Untrapped Part 1 [Serge]

I've got to admit that I love John Oliver's stuff. His video on voter ID laws made me reconsider my position on that issue. So when he took on abortion laws in a recent video, I paid very close attention. He used footage from an upcoming documentary "Trapped" to show that efforts from pro-lifers to legislate abortion clinics have made abortion unattainable in many parts of the country. Because of his popularity, I believe it is important to take his argument seriously, and respond to it appropriately. Is the legislative efforts of pro-lifers solely responsible for the significant decrease of abortion doctors and clinics willing to perform this procedure?

First, I do believe that I am in a unique position to respond to this argument. In many ways, I share some interesting parallels to an abortion provider. As a board certified oral and maxillofacial surgeon, I own and run an office that routinely provides outpatient surgical procedures under anesthesia. I have full hospital admitting privileges and understand the steps necessary for running a practice based on outpatient surgery.

There are many specific claims in Oliver's video that I could respond to, but I wish to start with his general point: that abortion laws have been predominantly responsible for the decrease in providers and clinics that perform abortions. He states that 70 clinics have closed because of TRAP (targeted regulation of abortion providers) laws in 11 states. Just to be clear, I am not in favor of every single TRAP law - in fact I think there have been some significant overreach in many of these laws. However, is it true that this legislation is primarily responsible for the closures of these clinics? There is an easy way to find out.

Let's take a look at a specific state: Iowa. Iowa is unique for a number of different reasons. First, according to Guttmacher, there are no TRAP laws that have been passed in Iowa. Second, in order to increase access to abortion, Iowa is the center of a program to provide telemed medical abortions throughout the state. This ability was challenged by the Iowa Board of Medicine, but last summer this decision was overturned by the Iowa Supreme Court. In other words, a woman can get a medical abortion through Skype throughout the state since 2008 without an actual physical exam. Third, every abortion clinic in Iowa is run by Planned Parenthood, the largest abortion provider and advocate for increased access to abortion. It seems that Iowa would basically be the shining star of abortion access and a model for other states to follow.

Running an abortion clinic would be so much easier in a state like Iowa with no restrictions and access to additional means of income by providing telemed abortions to rural areas. They are run by the largest advocate of abortion access. So how many new abortion clinics have popped up in Iowa since 2011?

Actually, 14 clinics that performed abortion have closed in that time. No TRAP laws. Increased access to medical abortions. Yet 14 clinics closed.

Putting that into perspective, Texas has over eight times the population than Iowa. If abortion clinics closed in Texas at the same rate as Iowa, 112 would have been closed in Texas during the same time period. Clearly there is something else besides TRAP laws that have caused the closing of so many abortion clinics. The "decreased access to abortion care" cannot be blamed on TRAP laws alone, and in the case of Iowa, cannot be blamed on them at all.

I may go into detail in a future post, but there are many reasons why abortion clinics are closing. All of medicine is being effected by increased consolidation. There appears to be less demand for abortion services. For a variety of reasons there are less doctors willing to perform abortions. All of these are factors that effect the ability for women to obtain an abortion, and not one was mentioned in Oliver's video.

Lastly, one of the more powerful portions of the video showed a clinic worker describing the plight of a poor woman unable to obtain an abortion without traveling a significant distance. Since she could not find an abortion provider in her town, she was asking how she could perform her abortion at home. The camera showed a teary eyed clinic worker recounting this story. The implication is that TRAP laws placed this poor woman in this precarious position.

However, here's a story about the latest abortion clinic to close in Dubuque, Iowa. This clinic offered both surgical and medical abortions, and is now being closed. Women who were served by this clinic will now have to drive 70 miles to Cedar Rapids for abortion services. According to a past board member:

They would have to travel,” Straley said. “For some people, that’s a deal-breaker … Often the people who need that service the most are people who do not have money for transportation for someplace that is 70 or 100 miles away.”

In other words, a state with zero TRAP laws, regulations specifically designed to increase abortion access, and an abortion industry fully controlled by the tax payer funded Planned Parenthood also has the problem of providing abortion care to poor women who "need" it. Repealing every single TRAP law will do nothing to help this woman's story if she were in Iowa. Blaming this situation fully on legislation brought about by pro-lifers is disingenuous and simplistic. There is far more going on here.