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= Barriers to Abortion Access in Maryland = Maryland is a state that has highly ranked reproductive rights protections. According to the Institute for Women’s Policy Research, Maryland is ranked #3 across all fifty states for reproductive rights and an A- rating.

Regardless of these protections, there are still barriers that exist in Maryland that make it so not all women have access to a safe and secure abortion.

Parental Notification
In the state of Maryland, minors can obtain safe and legal abortions however the health care professional much provide parental notification to at least one parent or guardian before the abortion can be administered. This parent or guardian does not have to agree with the patient's choice, they just must be notified. There are exceptions, including: if the minor is capable of giving their informed consent, if notification would not be in the best interest of the minor, if a reasonable attempt to give notification has been unsuccessful, if notice may lead to abuse towards the minor, or if the minor does not live with her parent or guardian.

The parental notification may be a deterrent for minors to get an abortion. The exceptions leave the decision in the hands of the abortion provider which creates uncertainty for the minors looking to get the procedure and might further be a deterrent. Additionally, the abortion providers might not decide to waive the parental notification for minors who need the procedure, proving the deterrent that this parental notification causes.

Contraception
There has been an increase in contraception, which is important to note, that has led to a slight decrease in abortions. As of 2014, 14% of women were using a long term contraceptive such as an IUD or implant, as opposed to less than 10% in 2009. Although 60% of reproductive aged-women are currently using some form of contraception, women aged 15-19 are the least likely to use contraception (18%) which further highlights how the parental notice can be a deterrent for this already at-risk group.

Contraception rates are also lowest among black women who are at risk of an unplanned pregnancy (83%) than their white (91%) and asian (90%) peers. Contraception is important to note because while it is readily available, the groups that are not able to get access to contraception are the same demographics with the highest abortion rates. Black women are five times more likely to get an abortion than white women, largely because black women are three times more likely to experience an unplanned pregnancy than white women.

Clinic Closures
Maryland currently has twenty five abortion clinics open, However The New York Times depicts multiple abortion providing clinic closing in Maryland from 2013 to 2018. Increased contraceptive use is one contributor to abortions going down on a national level. In 1981, there were a recorded 29.3 abortions out of every one thousand women aged 15-44, compared to 19.5 in 2005.

Safe and legal abortions are on a decrease but closing clinics is still a barrier to access for many women. The closing of clinics only stops safe and legal abortions. Studies prove that clinics closing leads to women attempting to performing their own, much more unsafe, abortions. Closures in clinics also leads to googles such as “self-induced abortions”, showing that the need for these procedures still exists. 20-50% of women who have unsafe abortions are hospitalized due to complications, introducing health risks but also additional costs to both the women and the Maryland government that are greater than an abortion would’ve been.

For the clinics that are still open, some do not offer abortions after 13 weeks. Maryland law states that abortions can be performed after or at viability if there is a fetal anomaly or the patient’s life is at risk. Viability is, for the most part, considered 24 weeks. Although the Maryland law is protective of the mother’s right to choose, clinics that only offer the procedure before 13 weeks introduce another barrier to access to safe and legal abortions. Additionally, rape and incest is not included as an exception after viability, which lends itself to be yet another barrier to safe and legal abortions for many in Maryland.

Clinic Locations
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Other Noticeable Legislation
Maryland has 38 crisis pregnancy centers with counselors working to convince pregnant patients away from abortions. https://www.baltimoresun.com/news/bs-xpm-2006-01-15-0601150011-story.html In 2018, a Federal Appeals court struck down a law that would’ve required Maryland clinics to clearly disclose in their waiting rooms if they do not offer or refer pregnant patients to abortion procedures because it was deemed unconstitutional. This, combined with the pregnancy centers show lack of information/counseling as another barrier to abortion access for many women in Maryland.

On a national level, barriers exist that prevent Maryland patients from pursuing safe and legal abortions. Before the Trump administration's 2019 restructure of Title X, federal funds could not be used for abortion services. The new Title X regulations restrict Title X providers from providing abortions within their clinic or referring patients to abortion providers unless they explicitly ask for the referral. Nationally, 4 million people rely on Title X (78% of these patients have incomes below 150% of the poverty level), and Maryland has since pulled out of the Title X network because of the new regulations and gag rule. This loss of funds has reduced Maryland’s network capacity by 90-99%. Maryland has passed emergency funding measures to mitigate this funding loss, however it is not a long term solution. The Title X changes introduce barriers to access to abortion access because of the loss of resources that come with the loss of funding for clinics and providers who do provide abortions, but separately also rely on Title X to keep their doors open. The new regulations introduce another barrier because the gag rule limits how much information doctors can provide their patients about all of their choices, including obtaining safe and legal abortions.