Since the Supreme Court’s 1973 Roe v Wade decision, which gives women nationwide the right to access abortion procedures, anti-abortion advocates have worked to chip away at the monumental court ruling.
Republican lawmakers across states have moved at a rapid pace in 2021 to introduce and pass some of the most restrictive abortion laws, all an effort to limit access.
These lawmakers introduced bills that would enforce 561 abortion restrictions, including 165 abortion bans across 47 states, as of 7 June, according to the Guttmacher Institute – an abortion-rights research organisation. More than 80 of these restrictions have been enacted in 16 states, including 10 bans.
This makes 2021 the most hostile year for abortion rights since Roe v Wade was ruled on. Previously, 2011 was regarded as the most hostile with 70 restrictions being enacted, including seven bans, the Guttmacher Institute reports.
Pushing forward anti-abortion legislation in state legislatures has worked to challenge Roe v Wade, as the Supreme Court announced in May that it would take up Mississippi’s ban that prevents most abortions after 15 weeks of pregnancy. The Supreme Court has a 6-3 conservative majority after President Donald Trump appointed three Supreme Court justices during his term.
Abortion is arguably one of the most divisive issues in the United States, and yet a majority of Americans support access to the reproductive health service. According to a Pew Research survey, 59 per cent of the public supports abortion access while 39 per cent say it should be illegal in all or most cases.
Additionally, 58 per cent of Americans are against overturning Roe v Wade while 32 per cent are in favour, a Gallup poll finds.
Yet 58 per cent of women of reproductive age (nearly 40 million) lived in a state that was considered hostile towards the procedure in 2019. And this hostility has only continued into 2021 with state legislatures attempting to pass some of the most restrictive laws to date to make it harder for women to access abortions.
For years, Arkansas’ state legislature has made attempts to limit residents’ ability to access abortions services by passing laws and restrictive measures.
Only two abortion clinics are available to the three million Arkansas residents: Little Rock Family Planning Services and Planned Parenthood’s Little Rock Health Center.
While residents can currently access the procedure up to 22 weeks after a patient’s last menstrual cycle, Governor Asa Hutchinson recently signed into law a near-total ban on abortions that will take effect on 28 July. This despite him expressing concern at the unconstitutional nature of the law and it making no exceptions in cases of rape and incest.
“I have not reviewed the lawsuit, but I expect the constitutional challenge to be decided ultimately by the US Supreme Court,” Mr Hutchinson said in a statement. “I signed this bill into law expressing my view that it would have been preferred to have included exceptions for rape and incest in the law.”
Arkansas also has a trigger law in place that would ban abortions if a constitutional amendment or court ruling were to leave the decision up to the states.
“This is just one more attack that we’ve endured over many, many years of continued incremental increases in restrictions on abortion from the legislature,” said Lori Williams, the director of Little Rock Family Planning.
The American Civil Liberties Union (ACLU) and Planned Parenthood filed a lawsuit against the state asking for a federal judge to strike down the abortion ban before it takes effect.
“Roe v Wade remains the law of the land. States cannot do what Arkansas is attempting to do under nearly 50 years of Supreme Court precedent that’s been consistently reaffirmed,” said ACLU staff attorney Meagan Burrows. “So we hope and we expect that the district court will abide by and follow that precedent and block the law from taking effect well before 28 July.”
Until then, abortion providers are making it clear the procedure is still accessible and available in Arkansas, but, like other conservative states, restrictions have been put in place, including a 72-hour waiting period.
This 72-hour waiting period requires for a patient to first visit an abortion clinic for an ultrasound then wait at least three days before they can then return to the clinic for the actual procedure.
“This is a real barrier for patients having to travel twice, take off work twice on childcare, and organise transportation twice to get them here,” Ms Williams said. “All of those things just double the burden on patients that are already trying to obtain the care.”
Dr Janet Cathey, a physician at Planned Parenthood’s Little Rock Health Center, has served patients who travel three hours just to access the clinic. People will also travel across state lines from places like Missouri, Tennessee, Mississippi, and Louisiana to access an abortion clinic.
“If I could pick one common denominator,” Dr Cathey said, “it is women with a child under one year old. They couldn’t get in for postpartum visits to get birth control. They had appointments for tubals (a surgical procedure to prevent pregnancy) that got cancelled. They couldn’t get in for their IUD to be changed.”
“It almost brings me to tears because I think it’s a very, very unselfish decision,” Dr Cathey added.
“It’s not that they don’t want this child. It’s that they can barely support the one child, two children, three children they already have, and they cannot bring another child into this world that they can’t provide for.”
Arkansas has the highest teen pregnancy rate in the country, according to the CDC. The state also had the third highest maternal mortality rate with approximately 35 deaths per 100,000 live births, which was higher than the national average of approximately 20 deaths per 100,000 live births in 2019.
“We have a shortage of providers in rural areas. We have a shortage of financial resources in our health department. We have a shortage of financial resources and legislative restrictions on sex education in schools,” Dr Cathey said.
All of these factors compound together and impact a woman’s access to healthcare, which can alter her decision when choosing if she should carry a pregnancy to term.
“Everyone has different needs, health status, jobs, and childcare access; all of these are just multitude of factors that influence a woman’s decision. It can’t be summed up as, ‘Oh, this patient is just not good at their birth control,’” Ms Williams said.
The number of abortions performed in Kansas increased in 2020 by 9.1 per cent, largely because women and girls travelled from states like Texas and Oklahoma in order to access the procedure.
“Because so many anti-abortion restrictions have already been passed in the surrounding states, we are already seeing a lot of patients come from out of state,” said Dr Iman Alsaden, who serves as an abortion provider for Planned Parenthood in several states including Kansas, Oklahoma, Arkansas, and Missouri.
Kansas Governor Laura Kelly has fought against signing similar abortion bans into law in the state compared to neighbouring states, instead calling the procedure an “essential need”.
But there is one measure on the state’s ballot in 2022 that would give voters the option to add an amendment to the state’s constitution that would ban the procedure if Roe v Wade was overturned.
“If Roe V Wade was overturned, abortion will become illegal in Arkansas, Missouri, and Oklahoma – which makes Kansas all the more important for just maintaining people’s access to essential healthcare,” Dr Alsaden said.
While the doctor has provided care for patients outside of Kansas, she emphasised that there were likely others who don’t have the resources to travel far to an abortion clinic.
“These are the people that have the money, the childcare, the ability to take off from their jobs, and the transportation to get to Kansas,” Dr Alsaden said. “But there are so many more people who just don’t have the resources to do that, and these types of laws affect those people the most.”
The new ballot initiative that anti-abortion advocates are attempting to pass in 2022 comes after the Kansas Supreme Court declared abortion a “fundamental right” in 2019.
The state legislature in Louisiana made headlines after it passed a bill this year that would require doctors to tell a patient who chooses a medication abortion that they can change their minds after taking the first of the required two pills – this despite minimal scientific data backing up those claims.
Under the bill, if signed by Democratic Governor John Bel Edwards, doctors would be required to provide patients with information that claims the medication “is not always effective in ending a pregnancy” and they should consult with a medical provider if they regret their decision in between the first and second pill.
“Nearly all of the laws that [the state legislature] pass are medically unnecessary,” said Ellie Schilling, New Orleans-based reproductive rights attorney and Lift Louisiana co-founder, a women’s health advocacy group.
“Some of the laws, like this abortion pill reversal, are also dangerous,” she added.
The American College of Obstetricians and Gynecologists (ACOG) has stated that claims of abortion “reversal” are “not based on science and do not meet clinical standards.”
“Yet, politicians are pushing legislation to require physicians to recite a script that a medication abortion can be ‘reversed’ with doses of progesterone, and to steer women to this care. Unfounded legislative mandates represent dangerous political interference and compromise patient care and safety,” ACOG’s website states.
The bill was just one law among many pushed by anti-abortion lawmakers in Louisiana in an effort to prevent people from accessing the medical procedure.
Louisiana has a 24-hour wait period that requires for someone to visit an abortion clinic twice to receive the procedure: once for an ultrasound with the physician and then a second visit at least 24 hours later for the actual abortion.
“Most of the women we deal with here at Hope [Medical Group for Women] are already at the federal poverty level,” said Kathaleen Pittman, the clinical director of the Louisiana abortion clinic. “So these are people who already did not have access to funds for the abortion and now have to pay for childcare, take time off work. It’s a double whammy for them.”
“It is not uncommon on the day of a procedure to look at a patient’s chart and see numerous appointments rescheduled … where they had to reschedule because childcare failed, their transportation failed, they were still short on money,” she added.
The clinic is one of three available for Louisiana residents to use when seeking an abortion.
But, similar to its surrounding states, Louisiana has in place a trigger law that could allow the state to almost immediately ban abortions if Roe v Wade was overturned or amended – making the Mississippi case one to watch for residents.
“The last assessment that I heard is if Roe is overturned, then essentially patients in Louisiana and similar states would have the closest place they would be able to access legal abortions being either Illinois or New Mexcio,” Ms Schilling said.
“We’re talking about thousands of miles of travel,” she added. “Some people will be able to do that … but that’s going to be an insurmountable barrier for many, many people – both in terms of the cost and the time away from your life, your work, your children … from everything.”
Anti-abortion advocates argue these laws would save lives given it would prevent a majority of girls and women in these states from accessing the procedure.
“But at what cost?” Ms Pittman asked. “We are looking at families, not just the women, but families who are going to be stuck in poverty, stuck in abusive situations.”
Louisiana has the second highest maternal mortality rate and foetal mortality rate in the United States, according to the CDC – two statistics abortion rights advocates credit to the lack of accessible healthcare and reduction of policies like medicaid and sex education.
“[Lawmakers] spend a lot of time trying to make it very difficult for women to obtain an abortion but not very much time thinking about how to support women through the healthcare system,” Ms Schilling said.
“The same people who come to our legislature to testify in favour of abortion restrictions also come to testify against mandatory sex education in Louisiana public schools … They won’t raise the minimum wage. They never vote in favour of equal pay.”
Texas Governor Greg Abbott signed into law the state’s first-of-its-kind abortion legislation in May that would ban the procedure as early as six weeks while also giving private citizens the ability to sue abortion providers.
The law will take effect in September, but abortion rights advocates have vowed to challenge the legislation in court given it would largely ban the ability to access the procedure, which goes against Roe v Wade.
“Ninety per cent of abortions happen after six weeks. Most people don’t even know they’re pregnant at six weeks,” said Amy Hagstrom Miller, the founder and CEO of Whole Woman’s Health, which operates nine abortion clinics in Texas, Indiana, Virginia, Maryland, and Minnesota
“This is just a way to figure out how to ban abortion without overturning Roe,” she added. “[Greg Abbott and Texas lawmakers] are blatantly stating, ‘We are interested in banning abortions by any means necessary.’ It’s not subtle.”
Under the new bill, abortion providers would be unable to perform the service once a foetal heartbeat is detected. There is only an exception to the ban under medical emergencies, meaning women who get pregnant by rape or incest would not be allowed to seek the procedure.
“What do I tell the 13-year-old who I saw who was being raped by her grandfather, and she doesn’t have any options because of the state she lives in?” said Dr Bhavik Kumar, Planned Parenthood’s Gulf Coast medical director and an abortion provider in Texas, when recalling a recent patient.
Her story is just one of hundreds Dr Kumar thinks about as Texas lawmakers attempt to further restrict abortion access in the state; a state where about 5.2 million women are of reproductive age, according to an analysis of data from the US Census Bureau.
“There are all different kinds of folks who access abortions,” Dr Kumar said. “Folks as young as 13, folks in their fifties, black women, white women, Christian women, transgender men … the list goes on.”
“We don’t know what it’s like to be in their shoes and they should have a right to choose,” he added. “I keep thinking about what it means to be American, what it means to have freedom, what it means to have control over your own body. That’s been taken away from people.”
Ms Hagstrom Miller described the exclusion of rape and incest cases in Texas’ abortion bill as “cruel” and “extreme” in a state that has long been hostile towards abortion services.
But she cautioned against abortion rights advocates focusing on the extreme cases as to why someone should have access to the procedure.
“Rape and incest is oftentimes what people like to talk about as an extreme because it allows us to see the pregnant person as a victim,” she said, “but I think anybody who decides that they cannot for whatever reason bring life into the world through their body because they don’t feel ready emotionally, they don’t feel ready financially, they don’t think they will have the kind of support they need to be the kind of parent they’d like to be … all of those reasons are completely valid for someone to say, ‘I’m not ready to have a child.’“
Additionally, the law, if it goes into effect, would give private citizens the opportunity to sue abortion providers or anyone who assists with the procedure.
“You cannot sue the person who had an abortion,” Dr Kumar said, “but, whether it’s a physician providing the care or the nurse that’s involved or anybody else, it allows for people to bring a lawsuit forward. So it essentially encourages abortion vigilantes.”
The passage of the “heartbeat bill” was not the first time the state legislature has incorporated laws that would limit abortion access. In July 2013, HB2 was signed into law and set forth provisions that would close a majority of abortion clinics in Texas.
Whole Woman’s Health had a clinic in McAllen, Texas, that was shut down for almost one year because of the law – meaning there was no accessible abortion clinic available to women south of San Antonio.
One mother called Ms Hagstrom Miller during this time begging for any available option.
“She said, ‘Can you just tell me what I can use to perform my abortion. Tell me out of all these things I have under my sink what I can do to cause my own abortion.’ That’s how desperate she was,” Ms Hagstrom Miller said. “This is in a country where abortion is legal. These are the kinds of situations that people are put into.”
Abortion is still legal in Texas, courtesy of Roe v Wade – which requires for the procedure to be available nationwide up to the point where the foetus can survive outside the womb, about 28 weeks.
But Texas has joined 11 other states in passing trigger laws that would ban abortion services outright if a court ruling or constitutional amendment gave states the ability to limit the procedure – potentially making the fate of Roe v Wade in the Supreme Court more detrimental for residents.
“Two different Americas” have formed, Ms Hagerstrom Miller said, due to some states’ hostility towards abortion services.
“We can talk about will Roe fall, will Roe not fall, which people have been talking about my whole career,” Ms Hagerstrom Miller said. “What we really need to talk about is if this is a society that values women’s autonomy and equality? Or are we treating women as second-class citizens?
“These kinds of laws have nothing to do with women’s health and safety. In fact, restricting abortion is directly correlated with increasing maternal mortality and poor pregnancy outcomes … What are we saying about the ability for over half of our population to plan their futures and have control of their bodies? To me, that’s really what’s on the block here.”