Next week, Alabama's backdoor ban on abortion will finally have its day in court. Starting Monday, attorneys for the ACLU and Planned Parenthood will argue the legality of a year-old law requiring that doctors who provide abortions have a specific kind of agreement with a local hospital. Since providers often don't have and can't easily obtain these agreements, called admitting privileges, the law has placed three of the state's five clinics on the brink of closure.
The bill passed the state legislature last year and was signed by Governor Bob Riley, a Republican whose former press secretary and speechwriter admitted what's been obvious to abortion rights advocates — that the bill's true purpose was to make it nearly impossible to terminate a pregnancy. A federal injunction granted in June has kept the law in limbo until now.
When asked to explain what exactly the bill aimed to accomplish if not to end-run Roe, its proponents argued that it's simply a matter of keeping women safe. After all, if something goes wrong during the course of a procedure and a trip from the clinic to a hospital is necessary, then the physician should be able to go with the patient. But for what other outpatient setting does that logic hold? If the unexpected happens during a cataract removal or a tonsillectomy, an ambulance takes you to an emergency room and the staff there takes over.
So why don't providers just roll their eyes and jump through the hoop? Why not just apply for the admitting privileges, knowing it won't mean much, and continue serving Alabama's women and families? Because often when providers apply, hospitals reject them. Some hospitals only grant privileges to physicians likely to admit a high number of patients per year. Abortion involves too few complications that require hospitalization, say advocates, so physicians who are narrowly focused on providing the procedure often can't clear that hurdle.
Proponents of the bill knew what they were doing. They knew that requiring these agreements would mean clinics would close. If the law goes into effect, the state's three biggest cities — Birmingham, Mobile and Montgomery — will be without providers. The remaining licensed clinics will be in Huntsville and Tuscaloosa, which means that women, especially those in the southern part of the state, will have hundreds of miles between them and a safe, legal way to end their pregnancies. This spells disaster for a state where too many women already struggle to get the healthcare they need. Alabama's infant mortality rate is second highest in the nation and the state's death rate from breast cancer ranks among the highest nationwide as well.
The American College of Obstetricians and Gynecologists (ACOG) has opposed laws requiring staff privileges, arguing that they're medically unnecessary and pose a threat to women's health by closing clinics. The Texas Hospital Association said much the same thing in opposing the provision of last year's anti-choice package that put a similar requirement in place in that state. The trend in copycat legislation has continued into 2014. Similar bills are under consideration now in Oklahoma, Louisiana and Pennsylvania.
Explicit bans on abortion still make their way through state legislatures. Last year, North Dakota made it illegal to terminate a pregnancy after six weeks (before many women even know they're pregnant), and Arkansas outlawed the procedure after 12 weeks. With laws like these, the public knows where it stands. By mandating hospital admitting privileges, anti-choice legislators are making backdoor maneuvers that for too many women have the same effect as an outright ban.
All eyes are on Alabama, and Wisconsin's up next. A federal trial on that state's law begins May 27.