A recently released Guttmacher Institute report finds that at least ten common categories of state laws and policies restricting abortion run contrary to science.

These anti-evidence laws are prevalent across the country, leaving almost a third of all U.S. women of reproductive age (ages 15-44) living in a state with at least five such restrictions.

This conclusion may sound obvious to those familiar with the hostile legislative landscape regarding reproductive rights and health. But “Flouting the Facts: State Abortion Restrictions Flying in the Face of Science” systematically documents the sheer scope of policies that ignore public health and social science research about the safety of abortion, among other issues. In this political environment—where anti-science attitudes at the state level are increasingly echoed by the Trump administration—researchers must keep reiterating there are such things as evidence and actual facts.

Rachel Benson Gold, Guttmacher vice president for public policy, and Elizabeth Nash, senior state issues manager, co-wrote the report, which was released in May. They note that “much of the anti-abortion universe has long been an evidence-free zone.”

This analysis comes just a year after the U.S. Supreme Court used research to declare some Texas abortion restrictions unconstitutional in Whole Woman’s Health v. Hellerstedt. In its 5-3 decision, the Court clearly was convinced that there were no public health reasons undergirding Texas’ admitting privileges and ambulatory surgical center provisions, which required abortion providers to obtain rights to admit patients to a hospital within 30 miles of their practice and forced clinics to have hospital-like facilities. The Court decided that the provisions did not improve women’s health, but actually worked to impede access to abortion.

The data-driven decision apparently didn’t sway many state legislators. According to Guttmacher data released in June, 1,257 reproductive health-related provisions were introduced in statehouses across the country in 2017; more than 40 that restrict abortion were enacted.

Those provisions join a deluge of pre-existing anti-choice legislation, which the May report categorized into three broad areas: those that target abortion providers, require various types of counseling or waiting periods, or use fetal pain as a pretext for restricting abortion access.

For each policy identified, scientific evidence or consensus contradicts the legislation’s claims or purpose:

• Ambulatory surgical center and hospital admitting privileges requirements: These two restrictions at the center of the Whole Women’s Health case have been shown to restrict care without improving safety. While some states have blocked these restrictions by court order, some before and others after the Whole Woman’s Health decision, 18 states still have ambulatory surgical center requirements in place, and three still have admitting privileges laws. Both provisions place onerous facility requirements on providers and contributed to the closing of 16 of Texas’ 41 abortion clinics.
• Telemedicine bans for abortion: Despite a 2014 joint American College of Obstetricians and Gynecologists (ACOG) and Society of Family Planning practice bulletin and recent studies asserting the safety and effectiveness of using telemedicine in abortion provision, 18 states still ban the use of telemedicine for abortion care.
• Restrictions on medical staff who can perform abortions: In 38 states, equipped health-care providers—such as physician assistants, nurse practitioners, and certified nurse midwives—are prohibited from performing abortions in the absence of a doctor. The World Health Organization’s 2012 guidelines disagree with such restrictions, and studies in various states have concluded that these health-care professionals can equally and safely provide abortion care.
• “20-week bans” and fetal pain bills: The two most common pieces of legislation built on the fetal pain pretext are “20-week bans,” which exist in 17 states, and policies that require a woman to be informed that a fetus can feel pain, which are on the books in 13 states. Bans at 20 weeks are unconstitutional, arbitrary, and counter to statements and recommendations published by leading U.S. and international OB-GYN groups.
• Mandatory waiting periods: These laws exist in 27 states and require people to wait between 18 and 72 hours after receiving counseling to have an abortion. Framed as a way to provide possible patients with time to consider whether they want to have an abortion, research has disproven this narrative. A 2008 survey found that 92 percent of women were confident about their choice to have an abortion when they made the initial appointment. A subsequent 2017 study found the majority of patients’ decisions to be unaffected by waiting period laws, and in some cases the laws only increased rates of confidence in decisions to have an abortion.
• Mandatory counseling: Three of the remaining policies require a doctor to counsel their patients about the effects that abortion can have on their mental health, breast cancer risk, or future fertility—all claims that have been roundly contradicted by research. A 2015 statement of facts from ACOG affirmed there is no link between abortion and breast cancer or future fertility; nor is there an increased risk of mental health conditions. The National Cancer Institute, American Cancer Society, and other medical organizations have all come to the same conclusions about the connection between having an abortion and one’s increased risk of breast cancer: There isn’t one.

Overall, 28 states have at least two of these restrictions in place. These restrictions are harmful: intervening in the patient-provider relationship, greatly limiting access to abortion care, or spreading misinformation. Individually or en masse, such restrictions amount to an unnecessary mountain of barriers for people seeking abortion care.

Nikki Madsen, executive director of Abortion Care Network, said in a press release:

Since 2010, state lawmakers have been engaged in a relentless crusade to push abortion out of reach: They’ve quietly passed more than 334 new restrictions on abortion. It doesn’t come as a surprise to abortion care providers or the women who seek their services that these laws aren’t based on science—but it should be a shocking wake-up call to lawmakers. We see what you’re doing, and it has nothing to do with women’s health and safety. This study shows that there’s no claim too specious for an anti-abortion lawmaker to use to justify taking away a woman’s health care.

While the Guttmacher report focuses on state level restrictions, it acknowledges that changes at the federal level are also of concern—and essentially create a compounding anti-abortion effect.

Various administration appointments and federal policy efforts are promoting anti-science rhetoric and action. In particular, the Trump administration has appointed individuals who subscribe to anti-choice, anti-science beliefs and whose track records show a commitment to restricting abortion access. President Donald Trump is packing the Department of Health and Human Services (HHS) with a science-denying cast; HHS Secretary Tom Price has previously that stated “there’s not one” woman who can’t afford birth control, and Charmaine Yoest was appointed as HHS assistant secretary for public affairs. Yoest previously worked as president and CEO for Americans United for Life, a prominent anti-choice organization that, as Rewire’s Ally Boguhn detailed last month, has been the architect of some of the legislation outlined in the Guttmacher report.

Combined with these federal appointments, the state-level policies outlined by Guttmacher paint a clear picture of an ever-present and overarching anti-choice agenda. Guttmacher’s sobering report illustrates that each law, policy, or court case is not an isolated example of “alternative facts.”