A watershed moment in reproductive rights history occurred today, when the Supreme Court ruled against HB 2, a Texas law that would have caused more than half of the state's abortion clinics to close. HB 2 was what is often referred to as a TRAP law — "Targeted Regulation of Abortion Providers." TRAP laws don't outright ban abortion or enforce a specific rule that women seeking an abortion must adhere to (like enduring a "waiting period"), but instead attempt to prevent abortions by forcing clinics to meet standards that other outpatient surgical facilities don't have to meet, like making sure their hallways are certain widths (to accommodate gurneys, which do not figure into any abortion procedures) and requiring doctors to have admitting privileges at local hospitals (a status many doctors who work in actual hospital emergency rooms don't even have).
The Supreme Court found these laws to be unconstitutional and create an undue burden for clinics, which means not only will Texas clinics stay open, but that other TRAP laws in other states may now also come under review. It's an amazing triumph, and one well worth celebrating! But it's also important to remember that as thrilling as this ruling is, it doesn't solve all abortion access issues in America. There are still a number of other threats that can keep women who want abortions from getting them — and in the wake of this historic ruling, it is more important than ever that we turn our attentions to them, and work to make sure that even more women are free to exercise their right to choose.
1. Financial Barriers
Many would argue that the greatest accessibility issue is money. As Justice Ruth Bader Ginsberg said, in a July 2015 talk at Duke University Law School, "poor women don't have choice. Women of means do. They will, always." Ginsberg also noted that, if Roe v. Wade were overturned, and abortion was once again a state-by-state issue, "Any woman who could travel from her home state to a state that provides access to abortion [could get one] ... So if you can afford a plane ticket, a train ticket or even a bus ticket, you can control your own destiny, but if you're locked into your native state, then maybe you can't."
Women who have fewer financial resources are at a disadvantage in almost every way when it comes to seeking abortion. To begin with, they may struggle to afford the abortion itself. A 1976 law known as the Hyde Amendment prevents Medicaid from covering abortions (it is the only healthcare procedure to have ever been banned by Medicaid), so while some private health insurance companies cover abortion, women on Medicaid must pay for the entire procedure out of pocket — and depending on method and where the woman is in her pregnancy, an abortion can cost up to $950. (This year's Democratic Party platform is the first to explicitly include a call to end Hyde).
But being able to pay for the procedure itself isn't the end of the issue — women have to deal with the financial fall-out from missing a day at work, and women who are already mothers (as 61 percent of women who have abortions are) often have to pay for childcare. A 2013 study in the journal Women's Health Issues surveyed 639 women who had had abortions, and found that at least 69 percent of these women were forced to pay out of pocket for an abortion. Thirty percent of women surveyed put off paying bills like utilities to pay for the procedure, while 16 percent had to skimp on food to afford it. The study also found that, on average, women spent $44 on transportation, and a significant number reported that they lost wages while getting their abortion, with an average loss of $198.
And this isn't even taking into account states with abortion restrictions, like waiting periods. Women with fewer financial resources must deal with the profound financial implications of missing multiple days at work; if they live far from a clinic, they also often struggle with affording transportation, finding housing for the days of their "waiting period," and other logistical issues that cost a lot of money.
What You Can Do: Donate to an abortion access fund. These are grassroots organizations that connect women who want abortions but can't afford them with funding, as well as volunteers who can help them with housing or transportation. You can find out how to donate (as well as volunteer time or other resources) to your local abortion fund through the National Network of Abortion Funds.
You can also take action to work for the repeal of the Hyde Amendment. The organization All Above All has tons of resources to help you write to your Congressional representative about Hyde and take actions in your community — they even have their own hashtag, #BeBoldEndHyde.
2. Lack Of Providers
According to NARAL Pro Choice America, "Eighty-nine percent of counties in the United States have no abortion provider"; the National Abortion Federation notes that in non-urban areas, that figure rises to 97 percent. While restrictive laws and threatening (and sometimes genuinely violent) protesters are obviously huge barriers to abortion access, there are also simply not enough doctors to meet patient demand.
Why are there so few providers? One contributing factor is that, in the years since Roe, most medical programs have stopped teaching students how to perform abortions (according to a 2013 article published in the American Journal of Public Health, only 12 percent of OB/GYN programs offered abortion care training in the early '90s).
Another is, of course, the violence, threats, and intimidation constantly directed at doctors who perform abortions. In 1999, a doctor named Stephen Dixon closed down his OB/GYN practice and discontinued providing abortions due to constant threats on his life from anti-abortion activists; he wrote, in a letter to his former patients, that "Sadly, the ongoing threat to my life and my concern for the safety of my loved ones has exacted a heavy toll on me, making it necessary that I discontinue practicing OB-GYN." Dixon isn't alone; a survey of 242 abortion providers across the country found that threats again them had doubled since 2010.
What You Can Do: Nonprofit organization Medical Students for Choice organizes pro-choice medical students and residents interested in becoming providers, and helps connect them with opportunities to study subjects like abortion and contraceptive counseling. They currently have a network of over 10,000 students and residents around the world. You can donate to them, or, if you're a medical student or plan on becoming one, contact them to get involved.
3. Violence & Intimidation
Violence against abortion providers (and sometimes, patients themselves) is a constant threat — as a 2015 NPR Fresh Air interview with Living in the Crosshairs authors David Cohen and Krysten Connon revealed, many abortion providers wear bulletproof vests, receive constant threats on their lives, and are often walked to their cars by an armed guard.
According to the National Abortion Federation, the first case of reported clinic arson was in 1976, three years after the passage of Roe v. Wade, and the first reported bombing of an abortion clinic was in 1978. The first murder of an abortion provider occurred in 1993, and there have been 11 murders and 26 attempted murders tied to anti-abortion violence. NARAL Pro Choice America reports that "opponents of choice have directed more than 6,900 reported acts of violence against abortion providers since 1977, including bombings, arsons, death threats, bioterrorism threats, and assaults, as well as more than 194,000 reported acts of disruption, including bomb threats, hate mail, and harassing calls." One doctor who provides abortions, Dr. Susan Dodd, told Marie Claire that she regularly meets with the FBI to discuss threats to her safety.
But assault, murder, and other violent attacks like these aren't the only form of intimidation that both women seeking abortions and abortion providers endure. They also must deal with clinic protests that intend to scare and intimidate patients and workers alike. In a 2014 Cosmopolitan article by Liz Welch, a woman named "Brittany" described her terrifying encounter with anti-abortion protesters outside a clinic when she went to get an abortion:
They had a box filled with torn apart baby dolls covered with red paint. All three of us were hit — in the head, chest, torso. As they were pelting us, they yelled, "This is what you're doing to your baby! Look at the street! It's strewn with the blood of your baby. That's your baby scattered across the street!" It was surreal and terrifying at once. And we still had to cross a wide street to enter the clinic. Then they shouted at my aunt, "Grandma, why are you letting her do this? Tell her to give her baby up for adoption!"
...As I sat in the waiting area, I could hear every single girl get out of her car and do that walk of shame. That was the worst part of the day. When the doctor pulled up later that morning, there was such a frenzy the building almost shook. I heard them shouting, "Murderer!" and, "Butcher!" and my heart started racing all over again.
There are numerous laws that restrict how close protesters can get to a clinic, and prevent protesters from "interfering" with access to clinics. However, these laws can't prevent protesters from creating an atmosphere of fear, anxiety, and threat for both women seeking abortions and doctors treating them — and, of course, they can't stop some anti-abortion protesters from deciding to violate those laws.
What You Can Do: There are a number of options here, depending on your personal levels of comfort and interest. You can volunteer as a clinic escort, helping women seeking abortions and their companions get from their cars to the clinic with as little interaction with protesters as possible. You can find out more on Planned Parenthood's Clinic Defender site. You can also donate money to Planned Parenthood — your money will help make sure that the clinic is able to function safely in every way, which includes making sure that they're able to keep their safety systems operational.
4. Waiting Periods & Other Restrictive Laws
As you may have heard, almost 300 state-level abortion restrictions have been enacted since 2010. These restrictions include TRAP laws like HB 2; state-mandated counseling (required in 17 states), which can often require doctors to tell patients medically inaccurate statements, like that there is a link between breast cancer and abortion; bans on abortions after certain points in the pregnancy (43 states), which frequently punish women who discover fetal anomalies later in their pregnancies or have to put their abortions off for financial reasons (like those listed above); and waiting periods (27 states), which require a wait between the required "counseling" session and the actual abortion. These waits can be shockingly lengthy — six states currently have 72 hour waiting periods. These restrictions not only cost women lots of money; they can thoroughly mess up their lives. Missing work twice can cause women to lose jobs, and having to sneak away to the clinic twice can endanger women who are living with abusive partners. Some women who are unable to orchestrate housing, transportation, and childcare, and find the money to fund it all, end up being forced to give birth when they did not want to.
And just in case you were wondering — waiting periods don't seem to actually change anyone's mind. As a report by the Guttmacher Institute found, "abortion providers report that almost all women obtaining abortions are sure of their decision to terminate their pregnancy before they have even picked up the phone to make an appointment."
What You Can Do: Get involved in the pro-choice community. Follow pro-choice groups like Planned Parenthood, NARAL, the National Abortion Federation, the National Network of Abortion Funds, All Above All, and others on social media, and sign up for their newsletters — they'll keep you posted on laws, petitions, protests, and opportunities to donate. And make sure to connect with local activists — since abortion restrictions are typically regional, local organizations, as well as local branches of national organizations, can make a big impact.
Yeah, there are still a lot of problems to be fixed, but don't let it get you too down. We fought back against HB2, and we can keep fighting for women to have control of their lives, every time, until every single one of us really and truly has the right to choose.
