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Due to more legislation curtailing abortion services, clinics in many states are threatened with closure, confronting women with physical and financial obstacles they may not be able to overcome
The current spate of state-level legislation aimed at curtailing abortion services in the United States – more than 55 restrictions passed by the end of July – raises an inevitable question: what good is a legal right for women if increasingly there is no way to exercise it?
American women have a constitutional right to abortion until a foetus is viable outside the womb, a point generally accepted as about 24 weeks into pregnancy, under federal law. This right famously was upheld by the U.S. Supreme Court’s 1973 ruling in the landmark case Roe v. Wade. But the distance between that right and access to abortion services is getting farther and farther – literally – for women in many states.
In 2008, even before the so-called “war on women” ramped up, one-third of U.S. women seeking an abortion had to travel more than 25 miles to get one, and a third of rural women had to travel more than 100 miles, according to “How Far Did U.S. Women Travel for Abortion Services in 2008?” - a report released on July 26 by the non-profit Guttmacher Institute, which researches sexual and reproductive health and policy in the U.S. and tracks restrictions on abortion rights.
In 2013, as legislators in state after state continue to chip away at abortion services by adding more and more onerous requirements for both abortion providers and women, that distance is getting farther.
“What we’re seeing are states essentially piling on restrictions, and these restrictions will make abortion less accessible because it’s a bigger mountain to climb for both women and providers,” Elizabeth Nash, Guttmacher’s state issues manager, told the Thomson Reuters Foundation.
“This effort to enact abortion restrictions is strategic because the goal is to eliminate access to abortion without having to jump through the legal hoops of overturning Roe v. Wade.”
THE ABORTION PROVIDER’S TRAP
Many of these restrictions are described by critics as “TRAP” measures - an acronym for Targeted Regulation of Abortion Providers. In many cases, women come to these clinics not for abortions but for contraceptives, Pap tests for cervical cancer, HPV vaccines against cervical cancer and family planning information.
But due to legislation, clinics in many states are threatened with closure, confronting some women with physical and financial obstacles they may not be able to overcome.
When abortion clinics are required to upgrade facilities with expensive alterations to physically match those of ambulatory surgical centres… even though no surgery is being performed in these clinics; or to have physicians obtain admitting privileges in local hospitals… even though many physicians are coming from out-of-town because there are no local doctors available to perform abortions and local hospitals are likely to refuse them privileges, it is nearly impossible for many abortion providers to continue to operate.
When women are required to make at least two visits to increasingly distant clinics before they can access abortion services, the physical and financial burden can be too great to bear. Many young and poor women can’t afford the price of travel, overnight accommodations, childcare or the loss of a paycheck for missing work due to travel.
The bill signed into law on July 29 by Gov. Pat McCrory of North Carolina is an example of the kinds of hurdles being thrown into the path of women seeking to exercise their right to an abortion.
Under the new law, abortion providers would have to meet the same physical standards as those for outpatient surgical centres. Such facilities cost about $1 million more to build than a typical abortion clinic, according to a report to lawmakers earlier in July by the director of the state’s Division of Health Service Regulation.
As a result, critics of the law say, 15 of the state’s 16 abortion providers are in danger of closing since only one currently meets the standards of a surgical facility.
The law would also ban the use of telemedicine for non-surgical abortions - requiring a physician to be physically present when a non-surgical abortion is performed through the use of such abortifacient medicines as methopristone. This would be a particular blow to rural areas, which are more reliant on telemedicine.
In 2008, there was no telemedicine, so it wasn’t an issue. Currently, 12 states ban the use of telemedicine for non-surgical abortions.
OF THE 50 STATES…
Other things have changed as well in the last five years — and few for the better.
In 2008, about 21 states required abortion providers to work in facilities meeting outpatient surgical centre standards. The current number is 26, according to the Guttmacher Institute.
In 2008, 25 states required women to undergo mandatory counseling and waiting time, a number that has risen to 26. And the number of states requiring two trips to an abortion clinic before the procedure is done has risen from seven to nine in that time.
It is too early to know the final impact of these state laws, given the lag time between their passage and implementation, but the evidence is beginning to come in, said Nash.
“For sure, we know in Pennsylvania, now that the clinic regulations have gone into effect, five providers have closed. In Virginia, at least two providers have closed, and in Tennessee, at least one provider. That’s just three states since 2011,” she said, referring to the year when state legislators introduced a record 1,100 reproductive health provisions. Of those, 135 were enacted, 92 of which were restrictions on abortion.
Still to be seen is what will happen in Texas, the state of the plaintiff in Roe v. Wade, which recently passed some of the most restrictive abortion laws in the country.
The new Texas law bans abortions after 20 weeks of pregnancy, requires doctors who perform abortions to have admitting privileges at local hospitals, and requires abortion providers to meet the standards of fully equipped surgical centres.
Of the state’s 42 abortion providers, only six meet those new requirements putting the future of the others in jeopardy.
Nash pointed out the state’s vast empty expanses as an obstacle to women seeking an abortion provider and the fact that there are about 5.5 million Texan women of reproductive age.
“You have a lot of women who fall into the categories of low-income women, women of color and young women, who are the women most burdened by restrictions on abortion,” she said.
Asked if this overall trend to restrict abortion access eventually could revive a market in illegal abortions, she said, “ It’s very concerning because we do not want to return to that.”
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