Maher v. Roe
432 U.S. 464 (1977)

Annotate this Case

U.S. Supreme Court

Maher v. Roe, 432 U.S. 464 (1977)

Maher v. Roe

No. 75-1440

Argued January 11, 1977

Decided June 20, 1977

432 U.S. 464

Syllabus

Appellees, two indigent women who were unable to obtain a physician's certificate of medical necessity, brought this action attacking the validity of a Connecticut Welfare Department regulation that limits state Medicaid benefits for first trimester abortions to those that are "medically necessary." A three-judge District Court held that the Equal Protection Clause of the Fourteenth Amendment forbids the exclusion of nontherapeutic abortions from a state welfare program that generally subsidizes the medical expenses incident to pregnancy and childbirth. The court found implicit in Roe v. Wade, 410 U. S. 113, and Doe v. Bolton, 410 U. S. 179, the view that "abortion and childbirth . . . are simply two alternative medical methods of dealing with pregnancy. . . ."

Held:

1. The Equal Protection Clause does not require a State participating in the Medicaid program to pay the expenses incident to nontherapeutic abortions for indigent women simply because it has made a policy choice to pay expenses incident to childbirth. Pp. 432 U. S. 469-480.

(a) Financial need alone does not identify a suspect class for purposes of equal protection analysis. See San Antonio School Dist. v. Rodriguez, 411 U. S. 1, 411 U. S. 29; Dandridge v. Williams, 397 U. S. 471. Pp. 432 U. S. 470-471.

(b) The Connecticut regulation does not impinge upon the fundamental right of privacy recognized in Roe, supra, that protects a woman from unduly burdensome interference with her freedom to decide whether or not to terminate her pregnancy. That right implies no limitation on a State's authority to make a value judgment favoring childbirth over abortion and to implement that judgment by the allocation of public funds. An indigent woman desiring an abortion is not disadvantaged by Connecticut's decision to fund childbirth; she continues as before to be dependent on private abortion services. Pp. 432 U. S. 471-474.

(c) A State is not required to show a compelling interest for its policy choice to favor normal childbirth. Pp. 432 U. S. 475-477.

(d) Connecticut's regulation is rationally related to and furthers its "strong and legitimate interest in encouraging normal childbirth,"

Page 432 U. S. 465

Beal v. Doe, ante at 432 U. S. 446. The subsidizing of costs incident to childbirth is a rational means of encouraging childbirth. States, moreover, have a wide latitude in choosing among competing demands for limited public funds. Pp. 432 U. S. 478-480.

2. Since it is not unreasonable for a State to insist upon a prior showing of medical necessity to insure that its money is being spent only for authorized purposes, the District Court erred in invalidating the requirements of prior written request by the pregnant woman and prior authorization by the Department of Social Services for abortions. Although similar requirements are not imposed for other medical procedures, such procedures do not involve the termination of a potential human life. P. 432 U. S. 480.

408 F.Supp. 660, reversed and remanded.

POWELL, J., delivered the opinion of the Court, in which BURGER, C.J., and STEWART, WHITE, REHNQUIST, and STEVENS, JJ., joined. BURGER, C.J., filed a concurring statement, post, p. 432 U. S. 481. BRENNAN, J., filed a dissenting opinion, in which MARSHALL and BLACKMUN, JJ., joined, post, p. 432 U. S. 482. MARSHALL, J., filed a dissenting opinion, ante, p. 432 U. S. 454. BLACKMUN, J., filed a dissenting opinion, in which BRENNAN and MARSHALL, JJ., joined, ante, p. 432 U. S. 462.

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Primary Holding

Paying for childbirth does not mean that a state needs to pay for nontherapeutic abortions.

Facts

The Connecticut Welfare Department provided that state Medicaid benefits for first trimester abortions would be issued only if they were medically necessary. The state Department of Social Services used a system of prior authorization to enforce this requirement. Roe and Poe, two indigent women, could not get a certificate of medical necessity from a doctor and challenged the validity of the regulation by suing Maher, the Commissioner of Social Services. The lower court struck down the regulation as a violation of the Equal Protection Clause, ruling that a state welfare program may not exclude nontherapeutic abortions when it chooses to subsidize medical expenses related to pregnancy and childbirth.

Opinions

Majority

  • Lewis Franklin Powell, Jr. (Author)
  • Warren Earl Burger
  • Potter Stewart
  • Byron Raymond White
  • William Hubbs Rehnquist
  • John Paul Stevens

The right to abortion that was created in Roe v. Wade (1973) is not unqualified but extends only to protect a woman from undue burdens on her liberty interest in deciding whether to terminate her pregnancy. States retain the authority to favor childbirth over abortion and allocate their funds accordingly. The state has a strong interest in encouraging the birth of children, and the regulation does not prevent a woman from obtaining an abortion, since an indigent woman still can rely on private sources for those services. No suspect classification or fundamental right is involved here, so rational basis is the appropriate standard of review.

Dissent

  • William Joseph Brennan, Jr. (Author)
  • Thurgood Marshall
  • Harry Andrew Blackmun

Indigent women are coerced by this funding structure into giving birth to children whom they otherwise would not choose to have. This violates the right to privacy guaranteed by the Due Process Clause.

Concurrence

  • Warren Earl Burger (Author)

Dissent

  • Thurgood Marshall (Author)

Dissent

  • Harry Andrew Blackmun (Author)
  • Thurgood Marshall
  • William Joseph Brennan, Jr.

Case Commentary

A state regulation favoring childbirth over abortion is not considered an undue burden on indigent women because providing Medicaid assistance would constitute an affirmative step to provide a benefit rather than a withholding of assistance.

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