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The Supreme Court confirmed women's right to choose abortion in 1973, and the courts have upheld that finding in subsequent cases. But access to abortion has been severely eroded. The most recent survey found that 87% of all U.S. counties have no identifiable abortion provider. In non-metropolitan areas, the figure rises to 97%. As a result, many women must travel long distances to reach the nearest abortion provider.
But distance is not the only barrier women face. Many other factors have contributed to the current crisis in abortion access, including a shortage of trained abortion providers; state laws that make getting an abortion more complicated than is medically necessary; continued threats of violence and harassment at abortion clinics; state and federal Medicaid restrictions; and fewer hospitals providing abortion services.
In 1973 the Supreme Court struck down state laws that had criminalized abortion. Doctors working in hospital emergency rooms and ob-gyn units before that time knew first-hand about the medical devastation that women suffered as a result of self-induced abortions or black market abortions performed by unlicensed practitioners. Today, many of those doctors are retiring. The younger physicians replacing them have little direct experience with the consequences of illegal abortions and the public health benefits of ensuring that safe abortions remain available.
Even those young doctors who are committed to providing safe abortions to their patients may have trouble getting the training they need. A survey in 1998 revealed that first trimester abortion techniques are a routine part of training in only 46% of America's ob-gyn residency programs. About 34% offer this training only as an elective, and 7% provide no opportunity at all for young doctors to learn to provide safe abortions.1
In 1996, the Accreditation Council for Graduate Medical Education, the agency responsible for accrediting medical residency programs, took steps to correct this problem. It now requires ob-gyn residency programs to include family planning and abortion training for their students. It is too soon to tell whether this will result in better preparation of ob-gyns in the future to provide safe abortion services, but it is clear that doctors who do not get this training are not in a position to provide the full range of care that their patients will need.
National polling consistently shows that the majority of Americans support a woman's right to choose, but many legislators are committed to bringing an end to legal abortion and have passed laws that have drastically diminished access to abortion. These include:
- Parental Consent or Notification Laws which are now enforced in over half the states can violate the privacy of young women by forcing them to involve their parents in their decisions, even when they have strong objections to doing so. As a result, some women to travel to other states that do not require parental involvement; others have resorted to illegal abortions rather than comply with a legal requirement that puts them in jeopardy.
- Mandatory Waiting Periods require women to wait some period of time (up to 24 hours) between a state mandated counseling appointment and their abortion. Many of these laws require the counseling be done in person rather than on the phone. These laws imply that women come to abortion clinics without having seriously considered their options. As a result of these waiting periods, a woman's abortion is often delayed much longer than 24 hours, particularly if she has to take time off from work, arrange for child care, travel a long way, and perhaps stay overnight in a distant city. These factors can significantly increase the cost as well.
- Biased Counseling Laws require that clinic personnel lead their patients through detailed, state prescribed "scripts" that promote childbearing. Abortion providers have long been at the forefront of developing and delivering sound and effective options counseling to their patients. They consider these scripts "biased" because they contain information that is designed to frighten and dissuade women from having abortions. These coercive scripts are completely incompatible with the goal of true informed consent.
Medical professionals who provide abortion services do so at a tremendous risk to their safety. Since 1993, three doctors who provided abortions have been murdered, and five others have been shot at by anti-abortion zealots in the U.S. and Canada. A clinic escort and three clinic employees have been murdered, and several other clinic staff have been shot. Violence against providers also includes bombings, arson, vandalism, burglary, illegal blockades, threats, and harassment.
Frivolous malpractice lawsuits against abortion providers are also generated by anti-abortion extremists who want to keep providers from offering abortion services. These lawsuits are rarely justified, but they are used unfairly to discredit the reputations of providers and frighten patients.
The cost of a first trimester abortion has increased only slightly since 1973 (see Abortion Facts: Economics of Abortion), but many women still cannot afford the fee. The Hyde Amendment denies federal Medicaid funding for abortions except in specific, rare circumstances, and most states have similar laws restricting financial help to women who need abortions. More than 2/3 of women must initially pay for their abortions themselves - only 13% of abortions are paid for with a state's public funds,2 and only 13% are covered by a woman's private insurance at the time of her abortion.3 A small number of women may be reimbursed by insurance after their abortion.
The result is that too many women who need abortions must wait while they raise funds, postponing their abortions until later in their pregnancies, when the costs of these more complicated abortion procedures are higher. For the women who are struggling to make ends meet and who do not have insurance that covers abortion, the legal right to have an abortion does not guarantee that they will have access to it.
Today, about 95% of women who need abortions have them in clinics or in private doctors' offices where costs can be kept low without increasing health risks.
This pattern of abortion service delivery represents a significant shift away from hospital provided abortion care, which was far more common in the early years after the laws criminalizing abortion were struck down. "According to the American Hospital Association, there were 5,801 hospitals in the United States in 2001. However, a 2001-2002 study by the Guttmacher Institute identified only 603 hospitals that provided abortions in 2001."2 This has serious implications for abortion access. Women in rural areas where there are no abortion clinics, and low-income women who depend on hospital emergency services for medical care, are left unserved when hospitals do not provide abortions. When hospitals do not offer abortions, young physicians they train have no opportunity to learn to provide safe abortions.
The National Abortion Federation's Access Initiative Project was created specifically to address the escalating problem of limited access to abortion in the U.S.. The Access Initiative Project works with medical residency programs, educational institutions, health care associations, legal experts, public policy organizations, and interested individuals to ensure that qualified clinicians are able to get the training they need to provide safe abortions and that women can continue to have access to the quality health care they deserve.
- Almeling R, Tews L, and Dudley S. Abortion Training in U.S. Obstetrics and Gynecology Residency Programs, 1998. Family Planning Perspectives, 2000, 32(6):268-271 & 320.
- Guttmacher Institute. Facts in Brief: Induced Abortion. January, 2003.
- Henshaw SK, and Finer LB. The Accessibility of Abortion Services in the United States, 2001. Perspectives on Sexual and Reproductive Health, 2003, 35(1):16-24.
Statistical information in this fact sheet is based on research by The Guttmacher Institute and other members of the National Abortion Federation.
For unbiased information about abortion and other resources, including financial assistance, call toll-free 1-800-772-9100
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For referrals to quality abortion providers call 1-877-257-0012 (no funding assistance provided on this line).
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National Abortion Federation
1660 L Street, NW, Suite 450
Washington, DC 20036
Writers: Stephanie Mueller and Susan Dudley, PhD
Copyright© 1997, National Abortion Federation