ACROSS AMERICA — Only a handful of weeks into the 2021 legislative session, the ongoing policy wars against abortion and the facilities that provide them are already heating up in several states across the country.
It’s been nearly a half-century since the U.S. Supreme Court handed down its landmark ruling in the case of Roe v. Wade, which granted women a constitutional right to obtain an abortion. Yet in the decades since that ruling, states have spent significant time battling its provisions.
From 2011 to 2017, 32 U.S. states enacted a total of 394 restrictions, most of which regulate or limit when, under what circumstances, and even if a woman may obtain an abortion.
This year is shaping up to be no different.
Since the start of the 2021 legislative season in January, more than 140 anti-abortion bills have been introduced in statehouses across the country, according to Rachel Sussman, vice president of state policy and advocacy for Planned Parenthood Federation of America.
The end result: a tangled web of abortion policy that lawmakers continue to spin, and a significant reduction in women’s access to abortion services.
“Over the past decade, there has been a jolt towards harmful, politically motivated abortion restrictions from politicians across the country,” Sussman said.
Yet nearly a year into the coronavirus pandemic, many have lost more than just access to an abortion clinic.
They’ve lost a vital lifeline to a suite of medical services that prevent unwanted pregnancies, provide life-saving diagnoses and help stop the spread of communicable diseases.
Ultimately, much of the legislation has further pushed basic health care out of reach, especially for people with low incomes, and those living in rural or minority communities.
Lawmakers Battle A Declining Issue
The legislative push comes as the number of women receiving the procedure is declining.
Centers for Disease Control and Prevention data shows abortions declined 22 percent over a decade, to nearly 620,000 in 2018 — or 11.3 per every 1,000 women ages 15 to 44.
While it reflects slightly different data, a 2019 report by the Guttmacher Institute underscores the CDC’s findings. Report authors also took their research a step further, suggesting that legislation is not the key driver of the decline in abortions. Instead, they cited a broader decline in pregnancies, and said it was likely a result of increased access to birth control since the Affordable Care Act was enacted in 2011.
“What’s true is that increasing people’s access to affordable and effective methods of birth control leads to fewer abortions,” Sussman said.
Despite the decrease, abortion foes continue to target health care facilities that provide these services.
Between 2011 and 2017, the number of clinics providing abortion in the United States declined by about 4 percent, according to the Guttmacher Institute. The decrease seems low, yet some areas of the country were hit harder than others.
During the same period, the South saw a net decline of 50 clinics, with 25 in Texas alone. The Midwest lost 33 clinics, including nine each in Iowa, Michigan and Ohio. Seven clinics shuttered in Western states.
By contrast, Northeast states added 59 clinics, mostly in New Jersey and New York.
The South and the Midwest also had the largest share of new abortion restrictions during that period — nearly 86 percent of total enacted restrictions were in those two regions.
Today, five states — Mississippi, Missouri, North Dakota, South Dakota and West Virginia — have only one remaining abortion provider each.
Despite the election of Democratic President Joe Biden and Vice President Kamala Harris, 29 states currently have legislatures where anti-abortion politicians hold the majority, according to Sussman. Of the legislation introduced this session, 40 percent involves a form of abortion ban.
Kansas is an extreme example. There, voters will decide in 2022 whether the state’s constitution protects abortion rights under a ballot measure approved by the state Senate.
And in South Carolina, a bill that would ban abortion before most people even know they’re pregnant was fast-tracked through the state’s Legislature only to be blocked by a federal judge a day after it went into effect.
“Politicians are wasting no time attacking access to sexual and reproductive health care,” Sussman said. “Some are still doing everything they can to take control of our bodies, lives and futures.”
Who Stands To Lose Most
Perhaps the most notable provider of sexual health and reproductive services, Planned Parenthood has more than 49 affiliates that operate 600 health care centers across the nation. Annually, the organization provides sexual and reproductive health services to more than 2.4 million people, 39 percent of whom are people of color.
Of those, more than 541,000 patients identify as Latino and 395,000 as Black. More than 297,000 male patients also receive services. Finally, Planned Parenthood also provides gender-affirming hormone therapy for transgender patients in 31 states.
In 2018, of Planned Parenthood patients who reported their income, nearly 75 percent were living at or below 150 percent of the federal poverty level — the equivalent of $37,650 a year for a family of four.
“Patients don’t come to us to make a political statement,” Sussman of Planned Parenthood said. “They come to get compassionate, expert care and education.”
Still, Planned Parenthood has frequently been the target of both state and federal lawmakers.
In 2019, Planned Parenthood dropped out of a $260 million federal family planning program rather than comply with what it called a “gag rule” imposed by the Trump administration on abortion referrals.
The order would have prohibited health clinics from receiving federal funds under Title X if abortions were performed at the facility or if specialists referred patients to centers where they could get an abortion. The administration made the call despite the Hyde Amendment which, passed in 1976, prohibits federal funding from directly paying for abortions.
While some states stepped in to cover the lost funding, others did not.
In total, providers in 34 states were forced out of the program, according to Planned Parenthood, prompting more than 1.5 million people across the country to lose access to Title X-supported services such as affordable birth control and sexually transmitted infection testing.
According to the organization’s 2018-19 annual report, abortions comprised only 4 percent of Planned Parenthood’s provided services, while sexually transmitted infection testing and treatment comprised 50 percent, contraception made up 26 percent, and 13 percent was attributed to other women’s health services such as well-woman exams and prenatal care.
Many of those who lost access to these crucial services were likely women of color. According to a 2018 fact sheet by the National Latina Institute for Reproductive Health, women of color make up more than half, and Latinas more than a third, of all Title X patients.
“People don’t turn to politicians for advice about cancer screenings or STI treatment,” Sussman said. “The bottom line is that Planned Parenthood has been around for over 100 years, and we’re not going anywhere.”
Anti-Abortion Groups Keep Fighting
While Planned Parenthood is gearing up to challenge several pieces of 2021 legislation, anti-abortion groups are lauding the efforts already being made by lawmakers this session.
National Right to Life, a federation with 50 state affiliates and more than 3,000 local affiliates, was founded in 1968 with the goal of creating a national organization to deal with life issues on the federal level. The organization’s oldest affiliate, Virginia Society for Human Life, was founded in 1967.
While National Right For Life is most known for its stance against abortion, the organization also provides education and lobbies on legislation pertaining to other life issues such as infanticide, assisted suicide and euthanasia.
While the organization works at a national level, its affiliates provide support, testimony and other help to states regarding anti-abortion legislation.
National Right To Life is also looking ahead to 2021, and leaders are anticipating “significant challenges” at the federal level, according to spokesperson Laura Echevarria.
Among them is the possible certification of the 1972 Equal Rights Amendment to the U.S. Constitution. In January 2020, Virginia became the 38th state to ratify the amendment, which guarantees equal rights for women. The vote followed ratifications by Nevada in 2017 and Illinois in 2018 after four decades of inactivity.
Hurdles remain in the path of the amendment’s certification, however. The ratification deadlines that Congress set after it approved the amendment have lapsed, and five states have acted to rescind their prior approval.
The Equal Rights Amendment has come under fire by anti-abortion proponents, some of whom claim that it would require taxpayer-funded abortions. Since only women can have abortions, any restrictions on the procedure could be deemed unconstitutional under the amendment.
“Everyone knows this renewed effort isn’t about women’s rights,” the office of House Republican Whip Steve Scalise said in a February 2020 report by Politico, summarizing the message sent by the GOP caucus. “It’s about eliminating federal and state life protections and ushering in an era of taxpayer funding of abortion.”
While the certification of the amendment ultimately passed in the Democratic-controlled House of Representatives, it was dead on arrival in the Republican-controlled Senate.
Following the 2020 election, Democrats now hold a razor-thin majority in the Senate.
“We see the right to life as the leading human rights issue of our day,” Echevarria said. “Without abortion-neutralizing language, the Equal Rights Amendment would be used to expand abortion on demand. We’ve seen this happen in states that use the same language in state ERAs.”
When it comes to how anti-abortion legislation might affect access to free and low-cost health care, Echevarria said that National Right To Life typically doesn’t take a stance on health care issues unless it’s somehow related to taxpayer funding of abortion or health care plans that are forced to cover abortions.
If a woman is in need of such health care, Echevarria recommended she seek out one of more than 2,700 pregnancy centers across the United States that provide free services to women in need, most of which are manned primarily by volunteers and financially supported with private funds from individuals, religious organizations and businesses.
In recent years, states and the federal government have increasingly touted these as an alternative or safety net for women. Many have even shifted money toward them and away from other facilities such as Planned Parenthood, which typically provides a wider range of services.
According to Echevarria, these centers often work with local agencies to help women find housing, health care, jobs and even transportation. They also provide formula, maternity and baby clothes, diapers and other essentials free of charge.
The downside is that, in some cases, services at these “crisis pregnancy centers” can come with strings attached.
An investigation by Vox found that at some, prenatal and other free services were only for available if patients took parenting workshops or classes, some of which had a religious component.
Some women told Vox they found the required instruction troubling, with one saying of a parenting video, “it hurt me.”
A 2018 publication by the American Medical Association Journal of Ethics also called crisis pregnancy centers “legal, but unethical” that pass themselves off as legitimate clinics but are exempt from the regulatory oversight that applies to other health care facilities.
“They strive to give the impression that they are clinical centers, offering legitimate medical services and advice, yet they are exempt from regulatory, licensure, and credentialing oversight that apply to health care facilities. “Because the religious ideology of these centers’ owners and employees takes priority over the health and well-being of the women seeking care at these centers, women do not receive comprehensive, accurate, evidence-based clinical information about all available options,” the report says. “Although crisis pregnancy centers enjoy First Amendment rights protections, their propagation of misinformation should be regarded as an ethical violation that undermines women’s health.”
According to Echevarria, the services provided at most private centers are usually grounded in a right-to-life ideology and, as a result, are often condemned by abortion-rights activists.
“Many women who have had an abortion feel that if they had someone in their corner saying that they could raise a child and finish college or raise a child and pursue employment opportunities, then they would have given birth and kept their child,” Echevarria said. “Pregnancy centers can provide this real-world support.”
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