Need for State Legislation Protecting and Enhancing Women’s Ability to Obtain Safe, Legal Abortion Services Without Delay or Government Interference

The American Public Health Association (APHA) has, since 1967, recognized as a public health issue the importance of women’s access to safe abortion services in the United States (APHA policy statements 89-01,¹ 2003-14,² 68-033). Further, APHA has called for federal funding for abortion services (APHA policy statements 76-26,⁴ 77-31,⁵ 78-406), increased training (APHA policy statements 79-077 and 96-088) and safeguarding abortion as a reproductive choice (APHA policy statement 89-011 and 2003-142). There is currently no active APHA policy addressing state legislation concerning abortion. This policy replaces archived APHA policy statement 67-18(PP),⁹ which was written in 1967 and addressed the need for state-level policies protecting safe access to abortion.

Since 1973, the US Supreme Court’s landmark Roe v. Wade decision has ensured that all women, throughout the United States, have the right to an abortion.¹⁰ The Roe v. Wade decision allows elective abortions before viability or afterward to preserve the health of the woman.¹¹

On April 18, 2007, the US Supreme Court upheld a federal law banning a specific abortion procedure, the Partial Birth Abortion Ban Act of 2003, without including a health exception for women. This ruling has opened the door for states to further restrict abortion, with an understanding that the courts will now allow legislation that does not include an exception to preserve a woman’s health.^12,13 Some analysts have also suggested that in this decision, the Supreme Court demonstrated a willingness to overturn the Roe v. Wade decision.¹²

In the time since the Supreme Court decision, the number of abortion restrictions proposed at the state level has drastically increased. According to the Guttmacher Institute,¹⁴ in 2007 alone, the following legislative measures were proposed at the state level:

• Abortion bans set in place to replace Roe v. Wade, should it be overturned at the federal level, were introduced in 12 states.
• Proposed laws requiring that women seeking abortions undergo mandatory counseling and then wait a specified period of time (usually 24 or 48 h) before undergoing an abortion were introduced in 25 states.
• Proposed laws requiring that minors obtain parental consent or that at least 1 parent be notified were introduced in 15 states.
• Bans on specific abortion procedures were introduced in 9 states.
• Limits on private insurance coverage of abortion were introduced in 9 states.
• Restrictions on public funding of abortion for low-income women were introduced in 15 states.
• Imposing requirements regarding reporting statistical information to state agencies by clinicians providing abortion procedures were introduced in 12 states. Many of these requirements were burdensome and involved data not currently collected by the Centers for Disease Control and Prevention.
• Targeted regulations of abortion providers or clinics (e.g., additional mandated equipment, requirement of admitting privileges, classifying abortion clinics as ambulatory surgical centers or other classifications requiring increased regulation) were introduced in 15 states.

This trend has continued in 2008.¹⁵

In light of the Supreme Court’s decision and the threat of new restrictions on access to abortion at the state level, APHA urges education of state legislatures and elected and appointed officials to do the following:

• Repeal or oppose existing state laws, including those that antedate Roe vs. Wade, that restrict or remove access to abortion services, including, but not limited to—
• Mandatory delays and information or counseling that is not science based,
• Bans on specific abortion procedures,
• Parental consent or notification requirements,
• Targeted regulation of abortion providers, and
• Limits for advanced practice clinicians in providing abortion services.
• Support state laws that improve access to safe abortion services, including, but not limited to—
• Provide funding for abortion care via state Medicaid funds,
• Maintain medical decisionmaking within the patient–health care provider relationship,
• Strengthen and enshrine the current federal protection on the right to access abortion under Roe v. Wade,
• Allow trained advanced practice clinicians to provide medication and aspiration abortions,
• Protect health facilities and clinicians who provide abortion care.

APHA calls on the public health community to become active at the local and state level to ensure access to safe and legal abortion by supporting the previously mentioned actions, regardless of the political climate.

References

1. American Public Health Association. APHA policy statement 89-01. Safeguarding the right to abortion as a reproductive choice. Washington, DC: American Public Health Association; 1989. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1180. Accessed December 11, 2007.
2. American Public Health Association. APHA policy statement 2003-14. Support for sexual and reproductive health and rights in the United States and abroad. Washington, DC: American Public Health Association; 2003. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=1251. Accessed December 11, 2007.
3. American Public Health Association. APHA policy statement 68-03. Abortion. Washington, DC: American Public Health Association; 1968. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=595. Accessed December 11, 2007.
4. American Public Health Association. APHA policy statement 76-26. The right to abortion for all women. Washington, DC: American Public Health Association; 1976. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=828. Accessed December 11, 2007.
5. American Public Health Association. APHA policy statement 77-31. Cutoff on public funds for abortions. Washington, DC: American Public Health Association; 1977. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=866. Accessed December 11, 2007.
6. American Public Health Association. APHA policy statement 78-40. Abortion funding. Washington, DC: American Public Health Association; 1978. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=917. Accessed December 11, 2007.
7. American Public Health Association. APHA policy statement 79-07. The right to second trimester abortion. Washington, DC: American Public Health Association; 1979. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=929. Accessed December 11, 2007.
8. American Public Health Association. APHA policy statement 96-08. Expanding options for early abortions. Washington, DC: American Public Health Association; 1996. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=126. Accessed December 11, 2007.
9. American Public Health Association. APHA policy statement 67-18(PP). Abortion. Washington, DC: American Public Health Association; 1967. Available at: www.apha.org/advocacy/policy/policysearch/default.htm?id=592. Accessed December 11, 2007.
10. Roe v. Wade, 410 US 113 (1973).
11. Center for Reproductive Rights. Reproductive rights: key cases. Roe v. Wade, 410 US 113 (1973). Available at: www.reproductiverights.org/crt_roe_cases_roe.html. Accessed December 11, 2007.
12. National Women’s Law Center. Gonzales v. Carhart: The Supreme Court turns its back on women’s health and on three decades of constitutional law. Available at: www.nwlc.org/pdf/GonzalesvCarhart2.pdf. Accessed December 11, 2007.
13. American Civil Liberties Union. US Supreme Court upholds federal ban on abortion methods. Available at: www.aclu.org/reproductiverights/abortionbans/29778res20070518.html. Accessed December 11, 2007.
14. Guttmacher Institute. Monthly state update: major developments in 2007. Available at: www.guttmacher.org/statecenter/updates/index.html#reporting. Accessed February 3, 2008. 
15. Laws affecting reproductive health and rights: trends in the first quarter of 2008. Available at: www.guttmacher.org/statecenter/updates/2008/statetrends12008.html. Accessed June 10, 2008.

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