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Duly Noted

Saturday, Jul 6, 2013, 12:50 pm

It’s a TRAP

By Lindsay Beyerstein

Texas State Sen. Wendy Davis (D-Ft. Worth) stages a 13-hour filibuster on June 25, 2013 to block the anti-abortion bill SB5, which includes such severe "TRAP" restrictions that the majority of abortion clinics in the state would be forced to close. (Erich Schlegel/Getty Images)  

On Friday afternoon, Wisconsin Gov. Scott Walker signed into law a bill that could shutter two of the state’s four remaining abortion clinics. The law, which goes into effect on July 8, will require all abortion providers to have admitting privileges a hospital within 30 miles of a clinic where they provide abortions—a provisions that will force clinics in Milwaukee and Appleton to close, if the law survives a pending pro-choice court challenge.

Wisconsin is the latest of eight states to require admitting privileges for abortion providers. Texas' SB 5, now under debate in a second special Senate session, includes such stipulations and would force an estimated 42 out of 47 abortion clinics in the state to close. Alabama and Mississippi are blocked from enforcing their versions of the law while challenges work their way through the courts.

So-called Targeted Restriction of Abortion Providers (TRAP) laws impose medically unnecessary but financially and logistically onerous restrictions on abortion clinics in the hopes of driving them out of business. Currently, over 90 percent of abortions in the U.S. are performed in outpatient facilities, including clinics and doctors’ offices.

Common TRAP tactics include requiring abortion clinics to upgrade their facilities to the level of ambulatory surgical centers. These laws force clinics to waste medical resources. Money that could have gone to free care for poor women is now being wasted widening hallways and installing special ventilation systems. These high-tech amenities may be necessary for performing an out-of-hospital gastric bypass or knee replacement, but they are completely unnecessary for a 5-minute suction abortion under local anesthesia.

Under a typical TRAP law, a doctor who prescribes abortion-inducing pills from her office must upgrade to the level of an ambulatory surgery center, complete with operating room and anesthesia machines, even if she doesn’t do surgical abortions. North Carolina’s new TRAP law requires that the abortion provider be in the same room with the patient throughout the procedure, which could be interpreted to mean that the doctor must sit with a drug-induced abortion patient for the 48-plus hours it takes for her body to expel the pregnancy. The North Carolina law certainly bans the increasingly popular practice of telemedical abortion, in which a physician in one location prescribes abortion drugs to a patient in a distant clinic via secure video conference, an option that allows women to get the benefit of expert medical opinion while receiving hands-on care close to home.

Proponents of TRAP laws hope to create the false impression that abortions are incredibly dangerous and therefore deserving of much stricter regulation than other outpatient procedures. The fact is, abortion is already an incredibly safe procedure. Less than 0.3 percent of all abortions result in complications that require hospitalization, and only a subset of these involve a rush to the ER. A woman is 14 times more likely to die from childbirth than from an abortion.

Laws that require providers to have local hospital privileges can cripple remote clinics where providers fly in from out-of-state. Anti-choicers argue that hospital privileges are a quality control issue, they falsely insinuate that doctors who can’t get local privileges must be bad doctors. The fact is, hospitals set their own rules for granting admitting privileges and the system is not a meritocracy. Some hospitals openly discriminate against abortion providers. Others won’t grant privileges unless a doctor admits at least 5 patients a year. Ironically, abortion is far too safe to allow any competent provider to meet that standard. North Dakota’s lone abortion clinic has sent only one patient to hospital by ambulance since it opened in 1998. 

There is no legitimate medical reason to require an abortion provider to have local hospital privileges.

"Let's say there's an emergency at my house, and I slip and fall and break my leg or something worse happens. My wife doesn't have to have admitting privileges for me to be able to call an ambulance and get into a hospital," bioethicist and legal scholar Jonathan F. Will told the Jackson Free Press, "(Emergency room) doctors have admitting privileges, and if you need to be admitted, you'll be admitted."

TRAP proponents claim to be champions of medical excellence while dismissing the real experts. The American College of Obstetricians and Gynecologists recommends that all abortion providers have a transport plan to get patients to hospital, but opposes laws that require providers to have local hospital privileges.

In the pitched battle over abortion rights at the state level, outright abortion bans—like the proposed 20-week limit in the Texas bill—garner the most headlines. However, other lesser-known provisions of anti-abortion laws proliferating at the state level may have even more profound effects on abortion access. The vast majority of abortions take place well before 20 weeks. If TRAP laws close all the clinics in a woman’s area, and mandatory waiting periods make it prohibitively expensive for her to travel out of state and stay there long enough to get the procedure, abortion has been effectively banned for her.

Lindsay Beyerstein is an award-winning investigative journalist and In These Times staff writer who writes the blog Duly Noted. Her stories have appeared in Newsweek, Salon, Slate, The Nation, Ms. Magazine, and other publications. Her photographs have been published in the Wall Street Journal and the New York Times' City Room. She also blogs at The Hillman Blog (http://www.hillmanfoundation.org/hillmanblog), a publication of the Sidney Hillman Foundation, a non-profit that honors journalism in the public interest.

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