This document discusses the ongoing use of Targeted Regulation of Abortion Providers (TRAP) laws to limit access to abortion services in the United States. It provides details on various TRAP laws across different states, including requirements for abortion clinics related to procedure rooms, hospital admitting privileges for doctors, and relationships with local hospitals. The document also summarizes key court cases like Whole Woman's Health v. Hellerstedt that challenged certain TRAP laws.

1. PETRIE-FLOM YEAR
IN REVIEW:
WOMEN’S HEALTHAziza Ahmed
Professor of Law
Northeastern University School of Law

2. Abortion / Self-Abortion
■ Ongoing Use of Targeted Regulation of Abortion Providers (TRAP) Laws
by Conservatives to Limit Access to Abortion Services
■ Supreme Court 2016: Whole Women’s Health v. Hellerstedt
■ Indiana: Purvi Patel v. State of Indiana
■ What can we expect going forward?

3. TRAP laws – Summary by Guttmacher
Institute (2017)
■ 21 states have onerous licensing standards many of which are comparable or equivalent
to the state’s licensing standards for ambulatory surgical centers.
■ 20 states have specific requirements for procedure rooms and corridors, as well as
requiring facilities be near and have relationships with local hospitals.
– 11 states specify the size of the procedure rooms.
– 10 states specify corridor width.
– 10 states require abortion facilities to be within a set distance from a hospital.
– 8 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.)
■ 11 states place unnecessary requirements on clinicians that perform abortions.
– 11 states require abortion providers to have some affiliation with a local hospital.
■ 4 states require that providers have admitting privileges.
■ 7 states require providers to have either admitting privileges or an alternative arrangement, such as
an agreement with another physician who has admitting privileges.

4. TRAP Laws: Targeted Regulation of
Abortion Providers
■ ACOG
– “Cease and repeal legislation that creates barriers to abortion access and interferes
with the patient–provider relationship and the practice of medicine, including for
example telemedicine bans, medication abortion restrictions, mandatory counseling
and delays, and Targeted Regulations of Abortion Provider (TRAP) laws.”
■ APHA
– “Admitting privilege restrictions have demonstrated serious, tangible consequences
for patients seeking care as a result of clinic closures cutting off their access and
entry points to reproductive health care.”

5. Whole Woman’s Health

6. Whole Women’s
Health
■ Challenging 2013 law HB2
– doctors who provide abortion
services must obtain admitting
privileges at local hospitals no
farther than 30 miles away from
the clinic; and
– every health care facility offering
abortion care must meet building
specifications to essentially
become mini-hospitals (also known
as ambulatory surgical centers, or
ASCs).

7. Regulations are seen as unnecessary by
experts (despite claims of Texas DHHS)
■ Regulatory proposals are framed almost entirely in terms of aiming to make healthcare
better for women from the perspective of experts
– Brief of Texas Department of State Health Services
– “Texas’s admitting-privileges and ambulatory- surgical-center (ASC) requirements raise
the standard of care for all abortion patients. Medical experts in this case testified to the
benefits of these requirements and explained how they will improve the health and safety
of women.”
• Brief for ACOG
H.B. 2’s ASC requirement and privileges requirement are contrary to accepted medical practice
and are not based on scientific evidence. They fail to enhance the quality or safety of abortion-
related medical care and, in fact, impede women’s access to such care by imposing unjustified
and medically unnecessary burdens on abortion providers. Accordingly, without this Court’s
review, H.B. 2 would deprive women in Texas of quality, evidence-based medical care and their
recognized rights under the U.S. Constitution.

8. The undue burden test (Casey v.
Planned Parenthood, 1992)
■ Does a state regulation have the purpose or effect of
placing a substantial obstacle in the path of a woman
seeking an abortion of a nonviable fetus?

9. Planned Parenthood of Southeastern
Pennsylvania v. Casey, 1992
■ Pennsylvania enacts the Pennsylvania Abortion Control Act
– Five abortion clinics and one physician sue in U.S. District Court
■ At issue were five provisions of Pennsylvania Abortion Control Act
of 1982
– Woman must give informed consent prior to the abortion procedure
– Woman must be provided with certain information 24 hours before the
abortion is performed
– For a minor parental permission is required (with judicial bypass)
– Married woman must tell her husband of the intended abortion
– Reporting requirement
■ Key holdings: does away with trimesters, new focus on viability
of the fetus, introduces the undue burden standard – “an
undue burden on a woman’s ability to make this decision”; all
are found constitutional except for the requirement for disclosure
to one’s husband

11. Purvi Patel

13. GOP Platform 2016
■ Through Obamacare, the current Administration has promoted the notion of
abortion as healthcare. We, however, affirm the dignity of women by protecting the
sanctity of human life. Numerous studies have shown that abortion endangers the
health and well- being of women, and we stand firmly against it.
■ We condemn the Supreme Court’s activist decision in Whole Woman’s Health v.
Hellerstedt striking down commonsense Texas laws providing for basic health and
safety standards in abortion clinics. We applaud the U.S. House of Representatives
for leading the effort to add enforcement to the Born-Alive Infant Protection Act by
passing the Born-Alive Abortion Survivors Protection Act, which imposes appropriate
civil and criminal penalties on healthcare providers who fail to provide treatment
and care to an infant who survives an abortion, including early induction delivery
whether the death of the infant is intended. We strongly oppose infanticide…

14. What you can and cannot do under the
GGR
■ Foreign NGOs, some private clinics and hospitals
– You CANNOT perform, counsel, refer or advocate with non-US government sources
■ You can provide referrals in rape, incest, or if the mother’s life is endangered
– You can do post abortion care: “injuries and illnesses caused by legal or illegal
abortions.”
– May not lobby the government for liberalization of abortion laws (may not
participate in public debates).
– Does not apply to HIV/AIDS assistance

15. Reagan – Mexico City 1984
■ The United Nations Declaration of the Rights of the Child [1959]
calls for legal protection for children before birth as well as after
birth. In keeping with this obligation, the United States does not
consider abortion an acceptable element of family planning
programs and will no longer contribute to those of which it is a part.
Accordingly . . . the United States will no longer contribute to
separate nongovernmental organizations which perform or actively
promote abortion as a method of family planning in other nations.

16. January 22, 2001
■ It is my conviction that taxpayer funds should not be used to pay for
abortions or advocate or actively promote abortion, either here or abroad.
It is therefore my belief that the Mexico City Policy should be restored.
Accordingly, I hereby rescind the "Memorandum for the Acting
Administrator of the Agency for International Development, Subject: AID
Family Planning Grants/Mexico City Policy," dated January 22, 1993, and I
direct the Administrator of the United States Agency for International
Development to reinstate in full all of the requirements of the Mexico City
Policy in effect on January 19, 1993.

17. January 23, 2009
“These excessively broad conditions on grants and assistance awards are unwarranted.
Moreover, they have undermined efforts to promote safe and effective voluntary family
planning programs in foreign nations. Accordingly, I hereby revoke the Presidential
memorandum of January 22, 2001, for the Administrator of USAID (Restoration of the
Mexico City Policy), the Presidential memorandum of March 28, 2001, for the
Administrator of USAID (Restoration of the Mexico City Policy), and the Presidential
memorandum of August 29, 2003, for the Secretary of State (Assistance for Voluntary
Population Planning). In addition, I direct the Secretary of State and the Administrator
of USAID to take the following actions with respect to conditions in voluntary population
planning assistance and USAID grants that were imposed pursuant to either the 2001
or 2003 memoranda and that are not required by the Foreign Assistance Act or any
other law: (1) immediately waive such conditions in any current grants, and (2) notify
current grantees, as soon as possible, that these conditions have been waived. I
further direct that the Department of State and USAID immediately cease imposing
these conditions in any future grants.”