It seems like every day we read about a new law being debated in some state capitol, forcing women to have trans-vaginal ultrasounds before they can have an abortion, requiring abortion clinics to add square footage and broom closets, or (the one that keeps me up at night) allowing health care providers to lie to women about test results if they fear she might consider abortion.  Anyone reading the news knows that state lawmakers around the country are going out of their way to restrict abortions. Now, a new study from the Guttmacher Institute shows just how much damage has been done.  It found that by 2011, more than half of women of reproductive age lived in a state hostile to abortion rights up from just 31 percent in 2000.

Researchers looked at state laws in 10 categories:

• mandated parental involvement prior to a minor’s abortion;
• required pre-abortion counseling that is medically inaccurate or misleading;
• extended waiting period paired with requirement that counseling be conducted in-person, thus necessitating two trips to the facility;
• mandated performance of non-medically indicated ultrasound prior to an abortion;
• prohibition of Medicaid funding except in cases of life endangerments, rape or incest;
• restriction of abortion coverage in private insurance plans;
• medically inappropriate restrictions of medication abortion;
• onerous requirements on abortion facilities that are not related to patient safety;
• unconstitutional ban on abortions prior to fetal viability or limitation on circumstances under which an abortion can be performed after viability; and
• preemptive ban on abortion outright in the event Roe v. Wade is overturned.

The authors note that some of these categories include more than one possible restriction. For example, there are two different ways in which states can restrict medication abortions: banning the use of tele-medicine or requiring the use of outdated protocols that will increase the cost and the side effects for women. They used the categories, however, to determine a state’s stance toward abortion rights.  A state was considered “supportive” of abortion rights if it had enacted provisions in no more than one of these categories, “middle-ground” if it had enacted provisions in two or three categories, or “hostile” if it had enacted four or more. 

In 2011, 9 states were considered middle-ground while 26 were hostile.  This is a drastic change from 2000 when 19 were middle ground and only 13 were hostile.  The analysis found that most states remained in the same category in all three years since 2000.   That said, the authors note:

“However, of the 15 states whose abortion policy landscape changed substantially, all became more restrictive.”

There are wide geographic variations.  States on the West Coast and in the Northeast have been and remain consistently supportive of abortion rights but the middle of the country and the South show a very different story.  The authors report:

“A cluster of state in the middle of the country—including Idaho, Indiana, Kansas, Nebraska and South Dakota—moved from being middle-ground states in 2000 to being hostile in 2011. And of the 13 states in the South, only half were hostile in 2000, but all had become hostile by 2011.”

In fact, 2011 was a dismal year when it comes to state laws restricting abortion rights. More than 1,100 provisions related to reproductive health and rights were introduced in all 50 states and 68 percent of these were abortion restrictions (up from only 26 percent in 2010).  In addition, of the 135 new reproductive health provisions that were enacted, 92 of them sought to restrict abortion.  This is up dramatically from the previous record of 34 abortion restrictions enacted in one year which was set in 2005.  

The authors note that it was the shift of a cluster of states from middle-ground to hostile that upset the national balance.  They argue that advocates for reproductive health and rights should focus on those states that remain in the middle-ground because there is high potential for these states to see new restrictive laws proposed but at the same time there is high potential for advocates to defeat such measures.  One of the study’s authors explains:

 “There is certainly ample precedent of reproductive rights supporters in those states stopping or blunting restrictive abortion bills.”

They point to a successful effort to defeat an expanded parental involvement requirement in Delaware as well as efforts in Iowa that defeated 13 of the 15 proposed measures aimed at limiting access to abortion.  In that state, for example, “the Senate refused to even hold a vote on a House-passed measure that would have banned abortion at or beyond 20 weeks’ gestation.” Moreover, the authors note that in some middle-ground states progress toward expanded access to reproductive rights has even been made.  In Colorado, for example, lawmakers mandated coverage of contraceptive services and supplies in insurances policies, expanded access to emergency contraception, and moved to ensure that students receive medically accurate sex ed.

Hopefully advocates will continue to have success in defeating restrictive bills and even passing supportive measures because daily attempts to limit abortion access seems like a trend that is sticking around. In fact, 2012 is off to a roaring start—in the first six weeks of the year 43 new restriction were introduced in middle-ground states alone.