Our Bodies, Ourselves (74 page)

In May 2009, Dr. George Tiller, an abortion provider in Wichita, Kansas, became the latest victim of antiabortion extremists when he was shot and killed in his church. Because Dr. Tiller's clinic was one of only a handful in the United States known to offer later abortions, including third-trimester care for women with serious health conditions or carrying fetuses with anomalies, he had become the most prominent target of antiabortion extremists in the country. His death inspired much reflection and activism around the words he often proclaimed: “Trust women.”

A health care provider speaks about the impact of the violence:

The fear of violence has become part of the life of every abortion provider in the country. As doctors, we are being warned not to open big envelopes with no return addresses in case a mail bomb is enclosed. I know colleagues who have had their homes picketed and their children threatened. Some wear bullet-proof vests and have remote starters for their cars. Even going to work and facing the disapproving looks from coworkers—isolation and marginalization from colleagues is part of it
.

Many physicians continue to provide abortions, despite the difficulties, because they deeply believe in women's right to choose. Dr. Susan Robinson and Dr. Shelley Sella, two physicians who worked with Dr. Tiller in Wichita, say of their ongoing commitment to providing abortions:

Women have always needed abortions and will always need them. A very few will need abortions late in pregnancy. Rather than empathizing with these women and respecting their difficult decisions, society vilifies them and the providers who care for them. We believe it is a privilege to support women's decisions, to care for them, and to help turn their desperation into relief
.

Dr. Tiller believed that kindness, courtesy, justice, love, and respect are the cornerstones of the doctor-patient relationship. He believed that women are capable of struggling with complex ethical problems and arriving at the best decision for themselves and their families. We share this belief. We are proud to continue his legacy
.

Insurance funding for abortion has been a central battleground. When the Supreme Court decided
Roe v. Wade
in 1973, public and private insurers covered abortion as a surgical procedure. In 1976, Congress passed the Hyde Amendment, which banned federal funding for abortion through Medicaid (a joint state-federal program for low-income people) unless the woman's life was in danger. Though some Medicaid programs use state funds to provide abortion coverage, they cannot access federal funds to do so. Although Hyde has since been altered to include exceptions for pregnancies that are the result of rape and incest, many women who should be eligible for funding are unable to obtain it. A recent study of abortion providers' experiences billing for Medicaid coverage in these circumstances found that less than half of the eligible abortions were reimbursed and one state represented most of these reimbursements, meaning that many states do not comply with the law.
30

Twenty state Medicaid programs do not fund abortion under any circumstances.
31
When Medicaid is denied, poor women wait on average two to three weeks longer than other women to have an abortion because of difficulties in obtaining the necessary funds.
32
When abortion is delayed, health risks to the woman increase. A later second-trimester abortion is also more expensive than a first-trimester procedure.

Congress has extended the ban on federal funding for abortion to other groups, including military personnel and their dependents, federal employees and their dependents, teenagers participating in the Children's Health Insurance Program, members of the Peace Corps, disabled recipients of Medicare, federal prison inmates, and Native American women.
33

Some of the restrictions on federal funds are even more stringent than those applicable to poor women eligible for Medicaid. For example, women serving in the military cannot obtain a federally funded abortion even when the pregnancy results from rape or incest. In fact, military doctors and health care facilities cannot provide abortions even if women pay themselves.
34
Women must go to private hospitals and clinics, though these are not available in many regions where women are stationed.

Lack of funding continues to be a significant barrier to abortion for thousands of women each year. It has also continued to be a rallying point for opponents of abortion. In the 2009 debate over health care reform, antiabortion legislators succeeded in passing an amendment to the legislation that expanded restrictions on insurance coverage of abortion, effectively excluding abortion coverage for millions of women. (For more information on how health care reform affects women's reproductive health care choices, see “The Politics of
Reproductive Rights.”

Abortion rights opponents have persuaded many states and localities to adopt mandatory waiting periods—which require women to wait up to thirty-six hours between receiving state-imposed, often biased information, and being able to have an abortion. These requirements burden women and doctors with extra costs and stress and result in delays in women obtaining care.
35
As the number of abortion providers dwindles, more women must travel longer distances for abortion services, stay overnight and pay for a hotel, take time off from school or work, or arrange for child care.

Until the 1992 case of
Planned Parenthood v. Casey
, the Supreme Court held that these laws were unconstitutional, finding that they did not promote women's health or real choice but were designed to stop abortion and express state disapproval of women who sought them. However, in the
Casey
decision, the Court allowed states to impose “informed consent” and waiting periods. As of 2009, thirty-four states specified the information that women must receive before consenting to abortion and twenty-six states require that women wait between consent counseling and the abortion procedure. As with parental consent, state approaches are diverse.
36

Biased information laws in some states require that doctors give misleading information to women. For example, some states' written materials claim that abortion may be linked to an increased risk of breast cancer, despite the fact that the National Cancer Institute has concluded that no such link exists.
37
Similarly, some state materials discuss only the negative emotions a woman might experience after an abortion, entirely omitting the relief experienced by many women and ignoring the conclusion of the American Psychological Association that a
legal first-trimester abortion poses no greater risk of mental health problems to a woman than does carrying a pregnancy to term.
38
The goal of these biased information laws is not to give women information but to discourage abortion as an option.

Who Decides 2010
, NARAL Pro-Choice America Foundation

Parental consent and notification laws also restrict access to abortion for girls and young women under age eighteen. Currently thirty-four states have laws requiring some parental involvement.
39
As a result of these laws, some teens must seek judicial bypass (permission from a judge) or leave their home state and travel to states with less restrictive laws to obtain services.
40

Another strategy to erode abortion access is Targeted Regulation of Abortion Providers laws, also known as TRAP laws. These laws, in place in thirty-five states, impose burdensome and medically unnecessary requirements, which are sometimes extremely expensive to implement. For example, some states have passed laws requiring that the offices of physicians who provide abortions must meet health facility licensing requirements that are not imposed on other providers of comparable medical procedures. TRAP laws make abortion services more expensive and cumbersome for women, and they force the closure of some clinics. A law passed in 2010 in Virginia will likely cause seventeen of Virginia's twenty-one clinics to either close or spend millions of dollars in unnecessary and costly modifications to their clinics that do not enhance patient safety.

A more recent strategy of abortion rights opponents is to claim that because a fetus feels pain, later abortion should be banned. Several states have passed laws or introduced legislation saying that women must be told that fetuses feel pain or have set limits on how late women can seek abortions. In April 2010, Nebraska passed a law banning abortion after twenty-two weeks LMP (since a woman's last menstrual period) based on the claim that the fetus feels pain at that stage. The Nebraska law grants exceptions after twenty-two weeks LMP only in cases of medical emergency, the pregnant woman's imminent death, or a serious risk of “substantial and irreversible physical impairment of a major bodily function.” It excludes the woman's mental health as a reason for abortion.