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Transportation Issues to accessing abortion:

In states such as Alabama and Mississippi women often have the challenge of traveling far distances to obtain a medical abortion. As of 2019, there are only 3 healthcare clinics in the state that offer abortion. According to Guttmacher Institute, about one-third of women seeking an abortion in Alabama must travel more than 25 miles to receive the produce 38.. Furthermore, only 7% of counties in Alabama have a medical provider in the county that offers abortion38. Women often must seek 2 trips to an abortion provider due to a waiting period. The waiting period is typically 48 hours before the scheduled abortion.

Organizations such as Yellowhammer Fund, help women seeking an abortion. They provide financial costs and transportation for women in Alabama, Mississippi, and the Florida panhandle area. On the other hand, most clinics do not offer transportation or financial resources to patients. Most of the time, it is the responsibility of a patient to find their means of transportation and finances to fund the abortion 38.

Language Barriers/Immigrant Issues related to Abortion:

An issue that can arise among non-native English speakers or immigrant women is the lack of access to a translator while attempting to seek an abortion. Under federal law, citing the Title VI of the Civil Rights Act of 1964 and the Affordable Care Act requires that providers who receive federal funding provide an oral interpreter and translated material 39. According to the American Civil Liberties Union, in 1976, Congress passed a bill called the Hyde Amendment which purposely excludes abortion from being included in healthcare services provided to people through Medicaid 39. The only exception to this rule is if a woman's life is in danger due to pregnancy, cases of rape or incest, illness, or injury. This results in many healthcare clinics that offer abortion, not be able to accommodate non-English speaking patients. Due to the limitations set by the federal government. There are limited resources for non-English speaking patients when it comes to abortion39.

Additionally, when it comes to organizations such as the United States Immigration and Customs Enforcement, abortion is heavily regulated. ICE complies with the Hyde Amendment from 1976, and only offers abortion for reasons related to incest, rape, or the endangerment of a mother's life due to pregnancy40. According to the National Latina Institute for Reproductive Justice, around 80% of women attempting to enter the United States through illegal means, get sexually assaulted. Thus, a high number of women in ICE detention centers often seek medical abortions. Furthermore, there have been proposals by Alabama Representative Robert Aderholt to attempt to allow ICE employees to refused to conduct an abortion40. Such proposals have so far not passed in congress.

Under the Trump administration, minors who were held in ICE custody were unable to seek an abortion. According to PBS, a federal appeals court ruled against the Trump administration on June 14, 2019. The three federal judges cited that the Trump administration could not regulate a minor’s decision to receive a medical abortion40. Furthermore, the policy dates to 2017, when the ban was supposed to take effect. The ban specifically targets immigrant minors attempting to enter the country, which is then held by the United States government for attempting to illegally enter the US. At the time, the Trump administration could have attempted to ask the United States Court of Appeals to hear the case, but that seems to have never gone through40

How COVID-19 impacted access to abortion in the United States

In March of 2020, COVID-19 impacted the United States, forcing the CDC to declare COVID-19 as a national epidemic. During this time, numerous conservative states began issuing orders to postpone any non-essential medical produces, specifically abortion41. The few conservative states to do so was Texas on March 23rd, 2020. The reasoning for Texas’ ban on non-essential medical produces was cited as the ongoing situation with SARS-CoV-2 (COVID-19) 41. In the following weeks, more conservative states such as Ohio, Alabama, Iowa, and Oklahoma followed Texas in the same ban on non-essential produces. In a press conference on March 27, 2020, Iowa Governor Kim Reynold clarified that surgical abortion procedures would be included in the temporary hold on all non-essential surgeries42.

The Supreme court accepted a request from the Food and Drug Administration to once again restrict the use of the “abortion pill” by not allowing medical providers to send the pill via mail. The “abortion pill” or otherwise known as mifepristone or misoprostol, includes cramping and bleeding of the uterus to extract the fetus from a woman’s body46. This form of medical abortion is primarily used for ending pregnancies that are within the first trimester. The rule was suspended by a federal judge in the summer of 2020 due to the ongoing pandemic46. The reinstated rule forces women seeking an abortion to go into a medical providers' office and have an in-person visit to receive the pill. The Food and Drug Administration attempted to appeal the original decision on August 26, 2020, to the Supreme Court. The Supreme Court responded with a denial to the Food and Drug Administration to overturn the order. The Supreme Court cited that the Food and Drug Administration needed to provide more information as to why Judge Chuang’s order needed to be overturned. Finally, on January 12th, 2021 the Trump Administration submitted a more detailed request, which was granted by the Supreme court to lift the suspension on not requiring in-person visits and mailing of the abortion pill46.

Admitting privileges is when a medical professional is granted to right to admit a patient to a certain hospital (Source) One of the main reasons for the denial of admitting privileges to abortion provides is often religious ones. Many hospitals may be Christian or morally opposed to abortion.

In March of 2020, the Supreme Court decided in a 5-4 to reverse a lower court’s ruling of allowing a Louisiana law to take effect in which abortion clinics were required to have admitting privileges within 30 miles 46

Limitations for Minors Under 18

In around 37 states, a parental figure is required to have a say in a minor’s decision related to abortion. Furthermore, in 27 states, one or both parents are required to give their permission to the minor. 10 states require both parents to consent to medical abortion. Furthermore, a minor may not have the finances or transportation to seek an abortion. Since most minors are labeled as dependent on their parents' or guardians' tax forms, they are most likely do not have the money to obtain an abortion. Also, if the minor is on their guardian's insurance, the guardian has access to the health insurance and information of the minor. It is estimated that around 350,000 United States teenagers under the of 18 become pregnant each year. From that population, around 31% of them have a medical abortion 43

Insurance limitations:

In 12 states, private insurance is restricted from covering abortion under their plans. In most cases, insurance only covers abortion if a woman's life is endangered by a medical professional. If an underinsured or uninsured woman seeks an abortion, she may need to pay out-of-pocket costs to receive the treatment needed. These limitations of the lack of insurance coverage greatly affect mostly low-income women of color. The average "abortion pill" cost around USD 500. On top of that, under the Affordable Care Act passed in 2010 by congress, abortion is not required to be covered under the 10 essential coverages. Government-run health insurances, such as Medicaid, can provide coverage for medical abortion 42

37. https://www.indemandinterpreting.com/wp-content/uploads/2017/03/InDemand-Interpreting-Trends-risk-1.pdf

38. https://www.guttmacher.org/fact-sheet/state-facts-about-abortion-alabama

39. https://www.aclu.org/other/public-funding-abortion

40. https://www.latinainstitute.org/es/node/4620

41. https://www.pbs.org/newshour/politics/court-rules-against-trumps-abortion-policy-for-immigrant-teens-in-government-shelters

42. https://www.kff.org/womens-health-policy/issue-brief/coverage-for-abortion-services-in-medicaid-marketplace-plans-and-private-plans/

43. https://www.google.com/search?q=how+many+minors+get+abortions&rlz=1C1GCEA_enUS946US946&oq=how+many+minors+get+abortions&aqs=chrome..69i57j0i390l2.5497j0j7&sourceid=chrome&ie=UTF-8

44. https://cbs2iowa.com/news/coronavirus/gov-reynolds-office-order-halting-non-essential-surgeries-includes-surgical-abortions

45. https://www.plannedparenthoodaction.org/issues/abortion/timeline-our-fight-against-abortion-bans-during-covid19

46. https://www.scotusblog.com/2021/01/justices-grant-fda-request-to-block-mail-delivery-of-abortion-pills/

47. Source: https://www.guttmacher.org/state-policy/explore/overview-abortion-laws#