Abortion Policy in the United States: June Medical and TRAP Laws
Being a reproductive rights advocate is akin to signing up for a relentless emotional rollercoaster.
Hope rises…
On June 29, the U.S. Supreme Court heard the case June Medical LLC v. Russo. Their decision reversed and declared unconstitutional Louisana’s Unsafe Abortion Protection Act that required doctors who perform abortions to have admitting privileges at nearby hospitals. This was the first pro-choice centered U.S. Supreme Court (SCOTUS) decision since 2016, the same year SCOTUS ruled on Whole Woman’s Health v. Hellerstedt, a case that was nearly identical, word-for-word.
…and falls…
In early July, SCOTUS undercut birth control access and there was another attempt to violate Roe v. Wade. Roe is one of the most prominent and historical decisions in U.S. history establishing abortion as a human right. It challenged a Texas statute that made it a crime to perform an abortion unless a woman’s life was at stake. Declared during a time when nearly all U.S. states outlawed abortion to some extent, the case influenced a huge cultural shift. Roe set a precedent for reigning in government interference in personal decisions around procreation, marriage, or abortion.
Unfortunately, Roe v. Wade did not create an all-accepting pro-choice world. Anti-abortion state and local-level governments revolted and began creating their own restrictions in defiance. Some of these restrictions manifested into burdensome and medically unnecessary “targeted restrictions of abortion providers,” known as TRAP laws. Within the broader landscape of abortion access in the U.S., it is critical to understand what these unconstitutional laws are and how they impact the right to choose.
What are TRAP Laws & Policies?
TRAP laws are inherently manipulative. The intention of these state-level policies is to appear supportive of abortion while posing significant barriers to access. They can be split into two major categories: supply-side and demand-side policies. Supply-side TRAP laws are strategically implemented to single out abortion providers and clinics, including:
- Requiring unnecessary admitting privileges to hospitals
- Regulating specific sizes and dimensions for procedure rooms and hallways in facilities where abortions take place
- Requiring abortion providers to be board certified or eligible in obstetrics and gynecology
- Prohibiting clinics from being located within 2,000 feet of a K-8 public school
- Prohibiting state public hospitals from entering into transfer agreements with abortion providers
Demand-side policies focus on increasing barriers for those seeking abortion services such as requiring a 24-hour waiting period, parental consent for minors, state-mandated counseling, or spousal notification.
During the mid-20th century, states began to liberalize abortion laws following Roe. In 1992, the Supreme Court heard Planned Parenthood v. Casey that challenged the Pennsylvania Abortion Control Act (PACA), a piece of legislation that introduced rigorous demand-side policies and was considered the original TRAP law. SCOTUS upheld all provisions included in PACA, excluding spousal notification which was deemed unconstitutional. Anti-choice legislators saw an opening and took it, implementing hundreds of target restrictions of abortion providers. By 2016, it was recorded that the years between 2010 and 2015 accounted for one-quarter of all abortion restriction laws enacted since Roe.
Abortion Providers’ Privileging Act
June Medical and Women’s Health were almost word-for-word identical as they were based on the Abortion Providers Privileging Act — legislation drafted and promoted by Americans United for Life (AUL). The AUL, a group that writes “model” anti-abortion policies, consulted with U.S. legislators on 74 anti-abortion measures in 32 states in 2014. The group was the driving force behind passing hundreds of anti-abortion laws.
The AUL claims “state laws mandating that abortion providers have hospital admitting privileges are critical to ensuring that women receive proper and competent abortion care” — the basis of their Abortion Providers Privileging Act. Their law argues that this provision:
- would make abortion safer for women, as it would ensure that proper surgical procedures would be followed and skilled gynecologists and surgeons would be behind the procedure.
- would provide “legality” to the procedure and would eliminate 5,000 to 10,000 deaths that claim to be a result of “back-alley” or illegal abortions.
- would ensure that no woman would bleed to death — “alone and in pain following an unsafe abortion.”
These ideas were taken and put into Louisana’s Unsafe Abortion Protection Act, heard in June Medical, and Texas HB 2, heard in Women’s Health. The basis of these admitting privilege laws seem logical as supplemental support to abortion clinics. Yet the intention and the on-the-ground realities are drastically different. The law gives hospitals the right to assert their own beliefs and turn away abortion providers, among many other “unintended” consequences.
“Invisible Labor” & the Impact of TRAP laws
In their 2017 study TRAP laws and the invisible labor of abortion providers, Mercier, Buchbinder, and Bryant coined the term invisible labor to highlight the “the critical work undertaken by abortion providers not only to comply with regulations, but also to minimize the burden that new laws impose on patients.” TRAP laws pose an extreme burden on abortion providers, as they attempt to comply with stringent guidelines to keep clinics open and their services accessible to those in need.
To date, anti-choice TRAP laws have been implemented in 44 states and Washington D.C. Many medical associations have gone on record opposing targeted restrictions, including the American Medical Association and the American College of Obstetricians and Gynecologists. Compliance with such guidelines drastically increases costs for clinics and limits the amount of services they can provide.
TRAP laws also greatly impact abortion providers and clinics that lack the services to accommodate unnecessary trainings, do not have funds to renovate their operating rooms, or cannot follow through with procedures because they are constantly being turned down from hospitals. This often leads to clinic closures. In some cases, the restrictions are so effective that they cause the closure of nearly all clinics in the state. In 2018, Mississippi, for example, only had one clinic in the entire state because of a strict admitting privileges policy. The state even argued that a total elimination of access to legal abortion in Mississippi, forcing those seeking an abortion to travel out of the state, was not an undue burden.
With the enactment of HB2 in Texas, the number of clinics plummeted between 2013 and 2014, tripling the number of women whose closest abortion clinic was more than 100 miles away. In Virginia, it was estimated that each clinic on average would accumulate costs upwards of $1 million to accommodate new regulations, leading to the closure of over 10 clinics from 2014 to 2017.
Closures have created increased burdens on individuals who seek abortion services. One study that looked at the average delays faced by those who obtained abortions in 2014 found that 76% of patients were able to obtain an abortion within seven days and the average time from call to appointment was 7.6 days. Any additional barriers or wait times could be disastrous. This is especially true for pregnant people who oppose surgical abortions and are seeking a medically induced procedure, a service that must be accessed within 70 days of the start of a pregnancy, or for those seeking providers that can accommodate late-stage pregnancies.
Income was also found to play a huge part in delays. Lower income patients or those with more than two children waited on average 2–3 days longer than higher income patients without children. Distance drives up the financial and time burdens of the procedure, making it out of reach for many living below the poverty line, working multiple jobs, or taking care of children. In addition, Black, Indigneous, people of color face unique and heightened barriers to accessing to safe abortion. These themes can be seen across the U.S., as illustrated by this tool from Guttmacher Institute illustrating the number of clinics in a state, the percentage of counties in that state without clinics, and the percentage of women who live in a county without a clinic.
There is a lot to unpack about TRAP laws, their continued impact, and the difficult road ahead of us to work to dismantle them. We have a duty to elect people in office who will support our fundamental right to choose. As an American woman, I can’t rest while my right to choose hangs in the balance of 5–4 votes in the Supreme Court.
Take Action
WATCH: Dascha Polanco reading Kayleigh’s abortion story or the documentary Trapped.
RESEARCH: TRAP Laws in Your State
READ: List of 11 Extreme TRAP laws
FOLLOW: NARAL Pro-Choice America or the NARAL account associated with your home state
ACT: See if your Senator or Congressman supports The Women’s Health Protection Act — Yes? Call them and say “Thank you!” No? Call them and say “Your support is essential to my health and well being!”
Note: While this piece focuses heavily on policy and a legal lens, it’s important to note that the lived experiences of individuals vary widely.
MJ Ulrich is the current Communications and Development Intern at Global Health Corps (GHC). Passionate about the intersectionality of sexual and reproductive health and justice, she looks forward to continuing the fight for health equity through words and action.
Global Health Corps (GHC) is a leadership development organization building the next generation of health equity leaders around the world. All GHC fellows, partners, and supporters are united in a common belief: health is a human right. There is a role for everyone in the movement for health equity. To learn more, visit our website and connect with us on Twitter/Instagram/Facebook
