Abortion clinics in the U.S. have closed at a record pace. In five states — Mississippi, Missouri, North Dakota, South Dakota and Wyoming — just one remains. Abortion-rights opponents in statehouses have propelled the trend by pushing to legislate the industry out of existence. The U.S. Supreme Court placed limits on that strategy in June when it struck down Texas's particularly burdensome clinic regulations, setting the stage for a reshaping of the legal landscape. Still, given other barriers faced by abortion providers, no one thinks significant numbers of new clinics will open quickly.
In its decision on the Texas law, the Supreme Court rejected the state's argument that it was acting to protect women's health by requiring abortion clinics to meet hospital-like surgical standards and abortion providers to have admitting privileges at local hospitals. Those rules, the court said, were medically unnecessary and imposed an "undue burden" on the constitutional right to abortion. The law would have closed all but 10 or so of Texas’s remaining abortion clinics and left none in the state's western half. It was a case study in the way abortion opponents changed strategies, opting for legislative action over the clinic blockades and violence of the past. Laws aimed at clinics proved more potent than those aimed at patients, such as waiting periods or parental notification requirements. Almost 300 abortion restrictions were enacted since a Republican-led push began in 2011. The Supreme Court decision strengthens the position of abortion-rights supporters in lawsuits contesting regulations passed in the name of protecting women's health. The ruling's impact was immediate: The next day, the high court turned away appeals from Wisconsin and Mississippi to revive their doctor admitting-privilege laws, and Alabama withdrew an appeal to implement its rule. Efforts to overturn abortion rights entirely, through state ballot initiatives giving the unborn the rights of a person, have failed repeatedly.
Abortion has persisted as a hot-button issue in U.S. politics since the Supreme Court’s landmark Roe v. Wade decision in 1973 legalized it in all 50 states. The groundwork was laid to undermine that ruling in 1992, when the high court said states could pass restrictions that don’t present an “undue burden” to women seeking the service. The ranks of clinics have been thinning since the late 1980s, when the number of nonhospital providers performing 400 or more abortions per year peaked at 705; by 2011, the most recent year for which data are available, that number had fallen to 553. Since 2011, more than 160 providers have closed their doors or stopped offering the procedure and 21 started up. Regulations account for many of the shutdowns, but other reasons include the unavailability of a doctor and a hostile climate.
Both sides of the abortion debate have a stake in the proposition that restricting access to clinics is holding abortion rates down. Health experts and social scientists say that's just one factor. American women were having fewer abortions before clinic closings accelerated in the last few years. Increasing cultural acceptance of single motherhood, the recession (which was accompanied by a decline in pregnancies) and more (as well as more effective) contraceptive use are also behind the drop. Still, almost half the 6.7 million pregnancies each year are unintended, and almost half of these end in abortion. One study concluded that if 31 states outlawed abortion tomorrow, the vast majority of women would still travel to states where it remained legal. But the impact on those unwilling or unable to travel could still produce a 15 percent drop in abortions nationally and as much as a 4.2 percent rise in the birth rate. In Texas, the abortion rate fell far faster during the time the state's now-rejected law was partially in effect. There is evidence that diminishing access also results in more women resorting to dangerous and illegal means to avert motherhood.
The Reference Shelf
- The Supreme Court's decision striking down the Texas abortion restrictions.
- Bloomberg Businessweek's in-depth look at why it's so hard to run an abortion clinic.
- The Guttmacher Institute researches and compiles medical statistics and legislative history about abortion.
- The Centers for Disease Control and Prevention collects data from most states for its abortion surveillance project.
- The American Congress of Obstetricians and Gynecologists offers a resource guide for abortion, including medical guidelines and research.
First published Nov. 20, 2013
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