Background

In the years immediately following the Supreme Court decision in Roe v. Wade, several states moved to impose strict regulations on abortion clinics, beyond what is necessary to ensure patients’ safety. Since many of these requirements were struck down by lower federal courts starting in the early 1980s, states moved on to other ways to restrict access to abortion, such as limitations on public funding. Efforts to use clinic regulation to limit access to abortion, rather than to make its provision safer resurfaced in the 1990s and have gained steam since 2010. However, in June 2016, the U.S. Supreme Court struck down some of the most burdensome of these restrictions that had been enacted in Texas.

While all abortion regulations apply to abortion clinics, some go so far as to apply to physicians’ offices where abortions are performed or even to sites where only medication abortion is administered. Most requirements apply states’ standards for ambulatory surgical centers to abortion clinics, even though surgical centers tend to provide more invasive and risky procedures and use higher levels of sedation. These standards often include requirements for the physical plant, such as room size and corridor width, beyond what is necessary to ensure patient safety in the event of an emergency. State standards, however, do vary, with the most burdensome standards in place in states such as Michigan, Missouri, Pennsylvania, Tennessee and Virginia.

They also often require that facilities maintain relationships with hospitals, provisions that add nothing to existing patient protections while granting hospitals effective veto power over whether an abortion provider can exist. Several states mandate that clinicians performing abortions have relationships with local hospitals, requirements that do little to improve patient care but that set standards that may be impossible for providers to meet.