The status of reproductive rights is precarious in the United States, thanks in no small part to the tireless efforts of abortion opponents to undermine them.
Targeted Regulation of Abortion Providers, commonly referred to as TRAP laws, pile unwieldy regulations on providers of reproductive health care and are intended to shutter abortion clinics while not outlawing the procedure outright.
By making abortion a more expensive endeavor for medical professionals and a logistical nightmare for patients, legislators aim to make terminating a pregnancy prohibitively difficult.
Health care providers and reproductive rights advocates continue to challenge TRAP laws in court, but as quickly as the Supreme Court strikes down particular maneuvers, crafty politicians devise new ones to replace them. Here are a few of the most popular methods used by anti-abortion factions to restrict abortion access within the United States.
Under Roe v. Wade, the landmark 1973 Supreme Court case that legalized abortion in the United States, a person retains the right to terminate a pregnancy up until fetal viability, around the 24th week of pregnancy.
Yet many states have instituted 20-week abortion bans: According to the Guttmacher Institute, 16 states currently outlaw the procedure 20 weeks post-fertilization. Lawmakers who support such bans argue a fetus can feel pain at that point in gestation, but medical professionals — including the American College of Obstetricians and Gynecologists — tend to disagree.
Michael Gerhardt, a constitutional law professor at the University of North Carolina at Chapel Hill, said the enactment of state-level abortion restrictions during time frames in which the procedure is legal is a strategy. By challenging provisions in Roe v. Wade, lawmakers hope to weaken its legitimacy and eventually tank it altogether.
"Legislators are looking to carve out exceptions to weaken Roe v. Wade," Gerhardt said in a January interview. "Think of the ruling like a house: If you keep hacking at the foundation, eventually you're going to be able to tear the whole house down."
Ambulatory surgical centers
Requiring abortion providers to become ambulatory surgical centers is another example of legislators "hacking" away at Roe's foundation.
Ambulatory surgical centers provide outpatient care for patients who've been referred by a doctor for surgery. By the Guttmacher Institute's count, 21 states now hold abortion clinics to the same licensing standards as ASCs. Twenty states hold abortion clinics to similar physical standards: hallways of a particular width, procedure rooms of a particular size, etc.
Abortion is an outpatient procedure, one that can be — and often is — performed in a physician's office. According to the Guttmacher Institute, fewer than 0.3% of abortions result in complications serious enough to warrant the patient's hospitalization. Surgical abortion takes between five and seven minutes and is, on the whole, a safe procedure that doesn't resemble what most people probably imagine when they hear the word "surgery." Requiring clinics to have hallways wide enough to accommodate gurneys is unnecessary because gurneys are unnecessary.
That's why, in June's Whole Woman's Health v. Hellerstedt decision, the U.S. Supreme Court struck down a Texas law that sought to impose ASC standards on abortion clinics, finding it did nothing to advance the protection of women's health.
That hasn't stopped anti-choice legislators from trying, though.
The other popular TRAP tactic addressed in Hellerstedt is the obligation for abortion providers to secure admitting privileges at nearby hospitals, essentially elevating doctors to the level of hospital staff and allowing them to admit patients whenever necessary.
The thing is, it's almost never necessary — which is why, in his majority opinion, Justice Stephen Breyer wrote that admitting privileges constituted an "undue burden" on women seeking abortions. Texas was unable to cite even "a single instance" in which admitting privileges translated to better care, Breyer wrote.
The only thing they do — and the only thing they are intended to do — is make it more difficult for clinics to remain operational. Because hospitals would often prefer to stay out of the political fray abortion care has become, they are loath to grant admitting privileges to abortion providers.
According to the Guttmacher Institute, 11 states currently require abortion providers to establish some kind of relationship with a local hospital.
Waiting periods and counseling requirements
While most states require abortion providers to counsel patients before performing the procedure, 27 have instituted a waiting period of at least 24 hours between the two. As TRAP laws continue to take effect and clinics close, women are left with fewer options when it comes to getting an abortion and are often forced to travel longer distances.
Take Missouri, for example: The state has only one abortion provider, Planned Parenthood of the St. Louis Region and Southwest Missouri. As PPSLR president and CEO Mary Kogut previously told Mic, the clinic serves patients from 14 states, many of whom have to travel 100 miles to get there. Missouri's three-day waiting period between appointments imposes all kinds of logistical problems, like finding money for food, housing and gas and arranging time off work.
Then there's the counseling requirement. It's not a bad idea to tell a patient what to expect from an abortion — indeed, informed consent is requisite in most medical procedures. The problem is that, in many states, women are deliberately fed misinformation about abortion designed to change their minds and are left to ruminate on this newfound knowledge for one to three days.
Similarly, many states require abortion patients to undergo ultrasounds before the procedure. According to the Guttmacher Institute, four states compel providers to show patients the ultrasound and verbally describe it. Ten states require providers to perform an ultrasound, and nine of those mandate that patients be given the opportunity to view the image.
Other states have fetal ultrasound laws that are more lax, but according to the Guttmacher Institute, it's just another barrier to abortion. Often, ultrasound makes the procedure more expensive and is likely intended to make a fetus seem more like a baby, thereby making abortion a more difficult proposition.
In 2014, North Carolina judge J. Harvie Wilkinson III struck down a law requiring health care providers to not only to perform ultrasounds on abortion patients, but to describe the images even if the patients refused to look or listen. Of the law, Wilkinson wrote: "It is intended to convey not the risks and benefits of the medical procedure to the patient's own health, but rather the full weight of the state's moral condemnation."
With fetal ultrasound requirements, that usually seems to be the case.
Fetal cremation and burial
In November, officials in Texas made it illegal to dispose of fetal remains in landfills, ruling they must be buried or cremated instead. The cost would be borne not by patients but by abortion providers, adding to the cost of the procedure itself. While a Texas judge blocked the rule days before it was set to take effect, Arkansas and Georgia have enacted similar laws — and more states have tried and failed.
Critics of such laws argue the measures aim to make a fetus or fetal tissue seem more like a person. In a statement, Heather Busby, executive director of NARAL Pro-Choice Texas, called the rule "a thinly-veiled attempt to shame Texans who have abortions and make it harder for the doctors who provide them."