Abortion in Pennsylvania

Abortion in Pennsylvania is legal. 51% of adults said in a poll by the Pew Research Center that abortion should be legal in all or most cases.

The number of abortion clinics in Pennsylvania has declined over the years, with 114 in 1982, 81 in 1992 and twenty in 2014.  There were 32,126 legal abortions in 2014, and 31,818 in 2015.

Terminology
Main article: Abortion

The abortion debate most commonly relates to the "induced abortion" of an embryo or fetus at some point in a pregnancy, which is also how the term is used in a legal sense.[note 1] Some also use the term "elective abortion", which is used in relation to a claim to an unrestricted right of a woman to an abortion, whether or not she chooses to have one. The term elective abortion or voluntary abortion describes the interruption of pregnancy before viability at the request of the woman, but not for medical reasons.[1]

Anti-abortion advocates tend to use terms such as "unborn baby", "unborn child", or "pre-born child",[2][3] and see the medical terms "embryo", "zygote", and "fetus" as dehumanizing.[4][5] Both "pro-choice" and "pro-life" are examples of terms labeled as political framing: they are terms which purposely try to define their philosophies in the best possible light, while by definition attempting to describe their opposition in the worst possible light. "Pro-choice" implies that the alternative viewpoint is "anti-choice", while "pro-life" implies the alternative viewpoint is "pro-death" or "anti-life".[6] The Associated Press encourages journalists to use the terms "abortion rights" and "anti-abortion".[7]

Context
See also: Abortion in the United States

Free birth control correlates to teenage girls having a fewer pregnancies and fewer abortions. A 2014 New England Journal of Medicine study found such a link.  At the same time, a 2011 study by Center for Reproductive Rights and Ibis Reproductive Health also found that states with more abortion restrictions have higher rates of maternal death, higher rates of uninsured pregnant women, higher rates of infant and child deaths, higher rates of teen drug and alcohol abuse, and lower rates of cancer screening.[8]

According to a 2017 report from the Center for Reproductive Rights and Ibis Reproductive Health, states that tried to pass additional constraints on a women's ability to access legal abortions had fewer policies supporting women's health, maternal health and children's health.  These states also tended to resist expanding Medicaid, family leave, medical leave, and sex education in public schools.[9] According to Megan Donovan, a senior policy manager at the Guttmacher Institute, states have legislation seeking to protect a woman's right to access abortion services have the lowest rates of infant mortality in the United States.[9]

Poor women in the United States had problems paying for menstrual pads and tampons in 2018 and 2019. Almost two-thirds of American women could not pay for them. These were not available through the federal Women, Infants, and Children Program (WIC).[10] Lack of menstrual supplies has an economic impact on poor women.  A study in St. Louis found that 36% had to miss days of work because they lacked adequate menstrual hygiene supplies during their period.  This was on top of the fact that many had other menstrual issues including bleeding, cramps and other menstrual induced health issues.[10] Connecticut, Florida, Illinois, Maryland, Massachusetts, Minnesota, New Jersey, New York, Nevada, and Pennsylvania all had exemptions for essential hygiene products like tampons and menstrual pads as of November 2018.[11][12][13][14]

History

In 2011, Kermit Gosnell, a licensed doctor who provided abortion services in the American state of Pennsylvania, was indicted by a grand jury on murder charges after a woman died in his clinic. The grand jury found that the conditions in Gosnell's clinic were not only unsanitary and that Gosnell staffed his clinic with unlicensed individuals, he had also commonly conducted the lesser known practice of severing the spinal cords of newly born babies.[15]

Legislative history

By the end of the 1800s, all states in the Union except Louisiana had therapeutic exceptions in their legislative bans on abortions.[16] In the 19th century, bans by state legislatures on abortion were about protecting the life of the mother given the number of deaths caused by abortions; state governments saw themselves as looking out for the lives of their citizens.[16] The Abortion Control Act was passed by the Pennsylvania government in 1982.  The law required women seeking abortions wait 24 hours before getting an abortion, and required informed consent of parents for minor children and husbands for married women.[17][18] It was principally written by Rep. Stephen F. Freind.[18]

The state was one of 23 states in 2007 to have a detailed abortion-specific informed consent requirement.[19] From 2011, the crimes of Kermit Gosnell, a physician who ran an abortion clinic in Philadelphia, spurred federal and state bills to more strictly regulate abortion facilities. Opponents of the restrictions questioned whether stricter regulations would have deterred Gosnell, who was alleged to be knowingly in violation of existing regulations.[20] In 2013, state Targeted Regulation of Abortion Providers (TRAP) law applied to private doctor offices in addition to abortion clinics.[21]

A fetal heartbeat bill (HB 2315) was introduced in the Pennsylvania House of Representatives on May 2, 2018, primarily sponsored by Rep Rick Saccone.[22] The bill was referred to the Judiciary Committee where it died.[23] The state legislature was one of ten states nationwide that tried to unsuccessfully pass a fetal heartbeat bill in 2018.  Only Iowa successfully passed such a bill, but it was struck down by the courts.[24] As of May 14, 2019, the state prohibited abortions after the fetus was viable, considered to be week 24 in state law. This period uses a standard defined by the US Supreme Court in 1973 with the Roe v. Wade ruling.[25][26]

Judicial history
See also: Planned Parenthood v. Casey

The US Supreme Court's decision in 1973's Roe v. Wade ruling meant the state could no longer regulate abortion in the first trimester.[16] In Planned Parenthood of Southeastern Pennsylvania v. Casey, the Court of Appeals for the Third Circuit affirmed in part and reversed in part, upholding all of the regulations except for the husband notification requirement.[27] The Third Circuit concluded that the husband notification was unduly burdensome because it potentially exposed married women to spousal abuse, violence, and economic duress at the hands of their husbands.[28]

In the 1992 United States Supreme Court ruling on Planned Parenthood of Southeastern Pennsylvania v. Casey, the court upheld Pennsylvania's law requiring pre-abortion counseling with a caveat that materials provided to women in this counseling needed to be  "truthful and nonmisleading."[29][17] At the conference of the Justices two days after oral argument, Justice David Souter defied expectations, joining Justices Sandra Day O'Connor, John Paul Stevens, and Harry Blackmun, who had all dissented three years earlier in Webster v. Reproductive Health Services with regard to that plurality's suggested reconsideration and narrowing of Roe. This resulted in a precarious five Justice majority consisting of Chief Justice William Rehnquist, Byron White, Antonin Scalia, Anthony Kennedy, and Clarence Thomas that favored upholding all five contested abortion restrictions. However, Justice Kennedy changed his mind shortly thereafter and joined with fellow Reagan-Bush justices Sandra Day O'Connor and David Souter to write a plurality opinion that would reaffirm Roe.[30]

Although upholding the "essential holding" in Roe, and recognizing that women have some constitutional liberty to terminate their pregnancies, the O'Connor–Kennedy–Souter plurality overturned the Roe trimester framework in favor of a viability analysis. The Roe trimester framework completely forbade states from regulating abortion during the first trimester of pregnancy, permitted regulations designed to protect a woman's health in the second trimester, and permitted prohibitions on abortion during the third trimester (when the fetus becomes viable) under the justification of fetal protection, and so long as the life or health of the mother was not at risk.[31] The plurality found that continuing advancements in medical technology had proven that a fetus could be considered viable at 23 or 24 weeks rather than at the 28 weeks previously understood by the Court in Roe.[32] The plurality thus redrew the line of increasing state interest at viability because of increasing medical accuracy about when fetus viability takes place. Likewise, the authors of the plurality opinion felt that fetus viability was "more workable" than the trimester framework.[33]

Under this new fetus viability framework, the plurality held that at the point of viability and subsequent to viability, the state could promote its interest in the "potentiality of human life" by regulating, or possibly proscribing, abortion "except where it is necessary, in appropriate medical judgment, for the preservation of the life or health of the mother."[34] Prior to fetus viability, the plurality held, the State can show concern for fetal development, but it cannot pose an undue burden on a woman's fundamental right to abortion.[35] The plurality reasoned that the new pre- and post-viability line would still uphold the essential holding of Roe, which recognized both the woman's constitutionally protected liberty, and the State's "important and legitimate interest in potential life."[36]

In replacing the trimester framework with the viability framework, the plurality also replaced the strict scrutiny analysis under Roe, with the "undue burden" standard previously developed by O'Connor in her dissent in Akron v. Akron Center for Reproductive Health.[37] A legal restriction posing an undue burden is one that has "the purpose or effect of placing a substantial obstacle in the path of a woman seeking an abortion of a nonviable fetus."[38] An undue burden is found even where a statute purports to further the interest of potential life or another valid state interest, if it places a substantial obstacle in the path of a woman's fundamental right to choice.[38] The Supreme Court in the 2016 case Whole Woman's Health v. Hellerstedt clarified exactly what the 'undue burden' test requires: "Casey requires courts to consider the burdens a law imposes on abortion access together with the benefits those laws confer."[39][40] In this case the court described the undue burden standard in its overall context with these words:

In applying the new undue burden standard, the plurality overruled City of Akron v. Akron Center for Reproductive Health, 462 U.S. 416 (1983) and Thornburgh v. American College of Obstetricians and Gynecologists, 476 U.S. 747 (1986),[41] each of which applied "strict scrutiny" to abortion restrictions.[42]

Applying this new standard to the challenged Pennsylvania Act, the plurality struck down the spousal notice requirement, finding that for many women, the statutory provision would impose a substantial obstacle in their path to receive an abortion.[43] The plurality recognized that the provision gave too much power to husbands over their wives ("a spousal notice requirement enables the husband to wield an effective veto over his wife's decision"), and could worsen situations of spousal and child abuse.[44] In finding the provision unconstitutional, the authors of the plurality opinion clarified that the focus of the undue burden test is on the group "for whom the law is a restriction, not the group for whom the law is irrelevant."[45] Otherwise stated, courts should not focus on what portion of the population is affected by the legislation, but rather on the population the law would restrict.[46] The plurality upheld the remaining contested regulations – the State's informed consent and 24-hour waiting period, parental consent requirements, reporting requirements, and the "medical emergencies" definition – holding that none constituted an undue burden.[47]

Clinic history
Number of abortion clinics in Pennsylvania by year.
See also: Abortion clinic

Madame Restell opened a business that performed abortions in the 1830s in New York City.  Her business remained open for around 35 years and openly advertised its services, including in newspaper advertisements.  She had branches in several other cities including Boston and Philadelphia, as well as having traveling agents working for the company who sold her "Female Monthly Pills."[48][49]

Between 1982 and 1992, the number of abortion clinics in the state decreased by 33, going from 114 in 1982 to 81 in 1992.[50] In the period between 1992 and 1996, the state ranked fourth in the loss of number of abortion clinics, losing 20 to have a total of 61 in 1996.[51] In 2014, there were twenty abortion clinics in the state.[52] That year, 85% of the counties in the state did not have an abortion clinic. That year, 48% of women in the state aged 15 – 44 lived in a county without an abortion clinic.[53]

In March 2016, there were 35 Planned Parenthood clinics in the state.[54] In 2017, there were 32 Planned Parenthood clinics in a state with a population of 2,825,578 women aged 15 – 49 of which eleven offered abortion services.[55]

Statistics

In the period between 1972 and 1974, the state had an illegal abortion mortality rate per million women aged 15 – 44 of between 0.1 and 0.9.[56] In 1990, 1,480,000 women in the state faced the risk of an unintended pregnancy.[50] In 2010, the state had seven publicly funded abortions, of which were zero federally funded and seven were state funded.[57] In 2014, 51% of adults said in a poll by the Pew Research Center that abortion should be legal in all or most cases.[58] In 2017, the state had an infant mortality rate of 6.1 deaths per 1,000 live births.[9]

Number of reported abortions, abortion rate and percentage change in rate by geographic region and state in 1992, 1995 and 1996[51]
Census division and stateNumberRate% change 1992–1996
199219951996199219951996
Middle Atlantic300,450278,310270,22034.632.732–8
New Jersey55,32061,13063,1003134.535.816
New York195,390176,420167,60046.242.841.1–11
Pennsylvania49,74040,76039,52018.615.515.2–18
Number, rate, and ratio of reported abortions, by reporting area of residence and occurrence and by percentage of abortions obtained by out-of-state residents, US CDC estimates
LocationResidenceOccurrence% obtained by

out-of-state residents

 YearRef
No.Rate^Ratio^^No.Rate^Ratio^^
Pennsylvania32,68313.623032,12613.32264.22014[59]
Pennsylvania32,02513.322731,81813.322652015[60]
Pennsylvania 30,954 13.0 222 30,881 13.0 222 5.4 2016 [61]
^number of abortions per 1,000 women aged 15–44; ^^number of abortions per 1,000 live births


Abortion rights views and activities

Protests

Women from the state participated in marches supporting abortion rights as part of a #StoptheBans movement in May 2019.[62][63] One #StoptheBans took place in Philadelphia outside the state legislature building on May 21, 2019.[63]

Anti-abortion views and activities

The Democrats for Life of America are a group of anti-abortion Democrats on the political left who advocate for an anti-abortion plank in the Democratic Party's platform and for anti-abortion Democratic candidates. Former vice-presidential candidate Sargent Shriver, the late Robert Casey, a former two-term governor of Pennsylvania, and former Rep. Bart Stupak (D-Mich), a former leader of the bipartisan anti-abortion caucus in the United States House of Representatives, have been among the most well-known anti-abortion Democrats.[64]

Footnotes
  1. According to the Supreme Court's decision in Roe v. Wade:
    (a) For the stage prior to approximately the end of the first trimester, the abortion decision and its effectuation must be left to the medical judgement of the pregnant woman's attending physician. (b) For the stage subsequent to approximately the end of the first trimester, the State, in promoting its interest in the health of the mother, may, if it chooses, regulate the abortion procedure in ways that are reasonably related to maternal health. (c) For the stage subsequent to viability, the State in promoting its interest in the potentiality of human life may, if it chooses, regulate, and even proscribe, abortion except where it is necessary, in appropriate medical judgement, for the preservation of the life or health of the mother.
    Likewise, Black's Law Dictionary defines abortion as "knowing destruction" or "intentional expulsion or removal".

References
  1. Watson, Katie (20 Dec 2019). "Why We Should Stop Using the Term "Elective Abortion"". AMA Journal of Ethics. 20: E1175-1180. doi:10.1001/amajethics.2018.1175. PMID 30585581. Retrieved 17 May 2019.
  2. Chamberlain, Pam; Hardisty, Jean (2007). "The Importance of the Political 'Framing' of Abortion". The Public Eye Magazine. 14 (1).
  3. "The Roberts Court Takes on Abortion". New York Times. November 5, 2006. Retrieved January 18, 2008.
  4. Brennan 'Dehumanizing the vulnerable' 2000
  5. Getek, Kathryn; Cunningham, Mark (February 1996). "A Sheep in Wolf's Clothing – Language and the Abortion Debate". Princeton Progressive Review.
  6. "Example of "anti-life" terminology" (PDF). Archived from the original (PDF) on 2011-07-27. Retrieved 2011-11-16.
  7. Goldstein, Norm, ed. The Associated Press Stylebook. Philadelphia: Basic Books, 2007.
  8. Castillo, Stephanie (2014-10-03). "States With More Abortion Restrictions Hurt Women's Health, Increase Risk For Maternal Death". Medical Daily. Retrieved 2019-05-27.
  9. "States pushing abortion bans have highest infant mortality rates". NBC News. Retrieved May 25, 2019.
  10. Mundell, E.J. (January 16, 2019). "Two-Thirds of Poor U.S. Women Can't Afford Menstrual Pads, Tampons: Study". US News & World Report. Retrieved May 26, 2019.
  11. Larimer, Sarah (January 8, 2016). "The 'tampon tax,' explained". The Washington Post. Archived from the original on December 11, 2016. Retrieved December 10, 2016.
  12. Bowerman, Mary (July 25, 2016). "The 'tampon tax' and what it means for you". USA Today. Archived from the original on December 11, 2016. Retrieved December 10, 2016.
  13. Hillin, Taryn. "These are the U.S. states that tax women for having periods". Splinter. Retrieved 2017-12-15.
  14. "Election Results 2018: Nevada Ballot Questions 1-6". KNTV. Retrieved 2018-11-07.
  15. "Investigation of the Women's Medical Society Grand Jury Report". Phila.gov. Retrieved 7 December 2017.
  16. Buell, Samuel (1991-01-01). "Criminal Abortion Revisited". New York University Law Review. 66: 1774–1831.
  17. Larson, Jordan. "Timeline: The 200-Year Fight for Abortion Access". The Cut. Retrieved May 25, 2019.
  18. deCourcy Hind, Michael (1992-02-21). "The 1992 Campaign: Pennsylvania; Trouble Shadows Specter in Senate Race". The New York Times. Retrieved 2009-08-15.
  19. "State Policy On Informed Consent for Abortion" (PDF). Guttmacher Policy Review. Fall 2007. Retrieved May 22, 2019.
  20. Caplan-Bricker, Nora (May 1, 2013). "The Kermit Gosnell Effect". The New Republic.
  21. "TRAP Laws Gain Political Traction While Abortion Clinics—and the Women They Serve—Pay the Price". Guttmacher Institute. 2013-06-27. Retrieved 2019-05-27.
  22. "Regular Session 2017–2018 - House Bill 2315". legis.state.pa.us. Pennsylvania General Assembly. Retrieved February 16, 2019. Referred to Judiciary, May 2, 2018 [House]
  23. "PA HB2315 | 2017–2018 | Regular Session". legiscan.com. Legi Scan. Retrieved February 16, 2019. Status: Introduced on May 2, 2018 - 25% progression, died in committee Action: 2018-05-02 - Referred to Judiciary
  24. Lai, K. K. Rebecca (2019-05-15). "Abortion Bans: 8 States Have Passed Bills to Limit the Procedure This Year". The New York Times. ISSN 0362-4331. Retrieved 2019-05-24.
  25. Lai, K. K. Rebecca (2019-05-15). "Abortion Bans: 8 States Have Passed Bills to Limit the Procedure This Year". The New York Times. ISSN 0362-4331. Retrieved 2019-05-24.
  26. Tavernise, Sabrina (2019-05-15). "'The Time Is Now': States Are Rushing to Restrict Abortion, or to Protect It". The New York Times. ISSN 0362-4331. Retrieved 2019-05-24.
  27. Planned Parenthood v. Casey, 947 F.2d 682 (3d Cir. 1991).
  28. Constitutional Law and Politics: Civil Rights and Civil Liberties, Eighth Edition, Norton & Company, 2011
  29. "Misinformed Consent: The Medical Accuracy of State-Developed Abortion Counseling Materials". Guttmacher Institute. 2006-10-25. Retrieved 2019-05-23.
  30. Lane, Charles. "All Eyes on Kennedy in Court Debate On Abortion". The Washington Post. Retrieved May 22, 2010.
  31. Casey, 505 U.S. at 872; Roe v. Wade, 410 U.S. 113, 163–66 (1973).
  32. Casey, 505 U.S. at 860.
  33. Casey, 505 U.S. at 870.
  34. Casey, 505 U.S. at 879.
  35. Casey, 505 U.S. at 873, 876-78.
  36. Casey, 505 U.S. at 871 ("[t]o protect the central right recognized by Roe v. Wade while at the same time accommodating the State's profound interest in potential life, we will employ the undue burden analysis as explained in this opinion.").
  37. City of Akron v. Akron Center for Reproductive Health, 462 U.S. 416 (1983).
  38. Casey, 505 U.S. at 877.
  39. Whole Woman's Health v. Hellerstedt, 579 U.S. ___ (2016), Archived 2017-06-23 at the Wayback Machine, Opinion of the Court, page 19-20.
  40. David H. Gans (June 27, 2015). "Symposium: No more rubber-stamping state regulation of abortion". SCOTUSblog. Retrieved June 29, 2016. [T]he majority held that the 'undue burden' standard announced in Planned Parenthood v. Casey 'requires that courts consider the burdens a law imposes on abortion access together with the benefits those laws confer.'
  41. Thornburgh v. American College of Obstetricians and Gynecologists, 476 U.S. 747 (1986).
  42. Dorf, Michael C. (1996). "Incidental Burdens on Fundamental Rights". Harv. L. Rev. 109 (6): 1175–1251. doi:10.2307/1342214. JSTOR 1342214. The undue burden standard is binding on lower courts, see Marks v. United States, 430 U.S. 188, 193 (1977) (defining the holding of a divided Court as the view of the members of the Court who concurred on the narrowest grounds), although for stare decisis purposes, only the portion of the three-Justice opinion that garnered five votes counts as a full-fledged precedent in the Supreme Court itself. [at Note 197]
  43. Casey, 505 U.S. at 893–94.
  44. See 897, 892–94 (noting that women may not inform their husbands because of "justifiable fears of physical abuse" or fear that notification will "provoke further instances of child abuse," and women may also fear reporting past abuse to the State because of the other consequences that can come from that).
  45. Casey, 505 U.S. at 894.
  46. Casey, 505 U.S. at 894 ("The proper focus of constitutional inquiry is the group for whom the law is a restriction, not the group for whom the law is irrelevant.").
  47. Casey, 505 U.S. at 880 (medical emergency), 887 (informed consent and 24-hour waiting period), 899 (parental consent), and 900 (finding that recordkeeping and reporting requirements are constitutional, except those related to spousal notice).
  48. "When Abortion Was a Crime". www.theatlantic.com. Retrieved 2019-05-22.
  49. Jessica Ravitz. "The surprising history of abortion in the U.S." CNN. Retrieved 2019-05-23.
  50. Arndorfer, Elizabeth; Michael, Jodi; Moskowitz, Laura; Grant, Juli A.; Siebel, Liza (December 1998). A State-By-State Review of Abortion and Reproductive Rights. Diane Publishing. ISBN 9780788174810.
  51. "Abortion Incidence and Services in the United States, 1995-1996". Guttmacher Institute. 2005-06-15. Retrieved 2019-06-02.
  52. Gould, Rebecca Harrington, Skye. "The number of abortion clinics in the US has plunged in the last decade — here's how many are in each state". Business Insider. Retrieved 2019-05-23.
  53. businessinsider (2018-08-04). "This is what could happen if Roe v. Wade fell". Business Insider (in Spanish). Retrieved 2019-05-24.
  54. Bohatch, Emily. "27 states with the most Planned Parenthood clinics". thestate. Retrieved 2019-05-24.
  55. "Here's Where Women Have Less Access to Planned Parenthood". Retrieved 2019-05-23.
  56. Cates, Willard; Rochat, Roger (March 1976). "Illegal Abortions in the United States: 1972–1974". Family Planning Perspectives. 8 (2): 86. doi:10.2307/2133995. JSTOR 2133995. PMID 1269687.
  57. "Guttmacher Data Center". data.guttmacher.org. Retrieved 2019-05-24.
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  60. Jatlaoui, Tara C. (2018). "Abortion Surveillance — United States, 2015". MMWR. Surveillance Summaries. 67 (13): 1–45. doi:10.15585/mmwr.ss6713a1. ISSN 1546-0738. PMC 6289084. PMID 30462632.
  61. Jatlaoui, Tara C. (2019). "Abortion Surveillance — United States, 2016". MMWR. Surveillance Summaries. 68. doi:10.15585/mmwr.ss6811a1. ISSN 1546-0738.
  62. Bacon, John. "Abortion rights supporters' voices thunder at #StopTheBans rallies across the nation". USA Today. Retrieved May 25, 2019.
  63. "Would overturning abortion rights turn back clock to 1973?". The Public's Radio. 2019-05-26. Retrieved 2019-05-26.
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