An abortion law that might actually help rural women?!?

That is one way the new California bill Governor Jerry Brown signed into law this week was presented in the news--as making abortion more accessible to rural women.  The law, discussed here in the Sacramento Bee and here in the New York Times, expanded access to abortion in California by "allow[ing] nurse practitioners, midwives and physician assistants to perform a common type of the procedure, an aspiration abortion, during the first trimester."

While neither the Bee nor the NYTimes notes the impact of this law on rural populations, a radio report I heard on the Sacramento NPR affiliate noted that this law will make it easier for rural women to get abortions and even suggested that this was one motivation for the law. The law has this effect, of course, because rural California (like every other rural area in the nation nation as far as I know) is underserved by health professionals--physicians in particular, never mind physicians who actually perform abortions.  (I note, as a related matter, recent wrangling in California over the extent to which nurse practitioners might be permitted to practice in California when not under a physician's supervision, an initiative I understand to be stalled by the lobbying efforts of the California Medical Association.)

What the Bee story does refer to is the obstacle of physical distance, an issue I wrote a great deal about here in relation to abortion access and the U.S. Supreme Court's jurisprudence on what constitutes an "undue burden" on the right to abortion:

Proponents of the bill, including Democrats in the state Legislature, said it will address a shortage of abortion providers and the need for women to travel long distances for the procedure.

Read more here: http://www.sacbee.com/2013/10/09/5809025/jerry-brown-expands-type-of-providers.html#storylink=cpy

As the New York Times notes, with this law California is swimming against the political tide on abortion--that tide being the one sweeping many state houses in the past few years to put added regulations on abortion provision and generally make abortions harder to get.  In 2013 alone, state legislatures have passed 68 laws limiting abortion.  Lawmakers from Ohio to Mississippi, North Dakota to Arkansas have all passed laws--many of them of questionable constitutionality--that shorten the time during which a woman can get an abortion (to as little as 6 weeks); make it harder for out-of-state physicians to provide abortions (read more here); require women to view an ultrasound and/or listen to a fetal heartbeat.  Federal judges have issued rulings barring enforcement of many of these laws until their constitutionality can be fully adjudicatd.

In Iowa, the state medical board rather than the state legislature recently voted to disallow remote prescription of abortion inducing medications.  This restriction has a particular impact on rural women--the very population the California law is said to help.  The Iowa change will become effective as early as November 6 according to this August 30 AP story by Catherine Lucey.

Lucey reports that Planned Parenthood of the Heartland pioneered the video-conferencing system to facilitate telemedicine abortions, the first such program in the United States. In August, however, the Iowa Medical Board voted 8-2 to disallow this practice, which has permitted patients at 15 remote clinics to confer with a Planned Parenthood physician in Des Moines before that physician authorizes distribution of the abortion-inducing pills to the patient.

The Guttmacher Institute, a reproductive rights think-tank, reports that 16 states have enacted laws barring telemedicine abortions.  Among those laws--all passed since 2011--some are no longer in effect.   Guttmacher reports that Iowa is the only state in which opponents were using the medical board to bar  this system, as opposed to using the legislative process.  In that regard:

Planned Parenthood says the program benefits women in rural locations and that it's received no complaints from patients. But board members said they had concerns about the process and the care women were receiving; they said the goal wasn't to restrict abortion access.

In Iowa, proponents of the Board's actions--including Iowa Governor Terry Branstad--praised the decision.  Branstad's spokesman, Tim Albrecht said:

Women deserve high quality medical care, and a standard of care designed to protect their health regardless of the procedure at issue.  The board made this decision based on the standard of health care that women deserve.

Branstad replaced all the members of the Medical Board following his election.  The Board's chairman, Dr. Greg Hoversten, had this to say about the vote:

How can any of us possibly find that a medical abortion performed over the Internet is as safe as one provided by a physician in person?

Needless to say, reproductive rights advocates are skeptical that abortion foes are really concerned about women's health.  Regarding women's safety in relation to the California law, lawmakers noted a University of California, San Francisco pilot program/study under which non-doctors such as nurse practitioners and certified midwives performed some 8,000 aspiration abortions beginning in 2007.  The study, directed by Dr. Tracy Weitz, found similar complication rates for doctors and non-doctors, at just 2%.  The New York Times story about the California law quotes Dr. Weitz: 

This is a very safe procedure, and we now have a very large study to show that this does not compromise safety. Most people saying it compromises safety actually have an agenda to make abortion illegal, which we know from decades of experience actually makes abortion unsafe. 

Hopefully this will give women more options early in their first trimesters, when we know abortion is safest.  And the second trimester, when it is more complicated, will remain in the domain of physicians.

It's interesting that Iowa, with a significant rural population, would be less attuned to the challenges facing rural women than would be California, with a smallish share of its population living in rural places.  But then, of course, decisions like that in Iowa are much less about the ability to understand and empathize with the transportation and health challenges facing rural women than they are about reproductive right politics.  And on that front, California is (thankfully) an outlier.

This prior  post discusses the link between abortion restrictions and the extent to which a state's population is rural.  Here's a story about abortion regulations in Ohio, not a place I think of as highly rural, though of course it has rural reaches.  

Meanwhile, the Center for Reproductive Rights, the UC Berkeley Journal of Gender Law and Justice,  and the UC Berkeley Center on  Reproductive Rights and Justice held a symposium on October  4 called "Speech, Symbols and Substantial Obstacles:  The Doing and Undue-ing of Abortion Law Since Casey."  The event featured what looks like an all-star line-up of of legal and other academics talking about different aspects of abortion law.  Sadly, though, I don't see listed any speakers whose work focuses on rural women, even though a very interesting strand of the U.S. Supreme Court's jurisprudence on the "undue burden" standard regards that group in particular.  Further, a search using just the word "rural" on the Center for Reproductive Rights website brings up more than 600 responses, most related to advocacy that the Center is doing in relation to rural women both domestically and internationally.  If the Center for Reproductive Rights is switched on to the needs of rural women (as its website suggests) but those needs were not addressed at the Berkeley symposium, that omission may signal that the rural population doesn't look particularly interesting to academics.  And that's a real pity.  For while academics' influence is limited, certainly, it is hard to imagine better outcomes for rural women seeking reproductive choices if the scholarly community is not involved in advocating for them.