Onerous laws exclusively target abortion clinics

(Reuters Health) - State laws governing facilities that oversee abortions are more numerous and burdensome than laws governing facilities overseeing other medical procedures, according to a new study that questions the laws’ constitutionality.

Researchers identified 55 laws in 34 states written specifically for abortion facilities, compared to 25 laws in 25 states covering other office-based interventions – and only one law in one state written specifically for any other procedure, cosmetic surgery.

In addition, the TRAP laws were routinely more burdensome.

The findings call into question the constitutionality of the 55 so-called TRAP laws (“targeted regulation of abortion providers”) – which range from regulations governing doorway widths to those requiring doctors to have hospital privileges.

The report in the American Journal of Public Health demonstrates “a concerted effort to regulate and restrict” abortion services, said Dr. Maria I. Rodriguez, a professor of obstetrics and gynecology at Oregon Health & Science University in Portland, who was not involved with the study.

“TRAP laws are an indirect attack on the legal rights women have to abortion by reducing the number of providers who can care for them,” she said by email.

The vast majority, or 80 percent, of abortion-specific laws that the study analyzed applied to facilities even if they did not perform surgical abortions but only handed out abortion medication. In contrast, only 12 percent of laws governing other office-based interventions applied regardless of whether surgery was performed.

“Why would you need minimum doorway widths or specific ventilation in order to be handed a medication?” said attorney Bonnie S. Jones, the study’s lead author and senior policy advisor for Advancing New Standards in Reproductive Health at the University of California, San Francisco, in Oakland.

TRAP laws aimed at clinics that do not perform surgery do nothing to protect patient safety yet increase the cost of facilities that provide abortions and render them less likely to be built, Jones said in a phone interview. Moreover, the cost of remodeling facilities so providers can dispense medication to induce abortions can be so expensive that providers are dissuaded from doing so, she said.

Nearly one-third of U.S. clinic-based abortions at less than nine weeks are induced by women taking pills, Rodriguez said.

Jones and her team compared TRAP laws with laws governing all office-based surgeries and procedures, from the removal of moles to gynecological procedures and vasectomies, across the U.S.

The discrepancies support the view that the laws do more to restrict access to abortion services than to safeguard patient health, Jones said in a phone interview.

The laws could be unconstitutional under a 2016 U.S. Supreme Court ruling striking down a Texas TRAP law, said Jones.

Proponents of the overturned Republican-backed Texas law said its provisions would protect patient health and safety. But a majority of the court ruled that the regulations failed to provide “medical benefits sufficient to justify the burdens upon access that each imposes.”

By age 45, one in four American women will have an abortion, according to the Guttmacher Institute, which tracks abortion policy.

Most U.S. abortions are provided in freestanding medical offices and clinics, where they have taken place since 1973, when the Supreme Court established a woman’s constitutional right to abortion in its landmark Roe v. Wade decision, the study authors write. The 2016 ruling held that the Texas law placed an undue burden on women exercising their right under the U.S. Constitution to end a pregnancy.

“The ramifications of restricting access to safe abortion are well-known,” Rodriguez said. “Abortion will not become less common, but maternal deaths and complications will increase, as women seek out abortion in unsafe circumstances.”

“I would like to ask people to imagine how they would feel if they or a loved one were faced with the challenging decision to terminate a pregnancy. Perhaps a much- anticipated pregnancy is no longer viable, or maybe your physical health is at risk. Perhaps you are simply not sure how you will feed the children you currently have if another is born,” Rodriguez said.

“Would you expect to be able to talk with your doctor about this? Receive care in your hometown? Have the care you need covered by your insurance?” she asked. “If the answer is yes, please be aware that TRAP laws would change this.”

SOURCE: American Journal of Public Health, online February 22, 2018.