It may still be legal, but women's access to abortion is under attack in America

The restrictive measures put on clinics under the Trap laws are designed to make access to abortion not only more complicated, but also more traumatic, in order to make women think again about their reproductive choices

There is a legitimate fear that women in more liberal states will continue to have access to abortion services but women in more rural and conservative states might have to travel long distances or consider unsafe or illegal means to end a pregnancy (EPA)

In the US, the pivotal legal case of Roe v Wade in 1973 legalised abortion, establishing that the decision to terminate a pregnancy was between a woman and her doctor, and was protected under the constitutional right to privacy. Since its inception, there have been over 1000 restrictive state laws to limit these rights afforded to women to make the process of acquiring an abortion more painful, challenging, and in some cases, impossible. There is no murkiness here – women have a right to have an abortion if they wish. Yet, in the US, a woman’s access to abortion is very much decided by where she lives alongside her financial resources and physical capacity.

This week, the US Supreme Court refused to hear the case against Arkansas, which is restricting the way medical abortions are conducted. Arkansas has determined that if a doctor prescribes tablets to induce abortion, they must have a contractual relationship with a hospital to manage complications. Whilst this may seem a method to ensure women’s safety, this enactment will effectively end medical terminations in the state, as there are no Arkansas obstetricians willing to accept hospital admissions. In Texas, complex, costly and unnecessary licensing regulations for abortion clinics have led to over half of all clinics providing these services to close down, leaving many women without safe access to abortion.

These aptly named Trap (Targeted Regulation of Abortion Providers) laws are asking abortion clinics to adhere to regulations similar to ambulatory surgical centres even though these clinics perform more invasive procedures with greater sedation than is usual for abortion clinics. Upgrading clinics to this standard can be extremely expensive and has resulted in a net loss of almost 150 abortion clinics nationwide. States such as Mississippi, North Dakota, South Dakota, West Virginia and Wyoming each only have one licensed abortion clinic and in Kentucky, the state is threatening to close its only one, due to apparent deficiencies in its licensing paperwork. Other states have instituted enforced counselling for women and waiting periods from anything from 24 hours to 3 days, as well as mandatory ultrasound scans before an abortion. Many states also deny health insurance coverage for abortion.

Every single one of these measures is designed to make access to abortion not only more complicated, but also more traumatic in order to make women think again about their reproductive choices. They also impact those women who have economic and family constraints which make travelling huge distances, taking time off work and securing childcare prohibitive. This leaves the most vulnerable women unable to access health services to which they are entitled.

The erosion of the legal right to abortion has taken greater significance since the election of President Trump. As a candidate, Donald Trump wrote a letter to pro-life supporters pledging to nominate pro-life judges to the Supreme Court to attempt an overturn of Roe v Wade, and committed to defunding Planned Parenthood which provides specialised family planning services across the US. Only last week, President Trump gave the keynote speech at the annual “Campaign for Life” gala urging supporters to vote for life. It is astonishing to see a president determined to use his power to strip back the hard won right that women have had since the 1970s.

In accordance with his pro-life platform, Trump is threatening to reform the Title X Family Planning programme which is the federal funding of affordable family planning healthcare, contraception and preventive services such as Planned Parenthood. Notably its clinics in the US are often the only source of care for young, immigrant, low income women since they operate in medically underserved areas. Crucially, it does not fund abortion services. Abortion care accounts for 3 per cent of Planned Parenthood services and cannot be paid for using Title X funding. The US abortion rate has declined 14 per cent between 2011-14 and in 2014 was at the lowest rate since abortion was legalised, attributed to education and contraception coverage provided by Planned Parenthood.

However, opponents of abortion attest that by allocating money to Planned Parenthood for the provision of other medical services allows other funds from philanthropic organisations to be reallocated for abortions. Removing Title X funding will not only significantly limit the ability of many marginalised women to access care related to their reproductive health but also severely restrict access to abortion services for women generally.

On both sides of the Atlantic, abortion continues to be a political and ideological issue. A week ago, we witnessed jubilant scenes across Ireland when the archaic laws governing abortion were repealed in a stunning 2:1 vote of almost all constituencies in the country. Women in Ireland now have the right to make their own healthcare decisions and no longer have to face the ignominious task of having to travel long distances to secure autonomy over their own bodies. Across the border, in Northern Ireland, abortion remains illegal and though polls have shown support for change, the delicate apple cart that is Brexit negotiations may complicate matters.

In the United States, abortion is legal, yet women are expected to navigate a maze of obstacles which may place an undue burden on their ability to exercise this right. There is a legitimate fear that women in more liberal states will continue to have access to abortion services but women in more rural and conservative states might have to travel long distances or consider unsafe or illegal means to end a pregnancy.

Ireland’s restrictive laws not only stigmatised abortion but also denied access to women with financial constraints who were unable to travel long distances. The country was able to reckon with its past and chose to safeguard women and their choices. Voters in Ireland have shown us that a pro-choice stance is not pro-abortion – it is actually something very different. It values autonomy for women, it acknowledges that those experiencing an unwanted pregnancy should not be subject to illegal and unsafe practices and that women have the right to make decisions about what happens to their bodies. It will be up to the people of the United States and Northern Ireland to lobby their legislators to be on the right side of history as they grapple with these issues and ensure an equally compassionate, thoughtful and considered way forward to protect women’s reproductive rights.

Reena Aggarwal is an obstetrician and gynaecologist from the UK and is currently working as a research fellow at Ariadne Labs in the United States