Abortion Laws: A State Or National Issue?

Abortion laws vary across the world, with some countries adopting a more national approach and others leaving the decision to individual states. In the US, for instance, abortion laws differ from state to state, with some states banning it outright while others protect it under state law. The US Supreme Court's decision to overturn Roe v. Wade in 2022 gave states the power to restrict or prohibit abortion entirely. This has resulted in a patchwork of laws across the country, with some states criminalizing abortion and others enshrining the right to abortion in their state constitutions. The situation is similar in other countries, such as Ethiopia, where abortion laws vary between regions and are influenced by religious and cultural beliefs. The debate around abortion often centres on the question of whether it should be legalized or decriminalized, with some arguing that removing criminal sanctions and treating it as a health issue is the best approach.

The Hyde Amendment

The impact of the Hyde Amendment is particularly felt by women with low incomes, who may not be able to afford the costs of an abortion without coverage. Medicaid is a significant source of health coverage for women who have higher rates of abortion in the U.S., including women with low incomes and women of colour. Without coverage for abortion under Medicaid, women must pay out of pocket for the procedure or rely on abortion funds or borrow money from friends or family.

There have been attempts to codify the Hyde Amendment into law, such as the Hyde Amendment Codification Act introduced in 2013, which would have prohibited the expenditure of federal funds for any abortion. However, the Hyde Amendment remains a temporary "rider" attached to the annual Congressional appropriations bill for the Department of Health and Human Services.

State-level abortion bans

In the United States, abortion laws are decided at the state level. In June 2022, the U.S. Supreme Court overturned Roe v. Wade, which had protected the federal constitutional right to abortion for nearly 50 years. This decision gave states the power to restrict or prohibit abortion altogether. As a result, 14 states have made abortion illegal, with varying restrictions and bans.

The impact of state-level abortion bans is far-reaching. People in marginalized groups, particularly those facing systemic racism and other forms of oppression, may encounter compounding barriers to obtaining an abortion. Additionally, almost half of the states in the U.S. are likely to enact highly restrictive laws or enforce current, unconstitutional laws prohibiting abortion. This has led to a division between "abortion deserts," where abortion is illegal, and "abortion havens," where abortion care is still available.

The legality of abortion at the state level has significant implications for individuals' reproductive rights and access to healthcare. The landscape of abortion access in the U.S. continues to shift rapidly, with state legislatures creating new restrictions and enforcing existing ones. As a result, individuals seeking abortions may face varying levels of access and legal protection depending on their state of residence.

State-level abortion restrictions

• Targeted Regulation of Abortion Providers (TRAP) laws, which impose burdensome legal requirements on physicians providing abortion care.
• Restrictions on insurance coverage for abortion, removing the comprehensive insurance coverage most people currently have.
• Mandatory ultrasounds, waiting periods, and biased counselling before receiving abortion care.
• Criminalisation of self-managed abortions, i.e. ending a pregnancy outside of a healthcare setting.
• Bans on specific abortion methods, such as dilation and extraction (D&X) and dilation and evacuation (D&E) procedures.
• Bans on abortion at specific gestational ages, such as pre-viability bans or 20-week bans.

These state-level restrictions have serious consequences for people seeking abortions, particularly those on low incomes, who may not have the resources to travel long distances, arrange accommodation, or navigate other legal hurdles.

Self-managed abortions

In the United States, where many states are banning abortion, people are increasingly turning to self-managed abortions. Self-managed abortions, also known as "at-home abortions", involve ending a pregnancy without the help of a doctor or nurse, and typically involve taking abortion pills. While this practice is fairly common, especially in places where abortion is illegal, there are legal risks involved in buying and using abortion pills outside of the healthcare system.

Research shows that self-managing an abortion with abortion pills (mifepristone and/or misoprostol) can be safe and effective, especially for those who are less than 10 weeks from the first day of their last period, have regular periods and are fairly sure of the first day of their last period, and do not have medical reasons for avoiding the pills. Additionally, it is important to have access to good information about how to take the pills, what to expect, and warning signs for possible complications.

There are several hotlines that provide support for those considering a self-managed abortion, including the Miscarriage + Abortion Hotline, which is a private and secure phone and text hotline staffed by medical professionals. The Aya Contigo hotline offers free and confidential live chat with educators, while the All Options hotline offers counselling and referrals to other professionals. The Exhale text message hotline provides emotional support, and the Repro Legal Helpline offers free and confidential legal information and support.

While self-managed abortions can be safe and effective, it is important to consider the legal risks involved. As of 2020, 61 people in the United States had been criminally investigated or arrested between 2000 and 2020 for allegedly self-managing their abortion or helping someone else do so. Most of those investigated or arrested were living in poverty, and a higher proportion were Black, Latinx, or Asian compared to national statistics. While public opinion is generally against criminalizing self-managed abortions, it is important to be aware of the potential legal consequences.

Federal-level abortion bans

In the United States, abortion laws are decided at the state level. However, there are some federal-level restrictions on abortion.

The Hyde Amendment

The Hyde Amendment, introduced in 1976, withholds federal Medicaid funding from abortion nationwide, except in extremely rare cases. This restricts insurance coverage for millions of low-income people and interferes with access to safe and legal abortions.

Federal Abortion Ban

On April 18, 2007, the U.S. Supreme Court upheld the first federal law banning abortion procedures. This law criminalises abortions in the second trimester of pregnancy, often the safest option for protecting a pregnant person's health. This restriction not only affects patients but also the doctors who care for them, giving politicians the power to interfere with people's reproductive health care decisions.

Federal and State 20-Week Bans

Anti-abortion politicians have been pushing for a nationwide 20-week abortion ban, which would be unconstitutional. Some states have already passed such bans, forcing people into tragic situations where they are unable to end a pregnancy for serious medical reasons.

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