Review Summarizes 'Unprecedented' State Action on Reproductive Health Restrictions in 2011

January 26, 2012 — Summary of "Laws Affecting Reproductive Health and Rights: 2011 State Policy Review," Guttmacher Institute, January 2012.

In a policy review, researchers from the Guttmacher Institute summarized action on reproductive health- and rights-related provisions at the state level in 2011. According to the review, state lawmakers introduced more than 1,100 such provisions in 2011, "a sharp increase from the 950 introduced in 2010." The researchers noted that their analysis encompasses all relevant "provisions," rather than bills or laws, because legislation includes multiple provisions.

Abortion Restrictions

Several states in 2011 took action to restrict abortion later in pregnancy, with five states enacting bans on the procedure at or beyond 20 weeks of gestation "based on the spurious assertion that a fetus can feel pain at that point." States also took action to ban certain procedures for abortion later in pregnancy or to narrow the health reasons for which women can obtain abortion care after viability. In addition, six states enacted or amended reporting requirements related to abortion after 20 weeks.

Five states adopted requirements that women receive pre-abortion counseling that includes false information about the procedure, such as statements linking abortion to cancer or mental health problems. Including those five states, a total of 16 states now require such counseling. Five states enacted measures requiring women to undergo an ultrasound before obtaining abortion care, while three states added waiting periods before abortion care. The additional waiting period measures bring to 26 the number of states with such requirements, including nine states that mandate in-person counseling, meaning that women must make two trips to the facility. In addition, six states adopted new requirements related to parental involvement in minors' abortion decisions.

Last year also saw an increase in state restrictions on insurance coverage of abortion care, with four states adopting provisions to ban all insurance policies in the state from covering abortion services unless a woman's life is in danger. Five other states adopted bans on abortion coverage that will only apply to policies in the health insurance exchanges that will be created under the federal health reform law (PL 111-148). In a "rare victory" for abortion-rights supporters, Montana Gov. Brian Schweitzer (D) vetoed similar legislation in April 2011.

For the first time, states moved to restrict medication abortion through bans on the use of telemedicine in abortion care. Seven states adopted requirements that physicians who prescribe medication abortion drugs be in the same room as the patient. Three of these states also moved to "require that mifepristone be provided in accordance with a long-standing FDA protocol rather than under a simpler evidence-based protocol that has been proven to be safe and effective," according to Guttmacher.

Four states directed their health departments to write new regulations for abortion facilities, such as standards for staffing and building design. In most cases, "supporters of the measures made it clear that the goal was to set standards that would be difficult, if not impossible, for abortion providers to meet," the review stated.

Family Planning Provisions

"Family planning services and providers were especially hard-pressed in 2011, facing significant cuts to funding levels as well as attempts to disqualify some providers for funding because of their association with abortion," according to the review. Nonetheless, given the fiscal problems facing many states last year, "it is significant that family planning escaped major reductions in nine of the 18 states where the budget has a specific line-item for family planning," the review noted.

Meanwhile, three states -- Maryland, Ohio and Washington -- expanded Medicaid eligibility for family planning services based solely on income, bringing the total number of states with Medicaid family planning expansions to 24.

Other Provisions

While there were no measures enacted to expand access to medically accurate, comprehensive sex education in 2011, Mississippi took steps to make it more difficult to include discussion of other topics in its abstinence education curricula and North Dakota mandated health education on the benefits of abstinence.

Four states expanded access to prevention and treatment for sexually transmitted infections, including measures that allow health care providers to prescribe STI treatments for a patient's partner without seeing the partner. In addition, eight states took steps to limit exposure to certain toxins, such as Bisphenol A, that have been shown to negatively affect reproductive health.

Four states passed measures designed to expand access to treatment services for pregnant women. Four other states approved the creation of "certificates of stillbirth" for women who miscarry, while two states adopted or expanded laws allowing homicide charges for injuries to a fetus.