Feature

Parole Requirements Stack the Odds Against Indigenous People

| Abaki Beck
A grim jail fence with razor wire and a sign warning that 'no hostages shall exit through this gate.'
The Two Rivers detention facility, a 460 bed jail in Hardin, MT. (Photo by William Campbell/Corbis via Getty Images)

When Benny Lacayo was released from prison after two and a half years, he had a rough time transitioning. “To try to reconnect, and gain that humanity back, that’s very hard,” he reflected. Reentry was an emotionally overwhelming experience, and the myriad requirements of his parole — and lack of support from the state — made his transition more difficult. Probation and parole typically restrict where someone can live and work, who they can socialize with, where they can travel, and more. People must also regularly report to a supervising officer. “[Probation or parole officers] are trained to help in a certain way, and the way they’re trained doesn’t help,” he says. “[It can] cause more problems and conflict and cause you not to seek help.”

Lacayo is one of the 4.5 million people on probation or parole on any given day in the U.S., almost twice as many people as are currently incarcerated. Community supervision is often thought of as a positive alternative to incarceration. But for many, the strict requirements and intense surveillance turn it into “a secondary form of incarceration,” says Amy Sings in the Timber, an attorney and executive director of the Montana Innocence Project. The consequences for not adhering to the conditions of parole are harsh: A quarter of state prison admissions nationwide are a result of technical violations such as failing a drug test or missing a meeting with a probation or parole officer. “In many instances, in our client populations, there are survival tactics that are criminalized,” reflects Sings in the Timber.

The issue is acute in rural states such as Montana, and disproportionately impacts tribal communities. Native Americans account for 6.5 percent of Montana’s population, but represent 20 percent of the population in men’s prisons and 34 percent of the population in women’s prisons. An ACLU report found that between 2010 and 2017, 81 percent of Native Americans in Montana who were reincarcerated while on probation were charged with a technical violation, not a new crime.

Technical violations send people back to prison because of a lack of support

Complying with requirements of probation or parole can be a high-stakes experience and the system is not set up to help people navigate the complicated network of needs post-release. The threat of punishment makes some fearful to reach out for help, said Lacayo, who is now a community organizer. “[Probation or parole officers] could easily make your life even harder, so it’s very hard to say how you feel,” Lacayo reflected.

There are also a number of practical barriers.

Many conditions of probation or parole require transportation, and in Montana, people may have to drive over an hour on rural highways to reach the nearest probation and parole office. “To be able to even access your supervisor can be impossible in some instances,” says Sings in the Timber.  These long trips are frequent, especially since the Montana Department of Corrections does not accept most urinalysis and drug testing, evaluations, or treatment programs that take place on reservations. Some tribes, like the Fort Peck Reservation in eastern Montana, have a memorandum of understanding with the state that allows tribal members to utilize the tribe’s probation and parole resources to fulfil state requirements. However, this is not a state-wide standard.

They have absolute power over you.

Housing is another common requirement of probation and parole, and Montana has 23 housing-related collateral consequence laws that restrict or ban certain forms of housing for formerly incarcerated people with certain convictions. Even pre-release centers — transitional facilities where formerly incarcerated people live under supervision — can be challenging to access, though they are meant to be a stepping stone to independent housing. All pre-release centers in Montana are in urban areas; none are located on reservations. Lacayo also  notes that they are not always designed to be a supportive transitional environment. “When I got to pre-release, one of the directors said ‘Just so you know, I’m not here to be your friend,’” he says. “They have absolute power over you. That’s a very scary thought.” At the time Lacayo lived there, it cost $14 per day. Montanans earn between just 16 cents and $1.25 per hour for employment while incarcerated.

Montana also has 189 employment-related collateral consequences, including bans on many jobs that require occupational licensing, such as commercial truck driving and selling real estate. (One in four jobs in America requires such licensing.) Some of these consequences are mandatory and lifelong, while others are at the discretion of the employer and time limited. Reservations have a separate set of laws, with their own restrictions. Some, including the Fort Peck Reservation, ban anyone with a felony from working for the tribal government, which is often the largest employer in the area. It can be a confusing system to navigate. “The number of employment opportunities are far and few between,” says Sings in the Timber.

Reentry is also expensive. Costs associated with probation and parole — such as mandatory drug tests, restitution, or GPS monitoring — can quickly add up. Compliance Monitoring Services, one of the companies Montana courts use for surveillance, charges up to $360 per month for GPS bracelets, plus a $50 installation fee. If someone can’t afford rent or other fees of probation and parole, the Department of Corrections can garnish their wages, tax refunds, or a tribal member’s per capita payment.

Reentry supports reduce technical violations and recidivism

Social support can be particularly hard to come by as a formerly incarcerated person. A common condition of probation or parole is that you are not allowed to associate with other formerly incarcerated people — especially challenging in small communities or if family members are formerly incarcerated.

Returning to a reservation presents a separate set of barriers. As sovereign nations, reservations do not fall under the jurisdiction of the state. This means that people on probation or parole cannot legally return to their home reservations without extradition waivers, which allowing the state to extradite someone from tribal jurisdiction if a violation occurs. Not all reservations have extradition waiver agreements, however. The Fort Peck Reservation in eastern Montana does, while the Crow Reservation in central Montana does not. Without an extradition waiver, people cannot live on a reservation until they have completed their probation or parole, which may be years.

“It’s almost impossible for [people on probation or parole] without their support system,” reflected Fort Peck Chief Judge Stacie Four Star. “But we see that a lot.” Four Star is pushing for standard memorandums of understanding and extradition agreements statewide, but these ideas have gained little traction.

Recent policy efforts to increase support for formerly incarcerated Native Americans have been unsuccessful. Two bills were introduced in 2019, which would have created a grant program for culturally-based reentry programs and revised an existing reentry housing grant program to require that a certain percentage of funding was allocated to programs serving Native Americans. Neither bill passed. There has been more success with tribal-led programs. The Confederated Salish and Kootenai Tribes Holistic Defender Program, for example, assists clients to find employment, housing, healthcare, obtain a drivers license, and connects people with mentors, such as tribal elders, to provide cultural support.

The pandemic has expedited the need for improved reentry support. In spring 2020, Indigenous and Latinx activists in Montana, including Lacayo, organized a campaign called Let Them Come Home to advocate for an end to arrests for technical violations, temporarily waive probation and parole requirements, and reduce the number of people in Montana jails and prisons. Despite their efforts, Montana actually released fewer people from prison in 2020 than they did in 2019.

Without meaningful reentry support, technical violations will likely continue and people will continue to be re-incarcerated. “How can you jump through all these hoops and follow the rules if you don’t know where your next meal is coming from or where you can sleep safely?” reflected Sings in the Timber. “We need to take a look at technical violations not as someone willfully doing wrong, but as a strong sign that there is support that is needed.”

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Feature

Can Minnesota Deliver Change for Missing and Murdered Indigenous Women?

| Ray Levy-Uyeda
An Indigenous person raising their fist, dripping with red paint.
Micaela Iron Shell has painted red hands over their mouth to show solidarity for missing and murdered indigenous, black and migrant women and children. (Photo by RJ Sangosti/MediaNews Group/The Denver Post via Getty Images)

Until very recently, the epidemic of missing and murdered Indigenous women and relatives (MMIWR) has often been neglected by local police, the Department of Justice, and state institutions with the power to prevent further violence committed against Native and Indigenous women and girls. A new office in Minnesota seeks to address the MMIWR crisis by tackling a number of factors that create conditions of violence and precipitate the lack of institutional alarm, using a $1 million budget to collaborate with the state’s 11 tribes. The state joins New Mexico, Arizona, and Wisconsin where similar efforts are underway.

In Minnesota, between 27-54 Indigenous women and girls were missing in a given month between 2012 and 2020, according to the task force report that led to the office’s creation. The task force found that Indigenous people comprised 1 percent of the state’s population, but Indigenous women made up 8 percent of all murdered women. Thirty-four percent of Indigenous and Native women experience a sexual assault in their lifetime and nearly double that experience some kind of violent assault, according to the National Congress of American Indians. Research shows that the majority of this violence is committed by white men, yet on reservations — where Native women are ten times more likely to be murdered — tribal governments don’t have the power to investigate most crimes committed by white perpetrators.

The Minnesota task force found the roots of the MMIWR epidemic are racialized and gender-based violence sanctioned by a series of social-legal patterns: forcible removal of Indigenous children and separation of families; creation of a predatory and racist child welfare system; laws that prohibited Indigenous people from engaging with cultural or religious ceremony; retribution for speaking tribal languages; creation of the social-psychological myth that Indigenous women and girls exist to serve white men’s sexual needs; and the use of police and surveillance agencies to criminalize and intimidate Native peoples, among others.

Minnesota’s MMIWR office, the first dedicated and permanent site to address this systemic violence, was proposed by state Senator Mary Kunesh, whose mother was an enrolled member of the Standing Rock Sioux Tribe. The office will collect and track data, review open and cold cases, draft relevant legislation, maintain communications with tribal governments, and coordinate with other state departments, among other mandates. Most importantly, Kunesh says, the office will be “led by Indigenous women and girls, especially those who have lived those experiences with violence and exploitation.” Ultimately, she says, “we really want to find ways for … survivors, our relatives, our communities, and even the perpetrators to heal and to understand what this is all about, and making sure that it’s culturally responsive and definitely a community led effort.”

This is a crisis. But the Minnesota office exists in a place of contradiction: If violence against Indigenous women and relatives is a product of federal and state government operations, then how and why would a government office be able to address it? 

The MMIWR office is expected to work with state, local, and tribal police to formalize reporting and investigative operations where processes are currently failing. For instance, the task force’s final report found that in many cases, police failed to follow the state’s Missing Persons Act, which demands that a report be filed promptly when Native women go missing. Often, there’s also a lack of communication between investigative teams and families or even a failure to identify the race or ethnicity of a recovered body. But that’s only when reports are filed.

This is a crisis.

A broad distrust in law enforcement keeps families from reporting instances of violence or providing details to police that might help locate victims, survivors, and perpetrators more easily. Mox Alvarnaz, a Kanaka Maoli and the outreach coordinator at the research organization Sovereign Bodies Institute explained: “It is important that we’re there in the room … you don’t want people or powerful entities who have in the past made dangerous and violent decisions against your community to be doing that in your name without you there.” Rebuilding trust is a central goal of the office, given that accurate reporting data is what will allow state agencies to develop solutions.

Kunesh acknowledges that the office won’t be able to address all of the underlying conditions of violence. For example, while the task force cited extractive industries and “man camps” — temporary housing sites for pipeline workers — as facilitators of sexual and gendered violence, there’s no clear demand of the newly formed office related to them. However, there is a movement at work to demand legislators recognize climate violence as part of and related to gender-based and sexual violence. “I don’t know that at the state level [the office] has any kind of power to address the extraction industry,” Kunesh said. “We would love to make that the priority, but even if it’s not stated, it is certainly one of the one of the efforts that we will continue to address.”

There’s also a limit on what the state can do by itself. The U.S. government has repeatedly chosen not to intervene and abate easily addressed conditions that trap Native people in violence. Strengthening tribal sovereignty, for instance, can allow tribal governments and police to investigate crimes on reservations and hold non-Native offenders accountable. There’s also growing awareness of the ways Native women are punished by the criminal legal system for surviving violence, as in the case of a 27-year-old Colville woman named Maddesyn George.

“The biggest problem is just that nobody knows this stuff,” Kunesh said of her non-Native colleagues in the legislature who were surprised to learn how high the incidence of violence is for Indigenous women and relatives. “As we’re sort of peeling off the layers, I feel like our agencies, the government, our tribes, are all looking for ways to address these historic inequities and traumas.”

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First Person

I Can’t Afford Sperm. So I Did DIY Fertility Treatment in My Bathtub.

| Nechama Moring
Empty peach bathtub and light green tiles.
(Getty Images)

My pregnancy began with my feet dangling haphazardly over the top of my bathtub. I’d duct-taped a hand mirror to the side of the tub so that if I squinted, I could see my own open cervix just well enough to guide a catheter through it into my uterus. It was my own version of intrauterine insemination (IUI), which is typically performed in medical facilities. However, I am queer, single, disabled, and most of all low-income, and thus unable to afford sperm banks or clinic-based IUI. When you don’t have access to institutions, you make do, so I read about the process and watched patient education videos until I felt brave enough to try it on myself.

This left me with my trusty headlamp, my speculum, and sperm donated by an old friend from growing up — a gay man who also planned to love my baby. In what was becoming our own weird tradition, I cooked him dinner and then left to walk my dog while he ejaculated into a red plastic solo cup. After my friend let himself out of my apartment, I began “washing” the sample he left on my bathroom counter, a procedure that separates the sperm from the semen surrounding it, using a $60 centrifuge I purchased from a science supply store.

I tried to inseminate at least twice per menstrual cycle, and it became so routine that my friend once accidentally blurted out that he needed to go jerk off at my place when a coworker asked why he wasn’t staying late for a team dinner. It was pure queer magic. I became pregnant after nearly a year of this.

My pregnancy, sadly, ended in stillbirth, for reasons totally unrelated to how I became pregnant (I contracted cytomegalovirus, a common virus that causes mild cold-like symptoms in adults but can be lethal for a fetus). Like many relationships that are tested by stillbirth and grief, my friend and I are no longer close. Certainly not close enough to resume trading a home-cooked meal for a party cup of semen.

Adoption was actually my first choice for parenting, but it is not friendly to low-income people. It often costs $20,00 to $40,000 or more for private domestic adoptions, and fostering or adopting through the deeply flawed child welfare system involves an extensive assessment process that costs around $900 to $3,000. Though grants and other forms of financial assistance are often available for the assessment itself, it’s likely that evaluators would count my poverty, my small apartment, my queerness, my disability, my background and beliefs as a radical activist, and even my sweet old pit bull as strikes against me. So for me to be a parent — for me to get to experience the sweetness of morning cuddles, the endless questions and challenges, the beautiful and mundane care work of guiding new life across a dying world — pregnancy is my best option.

However, without the ready access to fresh sperm that my friend provided, getting pregnant again will be expensive as hell. In addition to purchasing the sperm itself, which often retails for more than $850 a vial, there are storage fees ($350 per year), shipping fees ($180), and fees for viewing donor profiles ($50 for three months). All for a single attempt at insemination.

And it usually doesn’t stop at just one vial: Even for people in their 20s and early 30s, when it is generally easier to conceive, IUI has a success rate of less than 20 percent per attempt, and typically needs to be tried multiple times. In fact, in one study, only 24 percent of people had a live birth after 3 cycles of IUI, even when they attempted two IUIs per menstrual cycle. And while the birth rate rises with more IUI attempts, so does the cost.

In other words, even assuming the bare minimum cost for each IUI attempt, three attempts at IUI could cost $3,490, for a one-in-four chance of becoming pregnant.

Queer people might have to spend over $30,000 before their insurance begins to cover fertility care

And that’s just the sperm. Conception-related health care is also expensive, with costs for IUI in a clinic ranging from $250 to $4000 per attempt. Fertility specialists recommend moving to in vitro fertilization (IVF), which begins at $12,000 to $15,000, after three unsuccessful IUI cycles. Insurance companies, however, often demand that prospective LGBTQ parents “prove” their infertility by paying out of pocket for six or more in-clinic IUIs before providing insurance coverage for IVF (self-insemination doesn’t count towards this total). This means that, even with insurance, queer people might have to spend over $30,000 ($6,580 on sperm and another $24,000 on clinic fees) before their insurance begins to cover fertility care. (Straight, cisgender couples, in contrast, typically receive coverage if they report having unprotected sex for 6 months to a year.) For people who rely on surrogacy, the costs often start at six figures in the U.S.

These costs are obviously not an option for low-income people. So, we either don’t have kids or we get creative. Hence the duct tape.

Studies show that queer people want children at the same rate as straight people, but our access to parenthood is limited by our statistically lower incomes and, for those of us who don’t produce it, the price of sperm. The high cost of fertility treatments like IUI is often significantly, disproportionally burdensome for queer people, who are more likely than our cishet counterparts to live in poverty, especially if we are people of color, trans, gender nonconforming, or women.

Queer people like me are also more likely to have or acquire disabilities — in my case a brain injury from police brutality. Disabled people are almost twice as likely to experience poverty, with even higher poverty rates among disabled women, gender minorities, LGBTQ folks, and people of color. People who receive certain disability benefits can lose them if they ever amass assets worth more than $2000, which prevents disabled people from saving up for sperm, pregnancy, or parenting.

Sperm banking is a big business, with profits reported at almost 4.8 billion globally. Sperm banks are just one facet of the rapidly growing — and incredibly profitable — fertility industry, valued at 8 billion dollars in the U.S. alone. This industry is prone to predatory behavior, and increasingly controlled by venture capitalists.

Regulation might help with this, especially if it was designed to explicitly protect queer families and other oppressed groups. In addition, there is no reason to require people to undergo psychological evaluations (another expense) nor get a physician’s permission to purchase and receive sperm, though many sperm banks and clinics do.

Currently, just one state (New York) extends fertility coverage to people on Medicaid, the largest insurer of people living in poverty; fertility coverage for people on Medicaid must be extended nation-wide. Further, only 19 states mandate that private insurance companies cover any kind of fertility-related services. As described above, insurance industry policies often result in queer people having to pay dramatically more for care than straight couples.

A recent lawsuit against Aetna Health claimed this disparity constitutes a violation of Section 1557 of the Affordable Care Act, which bans insurance companies and health care entities from discriminating on the basis of sex. Though Aetna updated their policy within days of the lawsuit, Section 1557 should continue to be applied to ensure equitable treatment of LGBTQ health care consumers, including when it comes to building our families. I also want more legislation, such as the law recently enacted in Illinois, designed to prevent queer parents from having to pay more than our cishet counterparts to access fertility treatment.

Until we have equitable policies that protect us, queer people will care for each other, including helping each other build families. I started teaching friends and neighbors in my local queer community how to wash sperm and perform IUIs on themselves and their partners, usually in exchange for beer and pizza. Many of my friends were using known donors for the same reasons I had: cost. Even folks who were using sperm banks often wanted to do their own IUIs to save money after the outrageous amount they had spent acquiring each precious vial of semen.

I still dream of parenting, but it seems more and more out of reach as I approach 40 and my credit card debt gets worse, not better. I know I’d be a good parent, in that I would love my child hard, with the same drive that had me taping a mirror to my bathtub and processing semen in a centrifuge meant for high school chemistry classrooms. What stops me is not doubt, or even exhaustion, but the cost of being beautifully queer in a world that privileges heterosexuality.

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Feature

Doctors Drug Test Black and Poor Families at Higher Rates, Risking Family Separation

| Elizabeth Brico
Gloved hand holding test tubes of blood and urine samples in a lab

Ericka Brewington’s youngest child, a boy, was born on August 27, 2017, and it should have been a day of joy for her and her family. But instead of receiving the rest and celebration all new parents deserve, she was separated from her newborn infant. It was not due to an act of abuse or neglect on her part — it was the result of a drug test performed on her infant without her knowledge.

“I was given a stack of papers, and I remember on a couple pieces of paper the words were blurry, this is how much copying was going on. They just said, ‘it’s a normal consent form; if something happens to you and the baby, if the baby’s heart stops beating or yours, do you want us to save you?’ Of course I do, so I signed the form, a bunch of forms.”

Brewington said she was later told those papers included the consent forms that gave her providers permission to drug test her and her child. She said she never saw such consent plainly stated, even when she checked for it after the fact.

Drug testing pregnant and postnatal people and their infants without the patient’s informed consent is a common practice in the United States — but only among certain demographics. Several studies have found that Black women in particular are subjected to prenatal drug testing at higher rates than women in other racial and ethnic demographics, but do not have higher rates of positives. A study published in the February 2004 issue of Child Abuse & Neglect also found several other factors unrelated to drug use that led to higher testing rates, including single motherhood, tobacco use, a history of preterm labor, and a history of child services involvement, among others.

“I provided care in Black and brown communities, so [drug testing pregnant and postnatal patients] was routine, and it wasn’t until I got out and saw the difference in the way care was provided in communities that…were wealthier that it became clear that this is not routine, this is not what everybody does,” said Jamila Perritt, an OB-GYN in Washington, D.C., and the president and CEO of Physicians for Reproductive Health. Perritt also recounted that when she was pregnant, she was not drug tested despite being one of the more commonly-tested demographics (Perritt is a Black woman), which she attributed to her status as a physician.

Now activists are fighting back, saying the practice is rooted in racism and classism, and that it denies patients crucial agency over their care.

“Is our consent truly informed? It can’t be in those reams of paper that people are signing,” said Perritt. “What does it mean if we as physicians say informed consent is one of our core values? …Who would think you’re signing a form that could result in such severe consequences? The truth is that it is a violation of trust to not take the time to name that [drug testing consent is included] and its consequences.”

It wasn’t until I got out and saw the difference in communities that were wealthier that it became clear that this is not routine

As Brewington’s case demonstrates, those consequences can be devastating. After her newborn son tested positive for opiates and cocaine, which Brewington admits to using once during the last term of her pregnancy, New York child services placed him into foster care. Although her two older children were out of the state at the time on a vacation with their father, child services ordered her to bring them back and placed them into foster care as well. They are home with their mother now, but Brewington is still fighting to regain custody of her son, who was awarded to his father.

“The medical profession, health profession, that is still one of the top three referrants [to child services],” said Jeyanthi Rajaraman, a parental defense attorney at Legal Services of New Jersey. Rajaraman added: “I’ve asked [at hospitals] when do you drug test and when do you not, and the information that comes out is that ‘if mom shows up and we’ve never seen her and she didn’t do a hospital tour and says she’s had no prenatal care and she’s by herself.’ What I really think they are also saying is Black and poor or no medical insurance because that is the majority of our clients who face and experience drug testing.”

Because child removal data is self-reported by the agencies, which do not track how many removals occur due to hospital drug tests, it is difficult to gauge how often these tests lead to severe consequences on a national level. One report by Movement for Family Power estimates that in 2017, in the Bronx borough of New York City alone, 60 babies under one month of age were removed because of maternal substance use. The United States child services system acknowledges that Black and Indigenous children are markedly overrepresented when it comes to system involvement; between 2000 and 2011, one in nine Black children and one in seven Native American children had been removed from their parents’ care, versus one in 17 white children.

Infants who do experience side effects due to in utero substance exposure, which can occur from both prescribed and non-prescribed substances, fare better when they are able to have close maternal contact. Removing newborns from parents like Brewington because of substance use — a common result of pre- and postnatal drug testing — can decrease feelings of bonding and the parenting sense of competence, and has been linked to some infant cognitive and memory impairment in animal studies. It also leads to decreased ability to breastfeed, which normally helps reduce symptoms of withdrawal in substance-exposed newborns and provides some protection against illnesses, including COVID-19.

Rajaraman noted that she often encounters medical professionals who recognize this reality but are shockingly unaware of how their call impacts the family. “I’ve had many doctors say to me that by calling [child services] they don’t know the baby would be taken, they say ‘I was calling because I thought it would help get mom into [a] program, I would never recommend separation.’”

In 2021, New York State attempted but failed to pass a law that would ban drug testing of pregnant and postnatal people and their newborns without informed consent or a legitimate medical necessity.  Activists are planning to push the bill again during the 2022 legislative session. Should it pass, it would require that written consent be obtained at the time of testing and delivered to the patient in a manner that is clear and understandable. It must also include a statement that the testing is voluntary. Activists in Washington State also considered pursuing similar legislation, but decided to table the movement for the time being. Should New York succeed in passing the informed consent bill in 2022, it could pave the way for other states to take necessary action to protect pregnant and parenting people and their infants from non-consensual drug testing.

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Feature

Most Americans Have Pets. Almost One Third Can’t Afford Their Vet Care.

| Carol Mithers
A closeup of a kitten being held by a veterinarian
Veterinarian Jeff Gerlesits gives a kitten a dewormer during a check up. (Photo by Seth McConnell/The Denver Post via Getty Images)

Since mid-2020, more than a thousand low-income families have brought their sick and suffering pets to the nonprofit Pet Support Space, housed in a tiny Los Angeles storefront. One 14-year-old dog had a tumor that a veterinarian had quoted $5,000 to remove. A four-year-old pit bull had been vomiting for days, a cat’s painful bladder stones required surgery, a pug limped from the foxtail embedded in its paw. Skin and ear infections abounded. Neither the animals’ problems nor their owners’ inability to afford help for them was a surprise.

A recent nationwide study found almost 28 percent of households with pets experienced barriers to veterinary care, with finances being the most common reason. In low-income households, the researchers found, financial and housing insecurity can increase the risks that animals will not receive the care they need. Sociologist Arnold Arluke, author of Underdogs: Pets, People and Poverty estimates that 66 percent of pets in poverty have never seen a vet at all.

The “why” behind those numbers is complex. Of course, money is the primary problem. Veterinary care is expensive. A majority of practitioners work in for-profit clinics, consolidation in the industry has increased emphasis on profit margins, and vet prices have risen faster than the overall rate of inflation. That has checkups starting at $50, dental cleaning going for $70-$400, and blood work and x-rays at $80-$250. If a dog breaks a leg or eats a sock, surgery costs begin at four figures.

High prices aren’t necessarily about greed. Michael Blackwell, a former Deputy Director of the Center for Veterinary Medicine at the FDA, is the chair of the Access to Veterinary Care Coalition (AVCC) that was formed in 2016 to study this very problem. Veterinary training, he said, teaches vets to practice a “gold standard” of care, which means running every possible diagnostic test and pursuing every treatment option, even when a client’s budget is limited. (Many pet owners don’t know they can decline a recommended procedure, such as blood work, and even fewer are willing to decline care for fear of looking heartless.)

Some private vets offer struggling clients discounts, added Jeremy Prupas, DVM, Chief Veterinarian for the City of Los Angeles, but they themselves carry an average of $150,000 in student loan debt, so they simply “can’t carry the immense existing need on their own.” Telling clients you can’t help them because they have no money is one of the leading causes of burnout in the veterinary profession, according to Prupas. Pet insurance might help defray costs but requires monthly premiums and comes with such a complicated array of deductibles, co-pays, caps, and exclusions that one how-to guide recommends hiring an attorney to review the policy. Credit cards designed for medical care financing, if one can qualify, can carry punishing interest rates as high as 26.99 percent.

Equally critical is a long-term failure on the part of the animal welfare movement to consider, much less prioritize, the needs of low-income pet owners. Since the 1990s, the rescue/humane world has poured vast amounts of funding and energy into cutting shelter euthanasia through adoption, but far less into helping those without money take care of the pets they have. “If you can’t afford an animal,” the thinking went, “then you shouldn’t have one.”

“Until recently, we focused on shelter-centric challenges,” acknowledged Amanda Arrington, senior director of the Humane Society of the United States’s Pets for Life Program, which assists low-income pet owners. “There was a lot of judgment and making determinations on who was or wasn’t deserving of support and resources that was influenced by what I think a lot of society is influenced by, which is classism and racism. We conflated a lack of financial means and access with how much someone loves their pet or desires to care for it.”

In fact, owners can be punished because they can’t afford veterinary care — “most humane neglect cases stem from an inability to get care for a pet,” said Prupas. In Michigan, for example, failing to provide an animal with adequate care, including medical attention, is a misdemeanor that can carry 93 days in jail and/or a fine of up to $1,000. With a second violation, it becomes a felony.

The distorted belief that ‘those people’ don’t care about their pets has never been true.

What exists for pet owners in poverty is a patchwork of low-cost care options, ranging from local efforts — such as Emancipet in Texas and the Philadelphia Animal Welfare Society — to well-funded national enterprises such as Pets for Life, which operates in several dozen cities. The great majority, however, offer only basic services like sterilization, vaccination, and flea treatments. “We are not a full-service veterinary clinic and do not treat sick or injured pets,” warns one low-cost option on its website. Another suggests that needy people travel, since “vets in smaller towns may charge lower fees,” or start a GoFundMe. As a result, many types of care are largely unavailable: emergency care (by some estimates one in three pets will have an emergency need each year), management of chronic conditions such as diabetes or kidney disease, medication, dental care (dental disease affects perhaps 80 percent of older dogs), and the mercy of humane euthanasia (which can run $50-$300).

The final piece of the care gap is a practical and cultural disconnect. Because many economically challenged neighborhoods are “vet deserts,” with few if any practitioners, it’s not easy to find care, and reaching it can require wrangling an unhappy animal over distance and/or arranging private transportation. Keeping an appointment at an office with weekday-only business hours or a once a month clinic can mean losing a day’s pay. Paperwork raises the fear of immigration status inquiries. The veterinary profession also remains one of the country’s whitest: Just as people who feel alienated or unwelcome don’t utilize human health care options, pointed out Arluke, they don’t utilize care for their pets.

The result has been suffering: most directly for animals that remain untreated, die from what vets call “economic euthanasia” (putting an animal down because treatment costs too much), or end up in shelters. Fear of a looming vet bill, and the mistaken belief that all shelter animals receive medical care, is a prime cause of owner surrender.

But people pay, too.

Some sick animals can infect their humans. Roundworms, for example, can pass through contact with pet feces and cause lung, heart, and eye problems. Blackwell reports meeting an optometrist who practices in a low-income Florida community who has seen increasing numbers of children with roundworm larvae in their eyes.

The psychic toll is just as real. Families in poverty who love their pets and for whom “they offer an emotional core and possibly one of the only sources of joy” face “mental and emotional” devastation from the unimaginable choice of weighing that love against potential financial ruin, said Blackwell. Professor Katja M. Guenther, author of The Lives and Deaths of Shelter Animals, called the rupture of an animal-human bond “a kind of community violence” in a 2021 webinar.

Change seems increasingly possible. Covid-19 and the country’s recent racial and economic reckoning has prompted humane organizations to examine their assumptions and biases about who has the “right” to a pet’s love, and, said Arrington, there’s increasing recognition that “racial and economic injustice really impacts animal welfare.” Meanwhile, AlignCare, a new program out of Michael Blackwell’s Program for Pet Health Equity, is trying to create a national model of something like Medicaid for domestic animals. Under the program, families already found to be struggling (because they participate in SNAP or a similar program) and who ask for help at a shelter or veterinary clinic will be signed up and paired with a veterinary social worker or support coordinator. They’ll then be directed to a veterinarian who has agreed to offer preventative, dental, and even critical care, for a reduced fee; AlignCare will pay 80 percent of the cost. After three years of pilot programs in 10 disparate communities, it’s taking on its biggest challenge yet, Los Angeles, where one in five people live in poverty.

AlignCare won’t offer “gold standard” care, instead emphasizing preventative, incremental, and cost-saving measures (such as offering telehealth appointments and limiting diagnostics that won’t change treatment options) when possible. But it will expand the human safety net to include the animals most of us now consider part of our families. And while the effort is currently funded by grants from Maddie’s Fund, the Duffield Foundation, and Petsmart Charities, Blackwell’s goal is “community ownership:” The combined involvement of local vets, city animal services departments, social service agencies, rescue and community organizations, pet food and product manufacturers, and affluent pet owner-donors can make the model self-sustaining.

There is no perfect solution for low-income pet owners who need help accessing veterinary care. But growing awareness of the problem is a big step forward. “What we call ‘animal welfare’ is changing,” said Lori Weise, whose nonprofit, Downtown Dog Rescue, runs the Pet Support Space. “The distorted belief that ‘those people’ don’t care about their pets has never been true. People can’t afford care. Sometimes they don’t even know what’s out there; they themselves have never been in a hospital. As more people are brought into the system, we’ll see the first generation to get proper veterinary care.”

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