At least 162 clinics that provided abortion services have either closed or stopped offering the procedure since 2011, with 21 clinics opening during that time, according to a report by Bloomberg.
The clinics have closed in 35 states home to a combined population of 30 million women of reproductive age. Bloomberg compiled the data over a three-month period, building on a similar report from 2013.
Texas was home to the most clinic closures. At least 30 abortion clinics have closed throughout the state, twice as many as any other state.
Iowa has seen at least 14 clinics shuttered, Michigan has seen 13, and California has seen 12 clinics close since 2011.
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Abortion clinics can close for a variety of reasons, but according to reproductive rights advocates, a spate of anti-choice laws are the driving force behind the clinic closures. These are known as targeted regulation of abortion providers (TRAP) laws.
Elizabeth Nash, senior state issues associate at the Guttmacher Institute, told Rewire that numerous clinic closures are due to anti-choice activists pushing state lawmakers to pass measures making it impossible for many clinics to operate.
“Unfortunately the report shows that abortion access is becoming more and more limited and that restrictions do have a direct and negative impact on access,” Nash said. “As we see more restrictions, the climate in a state becomes more hostile to abortion, which makes it harder to keep clinics open.”
Laura McQuade, president and CEO of Planned Parenthood of Kansas and Mid-Missouri, told Rewire that the clinic closures are reaching “dramatic proportions.” Missouri is one of five states that has only one abortion clinic, as anti-choice state laws have closed all but the Planned Parenthood St. Louis clinic.
These closings disproportionately affect marginalized populations. “Laws like these impact women across the board, but impact rural women, lower-income women, and women of color in dramatically intensified ways,” McQuade said.
Further, Missouri’s 72-hour forced waiting period requires patients seeking abortion care to make multiple visits to the clinic, and for patients traveling long distances this can pose significant burdens, including getting time off of work, arranging travel, and paying for child care.
Sylvia Cochran, who operates two clinics in Louisiana, told Rewire that many clinics are closing around the country because of the rash of anti-choice policies pushed through Republican-majority legislatures.
“These regulations have been imposed on clinics, and many of them are imposed [by lawmakers who know] that they cannot meet the requirements,” Cochran said.
Those regulations, pushed by GOP legislators, include medically unnecessary measures that require abortion providers to secure admitting privileges at a local hospital.
Former Louisiana Gov. Bobby Jindal (R) in 2014 signed into law HB 388, an omnibus anti-choice bill that contained multiple abortion restrictions, including a requirement that physicians that provide abortion services obtain admitting privileges at a nearby hospital.
Reproductive rights advocates have challenged the Louisiana law, but the U.S. Court of Appeals for the Fifth Circuit ruled last week that the law could take effect during the legal challenge. While advocates have asked the U.S. Supreme Court to immediately block the law, the decision has forced two of the state’s remaining four clinics to stop providing abortion services.
Cochran’s Delta Clinic in Baton Rouge has stopped providing abortion services, and patients are being referred to the Women’s Health Care Center in New Orleans. The physician who provides abortion services at the Delta Clinic does not have the admitting privileges required by the GOP-backed law.
The Hope Medical Group for Women in Shreveport is the only other clinic providing abortion services in the state. Reproductive rights advocates say the lack of clinics creates significant barriers for people seeking legal abortion care.
Cochran says that patients around the state who do not live in the New Orleans or Shreveport areas will be forced to drive long distances to terminate a pregnancy, and make two visits to the clinic in order to satisfy the state’s forced counseling requirement.
The Women’s Health Care Center has already seen an increase in the number of patients due to the recent closure of another clinic, the Causeway Medical Clinic in Metairie. “We have seen an increase in our patient load,” Cochran said. “We have had to add two more days.”
The clinic now provides abortion services four days a week.
Those seeking abortion services already must plan the procedure taking into account their work schedule or child-care needs, but the increased patient load makes appointments more difficult to schedule. “It makes it difficult for patients when they come because there are longer waits,” Cochran said.
While anti-choice state laws have been the primary reasons for most clinic closures, clinics that have been the target of terroristic attacks have also been forced to close. In most cases they have been able to reopen.
The Planned Parenthood health-care center in Pullman, Washington, where a firebombing in September destroyed much of the facility, and the Planned Parenthood clinic in Colorado Springs, where a shooter killed three people in November, both reopened in February.
The All Families Healthcare, a family medicine and reproductive health-care facility in Kalispell, Montana, closed after being vandalized by an anti-choice activist. Susan Cahill, the owner of the clinic, has since closed the clinic indefinitely.