Restrictive Abortion Laws: Understanding Their Impact And Implications

Restrictive abortion laws are those that limit a person's access to abortion. In some cases, these laws can make it extremely difficult or even impossible for a person to obtain an abortion. These laws often have gestational limits, requiring abortions to take place within a certain number of weeks, and may also impose other restrictions, such as requiring the involvement of a medical doctor or mandating parental consent for minors. In some countries, abortion is prohibited altogether, even in cases of rape, incest, or when the mother's life is endangered. Restrictive abortion laws have been a subject of debate and controversy, with some arguing that they violate human rights and cause harm, while others believe the laws should be determined by individual states.

Characteristics of Restrictive Abortion Laws

Misleading information and waiting periods

In the United States, abortion laws vary from state to state. While every state requires that a patient consents before undergoing medical treatment and that the consent be "informed", abortion counselling requirements sometimes run afoul of these principles by requiring information that is irrelevant or misleading. For example, in 2003, Texas passed the "Women's Right to Know Act", which mandated that doctors give misleading information about the abortion procedure and alternatives to terminating the pregnancy.

In addition to abortion counselling requirements, many states require that at least 24 hours elapse between counselling and an abortion procedure. In states where counselling must be received in person, patients are effectively required to make two trips in order to obtain an abortion, which can be a hardship for some people.

The World Health Organization (WHO) has recognized that mandatory waiting periods "demean women as competent decision-makers" and has recommended against them. International human rights bodies have similarly encouraged states to repeal and not to introduce such waiting periods, which they recognize as barriers to accessing sexual and reproductive healthcare.

Evidence suggests that mandatory waiting periods contribute to abortion delays, especially when two visits are required. They also contribute to logistical difficulties in obtaining care, increased travel time and costs, and emotional stress. These negative impacts are exacerbated for women who need to travel far for an abortion.

While policymakers who support mandatory waiting periods argue that they are designed to ensure and support certainty for women who seek abortions, research shows that women who decide to end their pregnancies reach that decision quickly and experience a high level of decisional certainty. There is no significant increase in decisional certainty where a mandatory waiting period is imposed.

Gestational limits

In countries with restrictive abortion laws, such as those that only permit abortion when the woman's life or health is at risk, there is often no prescribed gestational limit. For example, in Bolivia, abortion is legal if the pregnancy endangers the life or health of the woman or results from rape or incest, but there is no specified gestational limit. Similarly, the Penal Code in Burkina Faso allows abortion when the woman's health is at risk or in cases of fetal impairment without imposing a gestational limit.

The World Health Organization (WHO) acknowledges that efforts to impose gestational limits on abortion may have negative consequences and could force women to seek unsafe alternatives or travel to other countries for access, resulting in social inequalities and increased health risks. WHO emphasizes that abortion to save a woman's life or minimize risk to her health may be necessary at any point during pregnancy.

The United States is one of eight countries that allows abortion on demand without any gestational limits at the federal level. This includes Australia, Canada, China, Guinea-Bissau, Mexico, South Korea, and Vietnam. However, individual states within the US have their own laws and policies regarding gestational limits, with Texas, for example, banning abortion after six weeks in 2021.

Criminalising abortion providers

Restrictive abortion laws can take many forms, including criminalising abortion providers. In Texas, for example, a law was passed in 2019 that criminalised abortion providers who do not provide medical treatment to a foetus born after an abortion. This law is particularly restrictive because abortions in Texas are banned after 20 weeks, and a foetus is not considered viable until 24 weeks.

Another example of a restrictive abortion law that targets providers is Texas's Senate Bill 22, passed in 2019, which prevents government entities from partnering with or providing assistance to clinics affiliated with abortion providers. This law cuts off support to communities that rely on these clinics for essential healthcare services such as birth control, cancer screenings, and diabetes testing.

Restrictive abortion laws can also create an environment that encourages violence and intimidation against abortion providers. In 2023, for instance, four defendants were charged with Civil Rights Conspiracy and FACE Act offences for their targeted attacks on pregnancy resource centres in Florida.

The global trend, however, is towards the liberalisation of abortion laws. Over the past 30 years, more than 60 countries and territories have liberalised their abortion laws, recognising abortion rights as fundamental human rights.

Insurance restrictions

Restrictive abortion laws have been on a steady rise in the United States, with politicians attempting to take away abortion coverage from most Americans with employer-based health insurance. While the global trend is towards the liberalization of abortion laws, the US stands as a notable exception, with the Supreme Court removing nationwide protections for abortion rights in 2022.

The impact of these insurance restrictions is significant, as they effectively deny women access to abortion care. This is particularly true for those who are insured through state or federal programs, including low-income women, public employees, military families, Peace Corps volunteers, and Native Americans. The trend towards restricting insurance coverage for abortion represents a concerted effort to limit abortion access and undermine reproductive freedom.

In addition to insurance restrictions, Texas has enacted a series of restrictive abortion laws over the past two decades. These include the "Women's Right to Know Act," which mandates that doctors provide misleading information and a 24-hour waiting period before the procedure. Texas has also banned abortions after 24 weeks, required parental consent for minors, and enacted mandatory sonogram and verbal explanation laws. More recently, Texas passed House Bill 2, which imposed additional restrictions on abortion providers and banned abortions after 20 weeks, except in cases of medical necessity.

The efforts to restrict abortion access in Texas and other states have been met with resistance from reproductive rights advocates, who have successfully challenged some of these laws in court. Despite these challenges, the trend towards restrictive abortion laws, including insurance coverage bans, continues to pose a significant threat to reproductive rights and access to safe abortion services in the United States.

Medication abortion restrictions

However, restrictive abortion laws have been implemented at the state level, banning or restricting access to medication abortion. These laws vary across states, with some imposing unnecessary restrictions that increase barriers to care. For example, some states limit the provision of medication abortion solely to physicians, despite evidence that advanced practice clinicians can safely provide this service. Additionally, some states require a physician to be physically present when administering the medications, prohibiting telemedicine provision. Other restrictions include mandating in-person visits, imposing requirements for in-person dispensing, and limiting the types of clinicians who can dispense the pills.

The impact of these restrictions is significant, particularly for people in rural areas or areas with few abortion providers. Telehealth services could expand access to medication abortion, but some states have blocked its use for abortion purposes. The cost of medication abortion has also increased, with the median self-pay price rising from $495 in 2017 to $560 in 2020.

The restrictions on medication abortion have led to an increase in self-managed abortions, where individuals obtain abortion pills outside of the medical care setting, typically by ordering them online. While none of the current state abortion bans criminalize self-managed abortions, there have been cases of people facing legal consequences for self-managing an abortion.

The trend towards restrictive abortion laws, including medication abortion restrictions, stands in contrast to the global movement towards the liberalization of abortion laws. The regression of abortion rights in the United States, particularly after the overturning of Roe v. Wade in 2022, has had a significant impact on access to safe and effective abortion care.

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