Ensuring Access to Abortion in a Progressive State: Better Laws are Just a Start
By: Stephen T. Chasen, MD
As a Maternal-Fetal Medicine (MFM) physician and abortion provider in New York City, I am used to providing necessary care for my patients who require abortion. For my patient population, this typically occurs following prenatal diagnosis of fetal abnormalities or due to medical complications during pregnancy. I have also taken care of women from states with very restrictive laws who had to travel long distances to access abortion care. I am fortunate to live and practice in a community that is very supportive of reproductive rights, and I have been able to advocate for the rights of my patients in legislative and judicial arenas with the full support of my medical school, hospital, and colleagues.
In 2019, the state of New York passed the Reproductive Health Act (RHA), which decriminalized abortion and vastly improved state laws by codifying protections in Roe v. Wade. The RHA removed barriers to abortion care and eliminated restrictions, such as gestational-age bans on abortion to preserve the health of pregnant individuals, or in the presence of lethal fetal anomalies.
So, what can somebody who lives and works among those who support abortion rights find to complain about? Without state restrictions like “heartbeat” bills, TRAP laws, or waiting periods, why does a state like New York have a less-than-ideal reproductive rights and justice environment?
One reason is that New York, like some other progressive states, is geographically very large. Less densely populated areas may have very few abortion providers and may have none that are capable of providing care after the first trimester. Pregnant individuals in these areas may have to travel long distances to access abortion care, and better laws have not changed that reality.
Another issue is that, as an MFM specialist, I perform abortions in a hospital setting. My patients include those with severe medical or obstetric complications who may not be candidates for an outpatient abortion at a family planning clinic. Thus, we must rely on hospital policies to ensure access to abortion. While state laws tell us what is permissible, they do not mandate what must be available. No individual hospital or OBGYN department is required to align their policies regarding abortion with state statutes, so improving laws does not automatically lead to improved access. My hospital’s policy, in which abortion is not permitted after 24 weeks, happens to be more restrictive than current state law. While my colleagues and I are engaged in efforts to improve the situation, there are many bureaucratic hurdles to overcome.
The bottom line is that laws that respect reproductive autonomy are necessary, but not sufficient, to making abortion available and accessible. Even in an environment in which patients, politicians, and physicians support abortion rights, the community that relies on the availability of safe abortion must be vigilant. While advocacy at the national and state levels is important, we must ensure that key decision makers, including hospital executives, department chairs, and other leaders support access to abortion care.
Those of us who are abortion providers can begin by educating our colleagues about specific limitations to access and enlisting them in our efforts. Many people who can facilitate access, including nurses, anesthesiologists, and those involved in operating room scheduling, support abortion rights. While they may understand the importance of abortion care, making them aware of specific institutional obstacles can build support for change that can achieve our shared goals.
