Abortion Doctor Murder: A Threat to Access?

News that abortion provider George Tiller was gunned down yesterday in his church should make every woman sit up and take notice. Despite having a president and Congress who favor abortion rights and a new Supreme Court nominee who presumably does as well, the safety and support of healthcare practitioners who provide them are obviously critical if women are going to have access. Certainly, Tiller was a controversial figure, as he performed abortions late into pregnancy—one of only three doctors in the country to do so. His killing was denounced by leaders from all political stripes, from President Obama to the president of Operation Rescue, an antiabortion group that has long had a Tiller Watch on its website. No one advocates murder.

While killings are rare—this is the first in a decade—abortion providers are frequently harassed and live in fear for their lives. I previously interviewed Warren Hern, who runs an abortion clinic in Boulder, Colo., and told me that the job "causes social and professional isolation and ruins your life." Like Tiller, Hern is willing to perform late-term abortions when fetuses have severe medical problems. And, like Tiller, he was put on an antiabortion hit list back in the early 1990s and targeted for assassination. He still receives regular death threats, and his Boulder clinic has been shot at by a sniper.

The ostracism, though, extends to doctors who perform abortions in only the first 12 weeks of pregnancy, which nearly half of Americans believe should be a woman's legal right. Hern says he knows physicians in his area who hide the fact that they do abortions because of the scorn they would face from friends, families, patients—even other gynecologists. I've had a hard time getting gynecologists to speak on the record about whether women in this country are having a harder time gaining access to abortions; one doctor told me that he didn't want his name or academic affiliation used for fear that he might have grant money withheld if he's associated with the procedure. It's no wonder the number of doctors performing abortions is dwindling.

Meantime, states are marching forward with their own efforts to limit a woman's access to abortion services. While they can't outlaw abortion outright under Roe v. Wade , state legislators can make it more difficult for women to obtain abortions. Indiana, for instance, has a bill pending that would require doctors who perform abortions to have admitting privileges at a hospital. Of the seven physicians performing abortions in Indiana, only one doctor has admitting privileges at a hospital, according to the Indianapolis Star.

A May report from the Guttmacher Institute provides this rundown of state laws currently on the books. Some make sense as a way to protect the well-being of pregnant women; others seem intended to restrict access to abortions.

Physician and Hospital Requirements: 38 states require an abortion to be performed by a licensed physician. 19 states require an abortion to be performed in a hospital after a specified point in the pregnancy, and 18 states require the involvement of a second physician after a specified point.

Gestational Limits: 36 states prohibit abortions, generally except when necessary to protect the woman's life or health, after a specified point in pregnancy, most often fetal viability.

"Partial-Birth" Abortion: 15 states have laws in effect that prohibit "partial-birth" abortion. 4 of these laws apply only to post-viability abortions.

Public Funding: 17 states use their own funds to pay for all or most medically necessary abortions for Medicaid enrollees in the state. 32 states and the District of Columbia prohibit the use of state funds except in those cases when federal funds are available: where the woman's life is in danger or the pregnancy is the result of rape or incest. In defiance of federal requirements, South Dakota limits funding to cases of life endangerment only.

Coverage by Private Insurance: 4 states restrict coverage of abortion in private insurance plans to cases in which the woman's life would be endangered if the pregnancy were carried to term. Additional abortion coverage is permitted only if the woman purchases it at her own expense.

Refusal: 46 states allow individual health care providers to refuse to participate in an abortion. 43 states allow institutions to refuse to perform abortions, 16 of which limit refusal to private or religious institutions.

State-Mandated Counseling: 17 states mandate that women be given counseling before an abortion that includes information on at least one of the following: the purported link between abortion and breast cancer (6 states), the ability of a fetus to feel pain (8 states), long-term mental health consequences for the woman (7 states) or information on the availability of ultrasound (6 states).

Waiting Periods: 24 states require a woman seeking an abortion to wait a specified period of time, usually 24 hours, between when she receives counseling and the procedure is performed. 6 of these states have laws that effectively require the woman make two separate trips to the clinic to obtain the procedure.