On a sweltering July morning in Jackson, Miss., a short woman with curly brown hair wearing a violet T-shirt and shorts joined pro-life activists protesting outside Mississippi's last remaining abortion clinic.
“It would really please the Lord God if Mississippi becomes the first abortion-free state,” she told the group. “Then all he'd have to worry about are the other 49.”
The speaker was Norma McCorvey — the once-anonymous “Jane Roe,” lead plaintiff in the landmark class-action lawsuit Roe v. Wade that legalized abortion in the United States. Since being born again in 1995, McCorvey has been an anti-abortion activist.
Both pro-life and pro-choice protesters descended on the Jackson clinic this summer, staging weeks of contentious rallies in an effort to make Mississippi a key state in the fight over access to abortion. However, abortion-rights groups say a quieter, more far-reaching battle over access has been raging in statehouses across the country, where anti-abortion forces have been working since the early 1990s to enact hundreds of laws restricting abortion. Pro-choice advocates say abortions are now particularly difficult for poor, rural and young women to obtain, or women in especially restrictive states.
Legislators have created “a gauntlet that women have to traverse before they can access abortion,” says Jackie Payne, director of government relations at the Planned Parenthood Federation, which runs 860 women's health clinics nationwide.
Partly as a result of the state restrictions, the United States has fewer abortion clinics today than at any time since Roe was decided in 1973. In addition to Mississippi, South Dakota has only one abortion clinic. Between 1996 and 2000, the number of abortion providers nationwide fell by 11 percent, and today more than a third of American women of childbearing age live in the 87 percent of U.S. counties that lack an abortion provider.
But pro-life advocates reject the notion that state laws have dramatically reduced abortion access, pointing out that 1.3 million abortions are still performed in the United States each year. “It's just not credible to claim that pro-lifers have been able to make abortions illegal,” says Cathy Cleaver Ruse, senior fellow for legal studies at the Family Research Council.
Anti-abortion advocates do concede, however that their push for greater state restrictions on abortion gained momentum after the Supreme Court's 1992 decision in Planned Parenthood of Southeastern Pennsylvania v. Casey, which said states could regulate abortion if they did not place “significant obstacles” in the path of women seeking abortions. With that opening, states enacted 299 laws in the 1990s limiting access to abortion and dramatically changing abortion politics.
“Casey helped us to focus our attention and build our movement” at the grass-roots level, says Wendy Wright, president of the anti-abortion group Concerned Women for America. It also “helped prepare us” for the coming battle over abortion bans that will shift to the states if Roe is overturned, she says.
Mississippi has led the pack, enacting more pro-life laws than any other state. Today, more than 30 states require patients to receive pre-abortion counseling, 24 states require a waiting period — usually 24 hours — between counseling and the procedure, 12 states have banned so-called partial-birth abortions, 32 states limit Medicaid funding of abortions and 34 states require parental notification or consent for minors to obtain an abortion.
Sondra Goldschein, an attorney for the Reproductive Freedom Project at the American Civil Liberties Union in New York, says that especially for poor women and minors, the level of access is “comparable to the access when abortion was illegal.”
The limits on Medicaid funding have had the greatest impact on poor women, says Smith. “One-fifth of the women who would have had abortions ended up carrying the fetus to term” because they cannot afford the procedure, she says. The mandatory waiting periods also force some women to travel long distances, pay for overnight child care and a hotel room and take time off from work. “This makes it harder for poor or rural women to obtain services.”
A recent report by the pro-choice Guttmacher Institute found that since the mid-1990s a widening gap has developed between poor women and higher-income women: Unplanned-pregnancy rates among poor women have increased by 29 percent while wealthier women's rates dropped 20 percent. Thus, the report concluded, a poor woman today is four times as likely to experience an unplanned pregnancy as a higher-income woman.
“They keep going back and trying to make it harder and harder to get an abortion, such as requiring notification and/or consent from both parents for a minor to get an abortion,” Goldschein says.
Although restrictive measures have been introduced in Congress, most of the action has been in the states. In 2005, about 500 anti-abortion bills were introduced in the states, of which 26 were enacted, says Vicky Supporter, president of the National Abortion Federation (NAF), a group of 400 U.S. abortion providers.
“We are worried that in some states the goal really is to make abortion inaccessible,” says Judith Waxman, vice president for health and reproductive rights at the National Women's Law Center.
Tanya Britton, president of Pro-Life Mississippi, makes no bones about that being her group's goal: “We'd like to see the Jackson clinic closed down, so Mississippi can be 100 percent pro-life.”
Britton strongly disagrees that limiting abortion access disproportionately harms poor women, as does Ruse. “Abortion hurts women — all women,” says Ruse. “It is a tragedy that minority women experience abortion at higher rates than white women today. Pro-life African-Americans see this as a form of racial genocide.”
Other pro-life advocates deny that state restrictions on abortion unduly block access. “Our legislation just nibbles around the edges,” says Wright. “Roe gave the pro-choice folks the entire pie: abortion on demand in all nine months. So they will go to the mat to oppose even the most common-sense legislation, such as allowing women to get full information before they get an abortion.”
Ruse agrees, noting that because Roe prohibited states from banning abortion outright, they can enact only “very limited” regulations — such as parental involvement, waiting periods and informed consent — “none of which impinges on access” unless a judge refuses to exempt a minor from parental-notification rules. “But minors do get abortions without their parents' knowledge. It happens quite readily.”
Even if, as Ruse says, state restrictions have not limited access to abortion per se, they have helped reduce the number of abortions performed each year, says Michael J. New, assistant professor of political science at the University of Alabama and a visiting health-policy fellow at the conservative Heritage Foundation. “These laws are having a real impact,” he concluded after analyzing abortion data from all 50 states. Abortion rates declined in states with more pro-life laws, he found, particularly in states that limited Medicaid funding or required informed consent and parental notice. “State legislation was a key factor in the 18 percent decline in the number of abortions performed in the United States between 1990 and 1999,” he wrote.
In addition to state restrictions, say abortion-rights advocates, access is declining because most young doctors today do not learn how to perform abortions. That's because fewer hospitals — where most doctors are trained — provide abortions, either because of fear or because they are operated by pro-life entities like the Catholic Church, they say.
“In most of the country, finding a doctor qualified to perform an abortion cannot be assured,” says Lois Backus, executive director of Medical Students for Choice (MSFC), based in Oakland, Calif., which is pushing medical schools to train students in the procedure. “The direst need is in the Midwest and Southeast, where the pro-life movement has gained political strength.”
Rose Afriyie, right, a field organizer for the National Organization for Women, leads demonstrators in Jackson, Miss., on July 17, 2006, against attempts to close the state's only abortion clinic. (Getty Images/Marianne Todd)
According to the pro-choice advocacy group NARAL, there are five or fewer abortion providers in eight states: Kentucky, Mississippi, Nebraska, North Dakota, South Dakota, Utah, West Virginia and Wyoming. And in 10 states, more than 95 percent of the counties have no provider: Arkansas, Kansas, Kentucky, Mississippi, Missouri, Nebraska, North Dakota, Oklahoma, South Dakota and West Virginia. Only Hawaii has an abortion provider in every county.
“Many providers have been driven out of business or are too scared to provide services,” says Goldschein.
But Ruse — noting that clinic violence has dramatically declined since Congress outlawed it in the 1990s — insists that restrictive state laws, fear of violence and lack of training have nothing to do with the disappearance of providers. “Most people in the healing profession do not want to go into the business of killing,” she says. That sentiment has grown among physicians and pregnant women since ultrasound technology became common in the 1990s, she says.
“People began to see that the baby had fingerprints, legs, arms and brainwaves. It wasn't just a clump of cells,” adds Wright. “Ultrasound did what we had been trying to do: explain that this was a human being that was being destroyed.”
In the final analysis, says Wright, pro-life groups have succeeded in the statehouses because they made their case “at the grass-roots level, using everyday language, while the other side has been making its case in the courts, using legal arguments.” Moreover, “80 percent of the American public” supports the “common sense” restrictions pro-life groups have advocated, she adds.
Pro-choice advocates have fought the anti-abortion efforts “every step of the way,” says Goldschein, while also pushing for their own “common sense” measures designed to prevent the need for abortions: increasing access to birth control, comprehensive sex education and emergency contraception. “We are trying to get legislators to come together on issues that both sides can agree on,” she says.
Susan Hill, who owns the beleaguered Jackson clinic, is optimistic that ultra-extremist groups like those that vowed to shut down the clinic in July will end up arousing abortion-rights advocates. During the rallies, many Jackson residents Hill had never seen before showed up to support the clinic, she says.
“When people get to the brink and realize they might lose their only access to abortion in the state,” she adds, “the pro-choice people begin to fight back.”