Strict Abortion Laws: Devastating Impacts On Women's Lives

Strict abortion laws can have a significant impact on access to abortion services and the lives of those seeking abortions. In the United States, the Supreme Court's decision to overturn Roe v. Wade in 2022 removed federal protections for abortion rights, allowing states to impose their own regulations. As a result, nearly two dozen states have banned or restricted abortion access, with 14 states enacting near-total abortion bans. These laws have led to a highly uneven landscape, with access to abortion clinics varying widely across the country. The consequences of these restrictions include higher rates of maternal and infant mortality and economic insecurity. Globally, the trend is towards liberalization of abortion laws, with over 60 countries and territories relaxing their restrictions over the past 30 years. However, restrictive abortion laws continue to cause significant harm, resulting in thousands of deaths from unsafe abortions and the loss of educational and economic opportunities.

Criminalisation of self-managed abortions

Self-managed abortions (SMA) refer to any action taken to end a pregnancy outside of the formal healthcare system. This includes self-sourcing mifepristone and/or misoprostol, consuming herbs or other drugs, and using physical methods. SMA is not a new phenomenon and occurs across histories, social and legal contexts, utilising a range of methods.

The criminalisation of SMA has a detrimental impact on the health outcomes, health systems, and human rights of those seeking abortions. Criminalisation is associated with negative health outcomes, such as unsafe abortions, increased maternal mortality and morbidity, and delayed access to abortion care. It also violates human rights, including the right to life, health, privacy, equality, and non-discrimination.

Criminalisation contributes to opportunity costs for those seeking abortions, including travelling for abortion, delayed and poor-quality post-abortion care, financial costs, and emotional distress. It also leads to unlawful abortions, which are sometimes unsafe and may result in death. Criminalisation further exposes those seeking abortions to criminal justice procedures and sanctions, creating fear and deterring individuals from seeking needed care.

The criminalisation of SMA also has implications for healthcare providers, increasing their workload and complicating referral pathways. It may also negatively impact the provider-patient relationship, as providers may feel they cannot provide optimal care due to criminalisation and may experience fear of litigation. In some cases, providers may face criminal justice procedures and sanctions themselves, particularly if they provide abortion information or care.

Overall, the criminalisation of SMA results in negative health and human rights implications for those seeking abortions and healthcare providers. It creates barriers to accessing safe and legal abortions and contributes to increased maternal mortality and morbidity.

Targeted regulation of abortion providers

Regulation of locations

This includes regulating the locations where abortion is provided and/or specifying facility specifications. For example, requiring that facilities be within a certain distance from a hospital or mandating the width of hallways and room size. These requirements are often costly and can involve unnecessary facility modifications.

Provider qualifications

Some states require abortion providers to have admitting privileges at a local hospital or an alternative arrangement, such as an agreement with another physician who has admitting privileges. This can be difficult or impossible for abortion providers, as abortion is a safe procedure and doctors rarely need to admit patients to a hospital.

Reporting requirements

TRAP laws may also include reporting or documentation requirements that are not necessary for patient safety. For example, some states require providers to report specific details about each abortion performed, such as the method used and the patient's age.

Impact of TRAP laws

The targeted regulation of abortion providers has resulted in the closing of health centers and delayed abortion care. Between 2013 and 2014, TRAP laws in Texas caused the number of abortion providers in the state to decrease sharply, leading to a tripling of the number of women who lived more than 100 miles from an abortion clinic. This has made it more difficult and expensive for people to access safe and legal abortions.

Parental involvement

In some states, the minor and a parent must provide government-issued identification to the abortion provider and/or as part of notarizing the parental consent form. A small number of states require the parent to also provide proof of parenthood. Several states allow grandparents or other adult relatives to be involved in place of the minor's parents, and many waive parental involvement requirements if there is a medical emergency or the young person is a victim of abuse or neglect.

The US Supreme Court has ruled that states may not give parents an absolute veto over their child's decision to have an abortion. Therefore, most state parental involvement requirements include a judicial bypass procedure that allows a minor to receive court approval for an abortion without their parents' knowledge or consent. Some states require judges to use specific criteria when determining whether to grant a waiver of parental involvement, such as the young person's intelligence, emotional stability, and understanding of the possible consequences of obtaining an abortion. Many states require a judge to use the unusually strict legal standard of "clear and convincing evidence" to determine whether a minor is sufficiently mature and the abortion is in their best interest prior to waiving the parental involvement requirement.

Research has shown that these laws, which disproportionately impact young women of colour and immigrant youth, often delay or prevent young people's access, endangering their health and safety. A majority of Americans support young people's self-autonomy and right to make decisions about their sexual and reproductive health without their parent's involvement.

Bans on specific abortion methods

The D&E procedure has been banned by 33 states, with very limited exceptions. These bans only permit the use of this method when it is necessary to protect the patient's life or when their physical health is at severe risk. On the other hand, 21 states have banned "partial-birth" abortion, with 13 of these laws resembling the federal version upheld by the Supreme Court in 2007.

The lack of clear definitions and exceptions in these laws creates confusion and challenges for physicians, who may face legal consequences for providing abortion care. The determination of whether an abortion qualifies under these exceptions is often left to lawyers or institutions rather than the treating physician.

The impact of these bans is significant, as they prevent physicians from providing medically appropriate care and deter them from practising in states with restrictive abortion laws. This further exacerbates disparities in access to obstetric care and contributes to adverse maternal and fetal outcomes.

Vigilante laws

Texas' Senate Bill 8 (SB8) is a vigilante abortion law that bans abortion after approximately six weeks of pregnancy, often before many women know they are pregnant. The law incentivizes individuals, including anti-abortion activists, to bring costly and harassing lawsuits against anyone who provides abortion care or assists someone in obtaining an abortion in violation of the ban. Doctors and abortion providers, drivers who provide transportation to a clinic, or those who help fund an abortion could all be liable to incur legal fees if they are sued. The threat of lawsuits has been enough to discourage providers from performing abortions in the state.

SB8 has been deemed a "vigilante law" or "bounty hunter law" as it allows citizens to sue and collect a cash "bounty" if they succeed in taking legal action against anyone who has helped a person obtain an illegal abortion. Texas Right to Life, the state's largest anti-abortion group, set up a "whistleblower" website that allows people to send anonymous tips about suspected violators of the law. This website, however, has not been able to find a permanent home due to multiple failed attempts to secure a web hosting platform.

Under SB8, doctors have been afraid to end pregnancies, even in legally authorized emergencies, as they fear fines, imprisonment, or the loss of their license for being involved in any kind of abortion. The law has been challenged in court, with a judge in Texas issuing a pre-trial injunction limiting the reach of the state's anti-abortion measures. The judge clarified that a doctor can decide when their patient needs an emergency abortion and held that the law is unconstitutional as it violates a provision in the state's bill of rights banning unreasonable fines and cruel and unusual punishment.

The Center for Reproductive Rights has stated that the U.S. Supreme Court's refusal to block Texas' abortion ban and vigilante scheme has left federal courts "powerless" to defend constitutional rights, effectively endorsing Texas' efforts to subvert the U.S. Constitution.

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