文章基本信息

标题：No Exceptions: Documenting the Abortion Experiences of US Peace Corps Volunteers
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作者：Angel M. Foster ; Grady Arnott ; Simone Parniak 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2015
卷号：105
期号：1
页码：41-48
DOI：10.2105/AJPH.2014.302358
语种：English
出版社：American Public Health Association
摘要：Since 1979, US federal appropriations bills have prohibited the use of federal funds from covering abortion care for Peace Corps volunteers. There are no exceptions; unlike other groups that receive health care through US federal funding streams, including Medicaid recipients, federal employees, and women in federal prisons, abortion care is not covered for volunteers even in cases of life endangerment, rape, or incest. We interviewed 433 returned Peace Corps volunteers to document opinions of, perceptions about, and experiences with obtaining abortion care. Our results regarding the abortion experiences of Peace Corps volunteers, especially those who were raped, bear witness to a profound inequity and show that the time has come to lift the “no exceptions” funding ban on abortion coverage. Since its creation in 1961, more than 215 000 Americans have served in the US Peace Corps. 1 Dedicated to increasing capacity in participating countries, promoting a better understanding of Americans by peoples served, and promoting a better understanding of other peoples by Americans, Peace Corps volunteers have served in 139 countries. Currently 63% of volunteers are women, more than 90% are single, and the average age at the initiation of service is 28 years. 1 Volunteers typically serve in-country for 2 years, with the possibility of a third year extension, after a rigorous selection process and a 3-month preservice training. Peace Corps volunteers receive a stipend to cover living expenses, which varies by location but is currently around $250 to $300 per month, and a readjustment allowance of roughly $7500 after completion of service. Volunteers also receive their health care, including prescription medications, routine examinations, and emergency care, free of charge; most services are provided in-country through a Peace Corps Medical Officer. When necessary, volunteers also receive health care services through regional medical facilities or in Washington, DC, after medical evacuation. Since 1979 US federal appropriations bills have restricted the coverage of abortion for Peace Corps volunteers. There are no exceptions to the coverage ban. Other groups who receive health care through US federal funding streams, including Medicaid recipients, federal employees (including employees of the Peace Corps) and their dependents, residents of the District of Columbia, women who receive health services through the Indian Health Service, and women in federal prisons, are all, as matter of policy, eligible to receive abortion coverage in cases when the pregnancy threatens the life of the woman or is the result of rape or incest. 2 In December 2012, the passage of the “Shaheen Amendment” to the FY2013 National Defense Authorization Act extended these same coverage benefits to military personnel and their dependents. However, for Peace Corps volunteers, abortion services are not covered even in these narrow circumstances. 3 Because volunteers are at risk for sexual assault, often serve in countries where abortion is legally restricted, and receive stipends that are minimal, these restrictions might be acutely devastating. 4,5 A body of research has documented the considerable impact that Medicaid funding restrictions have had on low-income women. 6–8 More recently, research on the experiences of US military personnel helped build the case for extending coverage for abortion in cases of rape and incest. 9–12 However, no published literature currently exists that explores the opinions, perceptions, or experiences of Peace Corps volunteers with respect to abortion care. Our study addresses this gap. To better understand the impact of the funding restrictions on Peace Corps volunteers and contextualize those experiences within the larger frame of reproductive health service delivery, we conducted a large-scale qualitative study with returned Peace Corps volunteers (RPCVs). Specifically, our study aimed to document the reproductive health and abortion experiences of RPCVs; explore RPCVs’ current knowledge of the abortion funding restrictions as well as the information provided about the policy at time of service; understand better RPCVs’ opinions about the funding restrictions and efforts to expand coverage in cases of life endangerment, rape, or incest; and identify ways in which reproductive health services could be improved.