SoluProb™: TRAP Laws

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Presumed Problem

Women seeking abortions in abortion clinics face special risks to their health and safety.


Solution

Targeted Regulation of Abortion Providers (TRAP) Laws seek to remedy the presumed problem by requiring that clinics satisfy major physical-plant specifications and requiring that those physicians providing abortions have admitting privileges at a local hospital.


Narrative

In 1973, the U. S. Supreme Court legalized abortion throughout the nation in its landmark Roe v. Wade decision. While that brought about profound changes for women’s reproductive rights, it probably changed very few minds on the topic. Resistance to abortion has persisted and numerous legislative actions have sought to chip away at women’s right to choose an abortion.

One form this resistance has taken is the TRAP laws that raise the bar to corridor-with-gurneypractice so high that few clinics can satisfy the requirements. The Guttmacher Institute provides an overview.

While all abortion regulations apply to abortion clinics, some go so far as to apply to physicians’ offices where abortions are performed or even to sites where only medication abortion is administered. Most requirements apply states’ standards for ambulatory surgical centers to abortion clinics, even though surgical centers tend to provide more invasive and risky procedures and use higher levels of sedation. These standards often include requirements for the physical plant, such as room size and corridor width, beyond what is necessary to ensure patient safety in the event of an emergency. State standards, however, do vary, with the most burdensome standards in place in states such as Michigan, Missouri, Pennsylvania, Texas and Virginia.

Prior to the institution of TRAP laws in Texas, the state’s women had access of 36 abortion providers scattered across the very large state. The website, Fund Texas Women, provides this update:

As of June 9, 2015, the Fifth Circuit has upheld the constitutionality of HB2 except as applied to Whole Woman’s Health McAllen. This leaves 10 clinics. The only cities that have clinics now are Austin, San Antonio, Dallas, Ft. Worth, Houston, and McAllen.

Texas has not been alone in anti-abortion legislation. Bloomberg News offers a visual report on the number of anti-abortion measures in state legislatures over time. They are clearly on the increase.

anti-abortion-laws


Was the Problem Real?

There has evidently been a substantial concern for the safety of women getting an abortion. Has that concern and the resulting solutions been justified?

As the Center for Reproductive Rights reports:

Leading medical associations have gone on record opposing TRAP requirements. For example, the American Medical Association (AMA) and the American College of Obstetricians and Gynecologists (ACOG) oppose a Texas law requiring abortion facilities to meet ambulatory surgical facilities requirements and physicians providing abortion services to have admitting privileges at a local hospital. In a court brief, those two leading medical associations argued that the Texas law “does not serve the health of women in Texas but instead jeopardizes women’s health by restricting access to abortion providers.”

While it is often argued that women’s safety requires that abortion clinics and abortion providers have admitting privileges at local hospitals in the ambulanceevent that emergency medical care is needed. Actually, President Reagan and the U. S. Congress solved this problem in its Emergency Medical Treatment and Active Labor Act (EMTALA) of 1986, requiring that emergency rooms treat patients in need–even if they aren’t citizens or are unable to pay. It doesn’t matter if their physician has admitting privileges or even if they have a physician.

The argument that TRAP laws have nothing to do with women’s safety and are merely an attempt to prevent them from getting abortions has been given additional support  by the pronouncements of various anti-abortion crusaders.

For example, in 2011, Ohio Right to Life executive director, Mike Gonidakis, said precisely that. NARAL has provided a transcript from the video recording:

We’re going to introduce a law in Ohio that any facility that performs… five abortions or more in a year have to meet the same standards as a hospital… to the point where they’re not going to be able to stay open…We’ve been chipping away and closing and closing and closing, and if we get this legislation we can close a whole heck of a lot more.

Mississippi Governor Bryant heralded the passage of his state’s TRAP laws as “the first step in a movement, I believe, to do what we campaigned on: to say that we’re going to try to end abortion in Mississippi.” The law was later blocked by a federal judge, who pointed out that no case had been made regarding women’s health and safety.

Ironically, abortions can pose a threat to the health and safety of women, as this graph from the Guttmacher Institute dramatically shows.

 abortion-mortality-graph
In 1965, 200 women died of illegal abortions. Following the liberalization of state laws on abortion and, finally, the federal legalization of abortion by Roe v. Wade in 1973, abortion mortality dropped off to virtually nothing. As long as abortion is legal, there is virtually no threat to women’s health and safety, while driving us back to earlier times would very likely start killing women again.

Negative Consequences

I’ve just alluded to a major problem flowing from the unnecessary TRAP laws: to the extent that shutting down legal abortion providers will force some women to seek truly dangerous alternatives. Thus alleged attempts to protect women will endanger them.

For women who try to adapt to the restrictive circumstances they now face, there will be necessary time and financial costs. Single mothers working low-paying jobs, for example, may need to take time off work to drive a hundred or so miles for consultation and then again, later, for treatment.

The clear effect of TRAP laws in Texas and elsewhere is to make it harder for women to obtain safe, legal abortions. A study by the University of Texas at Austin, summarized the logistical difficulty for Texas women this way:

Researchers analyzed surveys from 398 women seeking abortions at ten Texas abortion facilities between May and August 2014. The analysis shows that women whose nearest clinic had closed after HB2, which was the case for 38 percent of study participants, lived farther from open clinics and traveled longer distances to obtain services compared to women whose nearest clinic remained open. After HB2, the average one-way distance to the nearest abortion provider among women whose nearest clinic closed was 70 miles, compared to an average one-way distance to the nearest clinic of 17 miles before HB2 was passed. Some women confronted extreme travel burdens due to clinic closures, with 25 percent of women whose nearest clinic closed living more than 139 miles from the nearest facility and 10 percent living more than 256 miles away.

However, the Texas TRAP laws were not just inconvenient for women but expensive as well.

The study also documented increased out-of-pocket costs, overnight stays, and frustrated demand for medication abortion among women whose nearest clinic closed after HB2. Thirty-two percent of women whose nearest clinic closed reported spending more than $100 in out-of-pocket expenses beyond the cost of the abortion (i.e., lost wages, child care, transportation, or overnight costs) as opposed to 20 percent of women whose nearest clinic did not close. More than three times the number of women whose nearest clinic had closed reported needing to stay overnight (16 percent compared to 5 percent among those whose nearest clinic did not close). Thirty-seven percent of women whose nearest clinic closed did not get the medication abortion they wanted—instead scheduling a surgical procedure—as opposed to 22 percent of women whose nearest clinic did not close. Women themselves noted the burdens to obtaining care, with 36 percent of women whose nearest clinic closed reporting that obtaining an abortion was difficult, in comparison to 18 percent in the nearest-clinic-open group.

This is also a truly ironic negative consequence of many of the TRAP laws. Much of the anti-imageabortion anger has been focused specifically on one provider: Planned Parenthood. Discussions of this matter have revealed that abortions constitute three percent of PP’s services. Primarily they offer cancer screening and other medcal exams and treatments. As their name suggests, much of their work is in relation to family planning, offering a variety of contraceptive methods.

As Planned Parenthood clinics are closed by TRAP laws, women are denied contraceptive support. The lack of contraception results in more unplanned and unwanted pregnancies. This means more women are in the market for abortions. The Guttmacher Institute has estimated that publicly-funded family planning in the U. S. annually prevents nearly two million wanted pregnancies that would have resulted in 810,000 abortions.  Thus, closing family planning clinics will likely increase the number of abortions.

If one were to argue honestly that the real problem being addressed was women’s ability to obtain abortions as guaranteed by the Supreme Court, TRAP laws would be a logical though unlawful solution. However, the pretense that the problem involves risks to women’s safety in abortion clinics is plainly false.

© Earl Babbie 2016, all rights reserved  Terms of Service/Privacy


Sources

“State Policies in Brief, as of March 4, 2016: Targeted Regulation of Abortion Providers”  – accessed March 19, 2016 http://www.guttmacher.org/statecenter/spibs/spib_TRAP.pdf

Videoclip: Saturday Morning Public Forum Featuring Guest Speaker Mike Gonidakis, Executive Director of Ohio Right to Life on Pending Ohio Legislation Including the Heartbeat Bill.” March 12, 2011 at http://www.youtube.com/user/AMFANEdu#p/a/u/2/MKcgxljoe40 (last visited Nov. 6, 2015, also on file with NARAL Pro-Choice America).

Rich Phillips, “Judge lets Mississippi’s only abortion clinic stay open — for now,” CNN, 11 July 2012, accessed 26 July 2012, <http://www.cnn.com/2012/07/11/us/mississippi-abortion-
The graph of declining abortion mortality is taken from https://www.guttmacher.org/pubs/tgr/06/1/gr060108.html
Clare Coleman, “Five Myths about Planned Parenthood,” Washington Post, April 15, 2011 – https://www.washingtonpost.com/opinions/five-myths-about-planned-parenthood/2011/04/14/AFogj1iD_story.html
Estimates of abortions prevented by family planning is found in http://www.guttmacher.org/media/nr/2009/02/23/
FiveThirtyEight map of TRAP Law states is found at http://fivethirtyeight.com/datalab/maps-of-access-to-abortion-by-state/
A report of  the University of Texas study of the impact of abortion clinic closing can be found at http://www.utexas.edu/cola/txpep/releases/impact-of-clinic-closures-release-.php

2 thoughts on “SoluProb™: TRAP Laws”

  1. Another insightful article Dr. Babbie. There is something particularly infuriating about this example. There is no question TARP laws force some women to seek dangerous alternatives; the assured outcome is that there are women who will die because of the actions of legislators who with malice of forethought enact laws that result in their death. The statistical evidence is inescapable. It’s hard to imagine a legislator who is not well aware of what will unfold, and yet, they proceed. It doesn’t seem harsh to call this a form of premeditated murder.

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