The Washington PostDemocracy Dies in Darkness

Why abortion clinics in the U.S. are rapidly closing

(Chris Greenberg/Bloomberg News)

The United States' wave of abortion clinic closures continued Wednesday in Louisiana, where an appeals court issued an emergency order that abortion-rights groups say will shutter three of the state’s four providers.

An appeals court in New Orleans ruled that a 2014 state law requiring doctors who perform the procedures to have formal relationships with nearby hospitals can take effect as a legal challenge against it winds through the courts. A lower court in January had temporarily halted the rule.

Appeals court allows law that would shut three of Louisiana’s four abortion clinics

The Louisiana law resembles a Texas provision being challenged in a case the Supreme Court takes up next week, Whole Woman’s Health v. Hellerstedt. The regulation mandates that doctors must have admitting privileges at a hospital within 30 miles of their clinics, allowing them to treat patients there.

Some hospitals, however, deny such privileges because they oppose abortion, and in Texas, some clinics that operate near only antiabortion hospitals have been forced to close.

Proponents of the requirement say it safeguards women’s health. Abortion-rights groups, along with the American College of Obstetricians and Gynecologists and the American Medical Association, say the rules are not based on scientific fact and are medically unnecessary.

Louisiana's measure is just the latest abortion clinic restriction in a recent surge that has exacerbated the closures of clinics nationwide over the last five years.

Between 2011 and 2014, state lawmakers have enacted 231 abortion restrictions, according to the Guttmacher Institute, a reproductive health research organization. The new laws include required waiting periods, state-mandated counseling, parental consent — and, under review now in Texas, an order that, among other physical updates, clinics must maintain certain hallway lengths

The new regulations arrived as more Republicans became state leaders, and the national debate over the Affordable Care Act brought new attention to if and how the government should help women pay for fertility-related medical services.

Observe how legislative activity has gained strength:

The number of U.S. abortion clinics or medical facilities that perform more than 400 abortions annually, peaked in the late 1980s at 705. By 2011, 553 remained.

The clinics have been closing at a record pace, according to a new Bloomberg analysis: One-hundred-sixty-two have closed since 2011, while 22 have opened. Texas, for example, lost more than half of its clinics.

Note that providers are closing shop even in abortion-friendly California. A dozen have shuttered over Bloomberg’s four-year window.

Beyond the state laws that trigger closures, economic hardships play a role. Running an abortion clinic is difficult even without opponents working to shut down operations. More readily accessible birth control has softened the demand in some areas — Obamacare now covers the cost of the pill and other popular methods. Medicaid, meanwhile, funds abortion only in the case of rape, incest or life-threatening pregnancies.

Abortion-rights groups say the clinics are lucky to break even, and Planned Parenthood, one of the country’s largest providers, would likely enter dire financial straits without government funding.

As for the consequences of these sweeping clinic closures? Depends on whom you ask.

Antiabortion groups say more babies get a chance at life. Abortion-rights groups say women who lose access to a local clinic — and can't afford the trek to the next option — will risk their lives with unsafe, illegal procedures.

Also on Wonkblog:

When a photo of your stillborn baby appears in an antiabortion video

Defunding Planned Parenthood would cut many poor women off birth control

After Planned Parenthood closures, poor women started having more babies