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An Analysis of State and Nationwide Legislation on Women’S Healthcare Access in Virginia

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An Analysis of State and Nationwide Legislation on Women’S Healthcare Access in Virginia W&M ScholarWorks Undergraduate Honors Theses Theses, Dissertations, & Master Projects 4-2015 An Analysis of State and Nationwide Legislation on Women’s Healthcare Access in Virginia Lillian Singer Follow this and additional works at: https://scholarworks.wm.edu/honorstheses Part of the Health Law and Policy Commons Recommended Citation Singer, Lillian, "An Analysis of State and Nationwide Legislation on Women’s Healthcare Access in Virginia" (2015). Undergraduate Honors Theses. Paper 230. https://scholarworks.wm.edu/honorstheses/230 This Honors Thesis is brought to you for free and open access by the Theses, Dissertations, & Master Projects at W&M ScholarWorks. It has been accepted for inclusion in Undergraduate Honors Theses by an authorized administrator of W&M ScholarWorks. For more information, please contact [email protected]. Singer 1 Table of Contents I. Chapter 1: Introduction II. Background and Study Design 4-8 III. Overview of Legislation 8-11 IV. Chapter 2: Targeted Regulations of Abortion Providers a. What is TRAP? 12-15 b. Implications 15-17 c. Responses 17-20 d. Related Factors at Play 20-22 V. Chapter 3: PPACA and Hospitals a. PPACA and Virginia’s Hospitals 23-27 b. PPACA and Abortion Access 27-28 c. PPACA and Virginia 28-30 VI. Chapter 4: Interviews and Analysis a. Overview 31-32 b. Themes 32-47 VII. Chapter 5: Conclusion a. Overview 48-51 b. Conclusions 51-52 c. Reflections 52-55 VIII. Bibliography 56-59 Singer 2 Acknowledgements My personal and academic interests in the subject of abortion access were first fostered within the walls of my classrooms at William & Mary, and through the discussions with friends here who have never failed to challenge my thinking. I am indebted to many individuals for their time, patience, and willingness to work with me on this project. For any I do not list on this page, I hope it is known by all that this thesis would not have been completed and my education would not be complete without your help. I would first like to thank both of the advisors who have worked so closely with me on my research. First, I would like to express my deepest gratitude to and appreciation for Dr. Aday, who has served as my advisor for the last year, and pushed me to always think larger and more critically. Had it not been for your guidance and many hours spent working with me on this content, this thesis would have ceased to be many months ago. Second, I would not have begun this project at all had it not been for Dr. Buchanan’s initial advising in the first year of this project, when she helped me organize and build the ideas that led to this thesis, and then supervised my progress along the way. I am also so grateful for Dr. Castillo and Dr. Scott’s willingness to serve on my committee, and dedicate their time and energy to reviewing my work and providing suggestions for its amelioration. I would like to express my most sincere thanks to every interview participant who allowed me into his or her world for a brief time. Your selflessness has allowed me to better understand the work to which you have so selflessly committed yourselves. I would also be remiss not to attribute the success I have had with this project, and my entire college career, to the family members who have stood by me and guided me every step of the way. I hope the following pages do justice to every member of my community who has lent a listening ear or a critical eye to my research and my writing. In the words of one of reproductive healthcare’s most prominent advocates, “it takes a village.” Thank you. Singer 3 An Analysis of State and Nationwide Legislation on Women’s Healthcare Access in Virginia Chapter 1: Introduction Background and Study Design The issue of abortion access has been a contentious one long predating 1973, when the passage of Roe v. Wade brought it to the fore of U.S. political discourse. Incorporating moral, religious, financial, and political interests, the debate launched by this landmark case marked only the beginning of decades of advances and reversals in the legislation surrounding abortion access. Once a deeply personal and private matter, abortion has risen to the top of political agendas on both sides of the political aisle, and become one of the prominent civil rights issues of this century. Virginia serves as an optimal case study for examining legislation on this complex topic. It has a long history as a battleground state in national and statewide elections, making it a hotbed for political activism regarding controversial issues. In addition, Virginia is the birthplace of many of the court cases that eventually arrived at the Supreme Court. These cases have helped to shape the policy surrounding reproductive healthcare at a national level in a lasting way. Today, much of Virginia’s state legislation regarding abortion services is as divisive as the Roe v. Wade ruling was at its outset, making the topic of women’s healthcare one that many politicians pointedly avoid, and only a select few leverage greatly. Former Governor Bob McDonnell, for example, spent much of his time in office working to amend Virginia statutes and introduce bills that were aligned with the conservative values for which he was elected. One of the last pieces of legislation he Singer 4 signed regarding reproductive healthcare was Senate Bill 924, colloquially known as TRAP – Targeted Regulations of Abortion Providers. The bill was signed in 2011 as emergency safety legislation, and as a result, was implemented immediately (Guttmacher Institute, 2015). Senate Bill 924 outlines architectural and administrative requirements that hold clinics performing upwards of five first-trimester abortions per month to the same safety and reporting standards as hospitals (Guttmacher Institute, 2015). However, the bill addresses abortion care as a singular service, when in reality, there are multiple methods of abortion depending upon stage of gestation. While the more widely controversial form of abortion is surgical – particularly late-term, high-risk abortions in the second trimester – nearly 90% of all abortions in the U.S. are performed in the first trimester and involve no surgery at all (Guttmacher Institute, 2014). In fact, one third of abortions occurs prior to six weeks gestation, and are typically medical abortions, which consist of taking two pills over the span of 48 hours (Guttmacher Institute, 2014). For those first trimester abortions that are surgical, the service is currently categorized as an outpatient procedure, which formerly meant that it could be performed in ambulatory care facilities under the same regulations as other outpatient operations. Currently, women who undergo surgical abortions experience complications at a rate of less than 0.3%, making first-trimester abortions nearly fourteen times safer than childbirth (Gold & Nash, 2013). This raises the question: whose safety are the terms of SB 924 designed to protect? And in this light, are these terms constitutional? These were the initial questions I intended to answer when I began researching TRAP and its impacts on reproductive healthcare access in Virginia. Finding answers has Singer 5 required me to reach far beyond simple statistics or putative facts associated with abortion care. The investigation points to a complex web of politics, misinformation, and extensive red tape that have all muddied the waters of reproductive healthcare policymaking. This investigation began in the summer of 2013, at the height of TRAP’s implementation, and as its effects were being felt fully by women’s clinics throughout the state. I wanted to understand these regulations and their consequences for Virginia clinics, were there any to be had. Additionally, I wanted to explore the projections made by current abortion providers and public interest group representatives concerning the future of abortion access in Virginia. My questions were basic in the beginning: • What is TRAP? • How are TRAP regulations being implemented? • Have the TRAP regulations achieved the envisioned goals? • What are the anticipated long-term effects of TRAP provisions on women’s clinic services? I sought to depict the landscape surrounding abortion access as both a still-shot of 2013 and as a panorama stretching from 1973 to the present, including all pertinent legislation that has shaped abortion access nationwide. I recognized that I would need to examine abortion access at the macrocosmic level of Supreme Court cases and also examine Virginia as a microcosmic lens for viewing abortion access. First, I examined abortion access on a legislative level, giving an historical background of the topic on a state and national level, as well as describing in detail Senate Bill 924 and its inception. Though parts of this work are outside the scope of this Singer 6 thesis, and thus have been excluded from this manuscript, all data collected in my first year of research has helped me to narrow my focus on the topics to be presented in this paper. Based on my sense of how the law began to take shape and whom the key players were in the discussions that shaped outcomes, I decided that I should interview physicians, public advocacy group representatives, Planned Parenthood administrators, and those whose involvement was faith-based. I undertook these field interviews in order to investigate the effects of information and misinformation and to examine the perspectives of: (1) those who have participated directly in public debates about abortion access; (2) those who are involved in providing abortions and related services; and (3) those who have participated in the creation and passage of TRAP laws. In order to gain firsthand exposure to some of the complex realities of seeking abortion services, I also volunteered with a local task force that escorts patients at clinics.
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