Thursday, August 29, 2013

The decline in abortion clinics

As one might suspect, there has been a rather dramatic decline in the number of abortion clinics nationwide in the past few years.

Pro-life activists attribute this decline to three things (the first two, I think, having a real and concrete impact):
  1. State legislatures passing "TRAP" laws (targeted regulation of abortion providers) that require unnecessary and expensive changes to abortion clinics, which the clinics cannot afford. TRAP laws also sometimes require clinic doctors to have admitting privileges at a local hospital, which local hospitals refuse to provide. 
  2. State legislatures "defunding" family planning clinics (that also perform abortions) by passing laws ensuring that no state money goes to places that perform abortions. 
  3. Prayer vigils and other forms of direct action at clinics themselves, like the 40 Days for Life campaign. 
Because abortion services in the United States are so heavily dependent on the clinic system, attacking clinics legally and financially is a sound strategy for making abortion effectively illegal in the United States.

The clinic system in the United States exists largely because of increased demand from women for legal and safe abortion access after Roe v. Wade and Dow v. Bolton were decided in 1973. At that time, hospitals were seen as lacking the capacity and will to handle increased demand for abortion; in addition, many hospitals in the pre-Roe and Doe era had cumbersome approval procedures. Individual OB/GYNs have been performing abortions as part of their private practices (legally and illegally) for a long time, but were not seen as possessing sufficient capacity. In addition, at least in the ones run by feminists, clinics focused specifically on reproductive health were to provide abortions and information about it in an enlightened and sensitive way.

In order for access to abortion services to be maintained or increased, one or more things has to happen:
  1. TRAP laws must be declared unconstitutional under the doctrine of the "undue burden" of Casey v. Planned Parenthood. Everyone is aware of the true motivation of TRAP laws, which is to shut down clinics without attacking the right of abortion directly. 
  2. Abortion services must be offered in non-clinic settings, such as private OB/GYN practices or hospitals. This would be difficult to do, for a host of reasons (that can be the topic of a separate post). That being noted, embedding abortion services within a larger network of other medical services and providers would make TRAP laws and defunding efforts almost impossible. 
  3. Early-stage abortion (which comprises 85-90% of all abortions in the U.S.) can be provided through medical abortion (i.e., abortion caused by taking one or more drugs). Medical abortion could be provided by private OB/GYNs, or by existing clinics but remotely (the drugs are provided locally after a video conference with a consulting physician, who could be several hundred miles away). Note that pro-life activists, alarmed over the access benefits of medical abortion, have been legislating against it as well. 
Links:

Article in The Huffington Post (August 26, 2013): Anti-Abortion Laws Take Dramatic Toll on Clinics Nationwide

Feature on RH Reality Check that contains documents from state agencies describing how the state currently regulates abortion providers: State of Abortion

Article in The Daily Beast (January 22, 2013): The Geography of Abortion Access

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