Federal Protection of Abortion Does Not Equate to Access for All

It’s not just Brett Kavanaugh posing a risk to reproductive rights in America. State-level restrictions prevent many women from exercising their right to choose here at home. What’s at stake when women are denied their reproductive rights? The country of El Salvador offers a cautionary tale.

Kamala Harris: “Can you think of any laws that give the government power to make decisions about the male body?”

Brett Kavanaugh: “I’m not…I’m not thinking of any right now, Senator.”

~ Brett Kavanaugh testifies before the U.S. Senate during confirmation hearings for his appointment to the U.S. Supreme Court. His vote could become the deciding factor on the future of reproductive rights in the U.S. and serve as a harbinger for our leadership around the globe.

For now, access to abortion is protected under U.S. constitutional law. But does that mean everyone really has access? While concerns rightfully loom large about the preservation of Roe v. Wade in response to Brett Kavanaugh’s nomination to the Supreme Court, the truth is that many U.S. citizens already lack access to abortion care.

The Guttmacher Institute recently conducted a study which found substantial geographic disparities in access to abortion in the U.S. This may not seem terribly surprising given that individual states have the power to limit access in various ways – such as eliminating state funding for health centers that provide abortion in Nebraska, prohibiting abortion after 15 weeks of gestation in Mississippi, or actually attempting to criminalize abortion, even in the case of rape, in South Carolina.

But in addition to legal restrictions, access is also a factor of population density: urban areas have a much higher percentage of clinics, doctors, and practitioners available in comparison to rural ones. Take New York, for example, where the average woman has to travel about three miles — compared to Wyoming, where the average required travel is around 168 miles.

Researchers from UC San Francisco and UC Berkeley counted 152 clinics offering abortion in California, making it the state with the highest number of clinics in the country. Maine had the greatest access per person, with one clinic available for every 13,905 women. In contrast, Missouri, which imposes extremely restrictive abortion laws, has the lowest abortion access of any continental state, at around 1.4 million women per facility.


On a national level, the overall number of clinics offering abortion care is declining, as the imposition of increasingly onerous restrictions makes it impossible to operate. And in this context, rural regions are hit the hardest. Between 2011 and 2014, the number of clinics offering abortion in the U.S. dropped by 22 percent in the Midwest, making it the largest “abortion desert” in the country, while clinics declined by 13 percent in the South, and six percent nationwide. In states with the longest average distance to travel – Wyoming, North Dakota, and South Dakota – at least half of women of reproductive age live more than 90 miles from the nearest clinic providing abortion.

And, unfortunately, access is not even guaranteed in urban areas. In a study of more than 780 clinics offering abortion across the U.S., researchers found that 27 major cities are at least 100 miles from the nearest abortion provider. In the states of Kentucky, Mississippi, Missouri, North Dakota, South Dakota, and West Virginia, there is literally one (singular) clinic offering abortion in the state. Women in Rapid City, South Dakota must travel 319 miles to reach the nearest abortion provider. The reality for women seeking the complete spectrum of reproductive care in these regions becomes extremely bleak.

Okay, so travel time is an issue for many. But if someone really wants the procedure, they’ll find a way to make it happen, right? Well, just imagine all it would take to travel around 200 miles in a given day. You would likely need to take time off of work, access a car or some other form of public transportation (in the latter case, your journey would be significantly longer), arrange for childcare (if necessary), and pay for all of that, in addition to paying for the procedure itself. In this way, for women forced to travel substantial distances to receive care, the ability to have an abortion becomes less about legality and more about economics.

People in low-resource settings are much less likely to receive comprehensive health care than those in affluent regions, as their ability to confront the many geographical, economic, and time-related barriers to receiving care is often much more complex and therefore restrictive. What’s worse, the ironic tragedy is that limited access to reproductive health care virtually institutionalizes poverty. A study published by the American Journal of Public Health found that poor women who are denied access to abortion are increasingly likely to remain poor, and that carrying an unwanted pregnancy to term actually quadrupled the odds that a new mother and her child would live below the federal poverty line. The same study found that the single most common reason women cite for wanting an abortion is because they cannot afford to raise a child.

“The things they worry about coming true are exactly the things they experience when they’re denied an abortion and carry the pregnancy to term,” said lead author Diana Green Foster, a professor at Advancing New Standards in Reproductive Health at UC San Francisco. “They tell us they can’t afford a baby, and we find they become poorer.”

Geographic isolation and economic marginalization are just two of many different factors influencing a woman’s ability to receive abortion in this country – and at the individual level, both seem to transcend federal or even state-level protections.

The U.S. should work toward removing barriers to reproductive health care in this country and abroad. Instead, Brett Kavanaugh’s nomination to the Supreme Court threatens to unwind constitutionally protected reproductive rights. For anyone who doubts that our country could revert back to the old days of back-alley abortions, just consider how pervasive the barriers to abortion services are already. And what can happen when abortion is criminalized? El Salvador offers a cautionary tale.


Maria Teresa asks for the release of Teodora del Carmen Vasquez, who was sentenced to prison for aggravated homicide after suffering a stillbirth at work [Jose Cabezas/Reuters]

El Salvador is one of the most dangerous places in the world for women seeking reproductive care. Abortion in all circumstances and without exception has been outlawed since 1998 and is punishable by up to eight years in prison, or up to 40 if the judge rules that the abortion was in fact a “homicide.” Yes, El Salvador has placed such disproportionate value on the rights of fetuses rather than those of living women that a judge can rightfully convict a woman for “homicide” if she has had an abortion – or even, in some cases, a miscarriage. This rule applies to women who have been told that there will be life-threatening complications with their pregnancies. It applies in cases where birthing a child will definitely compromise the safety of the mother. And it applies in cases of rape and incest. Above all else, these draconian laws that dictate a woman’s access to reproductive care in El Salvador affect her entire life; her ability to remain healthy, to feel empowered to access care, to believe that she is protected by her government.

This might seem hard to imagine, but it is absolutely the reality for many people living on this planet right now. This is why understanding structural limits to abortion in the U.S. is so important, and another reason why we must adamantly oppose Bret Kavanaugh’s nomination.

Limits to comprehensive health care hinders social and economic development and prevents people from accessing the care to which they are legally entitled – in particular for those who are most marginalized. If the U.S. fails to lead on this basic human rights issue facing women at home, then it will become that much harder for us to advocate for reproductive rights around the globe. We must continue to fight for reproductive autonomy for everyone. Please work with us to ensure that all people have access to the full spectrum of reproductive healthcare, no matter where they live.

Population Connection

Pop Connect Action Fund


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