The Supreme Court is expected to rule soon on its first major abortion case since President Donald Trump put in place a conservative majority on the bench.
At the heart of the case is a Louisiana law, Act 620, that requires doctors performing abortions to have admitting privileges at a hospital within 30 miles of the clinic. If the law is upheld, a district court found that Louisiana would be left with one abortion clinic to serve the nearly 10,000 women who seek abortions in the state annually.
“The clinics are busy and there is a great need for them,” said Louisiana state Rep. Mandie Landry, a Democrat. “When you’re down to one clinic, there’s just only so much capacity they have.”
Abortion rights advocates have said the measure is nothing more than a backdoor way to curtail abortion access. Louisiana, however, argued that the law is intended to hold abortion providers accountable and ensure that the provider is competent to perform the procedure.
When clinics close, pregnant people face significant hurdles, ranging from additional costs, to longer travel and delayed care. The barriers would also be greatest for those with the fewest resources.
“Abortion access is already hanging on by a thread in Louisiana,” said Nancy Northup, president & CEO of the Center for Reproductive Rights. “If the Supreme Court upholds this law, more clinics will be forced to close, and an already dire situation will be made worse.”
But Louisiana Solicitor General Liz Murrill said the law establishes a continuity of care if a patient experiences a complication.
“It’s absurd to suggest that this was simply just to shut down clinics, this has always been bipartisan legislation that was led by women,” Murrill told NBC News, questioning whether providers who applied for admitting privileges tried hard enough.
“To the best of my knowledge for six years they haven’t done anything to guard against the potential for the law to take effect,” she added. “That alone tells me that they aren’t seeking to protect women because they aren’t even trying to obtain privileges.”
While individuals of all socioeconomic and ethnic backgrounds receive abortion care in the United States, about half of all women who get an abortion live in poverty. Likewise, in Louisiana, women who seek abortion care are disproportionately poor and 230,000 women of childbearing age live below the federal poverty line, according to court documents.
Marginalized communities in the state face large obstacles when accessing care, like the cost of an abortion, difficulty taking time off from work or securing childcare, even in the absence of the admitting privileges law.
On average, the cost of an abortion procedure is about $500, however nearly 40 percent of Americans can’t cover an unexpected $400 expense.
“If this law is upheld and it closes one or two, or even all three of our clinics, it’s just going to deepen the inequities that already exist,” said Steffani Bangel, executive director at the New Orleans Abortion Fund, which provides financial and practical support for those in need of an abortion.
In Louisiana, African Americans have the highest rates of poverty, followed by Latinos and Native Americans. In 2018, a majority of the people who got an abortion in the state were black.
“The reality is that anything that has a detrimental impact on the general community has a more detrimental impact on communities of color,” said Nia Weeks, a reproductive justice attorney based in New Orleans.
Elizabeth Nash, interim associate director of state policy at the Guttmacher Institute, said that existing barriers are compounded when people are forced to leave their community or state to get an abortion.
According to the Guttmacher Institute, the average one-way driving distance to an abortion clinic in Louisiana is 41 miles, while the distance is four miles in states like Maryland, New Jersey and Florida. However, if one clinic remains in Louisiana, that distance will likely increase for many.
“When we see states try to ban abortion or close abortion clinics, then we’re seeing much larger distances for travel and travel has an impact,” said Nash.
Added Bangel, “It’s not just the cost of the actual procedure that pushes it out of reach for many people in my community. It’s also the cost of getting there.”
Amid the coronavirus crisis, the New Orleans Abortion Fund has already noticed more callers traveling out-of-state to get an abortion, as a result of longer wait times, because clinics are only able to see a number of patients at a time with social distancing in place.
Further distances and longer wait times at clinics prevent timely access to care, according to Dr. Pooja Mehta, a practicing obstetrician and gynecologist in Louisiana.
“Really what this law is doing is eliminating points of access for women and for families, and will create delays in care,” said Mehta. “These delays have real implications in terms of people’s health and mental well being.”
When Texas passed a similar admitting privileges law, in 2013, it closed many abortion clinics in the state, and people were forced to travel longer distances in order to get care and experienced longer wait times.
Overall, abortions declined 14 percent in Texas between 2013 and 2014, and the Department of State Health Services recorded a 27 percent increase in abortions after 12 weeks, from 4,814 procedures in 2013 to 6,117 in 2014.
An abortion should be performed as early as possible, according to Skye Perryman, chief legal officer of the American College of Obstetricians and Gynecologists, adding that when it is delayed, that can push a pregnant person past the state’s gestational limit and risks of rare complications can increase.
“What we know is that delays in care can actually render the procedure completely inaccessible,” said Perryman. “There’s a grave concern on the part of the medical community that medically unnecessary restrictions will actually prevent women from being able to obtain care that they need.”
Northup agreed and said the repercussions would be felt nationwide.
“If the Court ignores its own precedent and upholds a law designed to shut down clinics, it will fuel the nationwide attack on abortion access,” said Northup. “Politicians hostile to abortion rights will no doubt feel emboldened by the Court and ramp up their attempts to cut off abortion access.”
The Supreme Court’s decision could be released as early as Monday or some time over the next few weeks.