Abortion restrictions increase at state level in US

BMJ 2013; 346 doi: (Published 07 January 2013) Cite this as: BMJ 2013;346:f98
  1. Michael McCarthy
  1. 1Seattle

Last year 19 US states adopted new legislation restricting access to abortion services, finds an analysis by the Guttmacher Institute, an independent non-profit organization that focuses on sexual and reproductive health policy.1

All told, in 2012 states passed 43 provisions restricting access to abortion. The number was second only to the record breaking total of 92 passed in 2011.

Most of the provisions sought to limit the gestational age at which abortions are allowed, to block coverage of abortion services through the state health insurance exchanges established by the 2010 Affordable Care Act, or to impede access to medical abortions, such as those involving use of mifepristone, the oral abortifacient also known as RU486.

Three states enacted measures to shorten the time during which abortion would be allowed without extenuating circumstances, such as the need to protect a woman’s life. A provision passed in Arizona, for example, prohibited abortion at 18 weeks after fertilization (20 weeks after the woman’s last menstrual period).2 Louisiana and Georgia passed legislation prohibiting abortions at 20 weeks after fertilization (22 weeks after the woman’s last menstrual period).

Opponents have argued that these limitations conflict with the US Supreme Court’s Roe versus Wade decision, the landmark 1973 ruling that legalized abortion in the United States. In that decision the court ruled that the state’s legitimate interest in the life of the fetus became “compelling” only at the point of viability, which abortion rights advocates argued came well after 20 weeks. Nevertheless, seven additional states now have laws on the books banning routine abortion at 20 weeks after fertilization. A number of these laws are being challenged in the courts.

Abortion opponents also successfully passed laws in 20 states restricting the coverage of abortion services through plans available on the state health insurance exchanges set up under the 2010 Affordable Care Act.

Efforts to dissuade women from having an abortion by making it compulsory to undergo ultrasound examinations before the procedure, however, were “blunted,” the report notes, after it became known that one such mandate being proposed in Virginia would require women to undergo transvaginal ultrasonography. Opponents, brandishing vaginal ultrasound probes on the floor of state legislatures, television news programs, and late night comedy shows, were able to rally public opinion against such measures, which many perceived to be too intrusive.

Nevertheless, eight states now require an ultrasound examination before an abortion, and two states require providers of abortion services to make the fetal heartbeat audible to the woman before an abortion.

No states passed laws to improve access to abortion, family planning services, or comprehensive sex education, the report notes.


Cite this as: BMJ 2013;346:f98