Last Friday, the Supreme Court decided to take up a case that would require physicians at Louisiana abortion clinics to have hospital admitting privileges. Given the health dimensions of this case, it is critical the court consider the research evidence before passing judgment. I've conducted studies with pregnant women in Southern Louisiana. The research shows it is already difficult to obtain an abortion there, and this law will only make it worse.
The fact is admitting privileges laws ultimately harm women. Abortion is extremely safe, with more than 99 percent of abortions resulting in no major complications. These laws make no difference in patient safety, but hamper a woman's ability to get an abortion. In Louisiana, it would result in the closure of abortion clinics, leaving only one clinic to serve the entire state and forcing the majority of Louisiana women to travel more than 150 miles for abortion care.
A Louisiana woman already faces multiple barriers to obtain an abortion, such as raising the cash to fully cover the cost, finding a clinic that provides care at her stage of pregnancy, and making the multiple clinic visits required by Louisiana law. Through my research, I've seen firsthand how each of these factors prevent women from getting the abortions they want.
Louisiana withholds insurance coverage of abortion from women enrolled in Medicaid. Instead of being able to use their health insurance to cover medical costs, women are forced to come up with more than $500 to pay out-of-pocket for an abortion. For many, this is more than one-third of their monthly income, and is an insurmountable barrier to getting an abortion. A 26-year-old mother in our study who wanted an abortion ran into problems raising the money. As she "got further along [in gestation], it got more expensive." In the end, she did not have an abortion because she just could not afford it.
For some women, these delays can push them beyond the gestational limit at the clinics where they are seeking care. For one woman we spoke with, by the time she was able to afford an ultrasound, she discovered that "I was over the amount of days" of pregnancy within which the clinic would perform abortions. She too was not able to get the care she needed.
Louisiana requires women to make two visits to an abortion clinic before they can have an abortion. My research from other states shows forcing women to make two visits does little to change their minds about having an abortion. Instead, it leads to more delays and increases the cost, especially for the mothers and working women who have to arrange for childcare and take time off from work for each trip.
Being denied an abortion can have serious consequences for women and their families. One Louisiana mother who could not pay for an abortion worried about how this would affect her ability to care for her existing young child "My other baby is so small and we've been having a hard time taking care of her. Now we're having another baby and it's scary."
The evidence shows her concerns are warranted. Women who are unable to obtain abortions due to restrictive policies experience more financial insecurity, more violence from the men involved in their pregnancies, and have worse physical health outcomes than women who are able to obtain abortions. Their children also experience harm, including to their development and economic well-being.
As a Doctor of Public Health, I believe that laws should be informed by research so that they can support the safety, health and well-being of patients. The research is clear: abortion is already very safe. An admitting privileges law is medically unnecessary and would ultimately hurt Louisiana women. If the Court allows the law to take effect, we will move further in the wrong direction.
Sarah CM Roberts, DrPH is an Associate Professor in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of California, San Francisco. She studies the ways policies and our health care system punish, rather than support, vulnerable pregnant women.
The views expressed in this article are the author's own.
