Reproductive health care, including abortion, is a vital component of women's health care. While women in the United States have had a constitutionally protected right to abortion since the 1973 Roe v. Wade decision, (1) actual access to abortion services is diminishing. (2) The Report Card examines five states policies which can have immense impact, both positive and negative, on women’s access to these services. States can affirmatively act to protect access in two ways. First, they can promote clinic access by banning violence, and by providing state police and prosecutorial authority in addition to that provided by federal authorities. Threats and violent attacks on reproductive health centers have had an extremely negative impact on women’s ability to obtain abortions. (3) In 1994, Congress passed the Freedom of Access to Clinic Entrances Act (FACE), (4) and a decline in such incidents followed immediately. (5) Similar laws at the state level would provide further protection through state enforcement mechanisms. Second, states can use their own funds to provide abortions to their Medicaid beneficiaries, many of whom are denied coverage of abortions due to the Hyde Amendment. Enacted in 1977, this amendment is a federal law which prohibits the use of federal Medicaid funds to cover abortion except in cases where the pregnancy is the result of rape or incest, or the life of the woman is endangered. (6) Using states' own funds to provide this access is critical for many low-income women.
On the other hand, states chip away at a woman's access to abortion when they enact policies to limit services. States can prohibit private insurers from covering abortions except in limited circumstances. (7) Second, states create a serious barrier through parental consent and notification policies. These laws require involving one or both parents in a minor’s decision to terminate a pregnancy and often serve to limit young women’s access to abortion. (8) Such requirements can endanger the health of young women—some may delay the procedure, and others may travel alone to another state to secure the abortion. (9) Finally, states limit access by requiring waiting periods, typically 24 hours, between the time a woman receives state-mandated counseling and the abortion. Waiting periods make it difficult to schedule appointments and cause delays, thereby increasing the risk of complications. They also force many women to incur greater financial costs or to face additional harassment at clinics and from abusive partners and spouses.