Since the 1973 decision, which enshrined a constitutional right to abortion, activists and their partners in state houses across the country have passed more than 1,300 laws since that decision has made the procedure more difficult to achieve.
Five states have only one clinic within their borders, and in large parts of the country, abortion seekers have to travel miles to get the procedure. States also impose borders, e.g. Waiting times, parental consent requirements, counseling mandates and limitations for the specific types of procedures offered.
About 580 of such restrictions have been adopted just in the last decade, according to the think tank Reproductive Rights Guttmacher Institute. These restrictions unite with each other, and especially in states in the South and Midwest, abortion patients are not faced with one or two, but several separate barriers to getting the procedure.
“You are told that you can not actually act on your decision until you jump through all the hangers that the state where you live has laid out in front of you,” said Elisabeth Smith, director of state policy and advocacy at the Center for reproductive rights. “It’s all that’s meant to make the person seeking abortion care feel the stigma that people against abortion think is true.”
This step-by-step approach to restricting access is at once a strategy for politics, politics and law. By focusing on laws that remove the availability of the procedure, anti-abortion activists have secured important court rulings that uphold the laws that have helped the Supreme Court closer to rethinking Roe, while preserving the issue in the national conversation.
“The way to deal with Roe v. Wade was to understand that if we were to change it, we would – in the meantime – operate under it, but challenge it or at least save lives in the meantime, with provisions that would limit abortion,” said James Bopp, longtime attorney general of the National Right to Life Committee, to CNN.
Sometimes states passed laws in response to court rulings that opened the door to more restrictions, according to Katie Glenn, government affairs for the anti-abortion group Americans United for Life.
“Or, it pushes the boundaries,” Glenn told CNN. “It’s like this: here’s the policy we want in our state, let’s go ahead and pass it. Let’s see what we can do in court.”
Meanwhile, abortion remains extremely difficult to access for some women, whether the Supreme Court upholds, reverses, or wanders Roe in the case involving the Mississippi’s 15-week ban heard in December.
Target clinics with rules that make them difficult to keep open
Abortion rights lawyers blame these and other restrictions on how the number of clinics in certain states continues to shrink.
Some states have mandates around the hallway or room size or a clinic’s distance 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 run clinics, especially when their facilities do not already meet the mandates, and more difficult to staff with physicians who have the necessary licenses.
Texas saw the number of clinics in its state halve over the past decade, while a law on clinic regulation became lawsuits. Louisiana went from having 11 clinics several decades ago to having seven in 2011 and now only three.
These numbers would be even more appalling if the Supreme Court had not ruled in favor of providers who challenged certain laws on clinical regulation – known as the Targeted Regulation of Abortion Providers, or TRAP, laws-enacted in those states in recent years that would have left Texas, the country’s second-largest population, with fewer than 10 providers. Everyone except a clinic in Louisiana would have closed.
Glenn, whose group supported this bill, denied that the goal was to close clinics, saying they were passed “for safety reasons” for patients’ health.
No matter what the clinics have closed, accessible care has been condensed into urban areas.
“For people in rural areas, access is really difficult because of the journey,” said Tamya Cox-Touré, co-chair of the Oklahoma Call for Reproductive Justice, which helps women navigate the procedure.
Additional obstacles when patients reach their provider
Getting to the clinic is often only the first step.
South Dakotas is the most extreme, as it excludes weekends and holidays from the waiting period, which means that if a woman shows up on a Friday to get the procedure, she will only be able to get it the following Wednesday.
These requirements – and especially those in states that require women to see the same doctors for their first and second visits – also complicate clinics operations by hampering staff time and planning.
While the vast majority of these states offer a judicial bypass for minors who do not want the involvement of their parents, this process can be time consuming, and in some states a judge is granted permission only in certain circumstances.
In five states, patients are mistakenly told that the procedure increases the risk of breast cancer, while in eight states, recipients of a medical abortion are told inaccurately that the procedure can be reversed midway.
“It’s a testament to how much people want and need abortion that they’re still going through with it, after all that the state requires them to hear,” he 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 the types of procedures
Since Roe, federal courts have mostly been skeptical of laws banning abortion before viability. However, other restrictions targeted at abortion based on the type of procedure offered have largely been successful in limiting women’s options based on where they are in their pregnancies.
Several states have sought to ban an abortion procedure known as D&E or “enlargement and evacuation,” the method most commonly used for women in their second trimester. Texas’ ban was recently upheld by a federal appeals court.
In addition to their practical effects, the laws also have a political impact.
“Prohibition of procedures is one way in which people against abortion can try to define abortion care and define this medical procedure … in a way that makes people oppose it,” Smith of the Center for Reproductive Rights said, pointing out, how anti-abortion activists have renamed medicine abortion to “chemical abortion”.
As anti-abortion activists see it, these types of laws let them highlight “the extremity of optional position and possibly Roe v. Wade himself,” Bopp told CNN.
About a dozen states set limits on abortion coverage from private insurance plans.
The time women spend saving money has knock-on effects. It can take so long that they get too far in their pregnancies to receive less invasive forms of the procedure, e.g. Medication abortion. In some states, the pregnancy limit may cross.
“When a person lives in a state like Texas where there are many abortion bans and restrictions that work together, banning coverage is one thing that can push abortion out of reach for anyone,” Smith said. “Abortion is time-sensitive medical care, so if you do not have the funds to pay for it yourself. You need to figure out how to pay for it.”