Last week, a federal judge in Wisconsin extended a temporary restraining order that prevented Wisconsin’s latest legislative attempt to reduce women’s access to safe abortion care—by requiring abortion providers to obtain admitting privileges from a local hospital—from going into effect.

Section 1 of Wisconsin Act 37 (SB 206), which was proposed by the Wisconsin legislature on June 4 and hastily signed by Republican Gov. Scott Walker on July 5, requires that physicians who provide abortion services have admitting privileges at a hospital within 30 miles of the location where the abortion is performed. The law was enacted ostensibly to reduce the risk to patients who suffer serious complications during an abortion, and to prevent abortion providers from abdicating their duty of care and leaving such women to fend for themselves. In reality, however, these laws place a substantial obstacle in the path of a woman seeking an abortion and contravene the constitutional principles set forth in Planned Parenthood v. Casey.

At first blush, these laws may seem sensible enough, especially if you believe that abortion is a dangerous procedure and providers should have hospital admitting privileges in case something goes horribly awry. Such is the concern of anti-choicers pushing for the Wisconsin law, as Susan Armacost, legislative director of Wisconsin Right to Life, noted in a July 5 statement. “Apparently, Wisconsin’s abortion clinics don’t believe their abortionists need to have hospital privileges at a hospital located within 30 miles of their clinic … or anywhere at all,” she said. “Currently, when a woman experiences hemorrhaging or other life-threatening complications after an abortion in Wisconsin, the clinic puts her in an ambulance and sends her to a hospital ALONE where she is left to her own devices to explain her medical issues to the emergency room staff. The abortionist who performed the abortion is nowhere to be seen. This deplorable situation must change.”

But documents submitted to the federal court in Wisconsin overseeing the case paint a very different picture of the admitting privileges law. According to Dr. Douglas Laube, a board-certified OB-GYN since 1976, the admitting privileges requirement is “medically unjustified and will have serious consequences for women’s health in Wisconsin.”

As Dr. Laube explained to the court, abortion is one of the safest medical procedures in the United States, alarmist claims to the contrary notwithstanding:

The risk of death associated with childbirth is 14 times higher than that associated with abortion. The risk of death related to abortion overall is less than 0.7 deaths per 100,000 procedures. (As a point of comparison, Dr. Laube states that the risk of death from fatal anaphylactic shock following use of penicillin in the United States is 2.0 deaths per 100,000 uses.) Less than 0.3% of women experiencing a complication from an abortion require hospitalization.

Abortion is an extremely safe procedure that rarely results in serious complications, and despite anti-choicers’ vehement efforts to cloak such laws in feigned concern for maternal health, current medical practices are such that risk to patients won’t be reduced by restrictive rules requiring admitting privileges.

When something goes wrong during a surgical abortion and hospitalization is required, the practical reality is that if a patient is transported by ambulance to a hospital, the EMT will make the decision about which hospital the patient should be taken to. Similarly, in cases of medical abortion, if a pregnant person experiences medical complications at home, she will likely be transported by ambulance to the nearest hospital, and not necessarily to the hospital nearest to the abortion clinic, or to the hospital for which, under the new act, the abortion provider will be required to have admitting privileges.

Moreover, such requirements do not account for modern practices for inpatient hospital care. Currently, typical hospital practices seek dedicated staff physicians to provide inpatient care, and whether an abortion provider has admitting privileges at a particular hospital plays little or no role in determining which hospital may be best suited to care for the patient.

Ultimately, as U.S. District Judge William Conley noted in his ruling, “[T]here is little likelihood that a doctor’s admitting privileges to a hospital located within 30 miles of the clinic where the abortion is performed will have any substantial impact on that doctors ability to affect the patient’s treatment once admitted to treating hospital.”

Quite simply, it does not matter whether an abortion provider has admitting privileges for a local hospital.

For all of Wisconsin’s claims, therefore, that these regulations are “reasonably related to ‘the preservation and protection of maternal health,’” it seems clear that is not the case. Indeed, as the court pointed out, the legislative history of Act 37 revealed no medical expert speaking in its favor, or articulating a legitimate medical reason for the admitting privileges requirement.

In response to the evidence submitted to the court that the admitting privilege restrictions serve no purpose in advancing maternal health, Wisconsin admitted that serious complications rarely result from a pre-viability abortion. Nevertheless, Wisconsin argued that the requirement for admitting privileges at a hospital within 30 miles of the location of the abortion would reduce risk to the patient. But Judge Conley wasn’t buying it. He wrote, “Aside from the claimed need for ‘continuity of care,’ counsel was unable to offer any support for this position, which does not bear even superficial scrutiny on the current record.”

Judge Conley seems to understand what pro-choice advocates know to be true: The real purpose of the law—like similar pending legislation in Alabama, Mississippi, and North Dakota—is not to protect maternal health, but to prevent women from exercising their constitutional right to choose an abortion, through forced closure of the clinics subject to targeted regulation of abortion provider (TRAP) laws, by making it virtually impossible to do so.

The Center for Reproductive Rights filed a lawsuit Friday in federal district court challenging abortion restrictions passed by Louisiana lawmakers this year.

Despite facing a budget crisis, lawmakers passed seven laws that restricted access to reproductive health care, including abortion services, which the Center for Reproductive Rights claims “individually, and cumulatively” unduly restrict the “constitutional right to abortion.”

Nancy Northup, president and CEO of the Center for Reproductive Rights, said in a statement that the laws collectively create a “web of red tape” that restrict women’s ability to access reproductive health care.

“Louisiana politicians are trying to do what the U.S. Supreme Court just ruled decisively they cannot, burying women’s right to safe and legal abortion under an avalanche of unjustified and burdensome restrictions,” Northup said.

The lawsuit comes in the wake of the U.S. Supreme Court’s landmark decision that struck down two provisions of Texas’ omnibus anti-choice law known as HB 2.

Stephen Griffin, a constitutional law professor at Tulane University, told the Times-Picayune that the Supreme Court’s ruling on HB 2 was a “strong rebuke” of the Fifth Circuit Court of Appeals that upheld the law.

“I think the Louisiana law and any similar laws are going to be struck down,” Griffin said. “[Justice Ruth Bader] Ginsburg filed a reminder to courts that the five-member majority is going to be looking very skeptically at targeted regulation of abortion providers.”

Among the laws challenged is a law similar to Texas’ HB 2.

HB 488 requires that physicians providing abortion care be licensed to practice medicine in Louisiana and that they be board-certified or board-eligible in obstetrics and gynecology or family medicine. Previously, the law required that a physician be licensed to practice medicine in Louisiana and be currently enrolled in or have completed a residency in obstetrics and gynecology or family medicine.

The bill was sponsored by Rep. Katrina Jackson (D-Monroe), who in 2014 authored the state’s Texas-style admitting privileges law. The law is the subject of another Center for Reproductive Rights lawsuit, and is currently blocked by a Supreme Court decision.

Ben Clapper, executive director of Louisiana Right to Life, told the Times-Picayune that the Supreme Court’s ruling on HB 2 “does not predict a favorable forecast” for a similar law passed in Louisiana.

“The sad thing here as we see it is that these judges are replacing the elected officials and the legislative process as the determiner of what is medically important or not,” Clapper said. “We don’t believe that’s how it should be.”

Among the other laws challenged include those that restrict abortion procedures, require a waiting period before an abortion, impose restrictions on the handling of fetal tissue, and ban public funding for organizations that provide abortion services.

HB 1081 targets a procedure known as dilation and evacuation (D and E), which is frequently used during second-trimester abortions. A growing number of states have passed laws to ban the procedure, while state courts have blocked such measures passed by GOP lawmakers in Oklahoma and Kansas.

HB 386 tripled the state’s waiting period for a pregnant patient seeking an abortion from 24 hours to 72 hours.

HB 1019 prohibits a person from intentionally performing or attempting to perform an abortion with knowledge that the pregnant patient is seeking the abortion solely because the “unborn child” has been diagnosed with either a genetic abnormality or a potential for a genetic abnormality.

HB 815 prohibits the buying, selling, and any other transfer of the “intact body of a human embryo or fetus” obtained from an induced abortion. The law also prohibits the buying, selling, and any other transfer of “organs, tissues, or cells obtained from a human embryo or fetus whose death was knowingly caused by an induced abortion.”

In addition, it “require[s] burial or cremation of remains resulting from abortion,” which acts as a de facto medication abortion ban, since an embryo miscarried at home, through medication abortion, cannot in practice be buried or cremated.

SB 33, similar to HB 815, prohibits the sale, receipt, and transport of fetal organs and body parts obtained from an induced abortion. Any person who violates this provision would be sentenced to a term of imprisonment at hard labor between ten to 50 years, at least ten years of which must be served without benefit of probation or suspension of sentence, and may, in addition, be required to pay a fine of not more than $50,000.

HB 606 prohibits entities that perform abortions from receiving public funding, unless the abortion was necessary to save the life of the pregnant patient, the pregnancy was a result of incest or rape, or the pregnancy was diagnosed as “medically futile.”

Most of the bills were passed with significant bipartisan support, and were signed into law by Gov. John Bel Edwards (D). Each of the laws is set to take effect on August 1. 

”We are asking the district court to immediately block these unconstitutional laws,” Northup said.

With the new U.S. Supreme Court abortion ruling, some Pennsylvania lawmakers want to roll back provisions similar to those struck down in Texas—and to head off any new restrictions in a bill debated on the house floor in late June.

Several legislators have called for repeal of Act 122, which was enacted in 2012 and mandates that Pennsylvania abortion clinics meet the standards of ambulatory surgical centers.

The U.S. Supreme Court struck down Texas’ ambulatory surgical center provision in the 5-3 Whole Woman’s Health v. Hellerstedt decision. Justice Stephen Breyer concluded in the opinion that the provision represented a “substantial obstacle in the path of women seeking a previability abortion” and was unconstitutional.

Soon after the decision, Sen. Daylin Leach (D-Montgomery/Delaware), a member of the bipartisan Women’s Health Caucus of the Pennsylvania legislature, wrote a memo recommending repeal of Act 122. And at a June 30 press conference organized by the caucus, Rep. Steven Santarsiero (D-Bucks) introduced legislation to do just that. He weighed in on another bill, HB 1948, discussed in the house on June 21.

During that debate, “[anti-choice lawmakers] were exposed, they were unmasked,” Rep. Santarsiero said. “They stood one person after another after another in support of [HB 1948], and they came right out and said this is all about the anti-choice movement. They were exposed. They tried 20 years ago to claim it was not about that, but they’re not making any pretense at this point.”

Like Act 122, HB 1948 is an urgent matter. Anti-choice lawmaker Rep. Kathy Rapp (R-Warren) introduced the latter legislation in April, which would be one of the most severe laws in the country if enacted. HB 1948 would ban abortion beginning at 20 weeks. It also includes a “method ban” provision, which would criminalize dilation and evacuation (D and E), often used after miscarriages and for abortions earlier than 20 weeks.

Currently, HB 1948 is still on the schedule of the Pennsylvania Senate Judiciary committee. Though the senate may reconvene this summer, it’s unclear when or whether HB 1948 will move forward.

But advocates must not lose sight of this bill. 

A ‘Dangerous Precedent’

HB 1948 inserts the legislature into the doctor-patient relationship, forcing medical professionals, ordinary Pennsylvanians, and even some legislators out of the process. In April, lawmakers twice rejected requests for input on HB 1948 from both medical professionals and the public. When Rep. Dan Frankel (D-Allegheny) spoke out against the bill, his microphone was reportedly cut off.

Struggling to be heard, doctors and relevant medical associations sent open letters and wrote op-eds against the bill. “We are highly concerned that the bill sets a dangerous precedent by legislating specific treatment protocols,” wrote Scott E. Shapiro, president of the Pennsylvania Medical Society, in an April letter sent to legislators.

They are right to be concerned. Around the country, lawmakers with no medical training frequently propose method bans to criminalize the safest, medically proven procedures. They then threaten to imprison doctors if they don’t provide less-than-optimal care for their patients. This kind of legislative coercion brings to mind Donald Trump’s March statement that women who seek abortion should suffer “some form of punishment” for having an abortion.

Punishment, indeed. Under HB 1948, the punishment can go one of two ways: Either women receive less-than-optimal care, or doctors must be incarcerated. While considering the potential fiscal impact of HB 1948, lawmakers discussed how much it would cost to imprison doctors: $35,000 a year, the annual expense to care for an inmate in Pennsylvania.

My colleagues here at the Women’s Law Project, who co-authored a brief cited by Justice Ruth Bader Ginsburg in her Whole Woman’s Health v. Hellerstedt concurrence, have sent an open letter to senate leadership asking them to remove HB 1948 from further consideration.

The letter said:

If enacted, HB 1948 would inflict even greater harm on the health of Pennsylvania women than House Bill 2 would have inflicted on Texas women. Relevant medical experts such as the Pennsylvania section of the American Congress of Obstetricians and Gynecologists (ACOG) and the Pennsylvania Medical Society strongly oppose this bill.

Under well-established constitutional standards, HB 1948 is quite clearly unconstitutional.

The Strange Debate About HB 1948

For a while, HB 1948 seemed to have stalled—like much business in the legislature. It took more than 270 days to finalize the 2015 budget—an impasse that forced dozens of nonprofit organizations serving rape survivors, domestic violence victims, hungry children, and the elderly to lay off workers and turn away clients.

But in April, Pennsylvania lawmakers whisked HB 1948 to the floor within 24 hours. Then, on June 21, the bill suddenly sailed through the appropriations committee and was rushed to the house floor for third consideration.

HB 1948 passed the house after the kind of bizarre, cringe-worthy debate that makes “Pennsylvania House of Representatives” feel like an insult to the good people of the state. Surely, Pennsylvanians can represent themselves better than elected officials who want to punish abortion providers, liken abortions to leeches, ignore science, and compare abortion regulations to laws restricting pigeon shooting. Surely, they can do better than the legislators who hosted the June 21 farce of a debate about a bill designed to force women to carry unviable pregnancies to term.

At that debate, primary sponsor Rep. Rapp stood for questions about HB 1948. But when Rep. Leanne Krueger-Braneky (D-Delaware County) began the debate by asking Rapp about what doctors, if any, were consulted during the drafting of the bill, Speaker of the House Mike Turzai (R-Allegheny) halted proceedings to consider if such a question is permissible. Also a co-sponsor of the bill, he concluded it was not, offering the explanation that legislators can inquire about the content of the bill, but not its source or development.

Rapp eventually stated she had many meetings while drafting the bill, but refused to answer with whom. She invoked “legislator’s privilege” and insisted the meetings were “private.” Legislator’s privilege is an esoteric provision in the state constitution intended to protect the process from undue influence of lobbyists, not shield lobbyists from public inquiry.

The bill’s language—referring to D and E by the nonmedical term “dismemberment abortion”—echoes legislation promoted by the National Right to Life Committee (NRLC). The NRLC has also drafted boilerplate 20-week bans, along with Americans United for Life, an anti-choice organization and a leading architect of the incremental strategy for building barriers to access safe and legal reproductive health care.

Next, Rep. Madeleine Dean (D-Montgomery) asked Rapp if similar bills have been deemed unconstitutional in other states.

Indeed, they have. According to Elizabeth Nash, senior state issues advocate at the Guttmacher Institute, similar D and E bans have been blocked in Oklahoma and Kansas, and 20-week bans have been struck down in Arizona and Idaho. HB 1948 is one of the first pieces of legislation to combine both provisions into one bill; at the Women’s Law Project, we call it a “double abortion ban.”

But no one in the chambers would know that these anti-abortion restrictions have been obstructed because, once again, Speaker Turzai halted the proceedings over these questions. This time, he stopped the debate citing the house rule that lawmakers cannot ask a question if they already know, or the speaker suspects they know, the answer.

In any case, so it went. Pro-choice lawmakers of the Women’s Health Caucus of the Pennsylvania Legislature spoke out against the bill, reading letters from physicians and sharing tragic stories of family members who died after being denied abortion care during severe pregnancy complications.

When Rep. Rapp was asked if she knew that many severe fetal abnormalities were not diagnosed until or after the 20th week of pregnancy, she responded that many were not diagnosed until birth, which misses the point: HB 1948 is designed to deprive women who receive a diagnosis of a severe fetal anomaly, even unviable pregnancy, at 20 weeks or later of safe and legal abortion.

That’s alright with Rapp and others pushing HB 1948; the bill contains no exemptions for fetal anomalies or pregnancies that were a result of rape.

The bill’s supporters didn’t refute allegations that if passed into law, it would negatively affect health care. They argued their case by invoking metaphors instead. They compared abortion regulations to laws about pigeon shoots. They compared fetuses to bald eagles and abortion to leeches. A white male legislator, a description unfortunately almost synonymous with “Pennsylvania legislator,” compared abortion to slavery, drawing the ire of Rep. Jordan Harris (D-Philadelphia).

“We use slavery references when it benefits, but won’t do anything about the systems that negatively affect their descendants,” tweeted Rep. Harris.

Democratic Rep. Dan Frankel, co-chair of the Women’s Health Caucus, attempted to put the bill into context by noting the barrage of abortion restrictions passed in Pennsylvania already. In addition to the ambulatory surgical facility requirement, the state already has a ban prohibiting women from purchasing affordable health insurance that covers abortion through the exchange; an arbitrary 24-hour mandated waiting period; and a Medicaid ban that allows federal funding of abortions only in cases of rape, incest, or life endangerment.

The house voted 132-65 in favor of the bill, mostly among party lines, though 25 Democrats voted for it and nine Republicans voted against it. Gov. Wolf has promised he will veto it if passes, while HB 1948 proponents are working to gather enough votes for an override if necessary.