Abortion Doesn’t Have to Be Illegal to Be Out of Reach

Alyssa Pointer/Atlanta Journal-Constitution via AP

Protestors rally outside of the Georgia State Capitol following the signing of a bill that would ban abortion as early as six weeks into pregnancy. 

Alabama legislators voted Tuesday to ban most abortions, including for victims of rape and incest, the strictest law in the country. Last week, Republican Governor Bill Kemp of Georgia signed a bill that would ban abortion as early as six weeks into pregnancy, which is often before women know that they’re pregnant. Georgia is one of the more than half of U.S. states that have advanced or enacted policies so far in 2019 that seek to further restrict abortion access. Ohio and Texas have also recently advanced multiple policies that put abortion out of reach, such as those limiting insurance coverage for abortion and banning abortion after 20 weeks, while Alabama votes Tuesday on making abortion a felony.

The proliferation of restrictive abortion laws is a reminder that abortion does not need to be illegal in order for it to be nearly impossible to obtain. Many state abortion restrictions already severely limit abortion access, which falls heavily on poor people. New data further illuminate the crisis of reduced abortion access in states like Louisiana, where restrictive policies already make abortion care impossible to obtain for some women and where new laws will make the current situation even worse.

Reproductive-rights advocates recently asked the Supreme Court to strike down a restrictive Louisiana abortion law that would effectively close abortion clinics throughout the state. The measure, which the high court temporarily blocked in February, would require Louisiana abortion providers to have admitting privileges at local hospitals. As a dissenting judge noted in a previous federal court case that upheld this new restriction, the Louisiana law is in “clear conflict” with the Court’s 2016 ruling in Whole Woman’s Health v. Hellerstedt, which overturned a similar admitting privileges requirement in Texas that forced numerous abortion clinics in the state to close.

study published late last year by my research team at Advancing New Standards in Reproductive Health (ANSIRH), a research group at the University of California, San Francisco, recruited more than 500 women entering prenatal care in Southern Louisiana and Baltimore, Maryland. About three out of ten women in both states had considered abortion for their current pregnancy; most of them decided to continue the pregnancy.

But in Louisiana, several state regulations prevented women from obtaining abortions. About six times as many women in Southern Louisiana than in Baltimore reported that a regulation (like Medicaid withholding funding for abortion and bans on abortions after 20 weeks) prevented them from terminating a pregnancy. If Louisiana’s admitting privileges law is upheld by the Supreme Court, more women would have another hurdle to overcome to obtain abortions.

How would measures like Louisiana’s admitting privileges law further restrict access to abortion? If all three remaining clinics in Louisiana were to close—a distinct possibility if the restrictive admitting privileges requirement were to take effect—71 percent of women in the state would be more than 150 miles from the nearest abortion clinic, up from just 1 percent today. Fully 100 percent of Louisiana women would live at least 50 miles from the nearest clinic, compared to 45 percent currently. For the overwhelming majority of people in the state, abortion would be a right in name only: legal in theory, all but impossible to actually access.

When legal barriers like Louisiana’s admitting privileges law, restrictions on Medicaid funding for abortion, and 20-week bans make abortion nearly impossible to obtain, many women continue their pregnancies. And the women and their families suffer. Limiting women’s ability to obtain abortions negatively affects their physical healthfinancial security, their ability to escape from violent men, and the well-being of their children.

Not only do these types of restrictions lead women to continue unwanted pregnancies, they also lead some women to attempt to self-induce an abortion. More than 10 percent of Louisiana women entering prenatal care who had considered abortion also tried to self-induce using herbs, other drugs or medications, or by hitting themselves in the abdomen. They did not report trying to obtain, could not get, or did not know about misoprostol, a medication that women can use to safely and effectively induce abortions. By contrast, only 3 percent of women entering prenatal care in Maryland who had considered abortion tried to self-induce.

Lawmakers who pursue these policies are, of course, not basing their laws on science or the health and safety of abortion patients but on their own conservative anti-abortion political agendas, and have zeroed in on the strategy of establishing seemingly innocuous parameters like local hospital admitting privileges for doctors that actually reduce access.

Several states are following Maryland’s lead and implementing policies that can make abortion more accessible. New York recently passed the Reproductive Health Act, which removes unnecessary and arbitrary gestational limits on abortion. In Maine, state lawmakers are advancing legislation that allows public funding of abortion care for low-income women. Policymakers who are interested in evidence-based abortion policies that remove barriers to abortion can look to these states for examples.

Obtaining an abortion is already very complicated for some of the most vulnerable women in the country. Instead of agonizing about the uncertain future of Roe v. Wade and focusing solely on new laws—like Georgia’s six-week ban—designed to set up a legal challenge to Roe, public-health practitioners and policymakers should focus on how current state restrictions negatively impact women’s ability to terminate an unwanted pregnancy.


This article has been updated.

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