The Hidden Consequences of Forcing Women to Travel for Abortions
By Elisa Slattery
When the U.S. Supreme Court struck down a Texas law imposing restrictions that would have closed more than half that state’s abortion clinics, it held that excessive travel can be a factor in whether a woman faces an “undue burden” in exercising her right to an abortion.
The decision last week, Whole Woman’s Health v. Hellerstedt, a case brought by the Center for Reproductive Rights, throws into sharp relief that, in many parts of the world, it is difficult or even impossible for women to find an abortion provider near where they live. Unlike medical treatments that may be inaccessible because of financial or personnel constraints, when abortion is unavailable, it’s usually because a jurisdiction refuses to recognize it as a valid medical service.
Abortion opponents in the United States have been trying to constrict a woman’s right to abortion since it was recognized by the Supreme Court in Roe v. Wade more than four decades ago. Those efforts are evidenced by restrictions like those at play in Texas, which mandated—without any health benefit to women—that providers obtain admitting privileges at local hospitals and that facilities meet the same exceedingly high standards as ambulatory surgical centers.
But as nefarious as the Texas law may have been, in many cases, women in the United States are better off than their counterparts in countries where abortion rights are slim to nonexistent.
In most Mexican states, for instance, abortion is highly restricted, so women there must travel to Mexico City, where the service is available upon request in the first 12 weeks of a pregnancy. In Northern Ireland, women must leave the country entirely, due to a law dating back to 1861 that bans abortion even in cases of rape, incest, or fatal fetal anomalies. They also must cover the costs of the travel and procedure themselves—costs that are covered by the National Health Service for women in other parts of the United Kingdom.
Likewise, in the Republic of Ireland, a constitutional amendment granting equal status to the fetus and pregnant woman has resulted in a law that criminalizes abortion except in cases when carrying a fetus to term would result in the death of the pregnant woman. And while a cross-border directive allows residents of Ireland who require and are entitled to public health care services to be referred to and reimbursed by another EU member state for that care, the directive excludes medical services which are “contrary to Irish legislation,” as abortion is.
These are just a few of the places where reproductive rights are out of reach, and it’s not always the law that stands in the way. Italy’s Ministry of Health reports that seven out of ten gynecologists refuse to give abortions based on religious grounds, with refusal rates reaching almost 90 percent in some parts of the country.
What does it mean, as Justice Ruth Bader Ginsburg wrote in her concurring opinion in Whole Woman’s Health, to “strew impediments to abortion,” forcing women to search for cities and countries where abortion is available and for providers who are willing to provide it?
Traveling long distances for abortions disproportionately harms young women, low-income women, women with precarious immigration status, and women with disabilities, for whom travel is prohibitively expensive, not physically possible, or an otherwise risky proposition. There’s no way to measure the harm of forcing women to locate funds, arrange transportation, schedule childcare, and justify one’s absence to employers, family, and partners—all with the clock ticking as abortions become more expensive and medically complex later in a pregnancy.
But there’s another, perhaps more insidious, aspect of burdensome travel that’s even harder to quantify. It’s a type of social exclusion through which women, however temporarily, are effectively banished from society. Some women’s rights groups have begun to publicly acknowledge this, calling the practice “abortion exile.”
Forcing women to leave their communities for abortions is isolating and degrading; it denies them their status as full and equal citizens. In interviews I’ve conducted in Ireland, women whose pregnancy had a fatal fetal anomaly said that being forced to travel at such a heartbreaking time made them feel as though their country had turned its back on them.
Some progress is being made. Laws that force women to journey abroad for abortion have been found to violate women’s rights in the Republic of Ireland and Northern Ireland. And last week, the U.S. Supreme Court let stand lower-court rulings preventing restrictions from taking place in Mississippi and Wisconsin.
To assist women who are turned away in their search for a basic health service, some organizations have stepped in to provide escorts, places to stay, and (when a clinical abortion is not necessary) creative ways to access medical abortion. But not all women are able to access such options, and they shouldn’t have to. The resourcefulness and creativity of women’s rights groups and their allies do not absolve the state from its responsibility to meet women’s health needs.
The Center for Reproductive Rights is a grantee of the Open Society Foundations.