Updated on June 29, 2020:
On June 29, 2020, the U.S. Supreme Court struck down Louisiana’s harmful admitting privileges requirement in June Medical Services v. Russo. The Court’s 5-4 decision prevented the restriction from going into effect, allowing the state’s three remaining clinics to stay open. The Court also rejected Louisiana’s argument that abortion providers do not have standing to challenge abortion restrictions on behalf of their clients.
Updated on May 21, 2020:
Added new section on closest abortion clinics in other states if all clinics in Louisiana shut down.
First published February 11, 2020:
The U.S. Supreme Court is going to hear arguments in March in June Medical Services v. Gee, a legal challenge to a Louisiana admitting privileges requirement for abortion providers that is identical to a Texas law that the Court struck down in 2016. Contrary to arguments made by abortion opponents, requiring providers to have admitting privileges at a local hospital provides no benefit to patients’ health. This requirement is just one of the 89 abortion restrictions Louisiana has enacted since 1973, the most of any state. Any one of these restrictions can make abortion inaccessible for many people, especially those who have low incomes or face other barriers to health care.
This one restriction on admitting privileges is part of a labyrinth of abortion restrictions the state has erected. The number of restrictions enacted in Louisiana since abortion was legalized in 1973 far outstrips those enacted by any other state. The state with the second-highest total is Indiana, with 63 restrictions, and Oklahoma is in third place with 60.
Not every restriction enacted in Louisiana or other states is in effect; some have been struck down in court. A separate Guttmacher analysis, looking only at laws currently in effect, categorizes Louisiana as one of six states that are “very hostile” to abortion rights, further validating that the state has gone to extremes in restricting abortion. Having such a large number of restrictions impacts access to abortion in Louisiana in a variety of ways, from making it harder for patients to get to an abortion provider or pay for an abortion to making it harder for providers to keep their facility doors open. Even this one abortion restriction—an admitting privileges requirement—has the ability to shutter all but one abortion clinic in the state.
Louisiana’s Labyrinth of Laws
Louisiana has a long track record of attempting to ban abortion at various points in pregnancy, in direct conflict with the standard set by the U.S. Supreme Court that prohibits a state from banning abortion before fetal viability. Currently, Louisiana bans abortion at 22 weeks, which can be several weeks before viability (the point at which a fetus can sustain life outside the womb). Louisiana has also adopted four other bans on abortion at earlier points in pregnancy, none of which are in effect:
- A ban that would have permitted abortion only in cases of life endangerment, rape or incest (1991)
- A so-called trigger law that would ban abortion if Roe v. Wade were overturned (2006)
- A ban on abortion at 15 weeks of pregnancy (2018)
- A ban on abortion as early as six weeks of pregnancy (2019)
Collectively, these bans demonstrate that Louisiana’s real agenda is not to support patient health, but to limit access to services and stigmatize abortion. This strategy is further illustrated by the laundry list of other barriers for patients and providers imposed by the state. These policies, which are in effect, include:
- Banning nearly all Medicaid funding for abortion, which is tantamount to a ban for many low-income individuals
- Banning any coverage of abortion in the Affordable Care Act’s marketplace plans, which stigmatizes abortion care and puts the burden of payment (typically about $500) on patients
- Requiring that a minor obtain parental consent for an abortion, which can delay access to services and, in some cases, lead to abuse by non-supportive family members
- Requiring in-person counseling at least 24 hours before an abortion, which forces patients to make at least two trips for the procedure
- Mandating inclusion of misleading and irrelevant information in abortion counseling materials, a requirement that conflicts with medical ethics and further stigmatizes abortion
- Barring the use of telemedicine for the provision of medication abortion, which limits access to abortion services for those who cannot access a clinic, such as those in rural areas
- Requiring an ultrasound before an abortion and for the provider to show and describe the image, which is designed to shame the patient
This interconnected web of policies also includes laws and regulations that are designed to close abortion clinics. Before the state enacted the admitting privileges law, it already had onerous and overly burdensome requirements for the licensing of abortion facilities. For example, the state health department can immediately close a clinic if the facility has violated any federal or state law and the department decides there is an immediate threat to patients; this authority extends to even small administrative or paperwork violations. Also, only obstetricians and gynecologists may provide abortions, even though the necessary training and skill is within the scope of practice of other physicians, physician assistants, certified nurse midwives and advanced practice nurses.
Over the decades, Louisiana has made it clear that patient health and well-being are not the goals of its abortion policymaking, as these laws serve to erect barriers and deny patients access to the care they need. Rather, the state has one singular goal—eliminating providers’ ability to offer abortion care and patients’ ability to obtain such care. The Supreme Court should see Louisiana’s false claims for what they are and strike down the admitting privileges law, just as the Court did in 2016.
Potential Travel to Neighboring States
A new analysis from Guttmacher’s Jonathan Bearak shows that Louisiana residents would have to travel farther and meet unnecessary restrictions in neighboring states if all three clinics in Louisiana that are currently providing abortion care were closed.
Without any abortion clinics in Louisiana, the nearest clinic for 51% (481,000) of Louisiana women of reproductive age (15–44) would be located in Mississippi, the nearest clinic for 28% (265,000) would be in Alabama, the nearest clinic for 11% (103,000) would be in Arkansas and the nearest clinic for 9% (86,000) would be in Texas.
For many Louisianans, this would mean traveling long distances: If all Louisiana clinics were to close, the average (median) one-way driving distance to an abortion clinic would increase from 41 miles to 172 miles (or 320% longer).
Abortion access is also limited in these nearby states. Alabama has five abortion clinics, Mississippi has one, Arkansas has three and Texas has 21 across the entire state. Because of the lack of clinics, patients may face delays in obtaining care.
Moreover, all four of these states are considered either "hostile" or "very hostile" to abortion rights. Among many other restrictions, Alabama, Arkansas, Mississippi and Texas all mandate that patients make at least two trips to the clinic, separated by a waiting period; require parental involvement for those younger than 18 who are seeking an abortion; and have either enacted admitting privileges laws or are at risk of adopting them should the Supreme Court uphold Louisiana’s harmful law.