March 25, 2016

Spatial Inequity and Access to Abortion

TigonzalesBy Teresa Irene Gonzales

Abortion and women's access to abortion are often contested issues within the United States. A recent poll by Pew Research found that 51% of Americans think that abortions should be legal in all or most cases. Yet, 49% of Americans polled think having an abortion is morally wrong. How does this difference in legality and morality impact legal decisions?

Have you heard about the Texas abortion regulations case? In 2013, the Texas solicitor general passed an omnibus abortion bill (HB2) that places additional restrictions on abortion providers. Regulations include requiring doctors to obtain hospital admitting privileges within 30 miles from the clinic where they perform abortions, and requiring abortion clinics to be retrofitted to comply with building regulations that would make them ambulatory surgical centers.

The impact of these bills on women's health has been immediate. Since the passing of HB2, 900,000 women now live farther than 150 miles from an abortion provider and 750,000 live farther than 200 miles; 11 of 33 abortion clinics closed; and wait times have increased. In addition, according to researchers at the Texas Policy Evaluation Project (TxPEP), the number of physicians who provide abortions across the state fell from 48 to 28.

The restriction of a woman's right to access either reproductive health and/or abortion care exacerbates issues of spatial inequality and isolation. In Texas, women are faced with potentially long travel times, barriers to finding a culturally competent doctor and/or a doctor that speaks the patient's language, and increased costs (time off work, transportation, childcare, healthcare and prescriptions) to accessing reproductive healthcare. This is particularly onerous for impoverished women, women of color, immigrant women, and those who reside in more rural areas.

Spatial inequality refers to the ways that place (city, town, neighborhood, nation, county, and other locations) intersects with the various forms of stratification (economic, race, ethnic, gender, age, sexuality, and so forth). Researchers have investigated the ways that spatial inequality impacts access to social welfare programs, political mobilization, and housing, to name a few.

The Texas restrictions apply to both forms of abortion: suction curettage (surgical) and medical. Surgical abortions involve a visit to the doctor where s/he empties a woman's uterus. A medical abortion involves a combination of medications that can be taken at home over 2 days. Although there is no surgical procedure with a medical abortion, under HB2, a woman who is eligible for this option would need to travel to an abortion clinic in order to take those pills.

Texas lawmakers who support HB2 claim that the bill's provisions are needed in order to provide better medical care and ensure the safety of women seeking this treatment. They argue that this is particularly relevant in cases of surgical abortions.

The American Congress of Obstetricians and Gynecologists, however, claims that these measures "restrict the reproductive rights of women in Texas." Other challengers of HB2 maintain that these restrictions also limit women's access to safe, legal abortions, and, therefore, violate the ruling in Planned Parenthood v Casey (1992).

Given these concerns, a coalition of abortion providers have sued the state, and the U.S. Supreme Court agreed to hear the case (Whole Woman's Health v. Hellerstadt, No 15-274).

If HB2 is deemed constitutional by the U.S. Supreme Court, available clinics that serve the population of 5.4 million women of child-bearing age could dwindle from 41 to 10 statewide. Some women might have to travel a minimum of 200 miles to access a facility – even if they opt for a medical (pill-induced) abortion. These implications would extend beyond Texas to other states that are also considering similar bills to HB2.

In addition to these regulations, in 2011 Texas lawmakers moved to defund Planned Parenthood. As part of this effort, they reduced public funding to family planning agencies by two-thirds. As a result, 82 clinics have closed, and low-income women are increasingly unable to access affordable family planning or preventative screening services. This coupled with heightened regulations on abortion clinics places increased pressures on low-income women, especially those who live in more rural areas.

Political regulation of women's reproductive health is not new. U.S. doctors have regularly sterilized poor women, women of color, and imprisoned women without their consent. Laws, such as HB2, that restrict women's access to reproductive healthcare and to abortion clinics extend this legacy of inequity.

The lasting effects of a bill like HB2 are expansive and potentially dangerous to a woman's health. How might this play out in the day to day lives of women who are seeking abortion care?

Within Texas, there are approximately 65,000 to 70,000 abortions annually. Yet, as stated above, many of these women are unable to readily access basic reproductive healthcare, let alone abortion clinics.

In terms of access to medical care, this form of isolation may lead to higher rates of unwanted pregnancies, and increased rates of self-induced abortions – which are medically risky to both the woman and the fetus. These unintended consequences work to negate the rhetoric of "safety" that Texas lawmakers in support of HB2 claim.


My interest in choosing this article came from the fact that I feel like this topic is not covered enough and deserves more recognition than is given, so I was glad to see it in the articles to choose from. I have previously studied this topic from a reproductive biology perspective and was saddened to find out how few women have access to reproductive health resources. Now, looking at this issue from a sociological perspective I can begin to understand why our society still faces, what I think are, rudimentary health issues some of which include women performing self-induced abortions. Abortion, being a very political issue, leave the clinics to gain a bad reputation, therefore are being shut down in states whose political views are against these measures. I believe that regardless of the state’s political position on this topic that these resources should be made available and in close proximity to all women. Even more so in states whose political views are against abortion clinics they should allow free birth control to all women and see how this changes the abortion rates.
These clinics provide more than just abortions and these services are often overlooked by the state and shut down anyways. It is important to all of society that men and women of all income levels have access to various types of contraception, tests and screenings, and vaccinations. I believe a society with equal access to these types of health care will see positive outcomes in many ways. This could lessen the gap seen in social stratification and possibly make a change in the lack of mobility seen in America’s social class ladder. With the ability to prevent an unwanted pregnancy a women now has the choice to stay in school longer, get a career that might be outside her family's social class and begin to pursue the sought after “American Dream.”

Nice article.

Abortion is such a controversial can never be exhausted.

This topic is awesome

I know that Texas is an all-around fairly conservative state, so I understand them bringing up this bill, but it frustrates me to an extreme. The whole notion surrounding conservative politics is about having a hands-off approach. This bill looks to be the complete opposite of hands off. This bill is telling a woman what she can and can’t do with her body and her life. That doesn’t sit right with me. That isn’t the only issue with this bill. The BH2 bill also discriminates against various classes. It’s a form of disenfranchisement. People of the working or lower class are residentially segregated into more rural and less active areas. The majority of Planned Parenthood facilities are located in larger cities, not poor rural towns where they are needed the most.
The stigmas that create social stratifications derive from wealth inequalities that lead to poor health and discouraging living situations. It’s bills like this that make it even harder for poor people to make a difference and succeed. Taking care of a child required endless financial support and people living in already dire situations can’t afford to take on another life. When a woman has the ability to get an abortion she has the opportunity to rewrite her future by getting a good education, gaining a successful job, and starting a real family at a responsible age and achieving the such sought after “American Dream”.

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