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Roe v. Wade turns 30, faces an uncertain future. (Older Providers not being Replaced).

NEW YORK -- This month marks the 30-year anniversary of the precedent-setting Roe v. Wade Supreme Court decision that made abortion a legal option for all women in the United States.

In the decades since 1973, Roe v. Wade has remained the law of the land despite many significant legal and political challenges. But advocates for abortion rights and reproductive freedom who gathered for a press conference sponsored by the Henry J. Kaiser Family Foundation say the law faces even greater challenges in the coming years.

"A whole generation of women has grown up never knowing there was a time when abortion was not a legal option. But the abortion issue is by no means resolved," said Tina Hoff, the Kaiser Family Foundation's vice president and director of public health information.

Kathryn Kolbert, a lawyer who is widely credited with "saving" Roe v. Wade when it was directly challenged in the Supreme Court in 1992, said the Supreme Court has consistently struck down efforts to ban abortion at the federal level, thus safeguarding Roe v. Wade.

But since the 1980s, the Supreme Court has granted the states increasing latitude to create various types of restrictions and regulations that limit abortion services. For women in some states, Roe v. Wade does little to guarantee their actual free access to abortion services, said Ms. Kolbert, senior research administrator at the University of Pennsylvania's Annenberg Public Policy Center in Philadelphia.

State-level challenges to Roe v. Wade come in five general forms, she said:

1. State laws regulating clinical performance of abortion. This approach, which involves governing clinical settings, types of procedures, and practitioner qualifications, has its roots in early efforts to make abortion safer. In many cases, though, the rules have become increasingly restrictive and seem designed to limit access rather than protect health, Ms. Kolbert said. A good example is the requirement in many states for surgical backup in any clinic providing mifepristone (Mifeprex) or other forms of medical abortion. This rule created disincentives for physicians who would otherwise be willing to offer nonsurgical abortions, she added.

2. Restrictions based on marital status. Since the mid-1970s, several states have tried to mandate spousal notification and consent before abortion. While these moves have been challenged and struck down by the federal Supreme Court, this strategy remains a perennial challenge, albeit one that has been fairly quiescent in recent years.

3. Requirements for parental notification and/or consent. Ms. Kolbert said a growing number of states are establishing parental notification and consent regulations for minors. The Supreme Court has been largely tolerant of them.

4. Fiscal restrictions in federally funded health programs. State legislative efforts to block or restrict coverage of abortion and/or family planning services under state-managed Medicaid programs began in the 1970s and have largely been upheld by the federal Supreme Court.

5. Access restrictions secondary to violence or public protest. The degree to which a particular state or locale tolerates violence and public demonstrations at abortion clinics is highly variable. While the federal Freedom of Access to Clinic Entrances act is intended to protect both provider and patient safety and guarantee freedom from harassment, these protections depend on local enforcement.

As Roe v. Wade enters its fourth decade, it is likely to face several major challenges, Ms. Kolbert predicted. "There are three critical questions: the number of abortion providers, the political saliency of the issue, and the balance of pro-choice vs. pro-life justices on the Supreme Court."

Many of the justices are elderly and may retire at any time. Roe v. Wade passed by a vote of 6-3 in 1973. But attempts to ban abortion in the 1980s were voted down by only 5-4. "Whoever is appointed to the Supreme Court in the future will have a huge influence on whether the right to abortion remains a liberty for all women.

Given the estimated 1.3 million abortions annually, this is clearly a concern for many reproductive-age women, but the number that will actually vote based on the abortion issue is very much in question. Politicians, she said, will only take action on issues they perceive to be politically salient.

Access to abortion is entirely dependent on availability of physicians willing to perform the procedure or offer medical abortion. Those numbers have been shrinking steadily over the last 2 decades. Dr. William Harrison, an ob.gyn. who has been providing abortions in Fayetteville, Ark., since 1968, stressed that at both the local and national level, the average age of abortion providers has been increasing, and older providers are not being replaced.

"When I went into practice, there were three or four other doctors doing abortions in my state. At the peak, in 1983, there were 13. Now, there are three."
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Author:Goldman, Erik L.
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jan 1, 2003
Previous Article:AMA delegates demand fix for Medicare formula. (Protest Vote at Interim Meeting).
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