Despite the terrifying start to 2019 for abortion providers and their patients, June brought an unprecedented wave of wins as states like Illinois, Maine, Nevada and Vermont struck down antiquated laws and enacted new, historic protections and care expansions.
By the end of May, 27 bans in 12 states had brought the total number of abortion restrictions since Roe v. Wade to 1,271. But as anti-abortion legislators in states across the country continued to enact bans and dangerous, unpopular restrictions, a growing handful of states — along with the city of New York — have been breaking down barriers to reproductive freedom.
With dozens of clinics closed since 2011 and 90 percent of U.S. counties now without an abortion provider, these new protections and access expansions are important not only for the states in which they’ve passed, but for entire regions.
Nevada and Vermont Put Patients’ Rights First
Before the start of June, only 18 states had provisions on the books to protect abortion access should Roe be nullified under the newly right-wing Supreme Court. However, the May 31 signing of Nevada’s “Trust Nevada Women Act” (Senate Bill 179) — which repealed the state’s provisions criminalizing providers and centers the patient’s rights above all — ignited an entire month of similar legislative actions. The week of June 10, as the flurry of proactive legislation ramped up, Vermont’s Republican Gov. Phil Scott signed H.57, “An act relating to preserving the right to abortion.” The bill is unequivocal: Effective immediately, it prohibits the government from interfering in any way with the right to abortion. While Vermont was already a highly rated state when it comes to ease of abortion access, reproductive justice-minded advocates and legislators aren’t taking any chances by counting on federal protections.
“We celebrate the passage of [Vermont’s Freedom of Choice Act] as an affirmation of Vermonters’ longstanding commitment to reproductive liberty and personal autonomy,” James Duff Lyall, executive director of the ACLU of Vermont, said in a statement following the signing. “At a time of unprecedented attacks on abortion rights, this historic legislation sends a powerful message that efforts to overturn Roe v. Wade do not reflect our values, and that we will continue to defend reproductive freedom for all.”
Illinois’s Legislation Overrides Outdated Laws
Just two days later, Illinois took action with similar legislation: the Reproductive Health Act (RHA) was signed by Democratic Gov. J.B. Pritzker.
“If you believe in standing up for women’s fundamental rights, Illinois is a beacon of hope in the heart of this nation,” Pritzker said before adding his signature. “Today Illinois is making history once again…. We proudly proclaim that we trust women.”
While the legislation appears similar to Vermont’s, Illinois also had outdated laws to override. Its RHA immediately repealed a 1975 law, which included oppressive provisions, such as requirements for spousal permission, unnecessary waiting periods, and criminal penalties for abortion providers. Clearer, current language around fetal viability and development is among other smaller, important changes. Illinois residents are now protected by laws that conform to science and can stand up to an uncertain federal future.
“Governor Pritzker today completed a critical, much needed victory for access to reproductive health care in Illinois. Even as other states — including Georgia, Alabama, and our neighbors in Missouri — recklessly act to ban abortion, Illinois now stands as an example of how we can safeguard the right of every person to reproductive health care, including abortion,” Colleen K. Connell, executive director at the ACLU of Illinois, said in a statement following the signing. “The law is now clear in Illinois: decisions about reproductive health care are between patients, their family members, doctors and other health care providers.”
Maine’s Double Victory
Maine is a double winner in the proactive legislation category this year so far.
First, Gov. Janet Mills signed “An Act To Authorize Certain Health Care Professionals To Perform Abortions” (LD 1261), which expands the pool of medical personnel legally allowed to be trained in abortion provision to include physician assistants and advanced practice registered nurses.
“By signing this bill into law, Maine is defending the rights of women and taking a step towards equalizing access to care as other states are seeking to undermine, rollback, or outright eliminate these services,” Governor Mills said in a statement concurrent with the signing.
Mills went on to cite the safety of abortion, which has a serious complication rate of less than one-half of 1 percent during the first trimester. As HuffPost reported in 2016, being hit by lightning, having a baby, having a routine colonoscopy, texting while driving, and work-related accidents are all vastly more likely to result in severe injury or death. Routine dental work like wisdom teeth removal and other elective in-office “minor” procedures are also far more dangerous than first-trimester abortion.
“Allowing qualified and licensed medical professionals to perform abortions will ensure that Maine women, especially those in rural areas, are able to access critical reproductive health care services when and where they need them from qualified providers they know and trust,” Mills continued in a statement. “These health care professionals are trained in family planning, counseling, and abortion procedures, the overwhelming majority of which are completed without complications.”
Maine joins Alaska, California, Colorado, New Hampshire, New York, Oregon and Vermont as the eighth state to extend abortion training to nurse practitioners and advanced practice clinicians (APCs).
Two days later, Mills also signed “An Act To Prevent Discrimination in Public and Private Insurance Coverage for Pregnant Women in Maine” (LD 820) into law, overturning the state’s Hyde Amendment-like prohibition on public funding of abortion care. With this signature, Maine became just the 16th state to cover abortion within the state Medicaid program.
“Maine’s motto is ‘I lead,’ and today they proved that by taking the momentous step to expand abortion access for residents across the state, particularly for women of color and in low-income communities,” National Institute for Reproductive Health President Andrea Miller said in a statement.
Miller went on to cite the “unprecedented attacks” from the White House and a number of state legislatures during the first half of the year. Pushing back and securing victories for abortion access “reflects more than the work of a few individuals,” Miller said while praising Mainers for voting their consciences in the midterms.
“Access to reproductive health care should never be defined by who you are or how much you make, and I applaud the Maine Legislature and Governor Mills for making this idea a reality.”
Local abortion providers were also celebrating the back-to-back wins.
Andrea Irwin is executive director of the Mabel Wadsworth Center, a nonprofit health clinic that provides abortion care in Maine. “In expanding abortion coverage to include MaineCare and private insurance, the legislature has corrected the decades-long legacy of the Hyde Amendment that has pushed abortion out of reach for so many people,” Irwin told Truthout. “We are now one step closer to a future where we all have the ability to make our own decisions about pregnancy and parenting.”
Cait Vaughan, an organizer and community advocate at Maine Family Planning, spoke at length with Truthout about the passage of both the provider expansion bill and the long fight to end insurance restrictions on abortion care.
“The majority of our patients really do struggle with the cost of abortion care, and many of them are receiving the rest of their health care through Medicaid, and so this is a really exciting thing to be able to share with them and take that burden off,” Vaughan said.
Maine — like many states — is largely rural, making travel a potentially expensive hurdle for poor and working-class folks if medical care is not available locally. Its 35,000 square miles is largely without highways or interstates. This type of terrain makes the provider expansion — also described as repealing the “physician-only” requirement for abortion provision — as critical for access.
Nurse practitioners, certified nurse midwives and physician assistants — the three professions regularly grouped together as advanced practice clinicians — have been proven highly competent when trained to perform first trimester in-office abortion procedures (or vacuum aspirations). In states like California, where outdated physician-only laws have been overridden by recent evidence-based legislation, patient wait times are reduced and fewer are pushed beyond the 10-week mark (where medication abortion is effective) and the 12-week mark (for the simplest, cheapest and fastest in-office aspiration procedure). Fewer patients have to travel as well, greatly reducing the costs of gas, childcare, potentially unpaid time off work, and other hurdles.
Vaughan called nurse practitioners and other APCs a “bedrock of our medical system” in rural Maine — pointing out that these are “woman-dominated fields.”
“The anti[-abortion] testimony that APCs were not competent to do this work was misogyny on all sides; nurse practitioners and other APCs have really stepped up in the realm of marginalized health care,” said Vaughan, who pointed out that midwives help with one of the most dangerous, routine medical moments: giving birth.
Forty-one states still have laws perpetuating this safety myth, allowing anti-abortion legislators to continue to claim they are restricting access out of a concern for patients. As more and more states repeal physician-only laws and/or pass laws explicitly allowing APCs to be trained to perform in-office procedures and dispense medication abortion pills, those specious assertions grow less effective. More and more, the dual goals of abortion expanding legislation are being touted; more and more, the safety of abortion is part of the public record and harder to disingenuously deny in legislative bodies.
Vaughan’s voice held emotion as she described the feeling on the ground following the passage of both bills.
“I feel like it’s not just a practical win, it’s also about the dignity of poor folks, saying that there shouldn’t be two tiers when it comes to dignity and reproductive decision making,” said Vaughan. “People made this about tax dollars going towards abortion care and I’m just excited to say, ‘Yeah, that’s what we want! We want tax dollars to go to people’s health care, including abortion!’ To have so many Mainers stand up for that and have so many lawmakers fight for that is pretty exciting.”
Destiny Lopez, co-director of All* Above All, an organization dedicated to ending insurance bans like Hyde, also applauded Mainers for supporting these new protections.
“This victory for abortion coverage comes at a critical moment in our fight for justice,” Lopez told Truthout. “As states like Alabama, Georgia, and Missouri are in a race to the bottom to ban abortion and put politics over the lives and well-being of women and their families, Maine has recognized that no one should be denied coverage for abortion care just because they’re poor. This new law is a clear signal that our bold movement to expand abortion access continues to push forward against all odds.”
New York City Leads the Way on Abortion Funding
Lopez isn’t just being optimistic. As these state-level laws were being signed, the New York City Council was preparing to announce a historic move: becoming the first city in the country to directly fund abortion.
“As Illinois, Maine and Vermont step up this week to protect and expand access to abortion in the face of attacks, the New York City Council has demonstrated its commitment to equity and justice by ensuring that everyone, however much money they make or wherever they live, can get safe, affordable abortion care,” Lopez told Truthout. “New York has long been a leader in protecting abortion access, and this additional city funding will ensure that low-income people, who are disproportionately women of color, immigrants or refugees aren’t left out.”
Equally historic is the decision to tap an abortion fund — a nonprofit that assists with logistics and funding for low-income patients seeking abortion — to allocate the newly designated annual $250,000, starting with the 2020 budget. The New York Abortion Access Fund (NYAAF) already has the training, mechanisms, staff and volunteers in place to do the work itself. The decision to simply send additional funding their way rather than creating additional red tape shows an atypical appreciation for those involved directly in abortion provision.
NYAAF leadership applauded the move as they anticipate an increased demand for help from residents outside the city.
“As it gets harder for people to access abortion in conservative states, NYC will likely see an increase in out-of-state folks seeking abortion,” said a statement from the organization following the bill signing. “This city funding means NYAAF will be better-equipped to keep up with the increasing demand and to continue building a movement to lift barriers to abortion access here in New York and across the country.”
It’s Time to Expand Abortion Access, Not Restrict It
Proactive protections and access expansions at the state level are crucial to ensuring that everyone who can become pregnant — regardless of circumstance or ZIP code — can receive abortion care regardless of Roe’s future.
Ongoing research from Advancing New Standards in Reproductive Health (ANSIRH), published recently in Annals of Internal Medicine, continues to confirm that restrictive laws like those recently signed in Alabama, Georgia, Louisiana, Kentucky, Mississippi and Ohio detrimentally affect people who are unable to access abortion care. To date, ANSIRH researchers have proven that being denied a wanted abortion results in economic insecurity for pregnant people and their families, as well as psychological harm. And now they’ve added an additional conclusion about the long-term physical health of those denied care:
Although some argue that abortion is detrimental to women’s health, these study data indicate that physical health is no worse in women who sought and underwent abortion than in women who were denied abortion. Indeed, differences emerged suggesting worse health among those who gave birth.
Abortion is necessary health care and being turned away can seriously impact the rest of a person’s life and future health. Every city and state that protects access can become a sanctuary far beyond its borders.
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