The Geopolitics and Financial Obstacles to Abortion in the United States

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The Geopolitics and Financial Obstacles to Abortion in the United States

By Anshumi Jhaveri

Dulles High School, Class of 2022 Sugar Land, Texas

Edited by: Mia McElhatton Reviewed by: Mason Kortz

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I. INTRODUCTION

Throughout American history, the fight for women’s reproductive rights has been heated and divisive, with legislative decisions and court cases sparking debate from the highest levels of government to everyday citizens. While to many people, reproductive rights are human rights, this does not seem to be a universal sentiment. The argument for reproductive rights is at the intersection of religious rights, women’s rights, and constitutional rights, among others. The intersectionality of reproductive justice is particularly important because there are so many different liberties being fought for all at once––for instance, reproductive freedom can be seen as religious freedom, lest a woman’s decision about her body be determined by the religious belief of another.

While “reproductive rights” is an umbrella term for a multitude of healthcare laws and procedures, there is one subset of these practices that many people think of when they first hear the term––abortion. Abortion is defined as “the termination of a pregnancy after, accompanied by, resulting in, or closely followed by the death of the embryo or fetus” (Merriam-Webster). Abortion has been one of the most controversial topics in American political history, with both sides of the debate being extreme advocates for their causes.

As a native Texan woman, this author has observed the local debate surrounding abortion rights and restrictions. Not only is the argument against abortion heavily based on religious ideologies, but there also seems to be little regard for science or the actual impacts on women who are denied abortions. The matter tends to be viewed with only regard to the abortion itself, with no thoughts surrounding why a woman may need one and why abortion may be their best option. Pro-life organizations in Texas take pride in how much they believe they advocate for the right to life, yet they do nothing to reform systems that are already in place, such as the foster

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care system or welfare. Furthermore, the idea that a woman obtaining an abortion is a “baby killer” instead of an individual making a decision about what is best for her and her child is deeply rooted in patriarchal norms suggesting women cannot make proper and educated decisions for themselves (Mcbain). Finally, women are not a large part of groups making decisions that impact Texas healthcare legislation. Instead, decisions about their bodies are made almost solely by men (Ura et al.). A. Structure of the Analysis This paper will apply an economic lens in its analysis of partisan abortion laws. Specifically, this paper will apply a supply/demand analysis of abortion providers and abortion seekers. The analysis is as follows: when restrictive abortion laws are enacted, the supply for abortions decreases. As abortion clinics begin to close, one of two things can happen. Either the demand increases and whichever clinics are still open receive more traffic, or there’s a large increase in cost needed to obtain an abortion - so while the demand stays the same, less of the demand will be met.

As the costs - both financial and otherwise - of obtaining an abortion increase, women’s access to what should be a simple healthcare procedure becomes a frightening journey of navigating legal and social systems that do not support them. To dive deep into these different issues, this paper will be divided into the following sections: Section 2 will discuss politically “red states” with regards to their policies on abortion rights, with a deep dive into Texas, the nation’s largest battleground for reproductive rights. Section 3 will discuss “blue states” with regards to their policies on abortion. Finally, Section 4 will discuss a “purple state” and what it looks like when a state tries to fit in the middle of the abortion rights spectrum.

B. The Right to Privacy

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In the 1960s and 1970s, the Supreme Court held that there is an implied right to privacy in the U.S. Constitution. Throughout this period, the Supreme Court set precedent establishing that the government could not interfere with personal decisions surrounding family life; this includes choices surrounding procreation, marriage, and more. First, in Griswold v. Connecticut (1965), the Supreme Court held that “a state statute making it a crime to use birth control violated married couples’ right to privacy” (Planned Parenthood, 1). Then, in 1972, in Eisenstadt v. Baird, the Supreme Court extended this right to unmarried people (1). This right to privacy opened the door for parties to sue for the right to abortion, as it was related to familial matters, procreation, and the idea of individual choice surrounding healthcare decisions. The right to privacy is, in general, considered an extremely important right, as it created the notion that the government is not allowed to interfere within certain private matters of its citizens. Privacy is key in the foundation of citizens’ rights and is a major reason why Roe v. Wade, a landmark case, recognized the right to abortion. The right to privacy is riddled with complexities; for the purpose of this paper, all the intricacies will not be heavily analyzed. C. Roe v. Wade The right to privacy paved the way for Roe v. Wade (“Roe”), one of the nation’s most influential and controversial Supreme Court cases. Roe recognized women’s autonomy over their own bodies and was essential toward the societal recognition of women’s rights to make their own choices. In Roe, the Supreme Court struck down a Texas statute that criminalized abortion done for purposes other than saving the life of the mother (Planned Parenthood, 1). This was a monumental decision, recognizing for the first time that the constitutional right to privacy “is broad enough to encompass a woman’s decision whether or not to terminate her pregnancy” (Roe v. Wade). Roe became the case that led to the legalization of abortion in the United States.

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Prior to Roe, abortion was considered illegal in a large majority of states with few exceptions made in the case of rape, incest, or anomalies with the fetus (Planned Parenthood, 1). Roe declared this previous statute as unconstitutional and therefore the right to abortion became legal nationwide, a ruling that expanded women’s access to healthcare nationally. “This decision also set a legal precedent that affected more than 30 subsequent Supreme Court cases involving restrictions to access to abortion (1).” Since this landmark case, the fight for abortion rights has shaped American law and advocacy.

Roe’s holding was controversial when it was handed down, and even today, nearly five decades later, it continues to have passionate advocates on both sides. Anti-abortion groups work not only to get Roe overturned but also to create as many obstacles as possible in a woman’s path to receiving an abortion. Roe had a sweeping 7-2 majority in the Supreme Court, with six of the seven Justices in the majority having been appointed by Republican presidents. In December 2021, the Supreme Court will hear a Mississippi case, Dobbs v. Jackson Women’s Health Organization (“Dobbs”), that may have serious implications for Roe (Sorkin). The ruling could result in the overturning of Roe, especially with states such as Utah joining Mississippi in the fight. This raises questions about what happens to those who seek abortions but face temporary bans under the state-level laws as their legality pends at the Supreme Court.

II.

CONSERVATIVE “RED STATES” AND THE ANTI-ABORTION MOVEMENTA. Introduction to “Red States” Many states that align with Republican, conservative values have been working to pass laws that make getting an abortion extremely difficult or criminalize abortion altogether. The anti-abortion argument is closely connected to the separation of Church and State, or the lack

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thereof. Religious texts are often cited as reasoning why women cannot get abortions, thus intruding upon non-Christian religious freedom and the Establishment Clause.

In 2021 alone, Arkansas has added at least twenty new restrictions on abortion access––the highest number of restrictions a state has set in 2021 thus far (Herzog). Arkansas recently passed the Arkansas Unborn Child Protection Act or Senate Bill 6 (SB6), which says that an abortion can be performed only if the mother is in danger (Herzog). While this move may be frightening to many, it does not come as a surprise—Arkansas was named the “most pro-life state in the nation” according to the 2021 ranking by a national advocacy organization, “Americans United for Life” (Herzog).

SB6 also creates criminal penalties for doctors who are caught performing abortions: up to ten years in prison, as well as felony charges (Herzog). This move has a significant impact on both the supply and demand for abortion. If it becomes illegal for doctors to perform abortions, the supply for abortions begins to massively decrease. Next, a two-fold process will occur. First, the demand for abortions will increase at facilities that remain open in Arkansas and its neighboring states. Abortion clinics will receive more patients than they are equipped to handle, causing a backlog in not only providing abortions but also other necessary women’s healthcare services, such as contraceptives and neonatal care. Second, the demand will be too much for the current supply to handle, and therefore wont be met (or women will resort to dangerous self-help methods). This is precisely the purpose of what these restrictions aim in the first place—to step-by-step, begin dismantling Roe with small laws that block women’s ability to access abortions.

In addition to laws like SB6 that directly target abortion access, many Arkansas laws also indirectly restrict abortions. One measure is known as the “Arkansas Student Protection Act,”

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which prohibits public schools from engaging in any transactions with abortion providers, including accepting any type of free instruction from them, such as sex education (Herzog). Representatives from Planned Parenthood have previously provided educational lessons to students on topics such as contraception, sexual orientation, and much more to students in Arkansas; this will not be permitted in public schools anymore under this law (Herzog). The consequences of this restriction are counterproductive: If teenagers are not educated about safe sexual practices, they will experiment on their own—a dangerous move that can more often than not lead to unwanted pregnancies, thus resulting in increased demand for abortions.

Senator Breanne Davis, a Republican Senator from Arkansas who co-sponsored the Student Protection Act, stated that they are the “[n]umber one most pro-life state based on policy that was passed, but have the highest birthrate amongst teenagers” and that at a certain point in, the state’s policies needed to align with their actions (Herzog). But minimizing discussions surrounding sex education does not mean that students will abstain from engaging in sexual activity. Instead, by taking away access to both sex education and abortion access, conservative lawmakers throw students into the very vicious cycle they claim to be working to end.

While Arkansas is one example of a state that has enacted harsh policies condemning abortion, other states are engaging in similar actions, as well. Texas, Louisiana, and North Dakota are all examples of states where the majority of the counties do not have abortion providers, and their governments have been anti-abortion for years (CBS 2011). To better understand the ramifications for women living in states that vehemently oppose reproductive freedom, this paper will conduct a case study on Texas, one of the nation’s most conservative states with regards to abortion policies, both in the past and at present.

B. Texas

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Currently, Texas is one of the biggest battlegrounds for reproductive justice in the nation. While certain laws have placed a spotlight on Texas in the past few years, the state’s battle with reproductive freedom dates back more than 50 years. In fact, Texas was the birthplace of Roe v Wade, as discussed above. The battle for abortion rights began in this southern, conservative state and continues to rage on today, both in Texas and throughout the country.

1. The Heartbeat Bill

In May 2021, Texas Governor Greg Abbott signed the “Heartbeat Bill” (SB8), which is known to be “one of the nation’s strictest abortion measures,” as it bans abortion as early as six weeks (Namjabadi). Six weeks is before most women know they are pregnant, as it is usually only about two weeks after a woman’s missed menstrual cycle (Namjabadi). SB8 is considered the strictest abortion law in the nation. For perspective, Dobbs, the Mississippi case that the Supreme Court is due to decide, deals with a law that bans abortion after fifteen weeks. Given the massive controversy surrounding a fifteen-week ban, six weeks seems unreasonably harsh.

SB8 is especially dangerous to reproductive freedom due to legal provisions making it much harder to be overturned by courts. In the past, abortion providers or healthcare agencies have sued state governments to prevent harsh abortion laws from becoming reality (Namjabadi). However, the Heartbeat Bill, SB8 says that the government would not be the one enforcing this law; rather it would be the private citizens of Texas (Namjabadi). Specifically, any person would be allowed to sue either an abortion provider or someone who received an abortion, regardless of whether they have any connection to the provider or patient. This creates a difficult situation for abortion rights advocates, who may have a harder time convincing courts that the law is unconstitutional, as government officials have no role in the statute’s enforcement. Furthermore, those who sue abortion providers and patients may win more than $10,000, providing a monetary

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incentive for people to bring these lawsuits (Namjabadi). This puts a large amount of power in the hands of everyday citizens, giving them the ability to both profit off of and question the rights of any individual.

2. House Bill 2 a. TRAP Law Restrictions

Whereas SB8 is the harshest abortion law Texas has seen to date, as discussed above, there was a law that passed many years prior which can help us understand what the potential ramifications of SB8 may truly be––House Bill 2. “In the summer of 2013, Texas passed House Bill 2 (HB2), a TRAP [Targeted Regulation of Abortion Provider] law that restricted abortion services in 4 ways: (1) physicians performing abortions must have admitting privileges at a hospital within 30 miles of the facility, (2) medication abortion must be administered according to the mifepristone label approved by the Food and Drug Administration (with some dosage exceptions), (3) most abortions at or after 20 weeks “postfertilization” are banned, and (4) all abortions must be performed in facilities meeting the requirements of an ambulatory surgical center (ASC)” (Gerdts et al., 857).

TRAP laws are state laws that are applied strictly to abortion providers, imposing licensing fees, personnel regulations, and other restrictions that are not placed on similar medical facilities (Medoff, 577). “According to many pro-choice supporters, the explicit or implicit goal of TRAP laws is to drive abortion providers from the market and reduce the supply of abortion services.” By imposing increased personnel requirements and annual fees on abortion doctors, an additional financial burden is imposed upon them—a burden they may not have the financial ability to meet. Legal abortion is one of the safest and cheapest medical procedures out there, meaning that TRAP laws serve little logical purpose and are solely enacted to limit abortions.

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While HB2 ended up getting struck down by the Supreme Court as unconstitutional, it had devastating impacts in the three years it was enforced. b. Cost-Benefit Analysis in Abortion-Seeking After HB2

The Theoretical Decision Making Model of Fertility Control was created post-Roe by Gary Becker and Robert Barro. Under this model, five costs determine whether a woman will obtain an abortion: mondetary, search, travel, time and emotional (Medoff 578). All of these costs increased after HB2 passed. This model heavily impacted behavior post HB2. Specifically, "the number of Texas facilities providing abortions declined, from 41 in 2012 to 17 in June 2016. Women whose nearest clinic closed traveled farther to access abortion services than those whose nearest clinic remained open. Overall, abortions declined 14% in Texas between 2013 and 2014” (Grossman 437). As can be seen from these statistics, geographical distance is one of the most important costs in determining whether women will choose to receive an abortion.

While abortions were still occurring in Texas, their frequency and geographical availability significant decreased. Specifically, “[i]n 2012, 66,098 abortions were performed among Texas residents (97 out of state). In 2014, 53,882 abortions were performed among Texas residents (754 out of state). Of 254 counties, there were 41 facilities in 17 counties in 2012 and there were 21 facilities in 6 counties in 2014” (Grossman 438). In this two-year difference, the number of abortions occurring out of state increased eightfold but, even with out-of-state options, the overall number of abortions still decreased. This is likely because many people are financially or otherwise unable to travel outside of the state for an abortion. Many people who chose to leave Texas to receive an abortion even had to take out a loan simply to cover the cost

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of the procedure (438). Thus, an increase in distance was connected to a large decrease in abortion access.

However, even in areas where abortion facilities remained open, there was a decrease in abortion due to the facilities’ inability to meet the new, massive demand (438).

While HB2 did not shut down every facility in Texas, it had impacted facilities that stayed open as well. Particularly, “HB2 affected women who were...directly affected by the closure of the clinic they would have used, as well as women whose nearest or preferred clinic did not close, but who nevertheless were burdened by the law through the discontinued offering of medication abortion, longer wait times for appointment availability, or higher costs of the procedure at one of the remaining facilities” (Gerdts et al., 858). Hence, regardless if a facility closed or remained open the end result was the same: HB2 succeeded in preventing abortions and other forms of reproductive healthcare from occurring.

Women in Texas battled factors other than geographical distance, as well. Not only was there an increased cost and travel time to obtain an abortion due to the geographic issue, but also many women reported additional health issues from high stress surrounding the abortion (Fuentes). While obtaining an abortion is a stressful decision to begin with, HB2 did not make this easier, as the enforcement happened quickly and with poor communication: “After having appointments canceled or being turned away from closed clinics, more than half of women reported being confused about where they could go for abortion services and frustrated with the

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lack of clarity about which clinics remained open.” This shows that once the legislation went into place, there was mass confusion with regards to what still was and was not a possibility, leaving women stranded (Fuentes). Abortion providers were also confused, due to a massive lack of communication and understanding. This led some women to be referred to more distant clinics when closer facilities were actually open (Fuentes). All of this resulted in a significant emotional burden for women seeking an abortion, which led many of them to make decisions they never would have before the passing of HB2.

Many of these decisions both crossed individuals’ emotional boundaries and infringed on women’s right to privacy. In particular, “[w]omen also reported that they needed to ask for more help than they would have if there had been a local provider, and in the process, they had to reveal their abortion decision to people they might not have told otherwise” (Fuentes). In other words, women had to compromise their right to privacy - the very foundation upon which Roe was built - as it was too difficult to navigate the harsh process of getting an abortion as a Texan alone. However, this violation of the right to privacy ended up playing a role in getting HB2 blocked three years later, making basic access to abortion accessible again for Texas women. Since HB2 was blocked, Texas has continued to restrict women’s access to their reproductive rights. With the Heartbeat Bill effective as of September 2021, it may become common for neighbors to get involved in each other’s personal health affairs. Abortion providers have already begun to sue Texas Officials over the Heartbeat Bill, stating that “85% of those who obtain abortions in Texas are at least six weeks into their pregnancy” and that these restrictions are there to enforce an “ideological agenda” (Pérez-Moreno). However, if these lawsuits fail, the Heartbeat Bill will go into full effect. While the Heartbeat Bill would not be the first private-citizen suit provision in Texan abortion law, navigating these new provisions looks to be

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an uphill battle for abortion providers.

III.

“BLUE STATES” AND THE PRO-CHOICE MOVEMENTA. Introduction to “Blue States” Whereas red states are known for harsh restrictions on reproductive freedom, blue states generally provide a stark contrast in both policy and ideology. “Blue” states are states that typically align with Democratic values and vote “blue” in national elections. Historically, northern states have been dark “blue” states and remain “blue” when it comes to abortion––New York, Virginia, and New Jersey have little-to-no restrictions at all (Hubbard). This further shows that the debate on abortion is deeply political.

Demographic differences, such as higher education, play a large role in the beliefs people tend to align with. For example, the Northeast has a 29.8% average college-educated population, as opposed to the 19.7% average in the South (US Census Bureau). An almost ten percent difference in those who have a higher form of education may contribute to why those in the South tend to place firmer belief in ideology rather than science. B. New York In contrast to the harsh restrictions in Texas, New York has few restrictions with regard to its abortion policies. The only abortion restriction in New York is a Viability Restriction, under which an abortion cannot occur after a specific period (usually 24-28 weeks) in a woman’s pregnancy where the baby will have a high survival rate (Danielsson; Guttmacher Institute). Other common restrictions, which can be found in other states, are not enforced in New York, as can be seen in the figure below (Hubbard).

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C. “Blue States” Conclusions Two conclusions can be drawn from this analysis of the blue states. First, the direct relationship: because there is a supply for abortions, the demands will be met. Due to the lack of restrictions on abortion laws in blue states, there are many abortion clinics in these states. As of 2017, New York had 113 abortion clinics (Guttmacher Institute). That’s nearly four times the amount of clinics in Texas, which has a population more than three times larger than that of New York and is geographically larger, as well (United States Census Bureau). Despite a majority of blue states being smaller than red states, there are far more opportunities for women to obtain an abortion in blue states. This shows that when there is an ample supply of abortion providers, there is a demand for abortions, as women know that they have the choice in case they need it. Furthermore, strong political and demographic trends contribute to the pro-choice policies that exist in blue states. While some people strongly believe other states should model the reproductive policies and freedoms in blue states, it is important to remember that there are external factors heavily influencing the red states in the same way. Education, politics, and geography, amongst many other factors, play a role in the fierce anti-abortion movement that runs rampant in the south.

IV.A “PURPLE” STATE AND THE ABORTION MIDDLE GROUND

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A. Introduction to the “Purple States”

While it may seem that states only seem to align with either “red” or “blue” when it comes to abortion policies, there is another color that lies in between these polar ends of the spectrum––purple. A purple state is one that does not consistently vote “blue” or “red” in national elections. Purple states are also where many of the abortion policies seem to not fit within either a pro-choice or a pro-life ideology. B. Arizona Arizona is a perfect example of a purple state. One survey indicated that 49% of Arizonans believe that abortion should be legal, while another 49% believe that it should not. (Roseberry). This is almost a near-perfect split in belief, illustrating how “purple” politics carry over into the abortion debate.

In April of 2021, Governor Ducey of Arizona signed a bill into law making it a crime to perform abortions based on genetic conditions such as Down Syndrome or Cystic Fibrosis (Polletta). This restriction appeals to both the “red state” goal of reducing abortions overall, while also appealing to “blue state” politics that better support people with these genetic conditions. As a result, “[w]hile many attorneys and OB-GYNs stated that this [law] was medically unsound and unconstitutional,” it raises moral questions about whether there ever is a reason where an abortion might be unethical: Would obtaining an abortion because one does not want to raise a child with special needs be ableist? Would aborting a baby because it is a girl be sexist? These are not easy questions to answer. Thus, this law in Arizona is considered controversial and requires conversations about whether abortion is always permissible, no matter the reason.

C. “Purple States” Conclusions

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While this paper does not propose any specific policy recommendations based on purple state restrictions, purple states open a larger conversation as to the ethics of abortion. While some may say aborting a child because it will have special needs is ableist, others may argue that it is not morally sound to bring a child into the world when the parent could not provide the treatment and support they deserve. Other people may also say it is cruel and selfish to bring children into a world where there is already so much suffering. These are all questions of ethics, which are deeply personal decisions and not for the law to make.

The beauty of the pro-choice argument is just that: it gives every woman a choice. Whether that choice is influenced by her ethics, values, financial abilities, career aspirations, whatever it may be, all women should get to make that decision for themselves. As a result, a key takeaway from the purple states is that abortion is not a light topic. There are many hard questions to answer and difficult decisions to make, but each woman should have the ability to arrive at these decisions on her own.

V. CONCLUSION

At the time the majority of this paper was written, SB8 had not yet gone into effect. Today, the lives of millions of Texan women are in peril; SB8 was passed, and Texas women’s access to reproductive healthcare has been attacked. The Supreme Court declined to block SB8 with a 6-3 vote, a shocking blow to women and men across the nation. However, they are yet to rule on whether SB8 is unconstitutional. Lawsuits against abortion providers have begun, and Texas has moved far backward in terms of gender equality, reproductive rights and freedom. In light of the Texas law, other states have moved to draft similar “heartbeat bills.”

While those with a uterus may be the ones directly suffering from harsh abortion laws,

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this is a fight that involves everyone, including men. While this paper calls upon both men and women to advocate for furthering and protecting reproductive rights, men, in particular, should use their platform and position of power to work to keep abortion legal. A person’s power is in their voice––using your voice when you are in a position of power to do good is one of the noblest feats.

The fight for reproductive justice is a long and hard one. The power to change these laws starts with all of us.

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