Republican legislation restricting abortion access has surged in the first quarter of 2015, a new report reveals, continuing a dangerous trend of coordinated attacks on reproductive health care.
According to an April 2 report from the Guttmacher Institute, Republican lawmakers have introduced 332 provisions to restrict access to abortion in the first three months of 2015 alone — an average of nearly four a day.
The anti-choice measures included many provisions roundly condemned by the medical experts, including measures that place arbitrary time limits on abortion, as well as bills seeking to impose targeted regulations on abortion providers (or TRAP laws).
As of April 1, 53 of those proposed restrictions have passed at least one legislative chamber, and nine of them have been enacted into law by four states:
Many of the new abortion restrictions enacted so far in 2015 would either limit the use of medication abortion or ban abortion at 20 weeks postfertilization, Guttmacher said. The nonprofit called it “a disturbing combination of attempts to curtail access in both the early and later months of pregnancy, potentially leaving women with fewer options and a greatly reduced time frame to get the care they need.”
Attacks on medication abortion
In Arkansas, a new law was enacted requiring abortion providers to follow an outdated FDA protocol for medication abortion that is “more expensive, carries a higher risk of side effects, and requires more clinic visits than does the widely used evidence-based protocol,” the report says. In addition, “the FDA regimen can only be used during the first 49 days of pregnancy, compared with 63 days for the evidence-based protocol.” Similar laws have been enacted in North Dakota, Ohio and Texas, despite objections from leading medical organizations like the American College of Obstetricians and Gynecologists.
Arkansas also adopted two measures banning telemedicine for medication abortion, as did Idaho — bringing to 18 the number of states that ban the use of telemedicine for the procedure. Again, these bans are widely denounced by medical experts as dangerous and burdensome for women.
As the Guttmacher Institute explained in a 2013 report on medication abortion bans, “anti-abortion leaders disingenuously insist that these restrictions are necessary to protect women’s health and safety. The safety of medication abortion, however, has been well-established. Rather, these restrictions are an attack on abortion itself. They burden women and potentially threaten their health. They prevent providers from engaging in practices that are accepted as mainstream in other medical specialties. And, of utmost importance, they threaten provision of abortion in the earliest stages of pregnancy.”
Unconstitutional 20-week abortion bans
At the same that Republican lawmakers are cutting off access to safe, early abortion services, several states are also moving to restrict the availability of abortion services later in pregnancy. In West Virginia, the legislature overrode a second veto by Gov. Earl Ray Tomblin (D) to enact a ban on abortion starting at 20 weeks postfertilization, according to the report. Including West Virginia, 14 states now unconstitutionally ban abortions at 20 weeks and similar measures are pending in several other states. None of these restrictions provide adequate exceptions for the health of the mother, and only one includes exceptions for victims of rape and incest.
Twenty-week abortion bans have also been proposed at the federal level. Almost as soon as Republicans took control of Congress in January, the US House of Representatives failed to pass its own 20-week abortion ban amid uproar over its narrow exception for rape. But Republican leaders have said they intend to bring up the legislation again. Furthermore, anti-abortion groups have maintained that the 20-week abortion ban is their top priority – resurrecting a fight that goes back to Roe v Wade, the U.S. supreme court’s landmark ruling in 1973 that legalized abortion and forbade states from banning the procedure until viability, generally at around 24 weeks.
Abortions after the 20th week of pregnancy are rare, accounting for only about one percent of the total number of abortions performed annually. When they do happen, they are often under tragic and/or complex circumstances, such as a serious medical diagnosis like cancer or the discovery of a severe fetal anomaly. Doctors strongly oppose these laws because they prevent them from giving their patients the best health care possible in an individual situation, and medical organizations like the Physicians for Reproductive Health and the American Congress of Obstetricians and Gynecologists (ACOG) have repeatedly condemned 20-week abortion ban proposals. Additionally, the vast majority of Americans believe that abortion should be legal after 20 weeks.
Criminalizing the safest method of second-trimester abortions
In another disturbing trend, several states are considering a new type of restriction that uses graphic, medically inaccurate terminology in an attempt to limit how a second-trimester abortion can be provided. The policies, based on model legislation by the anti-choice National Right to Life Committee, would effectively outlaw the dilation and evacuation procedure that is used for most second-trimester abortions and that medical experts unanimously agree is the safest, least invasive method of second-trimester pregnancy termination. Last week, Kansas became the first state in the nation to enact a ban on dilation and evacuation procedures, and similar measures have been approved by one chamber of the state legislature in Oklahoma and are pending in Missouri and South Carolina.
Continuing a recent trend, legislators in 21 states have introduced 43 provisions seeking to enact targeted regulations on abortion providers, or TRAP laws, which impose restrictions on abortion provision that are different and more burdensome than those imposed on other medical practices. According to the Guttmacher Institute, more than half of the states in the country currently have TRAP laws on the books. Two states — Arkansas and Arizona — have passed new TRAP laws in 2015, and similar measures have been passed by at least one legislative chamber in Missouri, Oklahoma, Texas, and Indiana.
As the LA Times explains, “TRAP laws are designed to fly under the radar, by mimicking ordinary health regulations. In reality, they target abortion facilities and providers with special, onerous regulations that are exceedingly costly or impossible to meet.” Common TRAP laws include those that: limit the provision of care only to physicians; force practices to convert needlessly into mini-hospitals at great expense; require abortion providers to get admitting privileges; and require facilities to have a transfer agreement with a local hospital (with nothing requiring hospitals to grant such privileges). Further, in many states abortion care is limited to hospitals or other specialized facilities, rather than physicians’ offices.
Anti-choice supporters of TRAP laws assert these are necessary requirements to ensure patient health and safety, but these claims are specious. Legal abortion is an extremely safe procedure. According to a 2013 Guttmacher report, “the risk of dying from a legal abortion in the first trimester—when almost nine in 10 abortions in the United States are performed—is no more than four in a million. In fact, the risk of death from childbirth is about 14 times higher than that from abortion.” Furthermore, all types of medical care—abortion included—are already subject to extensive health and safety laws and regulations. That’s why medical organizations like the American College of Obstetricians and Gynecologists have condemned these laws as dangerous and unnecessary restrictions that “create barriers to abortion access and interfere with the patient–provider relationship and the practice of medicine.”
Legalizing discriminatory health care practices through religious freedom laws
In yet another disturbing move, legislators in 16 states have introduced state versions of the federal Religious Freedom Restoration Act. Indiana Gov. Mike Pence (R) signed a bill mirroring RFRA into law in late March, provoking an enormous public outcry — yet not enough to stop the Republican governor of Arkansas from signing a similar bill the following week. In Georgia and Wyoming, similar measures have been passed by one chamber of the state legislature.
“Notably,” Guttmacher says, “the uproar over these measures has centered on their potential to sanction discrimination against gay individuals. However, the potential impact on contraceptive coverage—and reproductive health more broadly—has received little, if any, attention.” This could be a grievous error, as the U.S. Supreme Court relied on the federal version of the law in its decision in Burwell v. Hobby Lobby to justify permitting businesses to refuse to provide contraceptive coverage.
The bigger picture
The staggering number of abortion-related state-level legislation introduced so far in 2015 follows a trend of Republican-led state legislatures sweeping in a record number of abortion restrictions following electoral gains in 2010.
By contrast, just 189 abortion restrictions were enacted during the entire previous decade, based on data from 2001-10. The pace of anti-abortion restrictions introduced in the so-called “laboratories of democracy” – state legislatures – since then, it appears, has only increased.