January 23, 2013 Leave a comment
On January 22, 1973, the Supreme Court of the United States decided the landmark case Roe v. Wade, which established the right to abortion. Forty years later controversy still surrounds this decision and attempts to restrict and regulate abortion care have continued. In 2011 and 2012, the United States saw more regulation of abortion care and access at the state level than in the past 40 years, making it more and more difficult for women to exercise their rights.
State lawmakers are continuing to find new avenues through which to restrict access to abortion; 2012 saw trends in proposed and passed legislation that restrict insurance coverage, require provision of unnecessary procedures or misleading information to women, target abortion providers, and seek to ban abortions at later gestational ages based on theories regarding fetal pain.
Eight states now have laws that require a doctor to perform an ultrasound and show her the image or offer to do so before a woman can receive an abortion. Doctors already perform ultrasounds if they are needed to provide abortion care; enacting legislation to require the procedure and viewing of the image appears aimed solely at trying to dissuade women from choosing abortion. A 2012 study researching the effects of ultrasound viewing on women seeking abortion found that women can respond differently – some women felt dissuaded, some women experienced emotional difficulty, and some women reported a better ability to cope with their abortion. Given these varied outcomes, the authors suggest that the decision to view an ultrasound should be left to the doctor and patient. The leaders of five well-regarded professional physician organizations agree. Responding in part to the ultrasound mandates, they published a commentary in 2012 voicing concerns over legislative interference with the patient-physician relationship; they assert that such legislative intervention undermines the ability of physicians to give, and patients to receive, the highest quality care and medical guidance.
In a large number of states, a waiting period is required before receiving an abortion. In addition, doctors must provide mandatory counseling prior to abortion; in some states, specific language must be read, including information that is not supported by science regarding links between abortion and breast cancer and mental health risks. Not only do such mandates require physicians to provide misinformation, but a study conducted in June 2012 found that 87% of women are confident about their decision to make an abortion before visiting a clinic, suggesting that blanket regulations requiring counseling and waiting periods only interfere with a woman’s ability to receive personalized care.
These misleading practices can be amplified by Crisis Pregnancy Centers (CPCs), which often give the impression that they offer abortion services, but in fact typically only offer pregnancy tests and ultrasounds and are usually established expressly to discourage abortion. In a recent study, researchers contacted 32 CPCs in North Carolina and seventeen (53%) provided at least one misleading or inaccurate piece of information, including inaccurate information about links between abortion and breast cancer, mental health hazards, and infertility. Scholar Joanne Rosen also discussed the public health risks of CPCs in a 2012 commentary in Perspectives on Sexual and Reproductive Health, claiming that CPCs, which operate under the notion of informed consent, are actually, “contrary to the legal and ethical standards of informed consent”, given their practices of distributing misleading information.
In 2012, three states (Arizona, Kansas and Missouri) enacted new “conscience provisions,” expanding the types of entities that can refuse to provide care or insurance to patients or employees. Many states already have provisions in place that exempt individuals from providing these services on moral or ethical grounds, but new measures allow insurers to exclude coverage for contraception, abortion and sterilization. As Lisa Harris points out in a recent article in The New England Journal of Medicine, these measures allow for “conscience based refusals,” but there is little legal protection of “conscience based provision” of such services.
In the past year, there has been an onslaught of legislation establishing targeted restrictions on abortion providers (referred to as TRAP laws). Bills were proposed in twelve states that would place burdensome restrictions on clinics through building regulation mandates and new employee requirements. Last month, Governor Rick Snyder of Michigan signed a bill which requires clinics that regularly perform abortions to meet the same building license requirements as surgical outpatient facilities. This bill and others like it will likely result in not only the closing of many existing clinics, but will make the building of new clinics more arduous. Some women must already travel hundreds of miles to the nearest clinic, as this map demonstrates. These types of restrictions will make access even more difficult.
With the passage of the Affordable Care Act and the resulting creation of new state exchange programs, many legislatures have made efforts to curtail coverage for abortion. Four states in the past year passed bills which prohibit abortion coverage through their exchange programs, while a number of other states are working toward abortion care bans both within and beyond the exchange. In addition, many states continue to pursue a ban on abortion at earlier gestational ages. Eight states in the past year saw bills that proposed abortion bans as early as twenty weeks post fertilization, which precedes the current legal viability mark. These bans likely impact the most vulnerable women; in a recent study, researchers found that patients seeking second trimester abortions were often younger (age 19 and below), Black, less-educated, lower-income, had experienced more disruptive life events, and were more likely to have been exposed to intimate partner violence.
A major victory for women in the year 2012 was the passage of the Shaheen provision in the National Defense Authorization Act, which provides military servicewomen and military families the same abortion coverage as other federal employees. Previously, insurance for these women only covered abortions when a woman’s life was at risk, but the Shaheen provision allows for additional coverage in the case of rape or incest. This change is especially welcome given the findings of a recent study which showed a number of challenges women in the military face when seeking contraception; one third reported that they were unable to access a method they might want for deployment, certain methods were reportedly discouraged or not available for some women (including intrauterine devices and sterilization), and 41% of women requiring refills found them difficult to obtain.
Looking back on 2012, we can celebrate the reproductive justice achievement in the Shaheen provision, and applaud the successes that legislatures and reproductive justice advocates had halting the passage of proposed bills that would restrict access. However, some measures did pass which limit the ability of women to obtain supportive and quality reproductive care. As we move into 2013, there are promising ways to advance the rights articulated in Roe v. Wade. Such initiatives might include efforts to preserve insurance coverage and expand public funding for abortion care, expand sexual education, promote public awareness of issues related to reproductive justice and abortion, and increase women’s access to reproductive care.
 2012 Saw Second-Highest Number of Abortion Restrictions Ever. New York: Guttmacher Institute, January 2, 2013.
 State Policies in Brief: Requirements for Ultrasound, New York: Guttmacher Institute; 2013.
 Kimport K., et al. Women’s Perspectives on Ultrasound Viewing in the Abortion Care Context. Women’s Health Issues. 2012, 22(6): e513- e517.
 Weinberger SE, et al. Legislative Interference with the Patient-Physician Relationship. The New England Journal of Medicine. 2012, 367: 1557-1559.
 Foster DG, et al. Attitudes and Decision Making Among Women Seeking Abortions at One U.S. Clinic. Perspectives on Sexual and Reproductive Health. 2012, 44(2): 117- 124.
 Bryant A, Levi E. Abortion misinformation from crisis pregnancy centers in North Carolina. Contraception. 2012, 86(6):752-756.
 Rosen JD. The Public Health Risks of Crisis Pregnancy Centers. Perspectives on Sexual and Reproductive Health. 2012, 44(3):201-205.
 2012 Year-End Report. New York: Center for Reproductive Rights, 2013.
 State Policies in Brief: Restricting Insurance Coverage of Abortion, New York: Guttmacher Institute; 2013.
 Harris L. Recognizing Conscience in Abortion Provision. The New England Journal of Medicine. 2012, 367: 981-983.
 Marty R. “Michigan Governor Snyder Signs Abortion Superbill into Law”. RH Reality Check, 2012.
 2012 Year-End Report. New York: Center for Reproductive Rights, 2013.
 Jones RK, Finer B. Who has second-trimester abortions in the United States? Contraception. 2012, 85(6):544-551.
 Senate Votes to Ease Ban on Abortion Coverage for Military Servicewomen; Bill Now Moves to Conference Committee” New York: Center for Reproductive Rights, 2012.
 Grindlay K, Grossman D. Contraception access and use among US servicewomen during deployment. Contraception. 2012, 87(2): 162-169.