The state of Alabama believes it has a legitimate reason behind a new proposal that will limit the number of abortions a provider can perform before his or her office should be considered an abortion clinic. The measure would allegedly address the case of a doctor in the state who was accused of running an unlicensed abortion clinic, allegations that the doctor denied because he was not performing the 30 abortions per month that would require him to need licensing.
Abortion opponents have used the incident to rally for a new rule to reduce the number of procedures a physician can perform, declaring the need to protect a pregnant person’s health. But in reality, this may just be a trial balloon for seeking out more ways to block abortion access if Roe v. Wade is ever overturned.
Alabama has already lost a number of clinics over the years and is now down to just a handful of providers. Those few clinics that still operate are already open solely because of a legal challenge filed against a TRAP (Targeted Regulation of Abortion Providers) law passed in the last legislative session, one that would force the clinics to make expensive and medically unnecessary building remodeling and updates, as well as require that they each have transfer agreement with a local hospital.
With just five clinics remaining, the owners are struggling to try to come into compliance with the new rule, making the fight over how many abortions a doctor can perform before his or her office is considered a clinic an important one. As fewer patients are able to make it into clinics, those who have private family physicians will be more likely to turn to their own personal doctor and ask for help if they want to end an unwanted pregnancy. And with so many fewer options for their patients, more doctors may find themselves willing to consider doing it, although they would be unlikely to consider themselves actual abortion providers.
Obtaining an abortion through a family physician has long, historical precedent, especially when abortion was illegal. Many of the illegal providers pre-Roe were in fact family physicians who would occasionally terminate a pregnancy for a patient, with that remaining a close kept secret few were aware of unless they found themselves in need.
But as historian and sociologist Carole Joffe often writes, once abortion became legal, efforts began to remove the procedure and those who provide it from the rest of the general medical practice. As separate abortion clinics began opening, and later, more medical schools stopped requiring teaching how to terminate a pregnancy as a mandatory part of general medical care, the procedure and those who provide abortions became more isolated.
Obviously, with Roe still in effect and abortion still legal and accessible for the most part, albeit with more costs and difficulties every day, the concern over abortions in a doctor’s office doesn’t appear to be dire news. In the new proposal, the state of Alabama would require doctors to limit an abortion performed in the office from the current 30 a month to just 10, and a maximum of 100 per year. It’s a dramatic decrease, but would still likely allow physicians to perform the occasional abortion for a needy patient without forcing her to jump through the hoops that getting to one of the state’s few clinics would require.
But if the TRAP bill becomes unblocked, and clinics close either because they could not rebuild their facilities or, more likely, because they could not make a transfer agreement with a local hospital, then this 10 per month cap could be devastating. As clinics close, a patient is going to turn to her own physician as a last safe resort before she tries something far more desperate — and dangerous.
This proposal, which doesn’t need to go through the legislature but can be approved just by committee, isn’t about patient safety. It serves two purposes. The first is to continue to widen the gap between those who provide abortions and the rest of the medical community by forcing any physician who does more than a handful of abortions a month to “out” themselves as an abortion provider, as well as make it impossible for him or her to continue doing those terminations without massive financial costs.
The second is to put in place rules and regulations that already cut off access to alternate care should Roe ever be overturned, and states get to once more pass their own laws regarding when, where and if an abortion will be allowed. It’s an early warning shot to tell doctors that they will not be allowed to skirt any sort of regulations or laws if abortion is again made illegal.
At its most basic form, this is a proposal to force doctors who may perform the occasional termination into the public eye and to make them stop. If there was any doubt about that fact, it was dismissed by Jeanne Paxson, who testified in favor of the new limits, saying the new rule wouldn’t be enough and that a doctor must designate his or her office as an abortion clinic if even one abortion a month were performed there.
First they close the clinics, then they punish the doctors. With all providers cut off from providing care, they don’t need to overturn Roe. They will already have regulated abortion out of existence.
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