Types of abortion restrictions in the United States

Abortion restrictions in the United States are laws intended or resulting in restricting the availability or practice of abortions in the United States. The Supreme Court's decisions in Roe v. Wade and Planned Parenthood v. Casey recognized a legal right in the United States for a woman to get an abortion, but these cases permit states to make certain restrictions. Though Planned Parenthood v. Casey invalidated certain restrictions as providing an undue burden to women seeking abortions, some states have upheld that their abortion restrictions follow the precedent set forth in that case. Individual states, particularly in the 2010s,^[1] have imposed restrictions such as requiring the woman to view an ultrasound, requiring abortion providers to have admitting privileges at nearby hospitals, and long waiting periods after the first consultation with the abortion provider.^[2]

Laws targeting abortion clinics

This map shows 60-mile access to abortion providers in Texas

Regulations applying only to abortion clinics are sometimes called TRAP (Targeted Regulation of Abortion Providers) laws. According to Mother Jones and The New Republic they create standards that may be arbitrary or difficult to implement and are aimed at closing abortion clinics. For example, some laws require abortion clinics to meet the same standards as ambulatory surgical centers, which entail renovations that are prohibitively expensive for some clinics. Others require that doctors performing abortions have admitting privileges at a nearby hospital.^[3] Some hospitals refuse admitting privileges to any doctor who performs abortions.^[4][5] Opponents of admitting privileges laws and other TRAP laws include the American College of Obstetricians and Gynecologists, the American Public Health Association, and the American Medical Association, which have argued that such laws are medically unnecessary and that abortion is already very safe in the United States.^[6][7]

From 2011, the crimes of Kermit Gosnell, a physician who ran an abortion clinic in Philadelphia, spurred federal and state bills to more strictly regulate abortion facilities. Opponents of the restrictions questioned whether stricter regulations would have deterred Gosnell, who was alleged to be knowingly in violation of existing regulations.^[5]

Supporters of Texas Senate Bill 5, which included requirements for abortion clinics to meet ambulatory surgical center regulations and for abortion clinic doctors to have hospital admitting privileges, said the bill improved health care for women and babies. Opponents of the bill said it created unnecessary regulations for the purpose of reducing access to abortions. At the time of the bill's signing into law in 2013, five of the state's forty-two abortion clinics met the law's requirements. Courts had blocked enforcement of similar laws in some other states, pending lawsuits challenging their constitutionality.^[8] A federal district judge determined this law to be unconstitutional, finding that the admitting privileges requirement placed an undue burden on a person seeking to have an abortion;^[9] however, this decision was reversed by the Fifth Circuit Court of Appeals, resulting in the immediate closure of all but seven abortion clinics in the state, all of these in urban areas.^[10] For patients in Texas's Rio Grande valley, the nearest clinic is now 300 miles away.^[11]

Following the passage of a 2013 Wisconsin law requiring abortion providers to have admitting privileges at a nearby hospital, three Catholic hospital systems in the state intended to deny admitting privileges to abortion providers. Wisconsin's attorney general said this intent violated the Church Amendment of 1973, which prohibits hospitals receiving federal funds from discriminating against a doctor on the basis of whether the doctor provides abortions.^[12]

In Maryland, according to The New York Times, something "rare in this era of polarized abortion politics" occurred when laws that significantly tightened the licensing and inspection of abortion clinics were supported by those on both sides of the abortion issue.^[13]

Laws targeting methods of practice

On November 4, 2013, the U.S. Supreme Court declined to hear an appeal by the state of Oklahoma to the overturning, on constitutional grounds, of a bill intended to ban the practice of terminations of early pregnancies via medications.^[14]

Mandatory ultrasounds

As of March 2012, 20 states require that a person seeking an abortion have an ultrasound before being allowed to have the procedure. Mandatory transvaginal ultrasounds have been particularly controversial.^[15] In Texas, for instance, even if previous ultrasounds had indicated severe congenital defects, a woman seeking an abortion was required under a 2012 law to have another ultrasound done, "administered by her abortion doctor, and [she had to] listen to a state-mandated description of the fetus she was about to abort", though state-issued guidelines later did away with that ultrasound if the fetus had an "irreversible medical condition".^[16]

On November 12, 2013, the U.S. Supreme Court declined to hear an appeal by the state of Oklahoma to the overturning of a bill that mandated compulsory ultrasound examinations.^[17]

Waiting periods

Some states require that a person seeking an abortion wait for a period of one to six days, variously, after visiting the provider for the first time and before having the abortion. The state of South Dakota requires that the patient obtain mandatory counseling from an anti-abortion crisis pregnancy center during this time frame.^[18]

Fetal heartbeat bills

This type of legislation requires either that a woman be required to listen to her fetus's heartbeat should she attempt to obtain an abortion,^[19] or, more rigidly, that abortion become illegal as soon as a heartbeat can be detected, which is sometimes as early as six weeks.

Physician scripts

In some states, a doctor who performs an abortion is required to read a prepared script to the patient in order to secure informed consent. These scripts may include medically inaccurate information intended to persuade the patient not to have an abortion, such as the claim that the abortion will increase the risk of breast cancer or of psychological problems, which are not supported by mainstream medical organizations or scientific consensus.^[16][20] As of July 2013, 12 states require that women be given information on the ability of a fetus to feel pain.^[21] In Planned Parenthood v. Rounds, the Eighth Circuit Court of Appeals ruled that a South Dakota law requiring doctors to give patients false or misleading information about the suicide risk in women who have abortions was not unconstitutional.^[22]

Liability

A 1997 Louisiana law creates a civil cause of action for abortion-related damages, including damage to the unborn, for up to ten years after the abortion. The same law also bars the state's Patient's Compensation Fund, which limits malpractice liability for participating physicians, from insuring against abortion-related claims.^[23][24] An attorney for the Center for Reproductive Rights, which opposes the law, said the law is an attempt to drive abortion providers out of practice, and that every completed abortion imposes strict liability under the law because abortion necessarily involves damage to the unborn.^[25]

Reporting

As of 2010, 46 of 50 states and the District of Columbia had either mandatory or voluntary reporting of abortion statistics. According to an associate of the Guttmacher Institute, reporting requirements were generally "benign" and treated confidentially, but the requirements in some states have become more intrusive.^[26]

A 2009 Oklahoma law, overturned by a federal court in 2010, would have required doctors to report information from a 37-question form about every woman receiving an abortion to the state health department for publication in an online registry.^[26] A lawyer for the Center for Reproductive Rights, a co-plaintiff in the lawsuit challenging the law, said the law would have made public potentially identifying details about women, and was intended to dissuade women from seeking abortions.^[27] Todd Lamb, who sponsored the law as a state senator, called it "essential in protecting the sanctity of life" and "pro-life".^[26]

See also

• Unborn Victims of Violence Act
• Abortion in the United States
• Abortion in the United States by state
• Hyde Amendment
• Minors and abortion
• Partial-Birth Abortion Ban Act
• Trigger law
• War on Women
• Whole Woman's Health v. Cole

References