The last abortion clinic in Kentucky - another lesson in spatial inequality

A couple of weeks ago, this neat cartoon was brought to my attention. In this cartoon, the author illustrates the issue of lack of access to abortion providers in Kentucky and the vagueness of the "undue burden" standard set by Planned Parenthood of Southeastern PA v. Casey as well as many of the challenges faced by people in rural spaces. There has been some progress in acknowledging that space is a burden, most notably in 2016 with the Supreme Court's decision Whole Woman's Health v. Hellerstedt. However, much work has to be done. As the cartoon points out, many states continue to push the boundaries of the "undue burden" test. The cartoon draws heavily from the work of Hannah Haksgaard of the University of South Dakota, which I highly encourage you to read because it does a fantastic job of summarizing and explaining the issues at hand.

This example is powerful because it is yet another demonstration of the power of spatial isolation and its ability to interfere with the exercise of our fundamental rights. It is also a great illustration of the State's ability to act as an accomplice in the impediment of the free exercise of these rights. It is fairly well settled that Roe v. Wade is the precedent that must govern the question of whether or not a person's right to seek an abortion has been impeded. The right to seek an abortion is an extension of the right to privacy that is guaranteed by the Due Process clause of the 14th Amendment (see: 1965's Griswold v. Connecticut for another application of this principle). The Supreme Court however left a bit of wiggle room for states to regulate access by stating that "the State does have an important and legitimate interest in preserving and protecting the health of the pregnant woman, whether she be a resident of the State or a non-resident who seeks medical consultation and treatment there, and that it has still another important and legitimate interest in protecting the potentiality of human life." In Planned Parenthood v. Casey, the Court created the "undue burden" standard, which was based on the principle that, "a statute which, while furthering [a] valid state interest, has the effect of placing a substantial obstacle in the path of a woman’s choice cannot be considered a permissible means of serving its legitimate ends." 

Despite the general understanding that the right to a seek abortion is a right that can only be impeded under very specific circumstances, states continue to try to find ways to deny access to it. In the case that gave rise to Whole Woman's Health, Texas had enacted legislation that required doctors to have admitting privileges at a hospital within 30 miles of their clinics. Previous legislation had only required doctors to have a working arrangement with a doctor who had admitting privileges. In the immediate aftermath of that law taking effect, the number of abortion clinics in Texas dropped from 43 to 19.  Many rural areas simply did not have the ability to guarantee that a doctor would have admitting privileges to a hospital within that specific geographic radius and clinics located in those areas had to close, which restricted the ability of women who live in those areas to seek an abortion. The Court ruled that this was an impermissible impediment because it imposed an undue burden on the right to seek an abortion.

One of the most powerful graphics in the cartoon is the illustration of the number of clinics that disappeared after Planned Parenthood, often because of a state regulation that met the "undue burden" test. This is not the only example of states stepping in and providing a barrier to accessing resources that facilitate the exercise of a right however. I have previously extensively covered the issue of government interference in the mission and even funding of civil legal aid organizations. In addition to cutting their funding, Congress has passed laws that have unfairly stripped these organizations of the ability to advocate for certain causes and take certain actions. On the state level, notably in North Carolina, legal services has seen substantial funding cuts, which often force the closure of rural offices. Without access to legal services, a person may find themselves unable to defend themselves in an eviction proceeding, seek help when faced with domestic violence, receive fair representation in a divorce or custody proceeding, draft a will, create a trust or a litany of other necessary items.

The closure of these offices and clinics presents the largest barriers to people from lower socioeconomic backgrounds, which in the case of legal services makes up the entirety of their clientele. A lower-income woman in a state with strict barriers to accessing abortion services has to drive to the handful of abortion clinics available, an obstacle that can often be insurmountable. Many lower income people lack access to reliable transportation and work in jobs that have unpredictable, often ever-changing schedules, which can often make it difficult to schedule an appointment or plan what could end up being a multi-day long trip (Oregon has taken steps to address the issue of schedule irregularity). A person who sees their legal aid organization close down faces a similar barrier. Lower income people in rural spaces are at an extreme detriment when a critical resource leaves their community and their ability to exercise their rights is often impeded as a result. It is a sad reality that the State is often an actor in the impediment of these rights.

This is a fantastic example about why it's important to advocate for solving the issue of spatial inequality and inequities in access to resources. In many instances, the State creates situations where the ability to exercise our rights is impeded. Rural residents deserve fair and equitable treatment and raising awareness about these issues is critical.