In the wake of the U.S. Supreme Court’s opinion in the Dobbs v. Jackson Women’s Health Organization (JWHO) case that overturned Roe v. Wade, it has become clear that access to legal abortion in the United States is in grave danger. As it stands, abortion is now banned in at least seven states, with trigger bans expected to go into effect in several more. By turning the issue of abortion back to the states, the Supreme Court has put the reproductive freedom of the roughly 40 million women of reproductive age who live in states hostile to abortion rights in jeopardy. However, there are a number of levers that states can take to protect and expand access to abortion, whether that is expanding prescriptive authority, implementing state coverage mandates, or looking into Medicaid state plans and amendments.
Spotlight on Maryland
There are currently 1.4 million women of reproductive age in Maryland who may at some point need an abortion—and that number does not include those living in neighboring states with more restricted access to abortion, such as West Virginia, Pennsylvania, or Ohio who may travel across state lines in order to access care in Maryland, especially because Maryland has some of the only access to later abortion care. It must be emphasized that, as in all states across the United States, the people that are most negatively impacted by the fall of Roe v. Wade and the ensuing unraveling of abortion rights are women and birthing people of color and low-income people.
In 2017, there were forty-four facilities in the state providing abortions, of which twenty-five were clinics. Unfortunately, 71 percent of counties in Maryland still lack an abortion clinic.
In Maryland, a number of proactive abortion policies do exist. State Medicaid funds cover abortion; there are protections in place for patients and abortion clinic staff (such as the law prohibiting obstructing clinic access); and on July 1, the Abortion Care Access Act will go into effect, allowing health care providers outside of physicians (such as nurse practitioners, midwives, and physician assistants) to perform abortions and requiring most insurance providers to cover the cost of an abortion with no cost sharing. There are also still some restrictions—for example, parental consent is required for a minor’s abortion.
Additional Levers for Protecting and Expanding Access
Following the Dobbs v. JWHO decision, there are a number of people of reproductive age living in nearby states who may rely upon Maryland for abortion access should their legislatures implement further restrictions or ban abortion outright. There are several actions that Maryland’s state government can take in order to bolster equitable access to abortion care.
- Pass a measure to explicitly enshrine the right to abortion in the state constitution through the Maryland State Senate. This measure, which already has been drafted, was previously passed by the Maryland House of Delegates. Enshrining the right in the state constitution is important because, while Maryland does have abortion legally protected in a statute, constitutional amendments are more secure protections than laws, which can more easily change with the political winds.
- Stop withholding allocated funding. The Maryland legislature set aside $3.5 million in funding for a clinical training program to train nurses, midwives, and physician assistants to perform abortions. However, Governor Larry Hogan has been withholding this funding. Following the enactment of the Abortion Care Access Act on July 1, 2022, this funding will be critical for a smooth and effective expansion of abortion care in Maryland.
- Remove parental consent requirements for minors to access abortion care. Requiring parental involvement in order for young people to get an abortion is not only unecessary in a majority of cases, as most young people already do consult their parents before seeking abortion care, but it can put young people living in unsafe environments at further risk by forcing them to disclose their pregnancy to their parents. One in five pregnant minors have experienced physical abuse by a parent or other caretaker. Parental consent laws also disproportionately impact young people of color, who are more likely to experience unintended pregnancy as minors.
In addition to these measures specifically for lawmakers, advocates and nonprofit organizations can help facilitate equitable access to abortion care by highlighting the critically important role that abortion funds and independent clinics have played and will continue to play in the absence of Roe.
Even with legal access, abortion is still often out of reach for many people. Abortion funds make accessing care financially possible for those who may not be able to afford it otherwise. In Maryland, the Baltimore Abortion Fund is “a nonprofit organization that provides financial assistance and practical support to individuals who live in or travel to Maryland for abortion care.” They also have a confidential hotline to connect clients with funding, transportation, lodging, and more. In addition, the DC Abortion Fund also serves Maryland residents and anyone traveling to Maryland for care.
Independent clinics are where three out of five patients in the United States go to access abortion care. They are community-based clinics staffed by highly trained health care professionals that provide time-sensitive abortion services, often to low-income pregnant people or those with the fewest resources to access care. In Maryland, the carafem Health Center in Chevy Chase, Clinics for Abortion and Reproductive Excellence in Bethesda, and Whole Woman’s Health in Baltimore are all independent clinics offering abortion care. In fall of 2022, another independent clinic, Partners in Abortion Care, is set to open in Maryland as well.
In the days, weeks, and months following the Dobbs v. JWHO decision, proactive state-level policy efforts and community care in the form of uplifting abortion funds and independent clinics in order to protect and expand abortion access will be necessary in order to accomodate the influx of out-of-state patients seeking care from states where abortion is expected to become criminalized. In a post-Roe world, everyone still deserves access to safe, equitable, and compassionate abortion care, regardless of what state they live in.