Abortion is the termination of human pregnancy, often performed in the first 28 weeks of pregnancy. In 1973, the United States Supreme Court in Roe v. Wade recognized a constitutional right to obtain an abortion without excessive government restriction, and in 1992 the Court in Planned Parenthood v. Casey invalidated restrictions that create an undue burden on people seeking abortions. Since then, there has continued to be an abortion debate in the United States, and some states have passed laws in the form of regulation of abortions but which have the purpose or effect of restricting its provision. The proponents of such laws argue they do not create an undue burden. Some state laws that impact the availability of abortions have been upheld by courts. In 2022, Roe and Casey were overturned by the Supreme Court in Dobbs v. Jackson Women's Health Organization, meaning that states may now regulate abortion in ways that were not previously permitted.

Abortion clinic regulations

An abortion clinic is a medical facility that provides abortions. Abortion clinics may be private or public medical practices or nonprofit organizations. In 27 major cities, and much of rural America, most people live 100 miles or more from an abortion clinic.

Regulations for abortions in the United States include state licensing requirements, federal workplace safety requirements, and association requirements. Abortion clinics may also self-impose more stringent requirements than what these regulations require.

Post Roe v. Wade, many states have passed TRAP (Targeted Regulation of Abortion Providers) laws. These regulations are designed to limit the number of abortions performed by decreasing the number of facilities permitted to perform abortions.

One example of a TRAP law is a requirement which states that doctors performing abortions must have admitting privileges at a nearby hospital. Local hospitals may choose to deny admitting privileges to medical professionals if the medical professional is known to be an abortion provider. Critics of admitting privileges laws and other TRAP laws include the American College of Obstetricians and Gynecologists, the American Public Health Association, and the American Medical Association, which have argued that such laws are medically unnecessary and that abortion is already "very safe" in the United States.

In 2011, the crimes of Kermit Gosnell, a physician who ran an abortion clinic in Philadelphia, spurred federal and state bills to more strictly regulate abortion facilities. Opponents of the restrictions questioned whether stricter regulations would have deterred Gosnell, who was alleged to be knowingly in violation of existing regulations.

Following the passage of a 2013 Wisconsin law requiring abortion providers to have admitting privileges at a nearby hospital, three Catholic hospital systems in the state intended to deny admitting privileges to abortion providers. Wisconsin's attorney general said this intent violated the Church Amendment of 1973, which prohibits hospitals from receiving federal funds from discriminating against a doctor on the basis of whether the doctor provides abortions.

In 2015, an Arkansas law required a physician who sought to provide an abortion pill to contract another physician who had admitting privileges at a nearby hospital. As a result, no providers could offer medication abortions in Arkansas and two Planned Parenthoods within the state cancelled their abortion services. Critics argued that no evidence was presented that hospital admitting privileges improve the safety of abortions.

In March 2016, Whole Women's Health v Hellerstedt was heard by the Supreme Court, and over eighty amicus curiae briefs were filed. The case was decided on June 27, 2016, and was reversed and remanded, 5–3, in an opinion by Justice Breyer. The Supreme Court ruled that Texas cannot place restrictions on the delivery of abortion services that create an undue burden for women seeking an abortion.

In March 2020, the Supreme Court decided in a 5–4 to reverse a lower court's ruling of allowing a Louisiana law to take effect in which abortion clinics required admitting privileges within 30 miles.

In June 2020, the Supreme Court held in June Medical Services LLC v Russo that a Louisiana law requiring physicians who perform abortions to have admitting privileges at a local hospital was unconstitutional, and confirmed the Supreme Court's ruling in Whole Woman's Health v. Hellerstedt.

Federal funding of abortions The Hyde Amendment bars the use of federal funds to pay for abortion except to save the life of the pregnant woman, or if the pregnancy arises from incest or rape. Before the Hyde Amendment took effect in 1980, an estimated 300,000 abortions were performed annually using federal funds. The provision withholds federal Medicaid funding of abortions, which impacts especially low-income families. Medicaid funding restrictions decrease a state's abortion ratio by 39.76% per every one thousand pregnancies.Medoff, Marshall H. 2010. "State Abortion Policies, Targeted Regulation of Abortion Provider Laws, and Abortion Demand." Review of Policy Research 27 (5): 577-594.

Laws targeting methods of practice On 18 April 2007, the U.S. Supreme Court upheld, in Gonzales v. Carhart, the Partial-Birth Abortion Ban Act that outlawed an abortion performed, in or affecting interstate or foreign commerce, using the intact dilation and extraction method. However, throughout the United States, various states have implemented Targeted Regulations of Abortion Providers (TRAP) laws and other classifications of restrictions on abortion. These laws aim to reduce the rate of abortions and limit access to medical providers, which has been proven to be less effective than anticipated in various research reviews. Researchers find the methods of TRAP laws to be practical concerning the variables of loss in opportunity and potential costs but the impacts on abortion demand are otherwise insufficient. Some states have also successfully limited abortion access to specific periods and circumstances: laws banning abortion before 13 weeks, between 13 and 24 weeks, bans on particular reasons for abortion (genetic disorders or health issues). Abortion restrictions generate the threat of legal risks among clinicians and other medical professionals and impact the quality of care and treatments for the individuals residing in restrictive states. Based on a survey conducted by the Kaiser Family Foundation (KFF) that concentrates on responses of OBGYNs and their reproductive health services, the research found that their decision-making autonomy, the ability to practice within the standard of care, and provider-patient relationships have been depreciated by the Dobbs decision and the increasing state restrictions. Additional descriptions of existing restrictive laws on methods of practice include gestational limits, state-required waiting periods, parental involvement for minors who are undergoing pregnancy, the prohibition of the use of state funds for abortions, and the lack of insurance coverage in medical insurance plans.

Mandatory ultrasounds Ultrasounds are not medically necessary for abortions; however, some states require physicians to perform an ultrasound, and some require the people seeking an abortion to view the ultrasound and listen to the fetus's heartbeat if any. As of May 2019, twelve states required people seeking an abortion to have an ultrasound before being allowed to have the procedure. This number was 26 in September 2020. 14 states required people to be issued with ultrasound information in May 2019. Mandatory transvaginal ultrasounds have been particularly controversial. In Texas, for instance, even if previous ultrasounds had indicated severe congenital defects, a person seeking an abortion was required under a 2012 law to have another ultrasound done, "administered by [their] abortion doctor, and [they had to] listen to a state-mandated description of the fetus [they were] about to abort", though state-issued guidelines later eliminated the ultrasound requirement if the fetus had an "irreversible medical condition". Some states require people to seek counseling after the ultrasound to determine if they would like to continue with an abortion.

On November 12, 2013, the U.S. Supreme Court declined to hear an appeal by the state of Oklahoma to the overturning of a bill that mandated compulsory ultrasound examinations.

Waiting periods

In the case Planned Parenthood v. Casey, the Supreme Court upheld the constitutionality of waiting periods because the Justices determined that they don't pose an "undue burden" or "substantial obstacle" to getting an abortion. Many states require people seeking an abortion to have mandatory counseling before the procedure, and 28 of the states that require counseling have a mandatory waiting period, usually up to 24 hours, between the counseling and abortion. 16 states require a person to make two trips to the clinic before receiving an abortion because they must receive counseling in person at the clinic, wait the designated waiting period, and return to the clinic to have the procedure done. South Dakota requires the person to obtain mandatory counseling from an anti-abortion crisis pregnancy center during this time frame. Waiting periods often act as a barrier to accessing abortion because they delay the procedure and are not associated with increased decision certainty about having an abortion. South Dakota requires the person to obtain mandatory counseling from an anti-abortion crisis pregnancy center during this time frame.

Waiting periods are a method of fear mongering. An argument often used when putting them in place is to allow women to consider all their options. As of 2013, 10 states had two-visit laws. These laws require women to receive mandatory counseling in person at least twenty-four hours before their abortion procedure making women go to two appointments to obtain an abortion.

Six-week bans

Status of most restrictive states The Guttmacher Institute has designated 15 states as being having the most restrictive abortion restrictions.

Alabama Arkansas Idaho Indiana Kentucky Louisiana Mississippi Missouri North Dakota Oklahoma South Dakota South Carolina Tennessee Texas West Virginia

Physician scripts Some states require a doctor to read a prepared script to the person seeking an abortion to secure informed consent. These scripts may include medically inaccurate information intended to persuade the patient not to have an abortion, such as the claim that the abortion will increase the risk of breast cancer or of psychological problems, which are not supported by mainstream medical organizations or scientific consensus. As of July 2013, 12 states require that women be given information on the ability of a fetus to feel pain. In Planned Parenthood v. Rounds, the Eighth Circuit Court of Appeals ruled that a South Dakota law requiring doctors to give patients false or misleading information about the suicide risk in women who have abortions was not unconstitutional.Can the Government Require Doctors to Provide Misleading Information to Patients Seeking Abortions? Alaska, Kansas, Mississippi, Oklahoma, and Texas mandate that before an abortion can be performed, the patient must be counseled on the link between abortion and breast cancer. There is currently no evidence from scientific research that abortion has the ability to cause breast cancer. Kansas, Louisiana, Mississippi, Nevada, North Carolina, South Dakota, Texas, and West Virginia mandate that patients receive counseling on the potential psychological impacts of abortion on the person who receive them before an abortion can be given. Five states require that an abortion patient is counseled that personhood begins at conception.

Liability