Targeted Regulation of Abortion Providers

Background

Background

Laws and policies on abortion have been changing rapidly across the United States since the US Supreme Court overturned the federal constitutional right to abortion in late June in Dobbs v. Jackson. As a result, some information here may be out of date. Our team is working diligently to update this resource. Thank you for your patience.

 

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, paving the way to challenge other states’ overly burdensome regulations that target abortion providers.

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 and Pennsylvania.

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.

Visit our state legislation tracker for policy activity on all sexual and reproductive health topics.

Highlights

  • 23 states have laws or policies that regulate abortion providers and go beyond what is necessary to ensure patients’ safety; all apply to clinics that perform surgical abortion.
    • 13 states’ regulations apply to physicians’ offices where abortions are performed.
    • 18 states’ regulations apply to sites where medication abortion is provided, even if surgical abortion procedures are not.
  • 17 states have onerous licensing standards many of which are comparable or equivalent to the state’s licensing standards for ambulatory surgical centers.
  • 18 states have specific requirements for procedure rooms and corridors, as well as requiring facilities be near and have relationships with local hospitals.

    • 9 states specify the size of the procedure rooms.
    • 8 states specify corridor width.
    • 8 states require abortion facilities to be within a set distance from a hospital.
    • 5 states require each abortion facility to have an agreement with a local hospital in order to transfer patients in the event complications arise. (Including requirements on clinicians a total of 21 states require a provider to have a relationship with a hospital.)
  • 12 states place unnecessary requirements on clinicians that perform abortions.
    • 12 states require abortion providers to have some affiliation with a local hospital.
      • 2 states require that providers have admitting privileges.

      • 9 states require providers to have either admitting privileges or an alternative arrangement, such as an agreement with another physician who has admitting privileges.

    • 1 state requires the clinician to be either a board-certified obstetrician-gynecologist or eligible for certification.

The information provided on this website is not intended to, and does not, constitute legal advice. All information, content, and materials available on this site are for general informational purposes only. Information on this website may not constitute the most up-to-date legal or other information. We encourage anyone with legal questions to contact a licensed attorney.

Targeted Regulation of Abortion Providers   

STATE

REGULATIONS APPLY TO SITES WHERE:

FACILITY REQUIREMENTS:

CLINICIAN REQUIREMENTS:

 

Surgical Abortion Is Provided

Medication Abortion Is Provided

Structural Standards Comparable to Those for Surgical Centers

Procedure Room Size Specified

Corridor Width Specified

Maximum Distance to Hospital Specified

Transfer Agreement with Hospital

Requires:

OB/GYN Certification or Eligibility

Outpatient Clinics

Private Doctor Offices

Hospital Privileges

Hospital Privileges or Alternative Agreement

Alabama

X

X

X

X

 

X

 

X

 

Arizona

X

X

X

X

 

 

30 miles*

 

 

X

 

Arkansas

X**

X**

X**

X**

X**

 

30 minutes**

 

 

X**

**

Connecticut

X

 

 

 

 

 

 

 

 

 

 

Florida

X

 

X

 

 

 

 nearby

X

 

X

 

Indiana

X

X

X

X

X

adjacent county

 

 

X

 

Kansas

 

 

 

 

 

Kentucky

X

 

X

X

 

 

 

 

 

 

Louisiana

X

X

X

X

 

 

 

 ᐁ

Maryland

X

 

 

 

 

 

 

 

 

 

 

Michigan

X

 

X

X

X

X

30 minutes

X

 

 

 

Mississippi

X

X

X

X

X

X

 

X

X

Missouri

X

 

 

X

 

X

X

 

X

 

 

Nebraska

X

X

X

 

X

 

 

 

 

 

 

North Carolina

X

 

X

X

 

 

 

 X

 

 

 

North Dakota

 

 

 

 

 

 

30 miles

 

X

 

 

Ohio

X

 

 

X

 

 

30 miles

 

 

 

Oklahoma

X

 

X

X

X

 

 

X

ᐁ 

Pennsylvania

X

X

 

X

X

X

 

X

 

 

 

Rhode Island

X

X

X

X

 

 

 

 

 

 

 

South Carolina

X

X

X

X

 

X

 

 

 

X

θ

South Dakota

X

X

X

X

 

X

 

 

 

 

 

Tennessee

 

 

 

 

 

 

 

 

Texas

X

X

X

 

 

 

 X

 

Utah

X

X

X

X

X

 

 

 

 

 

 

Wisconsin

X

 

X

 

 

 

X

 

 

TOTAL

23

13

18

17

9

8

8

5

2

10

1

ᐁ  This law is temporarily enjoined pending a final decision in the courts. 
▼ This law is permanently enjoined and is not in effect.

*   Applies only to surgical abortions

** Abortion is banned in Arkansas except for cases of life endangerment. A state law requires all abortions to be performed in a hospital, superseding earlier regulations on abortion providers.

Ω A medication abortion provider must have an agreement with another provider who has hospital admitting privileges. This law is temporarily enjoined pending a final decision in the courts.

‡ Indiana law requires an abortion provider to either have admitting privileges or an agreement with another physician who has admitting privileges at a local hospital. A court has blocked a requirement that would have required the agreement with another physician who has privileges to be renewed annually and filed in every hospital in the local area.

θ Only an obstetrician/gynecologist may provide abortions after 14 weeks of pregnancy.