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The Supreme Court’s Next Abortion Chapter

Contributing Opinion Writer

An abortion opponent at the Supreme Court in January.Credit...Alex Wong/Getty Images

If it seems as if the noose is tightening around women’s access to abortion, that’s because it is.

Iowa just enacted a flagrantly unconstitutional law to ban abortion after a fetal heartbeat is detected — at about six weeks of pregnancy, before many women even know they’re pregnant. Mississippi recently banned abortion at 15 weeks, a point well before fetal viability and thus also clearly unconstitutional. A similar bill in Louisiana cleared the legislature and is on the governor’s desk.

And of course there’s the Trump administration’s plan to forbid medical professionals in clinics that receive federal money from providing their patients with pertinent and truthful information about abortion. This proposal, aimed at Planned Parenthood, is a clear suppression of free speech that flies in the face of the robust First Amendment that has evolved since the Supreme Court, by a 5 to 4 vote, upheld an earlier abortion gag rule 27 years ago.

Some or all of these measures will reach the Supreme Court in due course. Indeed, part of the anti-abortion strategy is to serve up a diet of far-fetched cases: While there is no chance the Supreme Court will uphold the fetal heartbeat law, a defeat serves the greater purpose of keeping the base attentive to the court and motivated at the polls.

There is a case already at the court that presents the justices with a more immediate test. It is scheduled for consideration at Thursday’s private conference, where the justices decide which new cases to accept. At issue is whether the court will choose to respond to a bold act of judicial defiance: the refusal by a federal appeals court to apply the Supreme Court’s most recent abortion precedent to a situation that is all but indistinguishable.

The new case is an appeal by Planned Parenthood of Arkansas and Eastern Oklahoma from a decision by the United States Court of Appeals for the Eighth Circuit. The Eighth Circuit refused to block an Arkansas law that requires doctors who provide medication abortions — the two-pill regimen that is used during the first nine weeks of pregnancy — to have a contract with an obstetrician/gynecologist who has hospital admitting privileges.

Two years ago, in Whole Woman’s Health v. Hellerstedt, the Supreme Court overturned a Texas law that required doctors who provided abortions either by surgery or medication to have admitting privileges in a local hospital. The court concluded that there was no demonstrable need for the requirement and that any health-related benefit would be outweighed by the drastic limitation the law would have imposed on access to abortion in Texas. The law, which also imposed new physical requirements on abortion clinics, would have led two-thirds of the state’s clinics to close, leaving large areas of Texas without an abortion provider.

The Arkansas law, cynically entitled the Abortion-Inducing Drug Safety Act, would leave only one of the state’s three abortion clinics in business because the other two, operated by Planned Parenthood, offer only medication abortions. Planned Parenthood conducted a statewide canvass of obstetrician/gynecologists and found none willing to enter into the required contract. The remaining clinic, in Little Rock, which currently offers both surgical and medication abortions, would have to limit its practice to surgical abortions, leaving Arkansas women with no medication option.

Federal District Judge Kristine G. Baker blocked the law’s enforcement after concluding that any medical benefit from the contract arrangement would be “incrementally small” while the burden on women’s access to abortion would be substantial. The law was “a solution in search of a problem,” the judge said. In a ruling last July vacating the district court injunction, the Eighth Circuit said that Judge Baker had “failed to make factual findings estimating the number of women burdened by the statute” and who would either forgo or postpone an abortion because of the law.

Only willful blindness to the facts of the case could have led the appeals court to fault Judge Baker’s description of the burden the law would impose. She explained that closing Planned Parenthood’s clinic in Fayetteville, in the northwest corner of the state, would require women there to make a 380-mile round trip to the remaining clinic in Little Rock not once, but twice, because Arkansas requires an in-person meeting between doctors and their abortion patients, followed by a 48-hour waiting period.

“Inability to travel to the sole remaining clinic in the state will lead some women to take desperate measures, such as attempting to self-abort or seeking care from unsafe providers,” Judge Baker wrote.

How many women? How many angels on the head of a pin? “We are left with no concrete District Court findings,” the Eighth Circuit complained in sending the case back to Judge Baker for further factual development. We are left to guess by what magic the judge can satisfy the appeals court’s burning curiosity.

The Eighth Circuit agreed to suspend its order to permit Planned Parenthood to appeal to the Supreme Court. The appeal, Planned Parenthood of Arkansas and Eastern Oklahoma v. Jegley, challenges the justices to stand by the ruling in the Texas case. The court’s “intervention is necessary to preserve the integrity” of that decision, the Planned Parenthood lawyers assert in their petition.

I see the case as presenting an additional challenge: the need for the justices to make clear to judges of the lower courts that, like it or not, the Constitution still protects access to abortion without the “undue burden” of state-created obstacles that serve no purpose other than to frustrate women in the exercise of their constitutional rights. And that need is urgent, given the Trump administration’s success in filling judicial vacancies with opponents of abortion, including one successful nominee to a federal appeals court who equated abortion and slavery as “the two greatest tragedies in our country,” and others who signal their opposition more discreetly.

Readers of this column know that I’ve only reluctantly shed my reticence about naming the presidents who appointed the judges whose decisions I discuss. It may or may not be relevant that all three judges on the Eighth Circuit panel were named by President George W. Bush. They were Judges William Jay Riley, Raymond W. Gruender and James E. Gritzner, a senior federal district judge temporarily sitting on the Eighth Circuit. Judge Baker was named to the Federal District Court in Arkansas by President Barack Obama.

Arkansas passed its law in 2015, before the Supreme Court’s ruling in the Texas case. The law was part of an effort by a number of anti-abortion state legislatures to stop the practice of medication abortion. The laws serving this goal required doctors to prescribe the two drugs according to the instructions on the original label that the Food and Drug Administration approved when it authorized the procedure in 2000. That sounds sensible enough, but it actually was a highly cynical maneuver. Over the ensuing 15 years, during which 2.75 million medication abortions took place, doctors had determined that the better practice was to use only one-third the approved dose of one of the drugs, mifepristone. It came to be considered bad professional practice to follow the original label, and doctors testified that if put to the choice, they would stop offering medication abortions rather than violate what was now considered the standard of care.

In case anyone wonders why the anti-abortion forces would train their sights on medication abortion, which takes place only in the first 70 days of pregnancy, I think the reason is obvious: It empowers women because they take the second pill, misoprostol, at home. There is no need for medical apparatus nor, once the appropriate stage of pregnancy is confirmed, even for a doctor. The procedure is a perfect candidate for telemedicine, which some states are trying to bar while encouraging telemedicine for other simple procedures.

In March 2016, the Food and Drug Administration updated its label to take account of the new consensus. So that part of the Arkansas law, which Judge Baker had also enjoined, fell away. What was left was the contract-physician requirement, which makes no sense. Not only is medication abortion extremely safe, with a hospitalization rate of 0.06 percent, but any complications occur after a woman has left the doctor’s office and traveled some distance, perhaps a substantial one, back to her home. The law requires a contract with a physician anywhere in the state, making it unlikely that the contract doctor would even be at hand or would have privileges in a hospital near the woman’s home.

Further, Arkansas has responded to Planned Parenthood’s complaint about the distance that women would have to travel from Fayetteville by arguing that those woman could get abortions 80 miles away in Tulsa, Okla., rather than 190 miles away in Little Rock. The fact that Oklahoma has neither a contract-physician requirement nor a face-to-face consultation requirement (the consultation can be by telephone) strips from Arkansas any facade of sincerity about the asserted health-protective rationale for its law. The law is phony. It’s unconstitutional. It’s the Supreme Court’s next test.

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