It's been a tough year for reproductive justice in the U.S., with 24 states approving policies and legislation that limit women's access to reproductive health care. The passage of Texas' HB 2, which is still being appealed, has already shut down one third of the abortion clinics in a state that has long been limiting access particularly for women with limited resources including low-income women of color and immigrants living in border regions. Many fear the Texas laws will encourage other states to consider similar legislation.
The onslaught of abortion-restriction laws, particularly in the form of so-called Targeted Restriction to Abortion Providers (TRAP) and Prenatal Nondiscrimination Act (PRENDA) laws, ramped up in 2013, and the strategies for limiting access to reproductive health services seem to be expanding each year. According to a Bloomberg report, 73 abortion clinics have closed nationwide in the last two years.
It hasn't been all bad this year. California passed AB154, which expanded access to abortion in the state and allows for a wider pool of trained providers. A ban on medical abortions was narrowly avoided in Oklahoma, and advocates in Albuquerque successfully blocked what could have been the first ever municipal ban on abortion in the U.S.
But between the high-profile drama in Texas, and states like Mississippi, Kansas, North Dakota and Wisconsin, growing trends are worrisome to some advocates.
Elizabeth Nash, the state issues manager at the Gutmacher Institute, says that she expects to see more laws requiring abortion providers to meet ambulatory medical center standards or to have hospital admitting privileges, which come with various structural requirements that experts say are medically unnecessary, as well as attempts to limit medication abortions such as what we saw in Oklahoma.
"They've been so successful with standards for clinics and hospital privileges, it just makes sense that we would see it in 2014. I'm also expecting to see more restrictions around medication abortion provisions. There are laws in effect in 14 states restricting medical abortion, and I think we'll see that number grow," she says.
Women of color obtain a disproportionate number of abortions. For instance, black people make up 13.1 percent of the population but black women obtain 30 percent of abortions. Latinos make up 16.9 percent but account for 25 percent of abortions. Asian, Pacific Islander and Hawaiian natives comprise 5.3 percent of the population but according to the National Asian Pacific American Women's Forum, 35 percent of pregnancies end in abortion for Asian American and Pacific Islander women. And women of color are more likely to have an unwanted pregnancy, which experts say is directly connected to their access to reproductive healthcare, education, and contraceptives. Because the Hyde Amendment restricts federal funding for abortion services in most cases, low-income women who rely on Medicaid have an undue financial burden.
Organizations such as the Guttmacher Institute and the National Center for Reproductive Justice provide tons of state-specific data on abortion and contraception access, but here are a few states to look out for next year, and some of this year's wins and losses for reproductive rights.
What's going on: This spring the Arkansas legislature passed two abortion restriction laws--one that prohibits abortions after 12 weeks after a woman's last period, and another that bans the procedure 22 weeks after fertilization. Under Roe v. Wade, a fetus is considered "viable" outside of the womb at 24 weeks. Both of these laws aim to bump up that timeframe in a way that directly conflicts with the Supreme Court's existing ruling on abortion rights. The 12-week ban is particularly controversial because much like six-week bans considered in states such as Ohio and North Dakota, it is connected to detecting a heartbeat.
Upcoming in 2014: Both of these laws have been appealed, and will remain unenforced until the courts decide.
Who needs access: The Guttmacher Institute estimates that of the 317,720 women in Arkansas who need access to contraceptive services and supplies, 18 percent are black, 7 percent are Latina and 69 percent are white. Nineteen percent live below the federal poverty level.
What's going on: This spring the Florida House passed a measure that is version of PRENDA, which requires physicians to report abortions they suspect are are based on a fetus' gender.
Upcoming in 2014: This measure is expected to come to a Senate vote in 2014. Similar PRENDA laws have popped up in other states across the country.
Who needs access: The Guttmacher Institute estimates that of the 2,061,580 women in Florida who need access to contraceptive services and supplies, 19 percent are black, 26 percent are Latina and 49 percent are white. Fifteen percent live below the federal poverty level.
What's going on: This spring the Georgia legislature joined states such as South Carolina and Michigan in limiting the use of state health insurance plans for abortion coverage, except in cases where the mother's life is at risk. This eliminated coverage for abortions sought as a result of sexual assault or incest. Forty two percent of all state employees are people of color, and 48 percent are women.
Upcoming in 2014: The new healthcare plan requirements will go into effect in January 2014.
Who needs access: The Guttmacher Institute estimates that of the 1,189,220 women in Georgia who need access to contraceptive services and supplies, 35 percent are black, 9 percent are Latina and 49 percent are white. Sixteen percent live below the federal poverty level.
What's going on: Mississippi has only one functioning abortion clinic, and this year the state legislature increased restrictions on this last provider. The new law requires providers to report all medication abortions to the state's department of health and the FDA, and also prohibits the use of telemedicine for prescribing medical abortions--a new strategy developed to address the needs of rural women. The legislature also introduced a law similar to that passed in Texas that requires abortion providers to have hospital admitting privileges, which was temporarily blocked by a U.S. district court.
Upcoming in 2014: The medication abortion law goes into effect in July. The move to require hospital admitting privileges has not been completely struck down.
Who needs access: The Guttmacher Institute estimates that of the 335,430 women in Mississippi who need access to contraceptive services and supplies, 42 percent are black, 3 percent are Latina and 52 percent are white. Twenty one percent live below the poverty level.
What's going on: This year Gov. Nikki Haley (R) passed a budget that continues to prevent state employees from receiving abortion benefits under the state healthcare system and did not increase funding for family planning providers, such as Planned Parenthood.
Upcoming in 2014: Advocates are keeping a close eye on South Carolina because of its proximity to North Carolina, which passed an omnibus abortion-restriction law that, requires abortion clinics to meet ambulatory surgical standards, limits abortion coverage to state employees, and includes PRENDA provisions.
Who needs access: The Guttmacher Institute estimates that of the 530,550 women in South Carolina who need of access to contraceptive services and supplies, 31 percent are black, 5 percent are Latina and 60 percent are white. Eighteen percent live below the poverty level.
The Southwest and Texas
What's going on: Earlier this year a federal appeals court struck down two abortion restriction laws: one limiting access to family planning services for Medicaid patients, and another banning abortions after 18 weeks. In November the state asked the U.S. Supreme Court to reinstate the law. But the state also successfully blocked an attempt at a PRENDA law that would ban abortion based on sex selection.
Upcoming in 2014: The Supreme Court has not yet confirmed that they'll hear the state's case on the 18-week abortion ban. Because of the growing popularity of this particular type of abortion restriction legislation--it's been adopted in nine states--the Supreme Court's decision on whether to move forward is significant. Policy experts are expecting a vote as soon as January 2014.
Who needs access: The Guttmacher Institute estimates that of the 788,050 women in Arizona who need access to contraceptive services and supplies, 4 percent are black, 34 percent are Latina, and 51 percent are white. Sixteen percent live below the poverty level.
What's going on: Residents of Albuquerque, N.M. rejected a proposed 20-week ban on abortions this fall despite polling that suggested most residents would support it.
Upcoming in 2014: No new legislation has been proposed for 2014, but the well-known anti-abortion group Operation Rescue has been active in the state and was involved in the recently proposed legislation.
Who needs access: The Guttmacher Institute estimates that of the 240,530 women in New Mexico who need access to contraceptive services and supplies, 2 percent are black, 51 percent are Latina, and 34 percent are white. Eighteen percent live below the poverty level.
What's going on: The 2013 Texas abortion law saga ended in November as the Supreme Court refused to block HB 2. Already, an estimated one third of clinics have stopped providing services. In, El Paso one clinic halted abortion services because none of its doctors have hospital admitting privileges, one of the provisions of the law. Should all of El Paso's clinics stop providing services, those seeking abortions would have to travel 550 miles away to San Antonio for services. Such long distances put an additional strain on low-income women who bear the brunt of increased travel and lodging expenses, as well as potentially finding childcare and taking time off work.
Upcoming in 2014: Planned Parenthood of Texas and reproductive rights advocates plan to continuing appealing HB2. The ambulatory surgical standards requirement is expected to go into effect in September 2014.
Who needs access: The Guttmacher Institute estimates that of the more than three million women in Texas who need access to contraceptive services and supplies, 13 percent are black, 39 percent are Latina, and 40 percent are white. Seventeen percent live below the poverty level.
What's going on: The Kansas legislature passed an expansive abortion restriction bill this year that decreases access on multiple levels. Counseling regulations will requie providers to counsel women seeking abortions on a scientifically unproven link between the procedure and breast cancer. In addition, the bill increased penalties for those who knowingly assist a minor in obtaining an abortion; enacted a 20-week ban; included a PRENDA provision; denied abortion benefits to women with state health insurance plans; and denied state funding to organizations providing abortion services.
Upcoming in 2014: This law is expected to go into effect in July 2014.
Who needs access: The Guttmacher Institute reports that of the more than 322,990 in Kansas who are of age and in need of access to contraceptive services and supplies, 6 percent are black, 12 percent are Latina and 74 percent are white. Sixteen percent live below the poverty level.
What's going on: In December the Michigan legislature joined Texas, North Carolina and Ohio in restricting funding for abortion in private and public health insurance plans by requiring women who want abortion coverage to pay additional fees. The legislature also voted to increase budget allocations for adoption and anti-choice family planning services.
Upcoming in 2014: The bill has been openly opposed by more than one state senator, among them Senate Minority Leader Gretchen Whitmer (D) who disclosed having been raped during the Senate hearing. Legislators and reproductive justice advocates are considering a ballot drive in 2014 to override the law.
Who needs access: The Guttmacher Institute estimates that of the 1,113,390 women in Michigan who need of access to contraceptive services and supplies, 17 percent are black, 5 percent are Latina and 71 percent are white. Sixteen percent live below the poverty level.
What's going on: This year Wisconsin ended its legislative session without a final vote on a series of abortion restriction bills, some of which bar access to services and others that increase funding for anti-choice causes. Among them is the introduction of a "Choose Life," license plate for an additional fee, a PRENDA provision, and a move to restrict abortion services for state employees.
Upcoming in 2014: These and other provisions will be up for consideration when the state legislature goes back in session in January 2014.
Who needs access: The Guttmacher Institute reports that of the more than 636,030 in Wisconsin who are of age and in need of access to contraceptive services and supplies, 8 percent are black, 7 percent are Latina, and 79 percent are white. Fourteen percent live below the poverty level.
What's going on: The governor of North Dakota approved one of the most rigid time-limit bans on abortion this year. The so-called "heartbeat ban" is similar to that unsuccessfully introduced in Ohio earlier this year (and expected to be considered in Kansas) and restricts abortions based on when there is a detectable heartbeat.
Upcoming in 2014: This legislation was blocked by a federal appeals court in July, but the courts are still figuring out their next move and the law will be up for consideration again in the 2014. A final decision in North Dakota could pave the way for other states.
Who needs access: The Guttmacher Institute estimates that of the 75,590 women in North Dakota who need access to contraceptive services and supplies, 1 percent is black, 2 percent is Latina, and 86 percent is white. Fifteen percent live below the poverty level.