d ever said anything that would have given her that impression. 

In theory, I believe no nurse should assist in abortion operations if they are morally opposed to the procedure. But in practice it’s so much more complicated.
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My mother is anti-choice and I’m pro-choice, and both of our stances are unlikely to ever change. I know that because we’ve spent years trying to sway the other. Debates, mostly in the cramped spaces of different cars throughout the years, usually ended the same: I’m mean and condescending and she’s narrow-minded and too religious. Nothing ever changes, except maybe the car.

Since the setting, this particular time, was the popular restaurant with the good ice cubes, I tried to avoid being mean or condescending. I didn’t ask what the point of signing such a document was, since she worked as an ENT nurse and abortions weren’t normally performed via ear, nose, or throat. I didn’t even launch into a speech about stigmatizing abortion because yes, yes, religious freedom. I reminded myself that my mother has a right to religious freedom, but I still felt betrayed by her decision.

Instead, I asked my mother if the paperwork was limited to women who had chosen to terminate their pregnancy for personal reasons or if it included women who were terminating their pregnancy for medical reasons. My mother told me she was excused from all abortions. Even those performed when the fetus has no chance of survival. Even those performed to save the life of the mother.

No, My Right To Abortion Did Not Cost Hillary The Election
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So logically, I asked my mother if she thought women who had abortions at the direction of a medical professional were, in fact, sinning. Because that’s what her religious disapproval comes down to—that it’s a sin—right? My mother is an intelligent, practical woman. She graduated first in her nursing class and supported our family while putting herself through nursing school. I thought this woman must know that it definitely isn’t a sin to terminate a pregnancy when a doctor tells you that you’ll likely suffer medical complications otherwise.

As I write this, I’m aware that my mother may sometimes apply a similar rationale to me. She must think of how I’m the same law-abiding girl who wouldn’t even sneak candy into movie theaters. She must think that I’m the sweet girl who she sent to Catholic school for twelve years. And that girl, my mother may think, must logically know that it’s always a sin to have an abortion, no matter what. Or perhaps, it’s the opposite. Perhaps my mother hears my pro-choice arguments and secretly knows I’ve been evil ever since that one time in the third grade when I found out Mary is the Queen of Heaven. I was eight years old and I wanted to be the Queen of Heaven when I died, so I said I hated Mary. My mother told me to say ten Hail Marys to repent, but I never did.

My mother and I are of the same blood and flesh, yet separated by this issue, and also our religious faith, and also our brands of logic. We’re two different radio stations playing the same exact song just a few beats off. We are so much of the same, but we are never the same.

My mother sidestepped the question. She said she didn’t want to aid in abortions, period. I could have asked hypothetical questions, like what if my mother was the only nurse in the whole hospital who could help, and the patient was going to die unless she terminated her pregnancy? Wouldn’t God think letting a woman die was just as serious an offense as an abortion?

But instead of the hypothetical questions, I ordered another Old Fashioned with a big ice cube and thought about my abortion.

I’ve never written about having an abortion before because I feared becoming “that girl who wrote about her abortion that one time.” I feared the story would become the first thing that popped up when someone Googled me and it would become all of me. I feared what someone from my biology or algebra or world history class would think if they read that essay. Or what about all the boys I had ever kissed, what would they think if they read that essay? I feared that my experience would be discussed and ridiculed and dissected on Twitter and Reddit and conservative websites. I feared Donald Trump and Kevin Williamson and Retribution. I feared, so I never wrote. But there are worse things to be in the world than the girl who wrote about the abortion she had one time.

But instead of the hypothetical questions, I ordered another Old Fashioned with a big ice cube and thought about my abortion.
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 My abortion story isn’t very special or different or significant. I had sex with a boy, and we were both irresponsible. The pregnancy test was positive, but I was in college and had taken out student loans and graduating was important to me. After a predictable chain of events and one awkward phone call later, I sat in stirrups much like I had done during my run of the mill trips to the gynecologist, only it was in the basement of Planned Parenthood, and before entering I was patted down by a security guard with a visible gun on his hip.

I had been called back several times: the psychological exam, the payment, and the ultrasound which I asked to see, partially out of curiosity and partially out of a sense of responsibility. If I was going to have an abortion, I was going to look at what I was aborting. I reasoned that I owed that much to whatever it was inside of me. And it was something—a blob, a ball of cells, a dark splotch in the ultrasound version of my body. It wasn’t a baby with a foot with toes I would one day call little piggies. But there was a distinct matter in my body. Seeing this made me feel both better and worse. It didn’t have little piggies, but it was also there and it soon wouldn’t be.

Finally, I was called back and given a gown. The nurse knocked, waited for the customary okay from me, and entered the room. She managed to achieve the ideal tone,neither cheery nor somber nor cold. She was professional, yet also personal. More than anything else, she seemed to understand that I was a real person in a less than desirable situation. I was making a choice I would have rather not have had to make, and this medical procedure may be something difficult for me. But she also made no assumptions in the matter. She was perfect. She told me that the doctor was male and she’d be in the room the entire time. She also told me the doctor usually narrates the procedure so his patients know what he’s doing to them while he’s doing it, would I like that? I nodded.

I Had An Abortion Because I Love My Son
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When the doctor entered, he was already wearing a surgical mask, so I never actually saw his face. For so long, this felt like a personal slight—it’s only now, as I type this, that I realize this man may have simply not wanted the risk. He provided my autonomy, but he demanded his anonymity. Years later, I’m okay with that. But sitting in stirrups that day, I wanted to see that he was a person, too.

The doctor didn’t make eye contact with me. He simply sat in the stool and asked if he could begin. I said yes and spiraled with the certainty that he was judging me as he parted my legs wider and disappeared into the tent of my hospital gown. I didn’t take into consideration that this was his job, which was likely exhausting and largely thankless and demonized by a whole group of citizens. And maybe he was sick of the cold weather we were having, I don’t know. There were so many possible reasons for his curt bedside manner, none of which had to do with me, but I took it personally. It was my abortion; I was taking everything personally. And why wasn’t he saying what he was doing to me? 

My face must have lit up with all these thoughts because the nurse stepped into the space next to me, held my hand, and narrated the procedure as the doctor silently worked. She explained every detail with language I can’t distinctly remember now, but I do remember her voice was calm and even. And she didn’t complain when I squeezed her hand from the pain. 

When the doctor needed assistance, the nurse politely asked if she could let go of my hand. It wasn’t a question, not really, but the fact that she phrased it that way was especially kind. We unlaced our fingers and I lost her to my lower hemisphere, but she kept narrating what was being done to my body and asking if I felt okay. That nurse’s compassion was the only bright spot of the procedure. 

I could get into the pain of the procedure, the tears my dog licked off my cheeks later that night, and the months of getting drunk and, one by one, telling my close girlfriends, some of which confessed their abortions to me, too. But, it’s all really pretty standard. 

I thought of telling my mother on several occasions, including over our fancy dessert. But if I told her in that crowded restaurant with people to either side of us, she would have likely had thoughts about my posture and my expression. She would have to remind herself that I have a right to reproductive freedom, but she’d still feel betrayed by my decision, as I did hers. And we’d both sit there in our betrayal, and the big ice cubes, dessert in the mason jar, and good fortune of those two open seats would be all for naught.

For a long time, I felt like I owed my mother an admission of my abortion because, if nothing else, she had gotten pregnant once, hadn’t had an abortion, and ta-da here I am. But there are also so many things that mothers and daughters don’t tell each other. I once went into the bathroom after my mother had showered and found that she had left behind a vibrator. I never told her I knew what she did during her showers and she never told me she liked to masturbate after shampooing. My sophomore year of high school, my mother had to pick me up from school because I bled through my tampon, through my underwear, and through my uniform. She knew the reason the school nurse had called her and she cleaned the large butterfly-shaped bloodstain from my skirt, but we never spoke of it.

She would have to remind herself that I have a right to reproductive freedom, but she'd still feel betrayed by my decision, as I did hers.
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And there were those quiet morning drives to school, during which we passed an abortion clinic. Even before 8 am, protestors would be outside with their chants and their signs and their rosaries. I’d wordlessly watch them from the window while my mother stared ahead. She was too tired from last night’s restaurant shift to discuss the protest, or maybe too tired to even notice.

Pregnancies seem to be marked by food. Women can recall with such specificity what they craved, what they missed eating, and what made them sick. My abortion, too, is marked by food. There was the sushi dinner I threw up, which was, in retrospect, likely the first sign of my pregnancy. There was the pizza I ate after my abortion, which went on to become my favorite pizza in the city. But every time I’ve ever eaten a slice, I remembered the first time I had this pizza was when I was wearing a jumbo pad and watching Rosemary’s Baby (an admittedly strange choice for post-abortion entertainment).

The salted caramel budino, too, has gone on to mark a moment in my story about my abortion. Between my mother and me were our vaginas we don’t talk about, religious freedom and reproductive freedom, decisions to or to not become mothers, and the nurse who never signed a paper exempting her from my abortion and who held my hand when I needed to hold someone’s hand. Between us there were no answers to be found, but there was dessert. And we split it. 

I n the wake of the GOP’s recent and unflagging attempts to repeal the Affordable Care Act — an unpopular move by multiple measures — a handful of Democrats are fighting back with a push in the opposite direction. Rather than try to tape the ACA back together, candidates and lawmakers are pushing for a health-care revolution in the form of a single-payer system. Last week, the idea got its most high-profile boost yet, when Sanders unveiled a Medicare-for-All bill with a record 15 Democratic co-sponsors in the Senate.

The legislation, of course, doesn’t stand a chance of passing in the current GOP-controlled political climate (Trump has even gone so far as to call the plan, ludicrously, a “a curse”) — but there’s reason to believe it has potential, especially if Democrats soon take back political power. A recent Pew poll, for instance, found that support for single-payer health care has grown 12 points since 2014.

This push for universal or single-payer health care — which aren’t exactly the same, but are similar enough that they’re largely used interchangeably — is undoubtedly promising. But there is also good reason to believe that a single-payer plan could potentially leave many pregnant people without a way to pay for a necessary medical procedure that hundreds of thousands seek each year.

A recent Pew poll found that support for single-payer health care has grown 12 points since 2014.

That’s because in the United States — a country where erectile dysfunction medication, cosmetic surgery, and numerous other pills and procedures are covered by insurance — abortion has largely been funded out of the pockets of the people who pursue it. Since the 1970s, Medicaid funds have been barred from paying for abortion services, and Targeted Regulation of Abortion Providers (TRAP) laws have restricted the ways in which even private insurance can pay for the procedure and aftercare. If restrictions like these aren’t expressly confronted and dismantled in a single-payer health-care plan, many reproductive-rights organizations believe that universal health care will not expand access to coverage for pregnant people in need, and could even further hinder access.

At a time when basic abortion services are in peril — when states are rolling back abortion rights with little resistance, and when Democratic organizations and lawmakers have made it clear that abortion is an area of potential compromise — how can we be sure that any attempt at single-payer health care will hold strong and ensure that everyone truly is covered?

Even as we fight back against the GOP’s latest last-gasp effort to get rid of Obamacare — and it’s crucial that we do — it’s also important that we open up a pro-choice dialogue around single-payer. Because no plan can be universal if it doesn’t support those seeking reproductive care.

The Power Of Hyde

It would be easy to assume that pro-choice advocates and single-payer advocates are one in the same — they are united in their interest in expanding health-care access, and both tend to come from more progressive camps. However, many reproductive-health organizers are skeptical that single-payer plans will truly be inclusive, while single-payer supporters view pro-choice groups as being too incremental.

The schism lies partially — but not entirely — in concerns over the budget appropriation known as the Hyde amendment, which bars most public money from paying for abortion services. Because of Hyde, for the 17% of non-elderly adult women who are on Medicaid (many of whom are members of marginalized populations), abortion services — which can run up to $1,500 — must be paid out of pocket except in very specific instances. That’s in addition to the cost of traveling over state lines and potential hotel stays in states that require 24-hour waiting periods, which only increase the chance that an unwanted pregnancy becomes financially ruinous.

Hillary Takes Crucial Stand Against Anti-Choice Hyde Amendment

However, there’s little political will to change the rule; since its passage in 1976, the Hyde amendment has been renewed every single year. And support has come not just from conservatives — but, in more subtle ways, from pro-choice organizations like Planned Parenthood.

This isn’t because Planned Parenthood is against reproductive justice for the less privileged, of course. But as the organization has clawed its way to remain funded in the wake of relentless GOP attacks, it’s often distanced itself rhetorically from abortion services. As a result, as Kylie Cheung wrote for Mediaite in July:

“Instead of fighting the Hyde amendment, which prevents thousands of low-income women from being able to access safe and legal abortion, [Planned Parenthood] routinely affirms the Hyde amendment’s legitimacy by reminding conservatives that they don’t use federal funding to pay for abortion.”

Still, there’s reason to be hopeful that getting rid of Hyde could be part of a push for universal health care. Despite Planned Parenthood’s rhetoric, the organization has in action fought the Hyde amendment in some key ways — it lobbied aggressively against HR 7 in January, which would have made Hyde permanent, and has supported numerous candidates who have listed rescinding Hyde as a major campaign promise. The organization also recently hosted a rally with Sanders, patron saint of single-payer, who has himself strongly backed repealing Hyde.

Rescinding Hyde as part of the push for single-payer is possible, then — but there’s also reason to believe it could be entirely ignored. And this would ensure many pregnant people would continue to struggle to access abortion services, even in the wake of “universal” care.

The Power Of State Control

Hyde isn’t the only thing standing in the way of universal health care covering abortion services. The United States prizes its ability to let states govern themselves in many ways, including how they distribute grant money and when and where they allow their medical professionals to practice. Without express federal protections for abortion that actively require states to expand access and coverage, the question remains: Even if we pass comprehensive universal health care, could it be whittled away by states looking to curb coverage and access?

There’s an example of precisely that just north. In Canada — where many in the United States look to see a shining example of single-payer at work — there’s a clear example of what happens when reproductive health is not at the center of the health-care conversation. In spite of the country’s reputation for progressive values, abortion rights have been whittled away, one province at a time.

Writing for Jacobin, Gerard Di Trolio explains what’s happening.

“Though there is no law regulating abortion in Canada, all provinces have varying restrictions on government-funded abortions. Women seeking an abortion have to meet a particularly high bar in New Brunswick. There, abortions are only covered when: performed before the 16-week mark, carried out by an obstetrician or gynecologist in a hospital, and after two doctors have signed off on the procedure.

Prince Edward Island (PEI) is even worse. The province doesn’t have a single medical facility that can perform abortions. This has led to instances in which women have harmed themselves because they didn’t have abortion access. Pro-choice activists have long argued these regional variations violate the Canada Health Act. Still, PEI Premier Robert Ghiz said this spring, ‘I believe the status quo is working.’ He can get away with such comments and policy positions because the federal government has never intervened to ensure equitable access.”

To see how state regulations could complicate abortion access under a single-payer system, one need look no further than Colorado. In 2016, voters from the state rejected a bill that would have achieved universal health care. And from the beginning, reproductive-rights organizations expressed concerns about one very specific legal hurdle: a state amendment passed in 1984 which prohibited public funds from being used to fund abortion services.

Even states like California — where health care access is greater than many others and abortion services are potentially more in-reach — still present significant barriers to accessing abortion. For instance, Medi-Cal, California’s Medicaid program, has a massive access problem; a 2011 report found that 45% of California counties don’t have a Medi-Cal abortion provider. Which means that even if the state were to pass a single-payer plan (without additional stipulations to provide more clinics or locations which offer abortion service), the coverage would still be just as limited, if not more so.

Sans federally mandated abortion protections within a single-payer plan, it’s easy to see how states could severely limit access to reproductive services.

The Power Of The Democratic Party

Perhaps the biggest threat to abortion services, though, is the current ideology of the Democratic party. Regardless of a person’s moral beliefs about abortion, there is an inalienable case to be made that abortion on demand is an economic imperative. Yet the party has made it clear in recent months that it views abortion services as an optional or superfluous part of the left’s agenda.

As such, the most important way to move forward on single-payer is to make this message crystal-clear: Interjecting mentions about Hyde and abortion and reproductive care into conversations about single-payer is not derailing — it is essential.

It’s possible to do, too — and when it’s done correctly, the desired effect of fewer abortions can be achieved. In Massachusetts, where statewide health care was used as a model (kind of) for the ACA, abortion rates declined significantly “despite public and private funding of abortion that is substantially more liberal than the provisions of the federal legislation currently under consideration by Congress,” according to a 2010 article by Patrick Whelan, M.D., Ph.D. in the New England Journal of Medicine.

Perhaps the biggest threat to abortion services is the current ideology of the Democratic party.

However, in the current climate, where the GOP seems more certain than ever that the only way to preserve their legacy to repeal the ACA, it seems exceedingly difficult to imagine that, as a nation, we could both a.) build and implement a functional universal health care system that truly works for everyone and b.) repeal the numerous state and federal bans on public dollars for abortions.

In the United States, where the GOP is so passionate about states’ rights, it’s easy to see how a situation like the one in Canada could unfold. States like Texas and Missouri are already attempting to reduce access at every turn. What happens if we do push so hard for single-payer that we forget how many in the country still desperately want to not only strengthen Hyde, but repeal Roe v. Wade?

What happens if we stop bringing up the existing barriers to abortion and as a result, they are never removed when new health-care policies are put into place?

What happens if the fervor for single-payer becomes so great that compromising on abortion becomes fair game?

There is a surging current of support for universal health care in some ways — perhaps even universal Medicaid or Medicare, as the Dem-backed new bill is pushing for. But if access to necessary medical procedures and reproductive health care aren’t part of the policy (if clinics aren’t added, waiting periods aren’t repealed, and requirements that trans-vaginal ultrasounds aren’t removed), it will necessarily be a half-measure achieved at the expense of millions.

What if the fervor for single-payer becomes so great that compromising on abortion becomes fair game?

Even if Hyde is repealed and universal health insurance can pay for abortions, if there’s nowhere to go, it’s not really a right.

Supporters of single-payer ought to be on the front lawn, in the streets, and on the phones with their representatives. They must be turning out at the ballots and holding town halls and pressing their lawmakers. But they also must do so with an eye on the very real, very scary potential that single-payer which doesn’t cover abortion is nowhere near universal.