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

Despite restrictions and bans, abortions rose across the U.S. according to new data

Nicole Karlis
Wed, May 15, 2024

Package with boxes of Mifepristone Photo illustration by Salon/Getty Images


Since the U.S. Supreme Court overturned Roe v. Wade nearly two years ago, eliminating the constitutional right to access abortion, 14 states have nearly totally banned abortions. The implications have varied from forcing women to carry unwanted or unviable pregnancies to term to women being forced to spend thousands of dollars to travel out of state to influencing where medical students attend their residency programs.

But one thing the restrictive landscape hasn’t done? Reduce the number of abortions happening nationwide.

According to a new report released this week by the Society of Family Planning's WeCount project, the number of abortions in the U.S. has continued to rise slightly since Roe was overturned. In 2023, there were on average 86,000 abortions per month compared to 2022 when there were about 82,000 abortions per month.

While the researchers don’t have their own data from pre-Dobbs, a previous study estimated that in 2020 slightly more than 930,000 abortions occurred in the United States in 2020, averaging about 77,500 per month. The same study estimated that abortion numbers had increased between 2017 and 2020 after decades of the annual number of abortions declining.

WeCount collected their data thanks to their database of all clinics, private medical offices, hospitals and virtual clinic-abortion providers in the United States. Leveraging this database, providers submit the monthly number of abortions. WeCount synthesizes the data and creates imputations for the clinics that don't send their data.

“We're finding that there were a slightly higher number of abortions in 2023 compared to the data we collected in 2022,” Ushma Upadhyay, a professor and public health scientist at the University of California, San Francisco who co-led the research, told Salon in a phone interview. “We’re also able to look at the loss in states with either total abortion bans or six-week bans, and we found that there are about 180,000 fewer abortions in the 18 months since the Dobbs decision in those states.”

These cumulative declines were most notable in Texas, Georgia, Tennessee, Louisiana and Alabama. Notably, the data found that accessing abortion care via telehealth has been a “game changer,” Upadhyay emphasized.

In a telehealth medication abortion, a patient typically talks to a provider over video or a secured chat platform. If the patient is less than 10 weeks pregnant and found to be eligible, the provider can prescribe the patient mifepristone, which blocks pregnancy hormones, and then misoprostol, which causes uterine contractions. The medicines can be delivered via a mail-order pharmacy even to those in states where abortions are nearly completely banned.

According to the report, more than 40,000 people in states with abortion bans and telehealth restrictions received medication abortion through providers in states protected by shield laws between July and December 2023.

Want more health and science stories in your inbox? Subscribe to Salon's weekly newsletter Lab Notes.

“Telehealth has really opened up access for people living in ban states who previously didn't have many other options,” Upadhyay said. “This is an option that their state may not see as legal, but the states providing the care see these as a fully legal option.”

Telehealth can help patients from having to travel many hours to access care, take time off or find childcare — and it’s also less expensive than in-person care.

“This care often does not even require an appointment. Some providers offer it in an asynchronous way, meaning that when the patient comes to the website, completes their medical history information and then any questions, a provider will review it,” Upadhyay said. “Patients that are able to do the entire process from the comfort of their home or even at their work. They don't actually have to take time off of work to communicate with their providers.”

Elisa Wells, co-founder and co-director of Plan C, a non-profit abortion access group, told Salon in a phone interview that she wasn’t surprised to see the increase in abortion numbers in the #WeCount report.

“Abortion is a common health need and as there is more information about abortion and abortion access available through the press — and in part because of these bans — I think people are considering how abortion fits into their lives and utilizing the service that they know is right for them," Wells told Salon. “So we're not at all surprised, and we also know that the WeCount numbers are an undercount because they do not account for the self-managed abortion option.”

At the same time, this is happening as anti-abortion legislators are targeting medication abortion and trying to restrict access. In Louisiana, a bill proposed by a Republican state senator would classify mifepristone and misoprostol as Schedule IV "controlled dangerous substances," essentially lumping it in the same category as sedatives like Xanax and Ambien. Meanwhile, the country is still waiting for the U.S. Supreme Court to make a decision on a case that would restrict access to mifepristone nationwide, and eliminate access to mifepristone by telehealth and by mail.

In other words — and in spite of the fact that self-managed abortions are safer than ever — the future of abortion access is not guaranteed. Even if telehealth access is not eroded, Upadhyay emphasized this data shouldn’t be interpreted as “all of the demand in states with abortion bans” is being met.

“Our biggest concern is that it will be overlooked that there are many, thousands of people living in states with bans who are unable to access abortion that are being forced to carry their unwanted pregnancies to term,” she said. “It's so important that people have healthcare in the communities where they live.”


US support for abortion rights up four points to 60% since fall of Roe v Wade

Carter Sherman
Tue, May 14, 2024

An abortion rights protester in Houston.Photograph: Callaghan O’Hare/Reuters


In the two years after the US supreme court overturned Roe v Wade, leading to abortion bans across many parts of the south and midwest, abortion rights have only grown more popular, new polling from Pew research Center has found.

A majority of Americans has long supported abortion rights. But more than 60% of Americans now believe abortion should be legal in all or most cases – a four percentage-point jump from 2021, the year before Roe fell.

This support transcends numerous demographic divides in US society: most men, women, white people, Black people, Hispanic people and Asian people believe abortion should be legal in all or most cases. It extends to majorities of all age groups and education levels, although 18-to-29-year-olds and people with more education are more likely than other cohorts to believe abortion should be legal in all or most cases.Interactive

People who live under abortion bans have also become increasingly supportive of abortion access since the overturning of Roe in June 2022. In August 2019, only 30% of people who live in states where abortion is now outlawed said they believed it should be easier to access abortion. Today, 42% of people in the same states say that.

The broad support for abortion may prove pivotal in the upcoming US elections – Joe Biden’s re-election campaign has zeroed in on abortion as a winning issue as the president continues to trail Donald Trump in polls. Battleground states such as Arizona and Nevada are expected to hold ballot measures to protect abortion rights, which Democrats hope will boost both voter turnout and their own chances.

Democrats are far more likely than Republicans to support abortion rights, with 85% of Democrats and Democratic-leaning voters believing that abortion should be legal in all or most circumstances. By contrast, 41% of Republican or Republican-leaning voters said the same.

GOP opposition to abortion is largely fueled by conservative Republicans, since more than 70% who identify as such think abortion should be illegal in all or most circumstances. More than two-thirds of moderate and liberal Republicans support abortion rights, Pew found.

Among the groups measured by Pew, conservative Republicans and white evangelical Protestants were the only groups with majorities that opposed abortion access. Nearly three-quarters of white evangelical Protestants think abortion should be illegal in all or most circumstances.Interactive

Some people’s views of abortion did grow more complex the deeper Pew inquired. Most groups that support abortion rights ultimately thought abortion should be legal in “most” circumstances, rather than “all”. In other polling on abortion, support for the procedure tends to dwindle when people are asked whether they would back abortions in the second or third trimester of pregnancy.

More strikingly, Pew also asked Americans to evaluate how much they agreed with certain statements about abortion. More than half of Americans agreed with the statement that “the decision about whether to have an abortion should belong solely to the pregnant woman”, while only 35% of Americans say they agreed that “human life begins at conception, so an embryo is a person with rights” – a stance that would logically lead them to oppose abortion.

Yet a third of Americans said that both statements describe their views to some extent, even though those statements clash.

Survey finds telehealth is driving increase in abortions, despite state bans

Nathaniel Weixel
Tue, May 14, 2024 



In the 18 months since Roe v. Wade was overturned, the number of abortions in the United States has continued to grow, according to new data, even as 14 states have banned abortion completely.

Tuesday’s report from the Society for Family Planning’s WeCount project found much of that growth was likely related to telemedicine, which accounted for 19 percent of all abortions nationwide by December.

The report was also the first to fully capture the impact of providers who use blue state shield laws to offer telehealth abortions.

Shield laws give some legal protections to clinicians who offer abortion care via telehealth to people who live in states that have total abortion bans or severe restrictions. In 2023, five states had shield laws in effect — Colorado, Massachusetts, New York, Vermont and Washington.

Since the WeCount data was collected, Maine and California have also passed shield laws protecting providers who offer care nationwide.

Nearly 8,000 people per month in states with bans or severe restrictions were getting medication abortion from clinicians operating under shield law protections from October through December 2023, making up nearly half of all telehealth abortions counted in the report.

“Access to medication abortion through telehealth continues to play an ever-increasing role in abortion care nationwide — even as the Supreme Court weighs the fate of telehealth abortion care,” said Ushma Upadhyay, a professor at the University of California, San Francisco’s Advancing New Standards in Reproductive Health and co-chair of WeCount.

By the end of 2023, providers in states with shield laws were prescribing abortion pills to an average of 5,800 people a month in states with total abortion bans or six-week abortion bans.

Shield law providers also prescribed abortion medication to about 2,000 women per month in states where the local laws limit abortion pill prescriptions by telemedicine.

According to the report, there were an average of 86,000 abortions per month in 2023 compared to 2022, where there were about 82,000 abortions per month, excluding abortion provided through shield law telemedicine.

In the 15 states with total or six-week abortion bans, the report estimated that more than 180,000 abortions would have likely been obtained through clinic providers had abortion not been banned. The states with the greatest cumulative declines in abortion volume over 18 months include Texas, Georgia, Tennessee, Louisiana and Alabama.

“Even as the total national number of abortions nationally has increased, we can’t lose sight of the fact that access to in-person abortion care has virtually disappeared in states where abortion is banned,” said Alison Norris, a professor at the Ohio State University’s College of Public Health and a WeCount co-chair. “The loss of clinic-based care — which makes up more than 80% of abortion care — is a devastating loss to access for people across wide swaths of the country.”

The states with the largest cumulative surges in abortions over the 18 months following Dobbs included Illinois, Florida and California.

Florida enacted a six-week abortion ban on May 1, so the impact of that new law isn’t measured in the report. But it’s likely to have far-reaching impacts, given the relatively high number of abortions in that state and the total abortion bans in Texas, Oklahoma, Arkansas, Louisiana, Mississippi, Alabama, and Tennessee.

While most of the surge states bordered states with abortion bans, there are also large increases in states that are geographically distant from states with abortion bans, including California, New Jersey, New York, and Massachusetts.

The report noted the increased numbers are likely due to people traveling from states where they cannot access care, as well as increased abortions among residents within these states.

Updated at 12:26 p.m. EDT

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