How the threat of ‘taxpayer-funded abortion’ is being used to mobilize conservative religious voters

In the midterms, some religious voters may be motivated by the argument that if abortion is funded with tax dollars, it makes them personally complicit in sin.

The right to abortion is among the top issues on the ballot in several states. (AP Photo/Jacquelyn Martin, File)

October 26, 2022

By 

Ruth Braunstein

(The Conversation) — Following the U.S. Supreme Court’s ruling in Dobbs v. Jackson Women’s Health Organization and the wave of state-level abortion bans that followed, it might appear that anti-abortion activists could declare victory and go home.

However, from their perspective, a major threat still looms: Their tax dollars may be used to fund abortion in states where abortion is legal.

As it currently stands, several policies are in place that almost entirely prevent federal funds from being used to directly pay for abortion services. Since 1976, the Hyde Amendment has prohibited the public funding of abortion through Medicaid except in rare exceptions. In the years since, “Hyde-like restrictions” have been added to other federal healthcare programs, as well as to private insurance plans purchased through the health insurance exchanges established by the Affordable Care Act.

There are also restrictions on federal funds granted to organizations that provide reproductive healthcare for low-income women, like Planned Parenthood, such that these funds cannot be used for abortion services. Even so, anti-abortion activists insist that because money is fungible, any federal support for organizations that provide abortion services or counseling represents an indirect taxpayer subsidy to the “abortion industry.”

As such, despite the multitude of restrictions currently in place, anti-abortion activists promote the idea that Americans are nonetheless being forced to pay for abortions. When the Democratic Party declared in 2016 its intention to roll back these restrictions, framing them as unjust barriers to abortion access, anti-abortion activists only ramped up this existing rhetoric.

In the post-Dobbs world of the 2022 midterms, abortion debates are primarily focused on whether abortion will be legal, but anti-abortion leaders are also highlighting the implications of these laws for voters’ tax dollars.

This should not be surprising. In the course of my research on debates about taxpayer-funded abortion, I found that this threat has historically been used to motivate and mobilize anti-abortion voters. This message has especially resonated for those conservative evangelical Christians and Catholics who believe that when abortion is funded using their tax dollars, this makes them personally complicit in sin.

Opposition to public funding

The U.S. Council of Catholic Bishops has long been a central player in advocacy campaigns to “stop taxpayer funding of abortion.” As one message encouraging voters to support this advocacy puts it, “Don’t let our government force you to pay for the deaths of unborn children.”

This concern resonates for Catholic Republicans, more than 7 in 10 who oppose the use of public funds for abortion, according to an analysis of national survey data that I conducted in 2021 with scholars Andrew Whitehead and Ryan Burge. This opposition is even stronger among Republicans who identify as born-again or evangelical Christian – between 84% and 90%.

But abortion funding bans also appeal to fiscally conservative voters who oppose welfare spending in general, whether or not they are morally opposed to abortion. Since the 1970s, anti-abortion leaders have argued that “funding bans protected taxpayers’ wallets as well as their consciences,” according to the legal historian Mary Ziegler. National survey data my colleagues and I analyzed suggests that this argument continues to resonate. Six out of 10 Republicans with no religious affiliation support abortion funding bans; so do between 14% and 17% of Republicans who support legal abortion.

Opposition to taxpayer-funded abortion, even more than abortion itself, is a thread connecting religious and fiscal conservatives within the Republican coalition.

A winning strategy

Campaigns to prevent tax dollars from funding abortion have kept these anti-abortion activists and other Republican voters engaged and mobilized for decades, even when a ban on legal abortion itself seemed unlikely.

As one leader of an anti-abortion organization told me in a 2021 interview: “Ultimately, I think our focus should still remain on criminalizing [abortion]. … But I think in the meantime we also should oppose the taxpayer funding of it … just because it’s a winning strategy.”

This seems no less true post-Dobbs. As the midterms approach, I have found that Republican candidates and movement leaders are continuing to stoke fear about taxpayer-funded abortion in order to mobilize voters, especially religious conservatives.

Bill codifying federal abortion rights

A major issue energizing voters this cycle is the possibility that Congress might pass a bill codifying abortion rights. While the primary issue at stake is whether abortions would be legal nationwide, abortion opponents are quick to note that such a bill would also “force taxpayers to pay for them,” as the anti-abortion news website LifeNews.com put it.

Anti-abortion activists are motivating voters by saying that they would be forced to pay for abortions through their tax dollars.
AP Photo/Jose Luis Magana

Even in the absence of such a bill, abortion opponents are raising the alarm about existing Biden administration policies that allow public funds to be used for abortion services, like a new Pentagon policy that would “pay for service members to travel for abortion care.”

As reported by the Baptist Press, the Southern Baptist Ethics & Religious Liberty Commission raised concerns that “the interim rule forces taxpayers to fund the taking of preborn human lives.” Meanwhile, the Christian Right organization Concerned Women for America warned, “A baby has already been killed under this cruel ploy. … Not only that, but the Administration wants Americans to pay for it.”

Abortion on state-level ballots

Voters in several states are also directly deciding the fate of their states’ abortion laws in November 2022. In at least two of these states, anti-abortion leaders are highlighting the implications for voters’ tax dollars.

For example, in Kentucky, where a near-total abortion ban went into effect shortly after Dobbs, voters will decide whether to amend the state constitution to say, “To protect human life, nothing in this Constitution shall be construed to secure or protect a right to abortion or require the funding of abortion.”

Explaining why voters should vote “Yes for Life,” the chair of the campaign supporting the amendment led with its implications for taxpayers: “The constitutional amendment is very clear. It protects taxpayer dollars, and it makes sure there is not an interpreted right of abortion in the constitution.”

In Michigan, where a ballot measure called Proposal 3 would enshrine abortion rights, backlash from anti-abortion activists led by local Catholic organizations prominently features the claim that “If passed, Proposal 3 would result in taxpayer-funded abortion.”

Municipal politics

Cities dedicating public funds to abortion post-Dobbs have also faced scrutiny in the lead-up to the midterms, especially from conservative religious groups.

In Philadelphia, for example, anti-abortion activists represented by the conservative Catholic Thomas More Society have filed suit against city leaders “for illegally using taxpayer money to pay for abortions.” Only weeks before the election, the Pro-Life Union of Greater Philadelphia rallied supporters to a hearing on the case, pleading “Don’t let Mayor (Jim) Kenney get away with it!”

Abortion debates are certainly not only about how abortions will be paid for. But journalists and scholars often pay far too little attention to anti-abortion activists’ persistent focus on the possibility that some abortions will be paid for with their tax dollars. If history and current research is any guide, this threat resonates with a diverse array of Republicans and will be used to mobilize voters in 2022 and beyond.

Gloria Dickson and Brianna Monte, undergraduate research assistants at the University of Connecticut, contributed research to this piece.

(Ruth Braunstein, Associate Professor of Sociology, University of Connecticut. The views expressed in this commentary do not necessarily reflect those of Religion News Service.)

AMERIKA
What Self-Managed Abortion Care Means for Abortion Bans in 2022

APRIL 12, 2022
ANNA BERNSTEIN

FELLOW

Within the next few months, the U.S. Supreme Court will issue a ruling in Dobbs v. Jackson Women’s Health Organization, a decision that could gut or overturn entirely the right to abortion secured in Roe v. Wade. If Roe is overturned, half of states are likely to ban access to abortion. The urgency of this moment has heightened public awareness and media coverage of the state of abortion access in the country.

Along with this renewed attention, there has also been a resurgence of coathanger imagery and narratives that rely on the threat of a return to “back alley abortions.” Of course, before Roe (and, even more recently, since the Hyde Amendment), this was often the reality for those that could not afford or access safe and legal abortion care. My own great-grandmother lost her life as a result of complications from an unsafe abortion—a tragic loss that too many families experienced.

The reality of abortion care in 2022, though, is vastly different: safe methods of self-managed abortion care can help ensure pregnant people today do not suffer the same fate as my great-grandmother. The availability of medication abortion care means that abortion accessed outside of the health care system can be safe, and often more affordable, than in-clinic care. Not only does framing this care as inherently unsafe fail to capture the reality of present-day self-managed abortion care: it also further stigmatizes the practice.

It is possible—and necessary—to comprehend the gravity of this crisis in abortion access and know that people can self-manage their abortions safely.

We must acknowledge the tragedy of lives lost to unsafe abortion without perpetuating misunderstanding of what self-managed abortion care looks like today. It is possible—and necessary—to comprehend the gravity of this crisis in abortion access and know that people can self-manage their abortions safely. Understanding the current implications of abortion bans requires understanding the landscape of abortion access and self-managed abortion care in 2022; this commentary aims to support that understanding.

A Further Fracturing of Current Access

The potential fall of federal protections for abortion access will not result in changes to abortion laws across the country. Rather, without Roe in place, access to abortion care will become even more dependent on states. This is a continuation of a trend that has been on the rise in the past several decades, with some states passing increasingly restrictive laws and others legislating to proactively expand and safeguard access to abortion.

Because of the patchwork of laws restricting access to abortion care, it is already difficult for a great many patients to get the care they need. These medically unnecessary restrictions include TRAP laws, which often force clinics to close; policies restricting insurance coverage of abortion care; and waiting periods and two-visit requirements, which double travel time and missed work for patients. Bearing the brunt of this crisis are communities of color, people living with low incomes, undocumented individuals, young people, and other oppressed groups that may be unable to travel for their care. For those that are able to overcome barriers to abortion access, costs compound. And, unsurprisingly, for those whom abortion care remains out of reach, abortion denial has detrimental emotional, social, and economic effects.

With the abortion access landscape dependent on state legislation, it is common for patients to travel out-of-state for their care. The ability to do so, however, is limited to those with the financial means for transportation, often in addition to costs for lodging, time off from work, child care, and other expenses. These costs add up: one study found that over a quarter of abortion patients surveyed lost nearly $200 in wages, two-thirds spent close to $50 on transportation, and a small portion had to spend an average of $140 for lodging and related travel costs. These expenses are in addition to the median cost of over $500 paid for the abortion care itself—costs which are increasing and often paid entirely out-of-pocket because of restrictions on insurance coverage for abortion care. Abortion funds often step in to assist patients with these travel costs, but they should not have to: just like any other form of health care, individuals should be able to access abortion care in the communities where they live and work.

In the case of Texas—where meaningful access to abortion care has been virtually nonexistent since the implementation of a six-week ban in September—many residents have travelled to other states for their care. Since the law (SB8) has gone into effect, thousands of patients have been forced to seek care out-of-state each month. The more states that adopt abortion bans—as Oklahoma and Idaho have just moved to do—the more strain is put on states with greater access, and the farther patients have to travel to receive care. It is not feasible for clinics in “friendly” states to provide care to everyone who needs it, and neither is it feasible for patients to travel for care as those distances increase.

Legislators are now going so far as to attempt to prohibit abortions beyond their states’ borders. Disturbingly, a Missouri lawmaker has just introduced legislation that stops patients from seeking care out-of-state and penalizes individuals that help patients do so. Self-managed abortion care allows individuals to access care without the potentially prohibitive burdens of travel.

The Reality of Self-Managed Care

The availability of medication abortion has changed the landscape of self-managed abortion care, particularly over the last fifteen years. Medication abortion care, with the most common regimen in the United States being comprised of two drugs (mifepristone and misoprostol), is overwhelmingly safe and effective. It is also growing in popularity: medication abortion care now accounts for over half of all abortions in the country.

Medication abortion can be administered safely via telehealth and with varying levels of involvement from the formal health system, including through self-management. Notably, the World Health Organization recently released new abortion care guidelines that note the following:

“…from the perspective of the health system, self-management should not be considered a ‘last resort’ option or a substitute for a non-functioning health system. Self-management must be recognized as a potentially empowering and active extension of the health system and task-sharing approaches.”

In response to the severe limitations on access to abortion in Texas, there has been a corresponding surge in demand for self-managed care. After SB8 went into effect, Aid Access (a non-profit that provides self-managed medication abortion care) saw a substantial increase in requests for their services. In the week after the law went into effect, the average number of daily requests surged from around eleven to over 135, and even after this initial peak, requests for the next three weeks were still nearly 2.5 times higher than before the law was implemented. It has even been suggested that out-of-state care and requests for medication abortion care combined may have offsest the decrease seen in abortions provided to Texas residents. However, as noted by Dr. Daniel Grossman (a clinical and public health researcher and director of the research organization ANSIRH), orders for abortion pills do not necessarily translate to receipt of abortion care—and, regardless, patients should not have to go outside the health system to receive this basic health care.

No one should be prosecuted for their pregnancy outcomes, including self-managed abortion care, and these laws pose a particular threat to communities of color.

Although self-managed abortion care is safe in terms of health risks, it can unfortunately carry legal dangers. The many laws that have been used to criminalize pregnancy outcomes include those that directly target self-managed abortion care, as well as laws criminalizing harm to fetuses; these are often arcane laws that have been on the books for decades, but are used in modern efforts to prosecute self-managed care. Moreover, archaic policies that criminalize individuals who provide abortion care have been used in attempts to prosecute the pregnant individuals themselves when abortion care is self-managed.1 These laws are not only dangerous to the people who have been—and will be—prosecuted, but may also deter individuals from seeking necessary care after experiencing miscarriages and stillbirths. No one should be prosecuted for their pregnancy outcomes, including self-managed abortion care, and these laws pose a particular threat to communities of color, who are already over-policed and overcriminalized.

What Can Be Done Now

Abortion care is already out of reach for too many people in the United States, and if Roe is overturned, access will be vastly more limited. As the dire situation in Texas has taught us, addressing access to medication abortion care and self-managed care in particular will become even more urgent.

It is crucial that people who self-manage their abortions are supported and not criminalized. State legislatures should repeal laws criminalizing pregnancy outcomes, and pass legislation that protects individuals from prosecution based on suspected self-managed abortion care; the Department of Justice (DOJ) should support these efforts. Medically accurate information should also be made available for those who are considering self-managed care: the Department of Health and Human Services (HHS) can develop these materials and provide guidance to clarify that mandatory reporting laws do not apply to people who self-manage their abortion care. Agencies like DOJ and HHS must be involved in the whole-of-government efforts to safeguard abortion access that President Biden called for last September in response to Texas’ SB8—a call the administration recently reiterated after Idaho adopted a similar law.

Medication abortion care, self-managed or not, should also be made more accessible: in particular, the policies that govern the provision of mifepristone must align with its robust record of safety. The recent removal of the in-person dispensation requirement for mifepristone is an important step toward making medication abortion care more widely accessible. However, it will not help individuals living in the nineteen states where telemedicine use for medication abortion care is banned. More must be done to remove all of the unnecessary restrictions on medication abortion care, and to ensure its availability in all states. This must go hand-in-hand with maintaining access to procedural care for patients who require or prefer in-clinic care.

Federal legislation such as the Equal Access to Abortion Coverage in Health Insurance (EACH) Act, which would allow for coverage of abortion care under federal insurance programs and facilities, and the Women’s Health Protection Act (WHPA), which would prohibit medically unnecesary restrictions on abortion care, are necessary to make abortion affordable and accessible. Although unsuccessful, the Senate’s recent vote on WHPA was historic. The chamber should follow the lead of the House of Representatives and pass EACH and WHPA.

As we await the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization, acting on these policy recommendations is crucial—but these are not the only tools we have. Now more than ever, abortion funds need support: both funds within the states that are restricting abortion and those in states receiving an influx of patients. Abortion funds and other practical support networks have already been assisting patients in traveling for abortion care, and this need will only increase.

Further, we must actively work towards destigmatizing self-managed abortion care—and this can be as simple as using the right language when we talk and write about abortion. As we consider a post-Roe future, it is past time to understand self-managed abortion care as a safe and legitimate option, and support those who choose it.

HEADER PHOTO: PROTESTERS, DEMONSTRATORS AND ACTIVISTS GATHER IN FRONT OF THE U.S. SUPREME COURT AS THE JUSTICES HEAR ARGUMENTS IN DOBBS V. JACKSON WOMEN’S HEALTH, A CASE ABOUT A MISSISSIPPI LAW THAT BANS MOST ABORTIONS AFTER 15 WEEKS IN WASHINGTON, DC. SOURCE: CHIP SOMODEVILLA/GETTY IMAGES

Notes
If/When/How has resources available for those in need of legal assistance, including a legal defense fund and a confidential helpline.




Anna Bernstein, Fellow
Anna Bernstein is a health care policy fellow at The Century Foundation, where she works on issues related to maternal and reproductive health.

COMMENTARY HEALTH CARE

State of Emergency: What’s At Stake for Abortion and Voting Rights as Roe v. Wade Turns Forty-Nine?

JANUARY 21, 2022

 BY ANNA BERNSTEIN

PODCAST OFF-KILTER PODCAST
Off-Kilter Podcast: The End of Roe v. Wade?

DECEMBER 3, 2021

BY REBECCA VALLAS, JAMILA TAYLOR AND ANNA BERNSTEIN

COMMENTARY HEALTH CARE
5 Things to Know about Abortion Access as Supreme Court Hears Dobbs v. JWHO 

NOVEMBER 30, 2021

BY ANNA BERNSTEIN AND JAMILA TAYLOR

REPORT HEALTH CARE
Medication Abortion Care Is Safe and Effective—It’s Time Everyone Has Equal Access

SEPTEMBER 28, 2021

BY ANNA BERNSTEIN

The 'roller coaster' state of abortion access 50 years after Roe v. Wade was decided


Kate Murphy
·Producer
Fri, January 20, 2023 

From left: Pro-abortion-rights protesters in New York City, 1970s; abortion-rights activists in Times Square following the Supreme Court decision overturning Roe v. Wade, June 2022. (H. Armstrong Roberts/Classicstock/Getty Images, Lev Radin/Pacific Press/LightRocket via Getty Images)


Sunday marks the 50th anniversary of the 1973 Roe v. Wade ruling by the Supreme Court that legalized abortion nationwide. But it’s also the first anniversary after the ruling was overturned last June, when the high court determined in Dobbs v. Jackson Women’s Health Organization that abortion access wasn’t protected under constitutional law. Since then, the issue has been left up to the states to decide.

As of Jan. 20, there are 14 states where abortion is unavailable, according to the Guttmacher Institute, a research organization that supports abortion rights.

“There are about 75 million women of reproductive age, from 15 to 49, in the country. And in these 14 states where abortion is unavailable, that affects nearly 18 million women of reproductive age,” Elizabeth Nash, a policy expert at the Guttmacher Institute, told Yahoo News.


A patchwork of abortion restrictions and bans are shaping the post-Roe landscape in the U.S. since it was overturned.

“Over the past seven months, it has been a roller coaster around states banning abortion,” Nash said. “Some states [have had] their abortion bans blocked by courts; other states have been able to enforce their bans.”

While restrictions on abortion have been implemented, progress has also been made to gain abortion access. Nash spoke to Yahoo News about where the state of abortion access currently stands and what to look out for in 2023. (Some answers have been edited for length and clarity.)

Yahoo News: Since the overturning of Roe v. Wade, how has abortion access changed?

Elizabeth Nash: We’ve really seen a deterioration in access across a large part of the country, particularly the South, the Plains and the Midwest, where as of Jan. 20 we have 14 states where abortion is unavailable. And then along the coasts and in states like Illinois, we’ve really seen policymakers step up to expand access. So we're really seeing the political fault lines coming to what is happening with abortion.

What are some examples of abortion bans and restrictions that have been put in place?

A number of abortion bans are in the South, and that means that these states are next to each other, meaning someone has to travel much further than one state over — they may be traveling across three or four states.

When we're talking about these states where there are abortion bans in place, many of them do have some exceedingly limited exceptions. And these exceptions do not provide meaningful access in any way, because it’s very difficult to meet the criteria. These exceptions are narrowly tailored, and the penalties are so steep that providers simply cannot provide care even if you meet the criteria. Someone has to become, for example, extremely ill in order to obtain an abortion.

For providers, the penalties are very steep. They involve jail time and fines and potentially loss of license. If they were to provide an abortion under the exceptions, they're really putting their livelihoods at risk.

On the flip side, what are some examples of abortion protections that have been enacted?

As abortion rights fall at the federal level, we saw states start to step up, and 77 abortion protections were enacted in 2022. That’s the highest number ever.

The types of protections that are put into place are policies and programs like funding abortion to help people get care and expanding the types of clinicians that can provide abortions.

Some states have also put in place legal protections for providers and patients so that care remains available. These legal protections are things like preventing an abortion-ban state from prosecuting a provider in an access state; not requiring the access state to help with an investigation of a provider; preventing extradition and preventing summons and subpoenas from being issued.

What legal action has been taken at the state level to expand abortion access, and what should we expect in 2023?

In South Carolina, the state Supreme Court just struck down the six-week abortion ban, saying that privacy rights in the state constitution include abortion. This is a very important case because it means that the six-week ban is not going into effect and that abortion will remain available in South Carolina. The state has a very conservative Legislature that is coming into session, and we’re anticipating they will try to adopt more restrictions on abortion.

We may see similar outcomes with other abortion bans under other state constitutions. We have cases pending in states like Utah and Wyoming, for example, so there's a lot more to come on abortion bans and the courts and legislatures as we go into legislative sessions after the fall of Roe.

What’s ahead for medication abortion access?

Because abortion pills can be mailed and you can access them through an online platform, abortion opponents are paying attention. We're expecting that we will see more restrictions debated and enacted at the state level on medication abortion, despite the fact that the Food and Drug Administration has rolled back some of their restrictions on abortion pills. They are now also in the process of setting up pharmacy access for abortion pills, and that is fueling more restrictions at the state level on medication abortion.

What should we expect in 2023 regarding further restrictions on abortion?

We’re going to see a lot of experimentation when it comes to legislation being introduced on abortion. We will see which trends stick and which ones don’t. We're anticipating that more states are going to seek to ban abortion. We’re anticipating that states that have banned abortion will try to tighten the screws on abortion access further. And then we’re expecting the progressive states to continue to step up and expand access.

Association of Travel Distance to Nearest Abortion Facility With Rates of Abortion

Kirsten M. J. Thompson, MPH¹; Hugh J. W. Sturrock, PhD²; Diana Greene Foster, PhD³; et alUshma D. Upadhyay, PhD, MPH³

Author Affiliations Article Information

JAMA Netw Open. 2021;4(7):e2115530. doi:10.1001/jamanetworkopen.2021.15530

Original Investigation 

Obstetrics and Gynecology

July 6, 2021

Key Points

Question  Is there an association between median travel distance to an abortion facility and abortion rate?

Findings  In this cross-sectional geographic analysis of US counties, increases in median travel distance to the nearest abortion care facility were associated with significant reductions in median abortion rate (21.1 per 1000 female residents of reproductive age for <5 miles; 3.9 per 1000 female residents of reproductive age for ≥120 miles). Reductions in travel distances were associated with significant increases in the median abortion rate (telemedicine simulation, 10.2 per 1000 female residents of reproductive age).

Meaning  In this study, the abortion rates declined as travel distance to an abortion care facility increased, and modeling suggests the need for abortion care can be only partially met through service delivery innovations.

Abstract

Importance  Travel distance to abortion services varies widely in the US. Some evidence shows travel distance affects use of abortion care, but there is no national analysis of how abortion rate changes with travel distance.

Objective  To examine the association between travel distance to the nearest abortion care facility and the abortion rate and to model the effect of reduced travel distance.

Design, Setting, and Participants  This cross-sectional geographic analysis used 2015 data on abortions by county of residence from 1948 counties in 27 states. Abortion rates were modeled using a spatial Poisson model adjusted for age, race/ethnicity, marital status, educational attainment, household poverty, nativity, and state abortion policies. Abortion rates for 3107 counties in the 48 contiguous states that were home to 62.5 million female residents of reproductive age (15-44 years) and changes under travel distance scenarios, including integration into primary care (<30 miles) and availability of telemedicine care (<5 miles), were estimated. Data were collected from April 2018 to October 2019 and analyzed from December 2019 to July 2020.

Exposures  Median travel distance by car to the nearest abortion facility.

Main Outcomes and Measures  US county abortion rate per 1000 female residents of reproductive age.

Results  Among the 1948 counties included in the analysis, greater travel distances were associated with lower abortion rates in a dose-response manner. Compared with a median travel distance of less than 5 miles (median rate, 21.1 [range, 1.2-63.6] per 1000 female residents of reproductive age), distances of 5 to 15 miles (median rate, 12.2 [range, 0.5-23.4] per 1000 female residents of reproductive age; adjusted coefficient, −0.05 [95% CI, −0.07 to −0.03]) and 120 miles or more (median rate, 3.9 [range, 0-12.9] per 1000 female residents of reproductive age; coefficient, −0.73 [95% CI, −0.80 to −0.65]) were associated with lower rates. In a model of 3107 counties with 62.5 million female residents of reproductive age, 696 760 abortions were estimated (mean rate, 11.1 [range, 1.0-45.5] per 1000 female residents of reproductive age). If abortion were integrated into primary care, an additional 18 190 abortions (mean rate, 11.4 [range, 1.1-45.5] per 1000 female residents of reproductive age) were estimated. If telemedicine were widely available, an additional 70 920 abortions were estimated (mean rate, 12.3 [range, 1.4-45.5] per 1000 female residents of reproductive age).

Conclusions and Relevance  These findings suggest that greater travel distances to abortion services are associated with lower abortion rates. The results indicate which geographic areas have insufficient access to abortion care. Modeling suggests that integrating abortion into primary care or making medication abortion care available by telemedicine may decrease unmet need.

Introduction

In the US, increasing travel distance or travel time to a health care clinician is associated with less use of preventive care and poorer health outcomes for women, including reduced use of mammography,^1,2 later stage at diagnosis of breast cancer,^3,4 and reduced use of risk-appropriate colonoscopy.⁵ County-level analyses of pregnancy-related outcomes have shown spatial relationships in rates of prenatal care use,⁶ and the closure of rural hospitals not adjacent to urban areas was associated with increased preterm births in the following year.⁷

Abortion is a common reproductive health care service, with 1 in 4 US women obtaining this care during their lifetime.⁸ However, many states have implemented policies restricting abortion care clinicians and facilities (hereinafter referred to as abortion providers).⁹ Studies of these policies have documented clinic closures and women unable to obtain abortion care, with disproportionate effects on low-income women and non-White women.^10,11 Increased travel for an abortion is associated with delays in care, increased costs, and stress.^10,12 Even when women are able to obtain abortion care, greater travel distance has been associated with decreased odds of returning to the abortion facility for follow-up care and increased odds of visiting an emergency department.¹³

Research in a variety of settings has indicated that the farther a woman lives from an abortion care facility, the less likely she is to obtain that care. These studies used distance or travel time to an abortion provider as a measure of potential rather than realized access.¹⁴ Regional research has focused on California, Texas, New York, and Wisconsin^11,15-18; national analyses have focused on disparities in access.^19-21 One longitudinal, econometric study in 18 states²² found an association between travel distance and abortion rate but did not generate interpretable abortion rates.

We conducted a national analysis to test the hypothesis that greater travel distance to the nearest abortion facility is associated with lower abortion rates and to provide estimated abortion rates under actual conditions and alternate assumptions of abortion access. We extend the literature by estimating changes in abortion rate under 2 travel distance scenarios: less than 30 miles (48 km), a common definition of network adequacy for primary care,²³ and less than 5 miles (8 km), a simulation of medication abortion by telemedicine

READ ON...

Association of Travel Distance to Nearest Abortion Facility With Rates of Abortion | Health Disparities | JAMA Network Open | JAMA Network

Supreme Court justices’ views on abortion in their own words and votes

The justices have had a lot to say about abortion over the years — in opinions, votes, Senate confirmation testimony and elsewhere


J. Scott Applewhite, The Associated Press In this Oct. 4, 2021 photo, the Supreme Court is seen on the first day of the new term, in Washington. Abortion already is dominating the Supreme Court’s new term, months before the justices will decide whether to reverse decisions reaching back nearly 50 years. Not only is there Mississippi’s call to overrule Roe v. Wade, but the court also soon will be asked again to weigh in on the Texas law banning abortion at roughly six weeks.

By MARK SHERMAN and JESSICA GRESKO | The Associated Press
PUBLISHED: October 11, 2021 

WASHINGTON — Abortion already is dominating the Supreme Court’s new term, months before the justices will decide whether to reverse decisions reaching back nearly 50 years. Not only is there Mississippi’s call to overrule Roe v. Wade, but the court also soon will be asked again to weigh in on the Texas law banning abortion at roughly six weeks.

The justices won’t be writing on a blank state as they consider the future of abortion rights in the U.S. They have had a lot to say about abortion over the years — in opinions, votes, Senate confirmation testimony and elsewhere. Just one, Clarence Thomas, has openly called for overruling Roe and Planned Parenthood v. Casey, the two cases that established and reaffirmed a woman’s right to an abortion. Here is a sampling of their comments:

Chief Justice John Roberts

Roberts voted to uphold restrictions in two major abortion cases, in the majority in 2007 to uphold a ban on a method of abortion opponents call “partial-birth abortion” and in dissent in 2016 when the court struck down Texas restrictions on abortion clinics in a case called Whole Woman’s Health. But when a virtually identical law from Louisiana came before the court in 2020, Roberts voted against it and wrote the opinion controlling the outcome of the case and striking down the Louisiana law. The chief justice said he continues to believe that the 2016 case “was wrongly decided” but that the question was “whether to adhere to it in deciding the present case.”

Roberts’ views on when to break with court precedent could determine how far he is willing to go in the Mississippi case. At his 2005 confirmation hearing, he said overturning precedent “is a jolt to the legal system,” which depends in part on stability and evenhandedness. Thinking that an earlier case was wrongly decided is not enough, he said. Overturning a case requires looking “at these other factors, like settled expectations, like the legitimacy of the Court, like whether a particular precedent is workable or not, whether a precedent has been eroded by subsequent developments,” Roberts said then.

In the same hearing, Roberts was asked to explain his presence on a legal brief filed by the George H.W. Bush administration that said Roe’s conclusion that there is a right to abortion has “no support in the text, structure, or history of the Constitution.’ Roberts responded that the brief reflected the administration’s views.

Justice Clarence Thomas

Thomas voted to overturn Roe in 1992, in his first term on the court, when he was a dissenter in Planned Parenthood v. Casey. He has repeatedly called for Roe and Casey to be overturned since.

In 2000, he wrote in dissent when the court struck down Nebraska’s ban on “partial-birth abortion.” Recounting the court’s decision in Roe, he wrote, “In 1973, this Court struck down an Act of the Texas Legislature that had been in effect since 1857, thereby rendering unconstitutional abortion statutes in dozens of States. As some of my colleagues on the Court, past and present, ably demonstrated, that decision was grievously wrong. Abortion is a unique act, in which a woman’s exercise of control over her own body ends, depending on one’s view, human life or potential human life. Nothing in our Federal Constitution deprives the people of this country of the right to determine whether the consequences of abortion to the fetus and to society outweigh the burden of an unwanted pregnancy on the mother. Although a State may permit abortion, nothing in the Constitution dictates that a State must do so.”

Justice Stephen Breyer

Breyer has been the lead author of two court majorities in defense of abortion rights, in 2000 and 2016. He has never voted to sustain an abortion restriction, but he has acknowledged the controversy over abortion.

Millions of Americans believe “that an abortion is akin to causing the death of an innocent child,” while millions of others “fear that a law that forbids abortion would condemn many American women to lives that lack dignity,” he wrote in the Nebraska case 21 years ago, calling those views “virtually irreconcilable.” Still, Breyer wrote, because the Constitution guarantees “fundamental individual liberty” and has to govern even when there are strong divisions in the country, “this Court, in the course of a generation, has determined and then redetermined that the Constitution offers basic protection to the woman’s right to choose.”

Justice Samuel Alito

Alito has a long track record of votes and writings opposing abortion rights, as a jurist and, earlier, a government lawyer.

Alito has voted to uphold every abortion law the court has considered since his 2006 confirmation, joining a majority to uphold the federal “partial-birth” abortion law and dissenting in the 2016 and 2020 cases.

As a federal appeals court judge, he voted to uphold a series of Pennsylvania abortion restrictions, including requiring a woman to notify her spouse before obtaining an abortion. The Supreme Court ultimately struck down the notification rule in Casey and reaffirmed the abortion right in 1992 by a 5-4 vote.

Working for the Reagan administration in 1985, Alito wrote in a memo that the government should say publicly in a pending abortion case “that we disagree with Roe v. Wade.” Around the same time, applying for a promotion, Alito noted he was “particularly proud” of his work arguing “that the Constitution does not protect a right to an abortion.”

Justice Sonia Sotomayor

Sotomayor joined the court in 2009 with virtually no record on abortion issues, but has voted repeatedly in favor of abortion rights since then. Recently, when the court allowed Texas’ restrictive abortion law to take effect, Sotomayor accused her colleagues of burying “their heads in the sand.” She was in the majority in the Texas and Louisiana abortion clinic cases.

Sotomayor’s displeasure with the court’s recent Texas ruling was evident at a recent virtual appearance she made. “I can’t change Texas’ law, but you can,” she said.

Justice Elena Kagan

Kagan also has repeatedly voted in favor of abortion rights in more than 11 years as a justice. She is also arguably the most consistent voice on the court arguing for the importance of adhering to precedents and can be expected to try to persuade her colleagues not to jettison constitutional protections for abortion.

Kagan was in the majority when the court struck down the Texas and Louisiana restrictions on abortion clinics. More recently, Kagan called Texas’ new abortion law “patently unconstitutional” and a “clear, and indeed undisputed, conflict with Roe and Casey.”

Kagan had already grappled with the issue of abortion before becoming a justice. While working in the Clinton White House she was the co-author of a memo that urged the president for political reasons to support a late-term abortion ban proposed by Republicans in Congress, so long as it contained an exception for the health of the woman. Ultimately, President George W. Bush signed a similar late-term abortion ban without a health exception. The Supreme Court upheld it.

Justice Neil Gorsuch

Gorsuch has perhaps the shortest record on abortion among the nine justices. He was in the majority allowing Texas’ restrictive abortion law to take effect. In dissent in 2020, he would have upheld Louisiana’s abortion clinic restrictions. As an appeals court judge before joining the Supreme Court in 2017, Gorsuch dissented when his colleagues declined to reconsider a ruling that blocked then-Utah Gov. Gary Herbert from cutting off funding for the state branch of Planned Parenthood. But Gorsuch insisted at his Senate confirmation hearing that he was concerned about procedural issues, not the subject matter. “I do not care if the case is about abortion or widgets or anything else,” he said.

Justice Brett Kavanaugh

Kavanaugh’s name was added to former President Donald Trump’s shortlist of Supreme Court candidates shortly after he sided with the administration in a 2017 case involving abortion. Trump chose him for the court the following year. As a justice, Kavanaugh dissented from the Louisiana decision and voted to allow the new Texas law to take effect, though he has taken a less absolutist stance than some of his conservative colleagues. In the Louisiana case, for example, Kavanaugh wrote that more information was needed about how the state’s restrictions on clinics would affect doctors who provide abortions and seemed to suggest his vote could change knowing that information.

Kavanaugh’s most extensive writing on abortion came while he was a judge on the federal appeals court in Washington. The Trump administration had appealed a lower court ruling ordering it to allow a pregnant 17-year-old immigrant in its custody to get an abortion. The administration’s policy was to decline to help those minors get abortions while in custody.

Kavanaugh was on a three-judge panel that postponed the abortion, arguing that officials should be given a limited window to transfer the minor out of government custody to the care of a sponsor. She could then obtain an abortion without the government’s assistance. The full appeals court later reversed the decision and the teenager obtained an abortion. Kavanaugh called that decision out-of-step with the “many majority opinions of the Supreme Court that have repeatedly upheld reasonable regulations that do not impose an undue burden on the abortion right recognized by the Supreme Court in Roe v. Wade.”

Kavanaugh was criticized by some conservatives for not going as far as a colleague, Judge Karen Henderson, who stated unambiguously that an immigrant in the U.S. illegally has no right to an abortion. At his appeals court confirmation hearing, Kavanaugh dodged questions on his own personal beliefs on Roe v. Wade.

Justice Amy Coney Barrett

Barrett’s one public vote on the Supreme Court concerning abortion was to allow the Texas “fetal heartbeat” law to take effect. She also cast two votes as an appeals court judge to reconsider rulings that blocked Indiana abortion restrictions.

In 2016, shortly before the election that would put Trump in office, she commented about how she thought abortion law might change if Trump had the chance to appoint justices. “I … don’t think the core case — Roe’s core holding that, you know, women have a right to an abortion — I don’t think that would change,” said Barrett, then a Notre Dame law professor. She said limits on what she called “very late-term abortions” and restrictions on abortion clinics would be more likely to be upheld.

Barrett also has a long record of personal opposition to abortion rights, co-authoring a 1998 law review article that said abortion is “always immoral.” At her 2017 hearing to be an appeals court judge, Barrett said in written testimony, “If I am confirmed, my views on this or any other question will have no bearing on the discharge of my duties as a judge.”