Question

Should each state have the flexibility to create individual policies regarding abortion or other health services? Which, if any of the TARP laws do you think have an impact on women’s health and safety? Which, if any, of the TARP laws do you think pose a burden on women attempting to access abortion services?

Answer 1

The number of clinics in Texas fell sharply between 2013 and 2014 because of admitting privilege requirements. As a result, the number of Texas women whose closest abortion clinic was more than 100 miles away more than tripled in that time. Complying with the physical plant requirements included in many state laws can be exorbitantly expensive for abortion providers. In 2013, the Virginia Department of Health estimated that on average, compliance with new regulations at clinics would cost up to $1 million per site.(In 2016, the state revised its regulations by repealing the most burdensome requirements.)
Impact of Delaying Abortion
When clinics close, delays in obtaining abortion services may increase. Delaying the procedure increases both the risk and the costs associated with having an abortion.

Clinic closures compound the barriers many women already face and could cause an increase in delayed abortions. In a 2014 national study of abortion patients, characteristics associated with experiencing a delay before an abortion included exposure to disruptive events, living at least 50 miles from a provider and living in a state with a waiting period. Delays averaged 7.6 days, but 7% of patients sampled waited more than 14 days for their appointment.
The risk of complications from abortion—although exceedingly small at any point—increases later in pregnancy. The risk of death associated with abortion rises from 0.3 deaths for every 100,000 abortions at or before eight weeks to 6.7 per 100,000 at 18 weeks or later.
Delays in seeking abortion can be a significant burden for poor women. In 2012, the median charge for an abortion was $495 at 10 weeks’ gestation and $1,350 at 20 weeks’ gestation. Forty-nine percent of women who obtained abortions in 2014 had incomes below the federal poverty level (FPL).(The 2017 FPL, which is similar to that for 2014, is $12,060 per year for a single woman with no children and $16,240 for a woman with one child.
Clinic closures typically mean women have to travel longer distances to receive services; as a result, they have to arrange for transportation and may need child care and time off from work. Nearly 60% of women who experienced a delay in obtaining an abortion in 2014 cited the time it took to make arrangements and raise money as reasons for that delay.
Most women are able to have an abortion early in pregnancy, but women who rely on financial assistance, are young, are black, or have at most a high school education are more likely than other groups to experience delays in obtaining an abortion.

Abortion providers already follow rigorously developed standards to protect patients. In the face of such evidence-based regulations, TRAP requirements are superfluous and unnecessary.
Abortion is an extremely safe medical procedure. Only 0.3% of abortion patients in the United States experience a major complication that requires hospitalization.
Clinics and providers are required to comply with federal and state safety standards. Federal standards include those set by the Occupational Safety and Health Administration, the Health Insurance Portability and Accountability Act of 1996 and the Clinical Laboratory Improvement Amendments of 1988; state regulations include building fire codes, professional licensing standards and continuing education requirements.

The World Health Organization (WHO) has made it clear that abortions can be safely performed in outpatient clinics and physicians’ offices.WHO guidelines state that regulation of abortion providers and settings “should be based on evidence of best practices and be aimed at ensuring safety, good quality and accessibility.”
Guidelines created by the National Abortion Federation (NAF) are updated annually and include standards on topics such as infection prevention; use of antibiotics, analgesia and sedation; and treatment of complications. Adherence to the guidelines is a condition of membership for abortion clinics.
Like NAF, Planned Parenthood Federation of America also maintains detailed requirements for affiliates offering abortion services. These organizational guidelines, which require that functioning equipment and medication be available onsite to handle emergencies, also require clinics to have protocols for the management of emergencies, including written and readily available directions for contacting external emergency assistance.
Requiring facilities that provide abortion to meet the same standards as ambulatory surgical centers (ASCs) cannot be justified as protecting patients’ health and safety.These standards go well beyond what is necessary to ensure clinics are prepared to handle an emergency.
ASCs are intended to provide riskier and more invasive procedures and use higher levels of sedation than abortion clinics do.
Standards for ASCs often include requirements for the physical plant, such as minimum dimensions for procedure rooms and hospital-grade ventilation systems. Meeting these requirements does not improve patient care, and compliance can often be expensive and logistically difficult.

Controversy over optional fetal tissue donation—to further medical research or for transplantation into patients undergoing experimental treatments—has been used to drum up support for additional TRAP laws, but the issue does not affect abortion patient care or the safety of an abortion procedure and thus does not justify further clinic regulations.
Disposal of fetal tissue by abortion providers has become a controversial issue following the release of deceptively edited videos in 2015 aimed at discrediting Planned Parenthood and other abortion providers. However, treatment of the fetal tissue as medical waste has been the norm for nearly a century.Abortion providers comply with standard protocols for handling and disposing of surgically removed tissue.Regulations to require burial or cremation of fetal tissue further stigmatize abortion services and pregnancy loss, and may contradict the wishes of abortion patients.