As state legislatures debate 300 new bills to further restrict women's constitutional right to legal and safe abortions, media should know that abortion is already restricted in the U.S. at unprecedented levels, that experts say it is medically unnecessary to require clinics to obtain hospital admitting privileges and adopt surgical center standards, and that limited access to abortions severely harms low-income women.
State Lawmakers Propose 300 New Bills Restricting Abortions
CBS News: During The 2012 State Legislative Session, "Lawmakers Proposed More Than 300 Bills That Would Have Restricted Abortions." CBS News reported that according to the American Civil Liberties Union (ACLU), state lawmakers across the country introduced more than 300 bills restricting abortion during the 2012 legislative session. Some of the restrictions were set to go into effect beginning July 2013, while others are still under debate:
Nationally, state lawmakers proposed more than 300 bills that would have restricted abortions, according to the American Civil Liberties Union. At least 13 state legislatures passed new limits, though two are waiting for governors to sign off. Notably, a bill that would have closed almost every abortion clinic in Texas was dramatically defeated by a Democratic filibuster and a restless crowd in late June. The Texas governor, however, has ordered another special legislative session to push the bill through. North Dakota has passed the nation's strictest abortion law, which takes effect in August, banning abortions after six weeks of pregnancy. [CBSNews.com, 7/1/13]
FACT: Since 2010, States Have Passed A Record Number Of Restrictions On Abortion
Bloomberg Businessweek: After 2010, "Lawmakers In 24 States Passed A Record 92 Provisions That Restrict Access To Abortion Services." Bloomberg Businessweek reported that anti-choice groups have made "unprecedented headway at the state level" in restricting abortions:
Under the Obama administration, abortion rights proponents have won significant battles on the national level, fighting back attempts to cut off funding to Planned Parenthood and eliminate the Affordable Care Act's requirement that most health plans cover contraception free of charge. But abortion foes have made unprecedented headway at the state level. After Republican gains in statehouses in the 2010 midterm elections, lawmakers in 24 states passed a record 92 provisions that restrict access to abortion services, according to the Guttmacher Institute, which researches and compiles data on reproductive health. That's nearly triple the old record set in 2005 and a sixfold increase over 1985.
Abortion providers say the laws have made their business more arduous and sliced into their earnings. By 2008, the latest year for which Guttmacher has data, the number of providers, which includes doctors' offices and hospitals, had fallen 38 percent from their 1982 peak, to 1,793. [Bloomberg Businessweek, 1/17/13]
NBC News: After 2011, 2012 Was Second-Highest Year On Record For New Abortion Restrictions Since 1985. NBC News reported that in 2012, "19 states enacted a total of 43 provisions limiting access to abortion, according to the Guttmacher Institute. That was half the number that went into effect the previous year, but still the second-highest number since 1985":
Forty years after the U.S. Supreme Court struck down many state restrictions on abortion with Roe v. Wade, women who want to terminate a pregnancy face a growing number of roadblocks in many parts of the country.
Last year, 19 states enacted a total of 43 provisions limiting access to abortion, according to the Guttmacher Institute. That was half the number that went into effect the previous year, but still the second-highest number since 1985. [NBCNews.com, 1/21/13]
FACT: Vast Majority Of U.S. Counties Do Not Have Abortion Providers
Guttmacher Institute: 87 Percent Of U.S. Counties Have No Abortion Provider. According to research from the Guttmacher Institute, a nonprofit research organization which works to advance reproductive health, "Eighty-seven percent of all U.S. counties lacked an abortion provider in 2008; 35% of women live in those counties." [Guttmacher Institute, August 2011]
Daily Beast: In The Midwest, Roughly 400,000 Women Live More Than 150 Miles From A Clinic. The Daily Beast reported that "[t]he clearest trend on the map is the dearth of clinics through the center of the country." Between northern Texas and North Dakota, "roughly 400,000 women of reproductive age (between 15 and 44) live more than 150 miles from the closest clinic." [Daily Beast, 1/22/13]
NBC News: North Dakota, South Dakota, Arkansas, And Mississippi Have Only One Abortion Clinic Each. NBC News reported that new legislation has severely limited access to abortion clinics in the U.S., and in "at least four states -- North Dakota, South Dakota, Arkansas, Mississippi -- there is only one clinic." [NBCNews.com, 1/21/13]
FACT: Experts Agree Hospital Admitting Privileges And Surgical Center Standards Are Medically Unnecessary For Abortions
American Congress Of Obstetricians And Gynecologists (ACOG): Hospital Admitting Privileges Are "Unnecessary Requirements ... Without A Basis In Public Health Or Safety." The Texas District of the American Congress of Obstetricians and Gynecologists opposed a proposed Texas abortion bill (SB 5/HB 60) because it required that doctors obtain hospital admitting privileges at a hospital within 30 miles of their clinics. In a statement, the ACOG explained that in many rural areas, hospitals are scarce and may not provide OB/GYN services:
Texas-ACOG opposes unnecessary requirements that may be extremely difficult and in some cases impossible to meet, without a basis in public health or safety.
- SB 5/HB 60 requires hospital admitting privileges for physicians performing an outpatient procedure that bears low risk. No other outpatient procedure requires a physician to have active admitting privileges in a hospital within a specific distance.
- Many specialties, including Obstetrics & Gynecology, have begun to stratify the primary practice location for providers: some providers work exclusively in the outpatient setting and others work exclusively in the hospital.
- Processes for approval of admitting privileges can take a lengthy amount of time.
- A physician may have active admitting privileges, but not within a 30 mile radius. This is especially problematic for rural areas where hospitals are scarce and jeopardizes access for rural women.
- SB 5/HB 60 requires that the physician or other health care provider be available by phone 24 hours a day indefinitely. This regulation is overly broad and could require 24/7 access for years.
- SB 5/HB 60 requires access to medical records 24 hours daily, which is unprecedented and unnecessarily broad.
- Criminally penalizing physicians for performing a legal procedure is inappropriate and prevents physicians from treating their patients based on the best clinical judgment. [Texas District American Congress of Obstetricians and Gynecologists, 7/1/13]
Texas Hospital Association: Hospital Admitting Privileges Are Not "Appropriate" And Are Unnecessary In Emergency Situations. The Texas Hospital Association (THA) issued a statement opposing the hospital privilege requirement of the Texas abortion bill SB 5/HB 60, arguing that it does nothing to improve women's health because emergency room physicians would be the ones to treat a woman who needs emergency care due to complications from an abortion:
THA agrees that women should receive high-quality care and that physicians should be held accountable for acts that violate their license. However, a requirement that physicians who perform one particular outpatient procedure, abortion, be privileged at a hospital is not the appropriate way to accomplish these goals. A hospital's granting privileges to a physician serves to assure the hospital that the physician has the appropriate qualifications to provide services to patients in the hospital. Thousands of physicians operate clinics and provide services in those clinics but do not have hospital admitting privileges. Requiring a hospital to grant admitting privileges to physicians who do not provide services inside the hospital is time-consuming and expensive for the hospital and does not serve the purpose for which privileges were intended; rather, the Texas Medical Board is the appropriate agency to address whether physicians are delivering appropriate care to patients, as the TMB regulates all physicians. Hospitals should not be required to assume responsibility for the qualifications of physicians who do not practice in the hospital.
Should a woman develop complications from an abortion or any other procedure performed outside the hospital and need emergency care, she should present to a hospital emergency department. Requiring that a doctor have privileges at a particular hospital does not guarantee that this physician will be at the hospital when the woman arrives. She will appropriately be treated by the physician staffing the emergency room when she presents there. If the emergency room physician needs to consult with the physician who performed the abortion, the treating physician can contact the doctor telephonically, which is often done in other emergency situations. [Texas Hospital Association, accessed 7/1/13]
American Journal Of Public Health: There Is No Evidence That An Ambulatory Surgical Center Requirement "Positively Affects Health Outcomes." Writing in the American Journal of Public Health, Bonnie Scott Jones of the Center for Reproductive Rights and Dr. Tracy A. Weitz of the Bixby Center for Global Reproductive Health noted that "Ambulatory surgical center requirements significantly increase abortion costs and reduce the availability of abortion services despite the lack of any evidence that using those facilities positively affects health outcomes":
Many women need access to abortion care in the second trimester. Most of this care is provided by a small number of specialty clinics, which are increasingly targeted by regulations including bans on so-called partial birth abortion and requirements that the clinic qualify as an ambulatory surgical center. These regulations cause physicians to change their clinical practices or reduce the maximum gestational age at which they perform abortions to avoid legal risks. Ambulatory surgical center requirements significantly increase abortion costs and reduce the availability of abortion services despite the lack of any evidence that using those facilities positively affects health outcomes. Both types of laws threaten to further reduce access to and quality of second-trimester abortion care. [American Journal of Public Health, April 2009, via National Center for Biotechnology Information]
Guttmacher Institute: "Fewer Than 0.3% Of Abortion Patients Experience A Complication That Requires Hospitalization." According to the Guttmacher Institute, "The risk of abortion complications is minimal: Fewer than 0.3% of abortion patients experience a complication that requires hospitalization." [Guttmacher Institute, August 2011]
FACT: Hospital Admitting Privileges Can Force Legal Clinics To Close
Bloomberg Businessweek: Laws Mandating Hospital Admitting Privileges Could Shutter Clinics, Force Mississippi's "Last Surviving Clinic To Close Its Doors." Bloomberg Businessweek reported that requirements that abortion providers be regulated more like hospitals "may shutter most, if not all, clinics in Virginia, Kansas, and Pennsylvania," and that a Mississippi law mandating hospital admitting privileges "could force the state's last surviving clinic to close its doors":
Requirements that abortion providers be regulated more like hospitals than doctors' offices may shutter most, if not all, clinics in Virginia, Kansas, and Pennsylvania. A Mississippi law mandates that abortion doctors secure admitting privileges at local hospitals, and could force the state's last surviving clinic to close its doors. Instead of seeking to ban abortion outright, which would violate the Supreme Court's 1973 ruling in Roe v. Wade, anti-abortion groups are pushing laws that would make it too expensive for providers to remain in operation. [Bloomberg Businessweek, 1/17/13]
NY Times: Texas Bill Requiring Surgical Standards Could "Cause All But 5 Of The 42 Abortion Clinics In The State To Close." The New York Times reported that a proposed bill in Texas that would require abortion providers to obtain hospital admitting privileges and would require clinics to obtain costly renovations could force "all but 5 of the 42 abortion clinics in the state to close":
The bill would ban abortions after 20 weeks of pregnancy, require abortion clinics to meet the same standards that hospital-style surgical centers do, and mandate that a doctor who performs abortions have admitting privileges at a nearby hospital.
Supporters of the bill, including the governor and other top Republicans, said the measures would protect women's health and hold clinics to safety standards, but women's rights advocates said the legislation amounted to an unconstitutional, politically motivated attempt to shut legal abortion clinics. The bill's opponents said it would most likely cause all but 5 of the 42 abortion clinics in the state to close, because the renovations and equipment upgrades necessary to meet surgical-center standards would be too costly. [The New York Times, 6/25/13]
FACT: High Cost Of Abortion Harms Low-Income Women
Guttmacher Institute: Women Forgo Paying For Rent And Food In Order To Afford Abortions. Guttmacher Institute research found that 42 percent of women having abortions have income levels below the federal poverty line, and women have reported having "to borrow money from friends & family and forgo paying rent, groceries & utilities to pay for their procedure." In 2008, the average cost of a first-trimester abortion was $470. [Guttmacher Institute, accessed 7/1/13]
NY Times: Women Denied Abortions Were Three Times More Likely To End Up Below The Federal Poverty Line. The New York Times reported on an ongoing longitudinal study that compared women who wanted to get an abortion but were denied to women who got the procedure. The study found that two years after being denied abortion services, women "were three times as likely to end up below the federal poverty line":
Adjusting for any previous differences between the two groups, women denied abortion were three times as likely to end up below the federal poverty line two years later. Having a child is expensive, and many mothers have trouble holding down a job while caring for an infant. Had the turnaways not had access to public assistance for women with newborns, Foster says, they would have experienced greater hardship. [The New York Times, 6/12/13]
Guttmacher Institute: 7 In 10 Women Wanted To Have An Abortion Earlier, But Many Delay Because They Cannot Afford The Procedure. Guttmacher Institute research found that of those who had second-trimester abortions, "Seven in 10 women would have preferred to have their abortion earlier. Many women experience delays because they need time to raise the money." The research also noted that most women pay out of pocket for their abortion. [Guttmacher Institute, accessed 7/1/13]
American Journal Of Public Health: "Effect Of Regulations That Increase The Cost Of Abortion Is Felt Most Acutely By Low-Income Women." Bonnie Scott Jones of the Center for Reproductive Rights and Dr. Tracy A. Weitz of the Bixby Center for Global Reproductive Health found that the cost of abortion care limits women's access to the procedures, and the "effect of regulations that increase the cost of abortion is felt most acutely by low-income women, who already lack the resources to pay for abortions":
In addition to the small number of facilities offering second-trimester abortion care, cost for such care is a limiting factor for women seeking services. The cost of abortion increases with the number of weeks a woman is pregnant, and most women pay out of pocket for those costs. Federal funds cannot be used to pay for the abortions of Medicaid-eligible women, and only 17 states use state funds to pay for such care. Prohibitions on insurance coverage for abortion care increase the number of women without financial coverage for abortion. The effect of regulations that increase the cost of abortion is felt most acutely by low-income women, who already lack the resources to pay for abortions. [American Journal of Public Health, April 2009, via National Center for Biotechnology Information]