Fixing Abortion Laws: A Guide To Reforming Legislation

Abortion laws are a highly contested topic, with some countries criminalising the procedure and others recognising it as a human right. The criminalisation of abortion creates a host of issues, including unsafe abortions, maternal deaths and disabilities, and a denial of bodily autonomy. To fix abortion laws, a multi-faceted approach is necessary, addressing legal, social, cultural and economic barriers. This includes decriminalising abortion, improving access to healthcare services, and tackling the stigma surrounding abortion. Additionally, allocating dedicated funding, repealing existing restrictions, and expanding insurance coverage are also crucial steps towards ensuring safe and accessible abortion services.

Remove state restrictions on abortion care

Removing state restrictions on abortion care is critical to ensuring that everyone, especially those with limited financial resources or marginalized backgrounds, can obtain an abortion with minimal logistical and financial barriers. Here are some key steps to remove these restrictions:

Repeal restrictions on abortion later in pregnancy

Gestational age bans may delay or deny access to abortion care. People of color, young people, and those with limited financial resources often seek abortions later in pregnancy due to overlapping factors such as discovering a pregnancy late or struggling to overcome legal, financial, and logistical barriers to care. Removing restrictions on abortion later in pregnancy is crucial to protecting bodily autonomy and ensuring equity.

Allow non-physician clinicians to provide abortions

Decades of evidence show that non-physician clinicians, such as physician assistants, certified nurse-midwives, and nurse practitioners, can safely and effectively provide abortions. Allowing these professionals to perform abortions and expanding training programs would increase the pool of abortion providers and enhance access.

Repeal parental involvement laws

Laws requiring adolescents under 18 to obtain parental consent before seeking an abortion create barriers to access, particularly for immigrant youth and youth in unstable or abusive homes. These laws limit young people's autonomy and can delay abortion procedures, driving up costs and potentially making care inaccessible if a patient can no longer meet a gestational age limit.

Expand insurance coverage of abortion

The average cost of an abortion at 10 weeks is around $550, and it can rise significantly later in pregnancy. Expanding insurance coverage is crucial to ensuring that care is accessible and affordable, especially given that people with limited financial resources represent the majority of abortion patients. State policymakers should ensure that both state Medicaid programs and private health insurance plans cover abortion under all circumstances.

Remove restrictions on self-managed abortion

Only three states have laws that explicitly criminalize self-managed abortion, but law enforcement agencies and prosecutors in 26 states have used other criminal laws to bring charges against people who self-manage an abortion. State lawmakers must repeal laws that could be used to prosecute people for their pregnancy outcomes or for self-managing an abortion. Instead, they should enact protections for self-managed abortion and strengthen legal protections for those who choose this option.

Expand public and private insurance coverage

Expanding Public and Private Insurance Coverage of Abortion

The average cost of an abortion at 10 weeks is around $550, and the cost can rise exponentially later in pregnancy. Expanding insurance coverage of abortion is essential to ensure that care is accessible and affordable, especially given that people with few financial resources represent the large majority of abortion patients. State policymakers can expand abortion access by ensuring that both state Medicaid programs and private health insurance plans cover abortion under all circumstances.

The Hyde Amendment bars the use of federal funds to pay for most abortions through the Medicaid program, and state-level restrictions deny insurance coverage of abortion to millions of people. For people enrolled in Medicaid, 34 states and Washington, D.C., limit abortion coverage, with most only paying for care in cases of life endangerment, rape, or incest. This includes states protective of abortion, such as Colorado, Delaware, Pennsylvania, and Rhode Island. Only eight states require abortion coverage in private health insurance plans: California, Illinois, Maine, Maryland, Massachusetts, New York, Oregon, and Washington.

A good example of a state taking concrete action to increase access is Illinois, which started covering abortion for people insured through Medicaid in 2019. In 2022, the state increased Medicaid reimbursement for abortion services by 20%, ensuring that providers are adequately reimbursed for offering abortions. In addition to abortion coverage bans, many people in the United States are denied access to public or private insurance coverage—for any service, not only abortion—because of their immigration status.

States should mitigate these harmful policies as well. For example, Oregon sets the standard for insurance coverage of abortion, as state Medicaid funds cover abortion care, private health plans are required to cover abortion, and abortion services are covered for people who are undocumented.

Specific funding for abortion care is critical to expanding access to all who need it. Funds should be allocated among established groups in the state, including abortion funds, practical support organizations, and reproductive justice organizations. Considering the regional variation in abortion access, state policymakers should allow out-of-state residents to access these funds as well. Another way states can increase dedicated funding is to invest in abortion-related infrastructure, such as building new clinics.

Protect abortion clinic staff and patients

In the US, assaults against abortion clinic staff and patients rose by 128% in 2021 from the previous year. As abortion restrictions increase, so does the risk of violence and harassment against abortion providers and patients. Here are some measures that can be taken to protect abortion clinic staff and patients:

• Enact and enforce laws that protect abortion clinic staff and patients: The federal Freedom of Access to Clinic Entrances (FACE) Act imposes penalties for acts of force, threatening force, or physically preventing access to abortion care. However, it rarely results in charges or prosecutions. States can adopt their own versions of FACE and enhance protections for clinic staff and patients through measures such as prohibiting specific acts of violence and establishing buffer zones around clinic entrances and driveways.
• Invest in protections that do not rely on police presence: As the majority of abortion patients are people of color, who have been disproportionate targets of state violence, investing in community support mechanisms such as clinic escort programs and de-escalation training for clinic staff can help create a sense of safety without the fear of law enforcement intervention.
• Include clinic staff and patients in address confidentiality programs: These protections can prevent abortion opponents from harassing individuals at their homes.
• Update and enforce laws that prohibit taking photos and videos of patients and staff: California, for example, has prohibited taking photos and videos of patients and staff at abortion clinics to enhance their privacy and security.
• Provide funding for security measures: Governments can allocate funds to increase security measures such as hiring security guards or off-duty police officers, installing security systems, and improving clinic infrastructure.
• Strengthen legal protections for clinic staff and patients: This includes enacting shield laws that prohibit state agencies from assisting in investigating, subpoenaing, or extraditing individuals involved in abortion care and ensuring that medical professionals do not face punishment from licensing boards for providing abortion care.

Increase dedicated funding to improve access

Financial and logistical challenges are the most significant barriers to accessing abortion care. The cost of a typical abortion is about $550, excluding potential additional costs related to timing and travel. As most people who seek abortions are already struggling financially, these costs present a significant obstacle. To address this, dedicated funding for abortion care is crucial to expanding access to all who need it.

Firstly, funds should be allocated among established groups within the state, such as abortion funds, practical support organisations, and reproductive justice organisations. Considering the variation in abortion access across regions, state policymakers should also allow out-of-state residents to access these funds.

In 2022, several US states increased dedicated funding to expand abortion access. For example, California allocated $200 million for reproductive healthcare, with $110 million specifically for abortion services and infrastructure. This included $20 million for an Abortion Practical Support Fund providing grants to both state residents and out-of-state patients. Massachusetts, New Jersey, New York, and Oregon also set aside state funds to help people pay for abortion services.

Another way to increase dedicated funding is to invest in abortion-related infrastructure, such as building new clinics. For instance, in New Mexico, Governor Michelle Lujan Grisham pledged $10 million for the construction of a new abortion clinic near the Texas border. This clinic will expand access to underserved parts of New Mexico and support Texans who are being denied care.

Additionally, states can increase funding for abortion-related infrastructure by allocating funds for the construction of new clinics or the expansion of existing facilities. This ensures that there are enough physical spaces dedicated to providing abortion services, reducing wait times and improving access for those in need.

Furthermore, states can also allocate funds specifically for transportation, lodging, and language translation services for those seeking abortions. This practical support is crucial for helping individuals overcome logistical barriers and ensuring they can access abortion services without financial constraints.

By increasing dedicated funding and investing in infrastructure, states can significantly improve access to abortion services, ensuring that financial constraints do not prevent individuals from making decisions about their bodies and their future.

Strengthen legal protections for self-managed abortions

Strengthening legal protections for self-managed abortions is an essential step towards ensuring reproductive autonomy and expanding access to safe abortion care. Here are some measures that can be implemented to achieve this:

Remove Legal Barriers

Self-managed abortion (SMA) refers to abortions undertaken without clinical supervision, often using medications like mifepristone and misoprostol. While SMA is considered safe by the World Health Organization, legal restrictions in many regions hinder access to these medications. It is crucial to repeal laws that criminalize SMA and remove unnecessary supervision requirements, allowing individuals to privately manage their abortions. Additionally, ensuring the registration and over-the-counter availability of abortion medications is vital. Removing restrictions on the timeframe for using medication abortion and location-based constraints further empowers individuals to safely self-manage their abortions.

Enhance Education and Awareness

Educating healthcare professionals about SMA is essential. They should be aware of the safety and effectiveness of SMA, as well as the legal rights of individuals choosing this option. Additionally, addressing the stigma associated with abortion and SMA is crucial. Public education campaigns can play a vital role in dispelling myths and misconceptions, ensuring individuals understand their rights and can make informed choices.

Protect Against Criminalization

Strengthening legal protections also involves shielding individuals from legal repercussions for their pregnancy outcomes or for self-managing an abortion. This includes repealing laws that could be used to prosecute individuals and enacting protections specifically for SMA. It is essential to emphasize that reporting SMA is not mandatory and that doing so violates medical ethics and patient privacy. Lawmakers should focus on protecting marginalized communities, including people of color, undocumented individuals, and members of the LGBTQ+ community, who are at higher risk of criminalization.

Ensure Access to Information and Support

Providing accurate and easily accessible information about SMA is vital. This includes resources on how to safely self-manage an abortion, as well as details about supportive services and organizations. Telemedicine and telehealth services can play a crucial role in offering remote assistance and guidance to individuals choosing SMA.

Advocate for Policy Change

Advocating for policy changes that explicitly protect SMA rights is essential. This includes amending state constitutions to safeguard reproductive autonomy and abortion rights. Additionally, allocating dedicated funding to SMA services and organizations can help expand access and ensure financial support for those seeking SMA.

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