What does having a doorway 32 inches wide have to do with having a safe abortion? Not a thing, say abortion rights advocates. In fact, they argue that state restrictions on abortion clinics are arbitrary, cosmetic and aimed at ending women's access to reproductive health care services. But that 32-inch rule isn't from out of the blue: it is in the Life Safety Code (LSC), which is now part of the U.S. Code and was originally written by the National Fire Protection Association. The LSC regulates everything from exit signs to sprinklers to revolving doors to elevators – you name it – in day care centers, health clinics, hotels, schools, prisons, businesses and homes across America. Alabama's latest abortion law, for example, doesn't mention 32-inch doors anywhere; it simply says abortion clinics must abide by the LSC.
And so when I read that several states have required abortion clinics to meet the same standards as ambulatory surgical centers – with doorways wide enough for ambulance gurneys, in case things go wrong – that didn't strike me as "extremist" or a "war on women." It struck me as common sense. I've been in a situation where a gurney couldn't fit through a door to help save someone who was dying, and it was horrendous. It's also common sense to have nurses on duty, a safe blood supply, and a hospital within 30 miles. Having a doctor with hospital admitting privileges, so there won't be an hourslong wait in the emergency room, seems like a good idea too.
So does limiting abortions to no later than 20 weeks, as Republican Sen. Marco Rubio of Florida is considering, with exceptions for rape, incest and when the life of the mother is threatened. Most abortions take place prior to 12 weeks; fewer than 0.2 percent take place after 24 weeks. Contrary to what you'd think from reading about Wendy Davis' filibuster last month, Texas would have been the 9th state to enact a 20-week limit for abortions, not the first.
When you look overseas, you see where the rest of the world stands on this issue. France, Spain and Germany all limit abortions to 14 weeks, according to the Center for Reproductive Rights. Sweden restricts them after 18 weeks. Italy bans them after 90 days. South Africa imposes increasingly tough restrictions from 12 to 20 weeks, and allows abortions after 20 weeks only if the life of the mother is in danger or there is a severe malformation or injury to the fetus. In a twist on Bill Clinton's mantra that abortion be "safe, legal and rare," the preamble to the South African law calls for abortion to be "early, safe and legal."
Where is this evolution coming from? I suspect sonograms have a lot to do with it. And it makes a difference to people if the baby is viable and able to survive outside the womb, which takes place somewhere between 20 and 24 weeks, right in the middle of the second trimester. Over the last few decades, as the technology has changed – both in terms of technological advances that allow better sonograms of the babies and medical advances that allow premature infants to survive – public opinion has been shifting as well.
In January of this year, Gallup found that 64 percent of Americans support outlawing abortion in the second trimester, and a whopping 80 percent in the third. A National Journal poll last month reported that more women (50 percent) than men (46 percent) support banning abortions after 20 weeks, except in cases of rape and incest. Nearly two-thirds want Roe v. Wade to stand. Most think abortion should be legal, but safe.
The Supreme Court agrees. In the 1992 case of Planned Parenthood v. Casey, the court upheld Roe, but also upheld the right of states to regulate abortion providers. So, it's no surprise that 17 states have enacted restrictions this year, according to the Guttmacher Institute. Despite what you may hear on cable TV, it's perfectly legal for states to regulate abortion clinics.
The Washington Post editorialized recently, "Safety in abortion clinics is a legitimate concern, but these regulations probably will have little effect on patient safety. Many of the requirements are costly and cosmetic, requiring clinics – without financial assistance from the state – to widen hallways, doorways and even entrance awnings." So not being able to get a gurney to a woman in trouble is a "cosmetic" problem, not a safety concern? Women's health advocates told the Post that as a result, all but one clinic in North Carolina "would probably close" because of associated costs, all but five clinics in Texas "would probably" close, and at least one clinic in Ohio is "already feeling the pinch." Similar predictions followed the restrictions on Pennsylvania clinics after the Kermit Gosnell verdict; yet news reports show that only five had actually closed, most voluntarily.