News Abortion

As Access to Safe Abortion Care Diminishes in Arizona, Rural Women Face Growing Hurdles

Robin Marty

Now that only doctors can perform abortions, rural women in the state have very limited options.

If you are a woman who has just discovered you are pregnant, want an abortion, and you live in Flagstaff, Arizona, you get to drive two and a half hours one way to a clinic in Phoenix. Live in Holbrook? That’s 3 hours and 30 minutes. 

This isn’t an issue to Cathi Herrod, President of the anti-choice group Center for Arizona Policy, who among other things, pressured lawmakers to pass a bill that made it impossible to provide abortions in any of the clinics outside the state’s two biggest cities, Phoenix and Tuscon. The Arizona law requiring that abortions only be performed in person by a physician curtailed even early medication abortions in areas like Flagstaff. Herrod claims that is not any sort of burden to the women outside the metro areas. According to Ahwatukee Foothill News:

Herrod said she does not believe the restrictions have created significant problems for women living outside the state’s two major metropolitan areas.

“Women living in rural areas certainly have access to medical services in Phoenix or Tucson,’’ she said. “So that’s not the issue.’’

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Women in Ahwatukee Foothills, a suburb of Phoenix, don’t have much reason to be concerned about the lack of access to clinics. Nor are the residents likely to face onerous  inconveniences because of a statewide 24-hour waiting period requiring two trips to a clinic before an abortion can be performed. For a Flagstaff woman on the other hand, that is an increase in the costs of both time and money.

Is it any wonder then that advocates within the state are looking at options for women to obtain an abortion in other states, even when the procedure is still technically legal in Arizona? USA Today interviewed Carrie Klaege of Abortion Access Network of Arizona, who is looking for clinics to send women to in order to get an abortion after 18-weeks post fertilization if the Arizona version of the so-called “fetal pain” ban ever makes it through the courts.

From the USA Today article:

In the year since Carrie Klaege moved to Arizona and started a non-profit program to help poor women afford abortions, she’s watched access to the procedure get tougher for her clients.

Following a rash of new laws, abortions are no longer available at clinics outside Tucson and Phoenix and women must wait 24 hours after required ultrasound tests before terminating pregnancies — forcing some to travel hundreds of miles and stay overnight. Klaege said she’s now making connections in other states where she could send women if the courts allow a ban on later abortions to take effect.

“Abortion is legal, but when you have to travel 300 miles to get to a clinic that provides the services you need, you don’t really have access,” says Klaege, co-founder of the Abortion Access Network of Arizona and the former clinic director for Dr. George Tiller, a Kansas physician murdered in 2009 for performing abortions. “The availability and access to services is being severely impacted, and it is starting to cause some real difficulty for women.”

So far, Klaege only appears to be focused on alternate arrangements for those that would be affected by the new ban. But for women in rural areas of the state, a first trimester abortion is becoming almost as difficult to access. The procedure may not be banned outright, but when a woman in Holbrook has the choice of driving nearly 200 miles to access an abortion in Phoenix, or drive an additional 30 minutes more to get one in Albuquerque, New Mexico. Add in a mandatory waiting period requiring at least one overnight stay in Arizona, and abortion might as well be banned in her home state.

We’ve seen abortion turn into a fight against time, finances and TRAP laws in states like Mississippi, South Dakota, Oklahoma, and other states with one lone clinic. But what we have also lost sight of is the fact that so many other states are in nearly as much of a crisis because access is only “easily” available to those who live in large metro areas and close to populated city centers. In the end, it doesn’t matter how many clinics a state has when they remain out of reach of rural women.

Analysis Law and Policy

Supreme Court Ruling on Texas Law Reverberates Around the Country

Teddy Wilson

"To the extent that similar state laws have different provisions, like those that contain transfer agreements for example, those laws will need to be litigated individually to fall," said Jessica Mason Pieklo, vice president for law and the courts at Rewire. "The good news is that the Supreme Court's decision in Whole Woman's Health provides advocates with a solid foundation to begin those next fights."

The U.S. Supreme Court struck down Monday two provisions in Texas’ anti-abortion omnibus law known as HB 2, and with that ruling the dominos began to fall. Similar anti-abortion laws in Wisconsin and Mississippi were blocked Tuesday by the Supreme Court, and Alabama’s attorney general announced he would drop an appeal to a legal challenge of a similar law.

However, significant obstacles remain to ensure access to reproductive health care throughout the country. A number of states have in place slightly different variations of the requirements struck down by the Court, which means it remains to be seen how lower courts may apply Monday’s ruling to restrictions that aren’t exactly like those included in Whole Woman’s Health v. Hellerstedt.

Monday’s decision is a significant victory for patients and providers, but it doesn’t guarantee that targeted regulation of abortion providers (TRAP laws) across the country will start to fall immediately, explained Jessica Mason Pieklo, vice president for law and the courts at Rewire.

“To the extent that similar state laws have different provisions, like those that contain transfer agreements for example, those laws will need to be litigated individually to fall,” Pieklo said. “The good news is that the Supreme Court’s decision in Whole Woman’s Health provides advocates with a solid foundation to begin those next fights.”

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Dozens of states in recent years have passed TRAP laws, which single out abortion clinics and providers and subject them to regulations that are more stringent than those applied to clinics and physicians in other medical fields.

Many anti-abortion measures introduced around the country resemble copycat legislation drafted by Americans United for Life (AUL), an anti-choice organization that distributes proposals to state lawmakers as part of a strategy to flood state legislatures with anti-choice bills.

As Rewire previously reported, key players in the development of HB 2 were deeply connected to AUL and other conservative lobby groups.

The Supreme Court ruled in Whole Woman’s Health v. Hellerstedt that two TRAP provisions under HB 2 placed “a substantial obstacle in the path of women seeking an abortion,” and constituted “an undue burden on abortion access.”

Specifically, the Court struck down the requirement that physicians who provide abortion care must have admitting privileges at a hospital within 30 miles of the facility where the physician will provide abortion services. The Court also struck down the requirement that facilities providing abortions meet ambulatory surgical center (ASC) requirements, which involve prohibitively expensive medically unnecessary building renovations.

There are 16 states that have passed laws mandating that physicians who provide abortion care have admitting privileges or similar requirements. In addition to laws that have been struck down in Alabama, Mississippi, Texas, and Wisconsin, courts have also blocked similar laws in Louisiana, North Dakota, and Oklahoma.

Laws requiring abortion providers have admitting privileges remain in effect in Arizona, Arkansas, Florida, Indiana, Kansas, Missouri, South Carolina, Tennessee, and Utah.

These laws typically require physicians have admitting privileges at a hospital near the facility where they provide abortion care. Some of these laws require that the hospitals provide OB-GYN services, and some require the physician to be board certified in OB-GYN medicine.

Other laws require that the hospital be no more than 30 miles from the facility where the abortion is performed, or have varied in defining the geographic boundary.

The law that was struck down in Mississippi required the admitting privileges be obtained at a “local hospital.” And Utah’s current law requires the hospital be within a “travel time of 15 minutes or less,” while Florida’s recently passed law requires the hospital be within a “reasonable proximity.”

There are 24 states that have passed laws requiring facilities in which surgical abortion services are performed to meet ambulatory surgical center standards that go beyond what is needed to ensure patient safety, and another 17 states require clinics that may only provide medication abortion to meet these same standards, according to the Guttmacher Institute.  

As Nick Bagley, an assistant professor at the University of Michigan School of Law, told Vox, similar laws that have been passed in other states may face legal challenges in the wake of Whole Woman’s Health, but the details of those challenges may vary. “The Supreme Court only applies to Texas,” Bagley said. “Other states will have slightly different laws with slightly different facts to argue over.” 

Florida and Indiana TRAP Laws Set to Take Effect 

This year Florida passed its own Texas-style anti-choice omnibus law, which takes effect Friday. However, there are some differences between the two laws, including differences in the types of regulations of physicians who provide abortion care.

Clinics that offer abortion services in Florida will be required to have a written patient transfer agreement, which includes the transfer of the patient’s medical records, with a hospital within “reasonable proximity” to the facility. Physicians also will be required to have admitting privileges at a hospital within “reasonable proximity” to their clinic.

The law also mandates annual inspections of all licensed abortion clinics, requires any medical facility in which abortions are performed to submit a monthly report, and prohibits state or local governments from entering into contracts with organizations that provide abortion services.

State Sen. Kelli Stargel (R-Lakeland), who voted for the bill, expressed concern after the senate vote that the bill’s language could become an issue in the courts. “Those clauses gave me concern that it would make it as though our intent was to close down all abortion clinics in the state,” Stargel told the Tampa Bay Times. “That was not the intent of this bill.”

After the Supreme Court’s ruling on Monday, Stargel reiterated that despite the bill’s similarities to the Texas law, it was not lawmakers intent to restrict access to abortion. “In Florida, we passed [the law] to safeguard women’s health, not to close abortion clinics,” Stargel said in a statement, reported the Florida Sun Sentinel.

Laura Goodhue, executive director of the Florida Alliance of Planned Parenthood Affiliates, told the Miami Herald that the language of the bill may be different, but that Florida lawmakers had the same intent as Texas lawmakers: to shutter abortion clinics.

“It’s definitely different language,” said Goodhue. “But the intent is the same.”

Planned Parenthood has filed a lawsuit challenging the law, however, the organization is not challenging the admitting privileges requirement. 

Goodhue told the Florida Sun Sentinel that the organization will determine if there are grounds for other lawsuits in the future. “Right now, we’re seeking emergency relief on the other three provisions, but we’ll make sure that access to care is protected,” Goodhue said.

Gov Rick Scott (R), who signed the bill into law in March, said during a press conference Monday that his administration is reviewing the Supreme Court’s decision, reported the Miami Herald

Lawmakers in Indiana have in recent years passed multiple laws to restrict access to abortion, including laws that have provisions mandating that physicians have admitting privileges and other reporting requirements

Mike Fichter, president and CEO of Indiana Right to Life, said in a statement that the Supreme Court showed “utter disregard for women’s health and safety,” and defended a similar law passed state lawmakers this year.

“We will be reviewing the Supreme Court’s decision thoroughly to see how this legal precedent could affect Indiana’s laws on admitting privileges and abortion facility building standards,” Fichter said. 

An omnibus abortion bill passed in 2011 contained multiple abortion restrictions, including a provision that a physician performing an abortion must have admitting privileges at a hospital located in the county where abortions are provided or a contiguous county.

The law also allowed for a physician to meet the requirement by entering into an agreement with a physician who has admitting privileges at a hospital in the county or contiguous county.

Another similar law was passed by Indiana lawmakers this year, which made numerous changes to state laws, including requiring forced counseling and mandatory ultrasounds for abortion patients, creating regulations on physicians who provide abortion care, and banning fetal tissue donation that has led to the development of vaccines and other public health benefits

The law created a requirement that a written agreement between a physician performing an abortion and a physician who has written admitting privileges at a hospital in the county or contiguous county be renewed annually.

The law also requires the state department of health to submit copies of admitting privileges and written agreements between physicians to other hospitals in the county and contiguous counties where abortions are performed.

Gov. Mike Pence (R) signed the bill into law in March, and it will go into effect on Friday.

Ali Slocum, spokesperson for Planned Parenthood of Indiana and Kentucky, told the Indianapolis Star that the organization does not have any immediate plans to challenge the law in court. “We are focused on what is currently in the pipeline. It is possible that the standard that the court set [Monday] could be used to challenge restrictions in other states,” Slocum said.

Efforts in State Legislatures to Repeal Laws

In some states lawmakers and advocacy groups may push to repeal similar laws following the Whole Woman’s Health decision.

Arizona lawmakers have passed several anti-choice laws in recent years and, like Texas and Florida lawmakers, justified those regulations as necessary to ensure the health and safety of women in the state.

Jodi Liggett, vice president of public affairs for Planned Parenthood Arizona, said in a statement that the Supreme Court made a “clear statement” that laws that restrict access to abortion care are unconstitutional.

“Arizona is a large state, with population spread across many rural areas. Laws that delay care, require travel over great distances and overnight stays certainly place real-life burdens on women seeking our care,” Liggett said.

Arizona Senate Minority Leader Katie Hobbs told the Arizona Republic that she will lead the effort in the legislature to repeal similar laws. “No woman or doctor should be punished for receiving or providing essential medical care,” Hobbs said. “These restrictions have never truly been about women’s health.”

However, repealing anti-choice laws in the GOP-dominated Arizona state legislature may prove difficult.

Republicans hold an 18-12 majority in the state senate and a 36-24 majority in the state house, and they have introduced dozens of anti-choice bills in the past several years. There have been seven laws to restrict access to abortion passed by Arizona lawmakers, including a law similar to Texas’ HB 2 which requires abortion providers to have admitting privileges.

Those efforts have been spearhead by the Center for Arizona Policy, a conservative think tank that promotes anti-choice, anti-LGBTQ, and so-called religious freedom legislation.

Cathi Herrod, president of the Center for Arizona Policy, said in a statement that the Supreme Court’s decision eliminated “common-sense safety precautions” for women seeking abortion care. “To give the abortion industry a blanket exemption from laws applicable to every other medical facility is unconscionable,” Herrod said.

Josh Kredit, general counsel for the Center for Arizona Policy, told the Arizona Republic that the Supreme Court’s decision suggest that abortion providers should be treated differently that other health-care providers.

“They are arguing they should be exempt from garden-variety health and safety regulations,” Kredit said. “It was clear that Texas, when it passed these, was focusing on protecting women, just like many of our laws that we pass in Arizona.”

Dr. Thomas M. Gellhaus, president of the American College of Obstetricians and Gynecologists, said in a statement that the Court’s decision made it clear these laws do not improve the health and safety of patients seeking abortion. Said Gellhaus: “As the court found, it was clear that the ambulatory surgical center and admitting privileges requirements at the heart of Texas law HB 2 did not improve the safety of women, and served only as a barrier to women’s ability to access safe, legal abortion when needed.”

“Of course, this is not the end of the battle when it comes to abortion access,” Gellhaus added. “In dozens of states, women are living under laws that impede access in a variety of ways, for example banning certain abortion procedures, setting gestational limits, mandating that medically inaccurate information be provided to patients, and more. None of these have a basis in medicine, and all of them represent political interference in the patient/physician relationship. We will continue to oppose these laws and to promote safe access to legal abortion for our patients.”

News Politics

Democrats in Utah, Colorado Make History as First Openly Transgender Women to Win Congressional Primaries

Ally Boguhn

Though Misty Snow's win may be historic for LGBTQ equality, she has previously noted that it was not the reason she is running for office."I'm not running because I'm transgender. I just happen to be transgender," the Utah candidate said.

Voters in Utah and Colorado made history Tuesday after nominating Democrats Misty Snow and Misty Plowright to run for Congress in their respective states—making them the first openly transgender women to win a major party’s congressional primary nomination.

Misty Snow, according to the bio listed on her campaign’s website, is a 30-year-old grocery store cashier from Salt Lake County, Utah, “concerned by the degree of income inequality in this country: particularly how it disproportionately impacts women, people of color, and the LGBT community.” Among the many issues prioritized on her website are paid maternity leave, a $15 minimum wage, and anti-choice regulations that “restrict a woman’s right to having a safe and legal abortion as well as any attempts to undermine a woman’s access to important health services.”

Though her win may be historic for LGBTQ equality, she has previously noted that it was not the reason she is running for office. “I’m not running because I’m transgender. I just happen to be transgender,” she told the Salt Lake Tribune in May. In later statement to the publication, however, Snow acknowledged that “a lot of people have told me whether I win or lose, I’m already making a difference just by running.”

Snow ran opposite Democrat Jonathan Swinton in Utah, having filed to run for office just before the March 17 deadline. Snow decided to run after Swinton, who was running for the Democratic ticket unopposed, penned an op-ed in September arguing that Planned Parenthood should be investigated—though the government should not be shut down over it. After reading the op-ed and thinking it over for several months, Snow told the Tribune she began to think the people of Colorado deserved a more liberal option and thought, “Why not me?”

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Snow’s win means she will move on to run against incumbent conservative Sen. Mike Lee. As previously reported by Rewire, Lee is stringently anti-abortion and has consistently pushed measures “attempting to limit access to or outright ban abortion.”

Misty Plowright, who is running to represent Colorado’s 5th congressional district, describes herself as an “Army veteran, a self-educated woman, a member of the LGBTQ+ community, and a passionate social democrat,” according to her campaign’s website. An IT worker from Colorado Springs, Plowright billed herself as the “anti-politician” during an interview with the Colorado Springs Gazette, and is running on a platform that includes campaign finance reform and defending voting rights.

Plowright will now challenge incumbent Rep. Doug Lamborn (R) for his seat in the House.

Plowright congratulated Snow in her win in a Wednesday post to her campaign’s Facebook page. “Congratulations from ‪#‎TeamMisty‬ to another progressive candidate in Utah, Misty K Snow,” wrote Plowright’s campaign. “Both women made history last night by winning their Democratic Primary.”

As Slate reported, though the candidates may have both won their primary races, “Snow and Plowright face uphill battles in the coming months”:

Despite a Gallup survey from March 2015 that calculated Salt Lake City’s LGBTQ population as the seventh-highest in the nation, Lee leads Snow 51 percent to 37 percent among likely general election voters according to a poll commissioned by the Salt Lake Tribune and the Hinckley Institute of Politics in early June. And Lamborn, who has represented Colorado’s heavily conservative fifth district since 2007, took nearly 60 percent of the vote in his most recent reelection fight.