You can find our coverage on TRAP laws in various states here.
Another day, another Targeted Regulation of Abortion Providers (TRAP) law, this time in Pennsylvania, where a proposed bill working its way through the legislature promises once again to flout all medical, public health, and economic evidence in a quest to limit women’s rights to determine whether, when, and under what conditions to bear a child.
Apparently, Pennsylvania’s legislature has decided that the best response to the anomalous case of Kermit Gosnell, the doctor who provided late and sometimes post-viability abortions under illegal and unsafe circumstances, is to impose medically-unnecessary regulations on those legitimate providers with excellent records, thereby reducing women’s access to safe, legal, early termination of pregnancy and, in doing so, push more of them into the kinds of shoddy practices once run by Gosnell.
Pennsylvania is a state with 7.8 percent unemployment and crumbling public infrastructure. More than a quarter of Pennsylvanians lack any kind of health insurance; the majority of the uninsured are members of working families. Two Pennsylvanians die each day due to lack of insurance. Seventeen percent of children in Pennsylvania live in poverty and nearly 8 percent live in extreme poverty. Pennsylvania is ranked 31st among all states for its rates of low-birth weight (on a scale where 1 is best and 51 worst).
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Despite these and other pressing issues, and despite the fact that Pennsylvania already has one of the most restrictive abortion laws in the country, the state legislature is so obsessed with limiting women’s rights to determine whether and when to have a child that its members have spent 30 percent of the legislative session on efforts to limit access to reproductive health care and abortion, such as a health insurance ban on abortion coverage.
And now there is the TRAP bill.
It was not the lack of abortion regulations but the lack of enforcement of existing regulations combined with the desperation of women who, for whatever reason, did not or could not obtain early abortion care from a legitimate provider that produced the Gosnell horror. For years, legitimate abortion providers were reporting Gosnell to the Pennsylvania Department of Health and Department of State, with no result. After the Gosnell case became public, Governor Tom Corbett put forth recommendations for better enforcement of existing laws regulating abortion providers and women’s advocates supported the move.
A bill was drafted in the Pennsylvania Senate that generally mirrored Corbett’s recommendations. That bill, however, came to a head-on collision with an ideological bill in the House recommending a set of onerous and unnecessary regulations of abortion providers, using the Gosnell case as an excuse for undermining safe, affordable abortion care. The House amended the Senate bill with its own version, leaving only the latter version in play.
The new bill, if passed and signed into law by the Governor, would mandate clinics providing abortion care be treated like Ambulatory Surgical Facilities (ASF). The new requirements include but are not limited to:
- mandating that providers enlarge their procedure rooms from an average of 100 to 150 square feet to 250 to 400 square feet.
- requiring that nurses be present full-time. Most providers have a registered nurse on site when abortion care is provided, to help with monitoring patients in recovery. But most providers also do not offer abortion care five days a week. Instead they see patients for routine gynecological care or family planning services, during which the presence of an RN (in addition to the physician and any assistants) is not medically necessary. The law however would require that nurses be in attendance “whenever patients are present,” implying additional staffing costs of $70,000 to $80,000 per year.
- installation of hospital-sized elevators in an office building or free-standing clinic.
Pennsylvania’s proposed TRAP law, like those in Kansas, South Carolina, and Virginia, have no basis whatsoever in medicine or standards of care. While three hearings were held on the Gosnell tragedy, not a single hearing was held on ASF regulation of abortion providers. And not a single medical entity or association supports the TRAP law. The only proponents are anti-choice advocacy organizations opposed to legal abortion per se.
If passed, Pennsylvania’s proposed law would put the state “on par with Kansas and Virginia,” said one expert, “with more severe restrictions and less access to safe abortion than Mississippi and Texas.” Like Kansas, for example, Pennsylvania lawmakers want to regulate the size of procedure rooms; creating size requirements for no apparent reason is now a popular tactic among anti-choice legislators because compliance requires expensive changes in the physical plant of a clinic or office. The wide variation from one state to another in these requirements (150 square feet under temporary regulations in Kansas, 250 to 400 in the proposed Pennsylvania law) boldly underscores the lack of medical need for these rules, and suggests lawmakers simply pick a number out of thin air. Is there any other reason 150 square feet is safer in Kansas than in 400 square feet in Pennsylvania?
What is not random is the intent: The result of these regulations, according to advocates for women’s health and rights, would be to force providers to alter their facilities and staffing in ways intended to make delivery of services expensive or impossible and possibly force most if not all of the 20 non-hospital based clinics in Pennsylvania to move or to discontinue offering surgical abortion services altogether.
For example, none of the facilities currently operating conforms to the architectural specifications in ASF regulations–because there is no medical reason to do so–and since some zoning requirements for ASFs versus office-based practices vary from one locale to another, clinics may be forced to relocate to a zone appropriate for an ASF.
Anti-choice groups and legislators like to claim that such regulations are intended to “protect women,” but nothing could be further from the truth. A statement by a coalition of health and rights groups called “We’ve Had Enough,” states:
When good, safe abortion facilities close their doors because of these unnecessary regulations Pennsylvania will be facing a public health crisis of major proportions. Regulations should make women safe – not close safe providers. There is not a single abortion provider in compliance with ASF regulations today. The lawmakers and organizations pushing this effort have long-standing histories in opposition to legal abortion. It is disingenuous for anyone to even claim that those same individuals are now committed to safe abortion services. This effort is nothing more than a Trojan horse to disguise the effort to make abortion inaccessible and prohibitively expensive in Pennsylvania.
Abortion in Pennsylvania has a complication rate of less than .01 percent. Hospitals and ambulatory surgical facilities have a total complication rate of between 2 and 4 percent. A Gosnell patient, brought to a hearing by an anti-choice group, stated that the only reason she went to Gosnell was that she could not afford the cost of other providers and so she sought out the ‘cheap’ provider. Raising the cost of and reducing access to early, safe abortion will only create more Gosnells in the future.
Anti-choice advocates and their allies in the legislature have spread other falsehoods, claiming, for example, that abortion is the only procedure not subject to ASF regulations. This is false, according to We’ve Had Enough. “Other surgeries such as oral surgery, foot surgery, and lasik eye surgery centers are not subject to these regulations.” They’ve documented–and refuted with facts–a range of false statements put forth by anti-choice advocates.
An estimated 38,000 women have abortions in Pennsylvania each year. Only 22 percent of the state’s counties have an abortion provider. ASF regulations could force the majority, if not all, of these providers to close.
Since it is unclear if any of the 20 freestanding facilities will be able to comply with the proposed regulations, there will be fewer clinics. Reduced access means women will either be forced against their will to carry pregnancies they do not want; travel to other states; seek out unsafe, unregulated providers which, history suggests, will flourish in such an environment; or self-abort. Experts note that hospitals could not absorb the volume of patients needing care, nor could women afford care in hospitals, which can be about 10 times the cost of abortion care in a freestanding clinic.
And because access to abortion care often depends on financial means, these restrictions will have the most dramatically adverse effect on low-income women and women in rural areas who already face limited access to health insurance, birth control, and abortion care. Many patients already struggle to pay $350 for an early abortion procedure. With increased regulation and increased fees, the cost could skyrocket and therefore become inaccessible to many women.
In addition, advocates point out that because the ASF regulations will require providers to make their floor plans public, they will be more open than ever before to anti-choice harassment and extremists.
During a phone call to the office of Pennsylvania House Majority Leader Mike Turzai, I asked the press officer why the Pennsylvania House GOP is pushing this bill when it doesn’t adhere to any medical standards and no medical associations support it. He first responded that it was about keeping women safe. When I pushed back, he effectively told me it didn’t matter, because “as long as the legislature wants to do it, they will do it.” I then asked him whether he felt that women should have access to safe abortion care in line with medical evidence and approved standards of care. He responded: “We feel everyone should have access to good quality health care.” When I asked again if his statement meant that Majority Leader Turzai thought that women should have access to safe abortion care, he refused to answer. Calls late last week and today to the Governor’s office and to other members of the Pennsylvania House were not returned by the time of publication. To be fair, while today’s calls were the second round to some offices, they came during the time that heavy rains were producing flood conditions in Harrisburg.
Still, it is clear that despite protestations to the contrary, lawmakers in the state, two-thirds of whom are male, have no interest in protecting women’s health. What they are interested in is limiting women’s rights to self-determination by eliminating means for terminating unintended and untenable pregnancies, and apparently it won’t matter if women die in the process.
Advocates note that final votes on this bill will likely be taken the last week of September. The fate of the bill is to some extent in the hands of the Governor, who could veto it or speak out now more forcefully against it. Yet while he originally proposed commonsense changes to strengthen enforcement of existing law, advocates worry he is will not work to prevent passage of an extremist TRAP law.
Let’s hope in this case they are wrong. If you want to assist or contribute to their effort, the visit the homepage of “We’ve Had Enough.”