Policies dubbed TRAP laws by pro-abortion rights groups – for Targeted Regulation of Abortion Providers – appear to be the most detrimental to their cause. One such law is the requirement that every clinic doctor be able to admit patients to a local hospital. Laws related to admitting privileges have been instituted in 10 states, according to the Guttmacher report, and have been particularly effective in shuttering clinics.
"We know that clinics have closed as a result of these restrictions. It's been documented in Virginia, Tennessee, Ohio and Pennsylvania," Nash says.
Five other states – Alabama, Texas, North Dakota, Wisconsin and Mississippi – recently passed laws requiring clinic doctors to have admitting privileges at nearby hospitals. The new rules have faced legal challenges in many states: An appeals court in Wisconsin rejected admitting privileges, while cases in North Dakota, Alabama and Mississippi are still in progress.
In Texas, the U.S. Supreme Court this November denied Planned Parenthood's request to block enforcement of an admitting privileges law while the case is in process, the Los Angeles Times reports. At least 11 centers in the state have closed since the legislation passed, according to advocates at Fund Texas Women, a pro-abortion rights group that has mapped the closures and re-openings using an interactive graphic. One clinic, in Fort Worth, reopened Monday.
Anti-abortion advocates say such measures are aimed at keeping women who choose to have an abortion safe.
"The purpose of hospital admitting privilege requirements is to ensure that women are receiving the best care possible," says Mailee Smith, staff counsel for Americans United for Life (AUL), which has helped craft abortion restrictions in various states. "Abortion is a risky procedure, [and] as the pregnancy increases it becomes even riskier.
"Women deserve to be treated by physicians who are able to face any complications that they may have following the risky abortion procedure," Smith says.
Like admitting privileges, laws governing a clinic's physical space – such as those mandating the size of corridors and operating rooms – can impact the availability of facilities. Other regulations requiring waiting periods, counseling, ultrasounds or mandatory testing for a fetal heartbeat – as well as a ban on abortions after 20 weeks in Texas, North Carolina, Alabama and other states, often based on a theory of "fetal pain" – may not shutter clinics, but pro-abortion rights activists say they impose a particular burden on the poor.
"These laws are designed to shame women, to make them feel worse about their choices, and to make abortion more expensive and less available," says Donna Crane, director of policy at NARAL Pro-Choice America.
The expense is certainly an obstacle, says Lindsay Rodriguez, president of The Lilith Fund for Reproductive Equity in Texas.
"When you look at something like a sonogram or multiple doctor visits, that all costs money," she says. "Every extra doctor's appointment that you add on, every extra procedure that you add on, makes it difficult for people that were already having trouble making ends meet."
In Arizona – where the U.S. Supreme Court this week refused to hear an appeal of a ruling declaring the state's ban on most abortions at 20 weeks unconstitutional – new regulations require women to receive in-person counseling only from a doctor before getting an abortion.
"While Planned Parenthood had staff in rural health centers, licensed staff, who could have provided that information or women could call in for it, now women – wherever they are in the state – have to drive up to eight to 10 hours to basically listen to a script for 20 minutes," says Bryan Howard, president of Planned Parenthood Arizona. "They then have to wait for 24 hours before they can return for an appointment to actually continue with the abortion."
Corrected on : Clarified 1/15/14: This story has been modified to clarify that Arizona’s abortion ban applied in most circumstances, but not all.