Supreme Court by Roe v. Wade. But what does abortion access look like in America even before it is reconsidered?

Since the 1973 decision, which ensured the constitutional right to abortion, activists and their allies at statehouses across the country have enacted more than 1,300 laws that have made the procedure more difficult to obtain.

Five states have only one clinic within their borders, and abortion seekers in large areas of the country have to travel miles to get the procedure. States also impose limits, such as waiting periods, parental consent requirements, advice orders, and restrictions on specific types of procedures.

About 580 such restrictions have been implemented only in the last decadehandjob According to reproductive rights think tank Guttmacher Institute. These restrictions are mixed on each other, and especially in the states of the South and Midwest, abortion patients face not one or two, but many different barriers to receiving the procedure.

Elizabeth Smith, director of state policy and advocacy, said, “You’ve been told that you can’t really act on your decision until you’ve jumped through all those hoops depending on where you live, the state you live in, and where you live.” live.” Reproductive Rights Center. “All this is meant to make the abortion care seeker feel the stigma that anti-abortion people believe to be true.”

This incremental approach to limiting access is, all at once, a strategy of policy, politics and law. By focusing on laws that reduce the availability of the procedure, anti-abortion activists have secured important court rulings upholding laws that helped the Supreme Court to reconsider Row while keeping the issue in the national conversation. is of.

“The way to deal with Rowe v. Wade was to understand that, if we’re going to change that, we’re going to have to — in the interim — act under it, but challenge it, or at least save lives in the meantime, those provisions.” with which would limit abortion,” James Bopp, longtime general counsel on the National Right to Life Committee, told CNN.

Sometimes states pass laws in response to court decisions that open the door to more restrictions, according to Katie Glenn, government affairs attorney for the anti-abortion group American United for Life.

“Or, it’s pushing the boundaries,” Glenn told CNN. “It’s like this: We want this policy in our state, let’s go ahead and get it passed. Let’s see what we can do in court.”

Meanwhile, access to abortion is notoriously difficult for some women, even though the Supreme Court upheld, overturned, or watered down a case hearing in December about Mississippi’s 15-week ban.

Targeting clinics with regulations that make it difficult to keep them open

Abortion companies in about two dozen states Per Guttmacher, Licensing mandates and other requirements set them apart from facilities offering comparable medical procedures.

Abortion rights advocates blame these and other restrictions on how clinics are declining in some states.

Some states have mandates around the size of the hallway or room, or the distance of the clinic from the hospital; According to the think tank, a dozen states require that clinics have a special relationship with a local hospital. Such requirements make clinics more expensive to operate, especially when their facilities do not already meet the mandate, and more difficult to staff with physicians holding the required licenses.

Texas saw the number of clinics in its state cut in half over the past decade, while a clinic regulation law was being sued. Louisiana had 11 clinics several decades ago, up from seven in 2011, and now, only three.

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Those numbers would be even more dire if the Supreme Court did not rule in favor of providers who challenged certain clinic regulation laws – known as targeted regulation of abortion providers.handjob or traphandjob Laws — passed in recent years in states that would have left Texas, the nation’s second most populous state, with fewer than 10 providers. All would have closed except one clinic in Louisiana.

Glenn, whose group supported that wave of bills, denied that the goal was to close the clinics, and said they were passed “for safety reasons” for patients’ health.

Even though clinics have closed, the care available has been limited to urban areas.

Distance can be challenging for women who cannot easily afford travel expenses, child care and vacation time required to travel. According to a 2019 study, Nearly “one-fifth of US abortion patients traveled more than 50 miles unilaterally and the most common reason cited for choice of clinic was that it was closest.”

“For people living in rural communities, access is really hard because of travel, which helps women navigate the process they seek,” said Tamya Cox-Ture, co-chair of the Oklahoma Call for Reproductive Justice.

Additional obstacles once patients reach their provider

Going to the clinic is often the first step.

almost half the states There is an effective waiting period – from 18 to 72 hours – which further increases the time and travel costs that individuals have to incur to receive the procedure.

South Dakota is the most extremehandjob Since it excludes weekends and holidays from the waiting period, which means that if a woman comes to receive the procedure on a Friday, she will not be able to receive it until the following Wednesday.

These requirements – and especially in states where women are required to see the same physicians for their first and second visits – complicate operations even for clinics, hindering staffing time and scheduling.

Minors face an additional hurdle in 38 states that require parental involvement in the decision, with either notice or consent required; In three states, both parents must give their consent, According to Guttmacher.
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While the vast majority of states offer judicial bypass for minors who do not want their parents’ involvement, the court process can be time-consuming, and in some states, a judge’s permission is granted only in certain circumstances. She goes.

The constraints are not just of cost and time, but of emotions, as many states Requires that providers tell abortion seekers certain things about the procedure that may not necessarily be true or accurate.

In five states, patients are falsely told that the procedure increases their risk of breast cancer, while eight states require that those receiving drug abortions be falsely told that the procedure can be reversed midway. Is.

“It’s a testament to how much people want and need abortions that they still go through with it, after everything the state needs them to hear,” said David Cohen, professor at the Drexel Kline School of Law and co-author of the book “The Obstacle Course: The Everyday Struggle to Get an Abortion in America.”

Restrictions on the type of procedures

Since Rowe, federal courts have mostly been skeptical of laws that ban abortions before viability. But other restrictions targeting abortion based on the type of procedure proposed have been widely successful in limiting women’s options based on the location of their pregnancy.

Several states have sought to ban the abortion procedure called D&E, or “dilation and evacuation,” a method commonly used for women in the second trimester. Texas’ ban was recently upheld by a federal appeals court.

Drug abortions – in which patients terminate their pregnancies using pills – have also become the target of legislators in places such as Texas, who recently enacted a threatening law Heavy penalties for physicians who provide drug abortion pills without meeting the state’s informed consent requirements. Nineteen states have effectively outlawed the use of telemedicine in the administration of drug abortion.

Laws, outside of their practical effects, also have political implications.

Smith of the Center for Reproductive Rights said, “Procedure restrictions are one way that anti-abortion people can try to define abortion care and define this medical procedure … Anti-abortion activists have called drug abortion “chemical abortion.” Rebranded as ”

As anti-abortion activists see it, these kinds of laws allow them to expose “the extremes of the pro-choice position, and possibly that of Roe v. Wade itself,” Bopp told CNN.

financial constraints

Then there is the question of how abortion patients are going to pay for the procedure. Given that the seekers of the process are low-income or poorOf course, they are particularly influenced by policies from the federal government and nearly three dozen states that limit the use of Medicaid to pay for abortions.
American United for Life’s Glenn points to limitations supporting elections on public abortion funding, and added that “no one should feel that they should have an abortion because of a financial decision concerning government benefits.”

About a dozen states put limits on abortion coverage by private insurance plans.

The amount of time women spend saving money has an impact. It may take them so long in their pregnancy to get a less invasive type of procedure like a drug abortion. The gestational limit may be passed in some states.

Smith said, “When someone is living in a state like Texas where there are a lot of abortion restrictions and restrictions that work together, restricting coverage is something that can make abortion out of reach for anyone.” Is.” “Abortion is time-sensitive medical care, so if you don’t have the money to pay for it out of pocket. You have to figure out how to pay for it.”


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