This article was originally published at Prism

In 2017, Beth Vial needed to have an abortion. She was 26 weeks into her pregnancy, and there was no legal cutoff in her resident city of Portland, Oregon, but she needed a simple majority vote from the department board at the hospital to approve her procedure. She was short one vote, and she was running out of time. Vial’s decision to have an abortion came just a week after the state’s Reproductive Health Equity Act was passed, which granted widespread access to preventive reproductive health services. Still, it had yet to go into effect. None of the doctors she visited would treat her, and every day, her options were becoming less viable.

Given her timeline, Vial’s best option was to travel to New Mexico and seek care there. She had 10 days to gather $10,500, which was the cost of a late-term procedure. By the time she could access care, she was 28 weeks into her pregnancy. She received about $2,000 from two different abortion funds, and the rest she was able to piece together by asking people in her life for help. Vial said she ended up spending roughly $13,000, including airfare and lodging to have her procedure. At the time, she was a phlebotomist at a blood bank and was just a few weeks shy from qualifying for FMLA, but she couldn’t delay her procedure and had to take three weeks off of work, unpaid.

“Abortion should not be financially devastating,” Vial said. “All medical procedures deserve paid leave and I don’t think abortion is an exception to that.”

Three cities across the country are now offering the paid leave that would have dramatically helped Vial in 2017. Portland, Boston, and Pittsburgh, are offering city employees paid time off following an abortion. Abortion advocates say the new policies are an important step in destigmatizing abortion and helping people plan for their future. In the fall of 2021, Pittsburgh and Portland were the first in the nation to include abortion in their bereavement leave policies for city employees. The policy in Portland allows employees to take up to three days of paid leave if they’ve had a miscarriage, stillbirth, or pregnancy loss. The policy covers time off “irrespective of whether [a pregnancy termination is] deemed medically necessary.” More recently, the city of Boston approved 12 weeks of paid time off—the same amount of paid time off granted for people who have gone through childbirth.

“It’s really important for us to be looking at ways that city government and employers can support people as they’re making important decisions about their health and their futures,” said Andrea Miller, president of the National Institute for Reproductive Health.

After spending thousands of dollars to access abortion care while not receiving any paid time off from work, Vial began volunteering with the Northwest Abortion Access Fund, which helped fund her procedure. Last year, she became a board member and helped advocate for $200,000 in municipal funding for abortion care. That same week, Vial recounts that a staff member for someone on the Portland City Council had to have an abortion. According to a conversation relayed to Vial, the staff member turned to the council member and expressed “this is the hardest thing I’ve ever been through. We should do paid time off for bereavement leave for abortions, miscarriages, and pregnancy loss.” That staff member’s personal experience inspired the policy that is now in place.

“A lot of people choose abortion as an economic decision in their life because they cannot afford the cost of raising a kid,” Vial said. “You shouldn’t be punished for having a medical procedure that is financially better for yourself.”

Abortion care advocates like Miller and Vial noted that the new paid leave policy should be extended to all medical procedures. According to Rae Pickett, a full-spectrum doula and the communications director for Planned Parenthood Advocates of Virginia, many patients may need time to take care of themselves mentally and physically after an abortion.

“People should have the time and support that they need to take care of themselves, whatever that might look like,” Miller said. “We want to really underscore that it’s essential that these leave policies provide options without reinforcing any stigma or misinformation about abortion care, to underscore that abortion is exceedingly safe, that very few people have complications.”

The Portland policy explicitly contains a confidentiality clause. Employees may disclose the purpose of their paid leave to a human resources employee, but it should remain confidential at all times to avoid any potential for retaliation if their employers are anti-abortion. The Boston and Pittsburgh policies do not mention confidentiality.

“We absolutely expect and we should demand that no one is ever penalized for any of their reproductive health decisions, whether that’s to have a child or to have an abortion or to use contraception,” Miller said. “These are new policies and we are hopeful that they will be undertaken with the greatest of caution in making sure that people’s confidentiality is protected and that people are treated with the respect that they deserve for any health care decision that they make. Those are going to be really important components to implementation of these kinds of policies.”

The timing of cities passing these supportive leave policies is crucial as more conservative states ban early-term abortion and the Supreme Court seems poised to overturn Roe v. Wade at the federal level.

“What we’re seeing right now overall is a recognition at the city level, where it’s possible politically, to address the wide range of issues that people are facing when it comes to making decisions about our reproductive lives, particularly when you look at the incredible rollbacks on access to abortion care, and the potential that we will lose the federal right entirely in the next few months,” Miller said. “I think it is an interesting time and an important time for cities and states that can to look at their policies and ask themselves, what else can we do to advance reproductive health and enhance the well-being of people in their families.”

The National Institute for Reproductive Health puts out a local reproductive freedom index that lists policies from 50 U.S. cities supporting families and enhancing access to abortion, contraception, sexuality, education, and pregnancy care. According to Miller, the index includes the full range of reproductive health services that can protect clinics that can ensure that people are not discriminated against and roadmaps for how cities can become more equitable.

“This is really the time for cities to step forward and to step up, so I’m hopeful that they will continue to do so whether that’s around these leave policies or other measures that will improve access to reproductive health care,” Miller said.

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