Testimony: Pass the Women’s Health Protection Act to Safeguard Abortion Access

TCF director of health care reform and senior fellow Dr. Jamila Taylor submitted testimony to the U.S. Senate Judiciary Subcommittee on the Constitution for a hearing on June 16, 2021, titled “Protecting Roe: Why We Need the Women’s Health Protection Act.” Her testimony, which you can read below, explains that the Women’s Health Protection Act is more necessary than ever as states pass increasingly restrictive abortion laws. This trend is in part a response to the new, more conservative makeup of the Supreme Court, which has decided to take up the anti-abortion case Dobbs v. Jackson Women’s Health this year. These laws, Taylor explains, are not only inhumane: they are also unconstitutional; and the Women’s Health Protection Act can help stop them in their tracks.

Chairman Blumenthal, Ranking Member Cruz, and members of the committe, thank you for the opportunity to provide written testimony regarding the Women’s Health Protection Act and the harmful impact of state-level abortion restrictions. I serve as the director of health care reform and senior fellow for The Century Foundation—a 100-year-old progressive, independent think tank that conducts research, develops solutions, and drives policy change to make people’s lives better. We pursue economic, racial, and gender equity in education, health care, and work.

So far in 2021, states have introduced well over 500 laws restricting abortion access, and passed over 70. This number is higher than past years, but continues a disturbing trend from the past decade. These laws are not based in science and are not designed to make abortion safer but rather more difficult to access by placing additional hurdles in the way of patients and providers. 

This year, state legislatures have been further emboldened by the changing makeup of the Supreme Court to pass a greater number of laws that are blatantly unconstitutional—banning abortion well before the legal standard of viability. These bans are meant to directly challenge Roe v. Wade, and anti-abortion activists recently suceeded in getting the now-conservative-leaning Supreme Court to take up Dobbs v. Jackson Women’s Health, a case challenging Mississippi’s fifteen-week abortion ban.

State laws are chipping away at abortion access, and the outcome of the upcoming SCOTUS case could reduce access even further. For historically disenfranchised groups and other people at the margins, access to vital abortion care could become completely out of reach.  A federal legislative solution is necessary to ensure that the right to abortion is made a reality. 

Passing the Women’s Health Protection Act (WHPA) is vital to stopping this attack on abortion access at the state level. Access to health care should not depend on your zip code, yet with abortion care, this is too often the case. WHPA would create a statutory right for individuals to be able to access abortion, and for health care providers to provide abortion, free from medically unnecessary restrictions.

Regardless of the outcome of the upcoming Supreme Court case, Roe has never been sufficient to ensure that abortion is accessible. Restrictions on abortion access at the state level mean that abortion is often a right in theory only: increasingly restrictive laws make abortion care inaccessible for many. WHPA would make this right a reality and eliminate these politically motivated restrictions.

Targeted regulation of abortion provider (TRAP) laws, for instance, require abortion providers to adhere to unecessary and onerous standards that often force clinics to close altogether. TRAP laws, such as admitting privileges requirements, are not medically necessary: abortion is one of the safest medical procedures and it is extremely rare that patients need hospital care.¹ Another common TRAP law requires abortion-providing facilities to adhere to the same standards as ambulatory surgery centers, but research has demonstrated that these facility differences do not affect patient outcomes.²

Laws such as in-person counseling requirements that force patients to make two trips to a clinic are particularly restrictive, given that over a third of women of reproductive age live in counties without abortion providers.³ Although nearly half of abortion patients in 2014 went to their nearest provider, 17 percent traveled twenty-five to forty-nine miles for their care and an additional 18 percent had to travel at least fifty miles.⁴ Additional visits compound the ancillary costs that abortion patients incur, including travel, time taken off work, child care, and other expenses.⁵ Two-visit requirements and waiting periods not only increase travel time and costs, but can also push back patients’ care later in their pregnancy. This can cause the cost of the abortion itself to increase and may even require patients to travel even farther to receive the care they need, since the availability of abortion providers is more limited as gestation increases.⁶

For individuals who cannot access abortion care as a result of restrictions such as gestational limits, the adverse effects are well documented. Research has demonstrated that women who are denied abortion care are less likely to be financially secure, more likely to remain with abusive partners, and at greater risk for health complications.⁷ Being able to access abortion is also associated with improved outcomes for existing—and future—children.⁸ This is notable, given that 59 percent of abortion patients in 2014 reported having previous births and 29 percent of people seeking abortion do so in part to be able to provide for and focus on the children they already have.⁹ Yet accessing abortion can be particularly difficult for mothers, as affordable child care is not widely available, especially in communities of color.¹⁰ The abortion restrictions that force abortion patients to return to clinic multiple times add to this burden, with no benefit to patients’ care. The fact that the majority of abortion patients already have children drives home the understanding that people seeking abortion are making the decision that is right for them and their families. Laws that mandate ultrasound viewing, non-evidence based counseling, and other similar laws are unnecessary and patronizing restrictions that undermine trust in women and pregnant people’s decision making abilities.

For patients who are able to overcome obstacles in order to receive abortion care, these laws clearly have the potential to increase financial burdens. This is particularly important given that low-income women, who face additional barriers to health care overall, are overrepresented among abortion patients.¹¹ In-depth interviews with abortion patients found that low-income women face longer delays to obtaining abortion care, not only due to the time it takes to secure needed funding for abortion care, but also because of scheduling and logisitical hurdles—which are only increased by abortion restrictions.¹²

These laws have the greatest effect on groups that already have less access to health care, including Black women and other people of color. Systemic racism, a history of reproductive oppression, and present-day discrimination in health care have made it so that women and pregnant people of color are less likely to be insured and to be able to access necessary preventive care (including contraception), and more likely to suffer worse health outcomes. For these reasons, Black women are overrepresented among abortion patients in the United States and bear the brunt of these restrictive laws. 

These disparate effects of abortion restrictions highlight the importance of framing WHPA within the context of reproductive justice: the “human right to maintain personal bodily autonomy, have children, not have children, and parent the children we have in safe and sustainable communities.”¹³ 

The reproductive autonomy of women of color has been controlled throughout U.S. history through practices such as forced sterilization and medical experimentation.¹⁴ Restrictions that make abortion inaccessible are rooted in racism and white supremacy, and continue this legacy of discrimination that limits access to health care and economic resources. Crucially, this iteration of WHPA uses a reproductive justice lens to ground the bill’s purpose. 

Abortion access is just one aspect in the spectrum of reproductive health care that must be available to every woman and birthing individual in order to achieve reproductive justice. Particularly in a country where Black women are over three times as likely as white women to die from pregnancy-related causes, abortion must be accessible for those who choose it—along with quality maternal health care for those who wish to carry out their pregnancies. It is essential that all women and birthing people are able to make their own health care decisions—decisions that are best for ourselves and our families. It is past time for politicians to stop interfering with our reproductive choices. 

Congress must be in solidarity with people and communities fighting for racial, economic, and reproductive justice and commit to protecting the right to access abortion by supporting WHPA. This bill enshrines the right to access abortion into law and provides clear guidance to states and courts about the rights of providers and patients.

We commend the Senate Judiciary Committee’s Constitution Subcommittee for holding a hearing on this important legislation—and we urge the Judiciary Committee to send WHPA to the Senate floor for a vote.

Thank you again for the opportunity to submit written testimony.

1. Upadhyay et al., “Incidence of Emergency Department Visits and Complications After Abortion”; Taylor, “Six Things To Know about the Next Supreme Court Abortion Case.”
2. Roberts et al., “Association of Facility Type With Procedural-Related Morbidities and Adverse Events Among Patients Undergoing Induced Abortions.”
3. Jones, Witwer, and Jerman, “Abortion Incidence and Service Availability in the United States, 2017.”
4. Fuentes and Jerman, “Distance Traveled to Obtain Clinical Abortion Care in the United States and Reasons for Clinic Choice.”
5. Jones, Upadhyay, and Weitz, “At What Cost?”
6. Jerman and Jones, “Secondary Measures of Access to Abortion Services in the United States, 2011 and 2012.”
7. Gerdts et al., “Side Effects, Physical Health Consequences, and Mortality Associated with Abortion and Birth after an Unwanted Pregnancy”; Roberts et al., “Risk of Violence from the Man Involved in the Pregnancy after Receiving or Being Denied an Abortion”; Foster et al., “Socioeconomic Outcomes of Women Who Receive and Women Who Are Denied Wanted Abortions in the United States.”
8. Foster et al., “Comparison of Health, Development, Maternal Bonding, and Poverty Among Children Born After Denial of Abortion vs After Pregnancies Subsequent to an Abortion”; Foster et al., “Effects of Carrying an Unwanted Pregnancy to Term on Women’s Existing Children.”
9. Jerman, Jones, and Onda, “Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008”; Biggs, Gould, and Foster, “Understanding Why Women Seek Abortions in the US.”
   
10. Halpin, Agne, and Omero, “Affordable Child Care and Early Learning for All Families.”
11. Jerman, Jones, and Onda, “Characteristics of U.S. Abortion Patients in 2014 and Changes Since 2008.”
12. Finer et al., “Timing of Steps and Reasons for Delays in Obtaining Abortions in the United States.”
13. SisterSong Women of Color Reproductive Justice Collective, “Reproductive Justice.”
14. Taylor, “Structural Racism and Maternal Health Among Black Women.”