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Since the 1973 ruling that enshrined a constitutional right to abortion, activists and their partners in state houses across the country have enacted more than 1,300 laws since this ruling made the procedure more difficult to obtain. .
Five states have only one clinic within their borders, and in large areas of the country abortion seekers have to travel miles to get the procedure. States also impose limits, such as timeouts, parental consent requirements, advisory mandates, and restrictions on the specific types of procedures offered.
About 580 of these restrictions have been enacted just in the last decade, according to the reproductive rights think tank Guttmacher Institute. These restrictions add to each other, and especially in the Southern and Midwestern states, abortion patients face not one or two, but several distinct barriers to getting the procedure done.
“You are told that you cannot follow through with your decision until you have cleared all the obstacles that the state where you live has placed before you,” said Elisabeth Smith, director of policy at the State and Advocacy at the Center for Reproductive Rights. “That’s all that is meant to make the person seeking abortion care feel the stigma that anti-abortionists believe is true.”
This progressive approach to limiting access is a political, political and legal strategy at the same time. By focusing on laws that reduce procedural availability, anti-abortion activists have secured key court rulings upholding these laws that have helped the Supreme Court move closer to rethinking Roe, while keeping the issue in the conversation. national.
“The way to treat Roe v. Wade was to understand that if we were to change it, we had to – in the interim – act under it, but challenge it, or at least save lives in the meantime, with provisions that would limit abortion, “James Bopp, longtime general counsel of the National Right to Life Committee, told CNN.
Sometimes states have passed laws in response to court rulings that have opened the door to more restrictions, according to Katie Glenn, government affairs adviser for anti-abortion group Americans United for Life.
“Or, it pushes the boundaries,” Glenn told CNN. “It’s like, this is the policy we want in our state, let’s go ahead and adopt it. Let’s see what we can do in court.”
In the meantime, abortion remains extremely difficult for some women to access, which the Supreme Court upholds, denies or mitigates Roe in the Mississippi 15-week ban case heard in December.
Target clinics with regulations that make them difficult to keep open
Abortion rights advocates blame these and other restrictions of how the number of clinics in some states continues to decline.
Some states have mandates regarding the size of hallways or rooms, or the distance from a clinic to a hospital; a dozen states require clinics to have a special relationship with a local hospital, according to the think tank. Such requirements make it more expensive to operate clinics, especially when their facilities do not already meet mandates, and more difficult to staff with licensed physicians.
Texas has seen the number of clinics in its state cut by half over the past decade, as a law to regulate clinics was in dispute. Louisiana has grown from 11 clinics decades ago to seven in 2011, and now just three.
These numbers would be even more dire if the Supreme Court had not ruled in favor of providers who challenged certain clinic regulation laws – known as targeted regulation of abortion providers., or TRAP, laws – passed in these states in recent years, which would have left Texas, the second most populous state in the country, with less than 10 providers. All but one clinic in Louisiana is said to have closed.
Glenn, whose group backed this wave of bills, denied the goal was to shut down clinics and said they were passed “for the sake of safety” for the health of patients.
Regardless, as clinics closed, available care was concentrated in urban areas.
“For people living in rural communities, access is really difficult because of the travel,” said Tamya Cox-Touré, co-chair of the Oklahoma Call for Reproductive Justice, which helps women navigate the process.
Additional barriers once patients visit their provider
Getting to the clinic is often just the first step.
South Dakota is the most extreme, because it excludes weekends and holidays from the waiting period count, which means that if a woman shows up on a Friday for the procedure, she will not be able to get it until the following Wednesday.
These requirements – and particularly those from states that require women to see the same doctors for their first and second visits – also complicate clinic operations, crippling staff time and schedules.
While the vast majority of these states provide legal circumvention for minors who do not wish their parents to be involved, this legal process can be time consuming and in some states a judge’s permission is only granted in certain circumstances.
In five states, patients are falsely told that the procedure increases the risk of breast cancer, while eight states require that recipients of a medical abortion be inaccurately informed that the procedure can be reversed halfway.
“It’s a testament to how much people want and need the abortion they still have, after everything the state asks them to hear,” said David Cohen, professor at the Drexel Kline School of Law and co-author of the book “Obstacle Course: The Everyday Struggle to Get an Abortion in America”.
Restrictions on types of proceedings
Since Roe, federal courts have been mostly skeptical of laws prohibiting pre-viability abortion. But other restrictions that target abortion based on the type of procedure offered have largely succeeded in limiting women’s options based on where they are in their pregnancy.
Several states have sought to ban an abortion procedure known as D&E, or “dilation and evacuation,” the method most commonly used for women in their second trimester. The Texas ban was recently upheld by a federal appeals court.
Laws, apart from their practical effects, also have a political impact.
“Procedural bans are a way for anti-abortionists to try to define abortion care and define this medical procedure… in a way that causes people to oppose it,” Smith said. , from the Center for Reproductive Rights, noting how anti-abortion activists have renamed medical abortion “chemical abortion.”
According to anti-abortion activists, these types of laws allow them to highlight “the end of the pro-choice stance, and possibly Roe v. Wade himself,” Bopp told CNN.
Financial constraints
A dozen states limit abortion coverage by private insurance plans.
The time that women spend saving money has ripple effects. It can take so long that they go too far in their pregnancy to receive less invasive types of procedures, like medical abortions. In some states, the gestation limit may pass.
“When a person lives in a state like Texas where there are a lot of abortion bans and restrictions that work together, banning coverage is one thing that can push abortion out of reach for someone.” , said Smith. “Abortion is urgent medical care, so if you don’t have the funds to pay for it out of pocket. You have to figure out how to pay for it.”
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