Reproductive health and rights were once again the subject of extensive debate in state capitols in 2013. Over the course of the year, 39 states enacted 141 provisions related to reproductive health and rights. Half of these new provisions, 70 in 22 states, sought to restrict access to abortion services.

In sharp contrast to this barrage of abortion restrictions, a handful of states adopted measures designed to expand access to reproductive health services. Most notably, California enacted the first new state law in more than seven years designed to expand access to abortion, and five states adopted measures to expand access to comprehensive sex education, facilitate access to emergency contraception for women who have been sexually assaulted and enable patients' partners to obtain STI treatment. (See Guttmacher's full 2013 analysis here.)

Abortion

Twenty-two states enacted 70 abortion restrictions during 2013. This makes 2013 second only to 2011 in the number of new abortion restrictions enacted in a single year. To put recent trends in even sharper relief, 205 abortion restrictions were enacted over the past three years (2011–2013), but just 189 were enacted during the entire previous decade (2001–2010).



More abortion restrictions have been enacted in 2011-2013 than in the entire previous decade.

Forty-five percent of the abortion restrictions enacted over the last three years fall into four categories: targeted restrictions on abortion providers (TRAP), limitations on insurance coverage of abortion, bans on abortions at 20 weeks postfertilization (the equivalent of 22 weeks after a woman's last menstrual period) and limitations on medication abortion. States enacted 93 measures in these four categories from 2011 through 2013, compared with 22 during the previous decade.

The number of new abortion restrictions ballooned from 43 enacted in 2012 to 70 in 2013. Four states were key to this increase. North Dakota and Texas, which did not have legislative sessions in 2012, together enacted 13 restrictions in 2013. In addition, the 2012 elections brought changes to the legislature in Arkansas and the governor's mansion in North Carolina that created environments more hostile to abortion; after adopting no abortion restrictions in 2012, these two states together enacted 13 new restrictions in 2013.

This legislative onslaught has dramatically changed the landscape for women needing abortion. In 2000, the two states that were the most restrictive in the nation, Mississippi and Utah, had five of 10 major types of abortion restrictions in effect (see Appendix). By 2013, however, 22 states had five or more restrictions, and Louisiana had 10.

In 2000, 13 states had at least four types of major abortion restrictions and so were considered hostile to abortion rights (see Troubling Trend: More States Hostile to Abortion Rights as Middle Ground Shrinks); 27 states fell into this category by 2013. In contrast, the number of states supportive of abortion rights fell from 17 to 13, while the number of middle-ground states was cut in half, from 20 to 10. The proportion of women living in restrictive states went from 31% to 56%, while the proportion living in supportive states fell from 40% to 31% over the same period.



Against this backdrop, it is particularly noteworthy that California moved to significantly improve access to early abortion services by expanding the types of providers permitted to perform either medication or surgical abortions. Legislation enacted in September allows physician assistants, certified nurse midwives and nurse practitioners to provide abortions during the first trimester. Thirty-nine states limit the provision of abortion services to licensed physicians (see Overview of Abortion Laws). Also this year, Colorado repealed its pre-Roe abortion law. Although these measures are not enforced, 12 states continue to have pre-Roe laws on the books (see Abortion Policy in the Absence of Roe).

Despite this progress, the overwhelming preponderance of legislation concerning abortion was aimed at restricting access to the procedure. Four types of restrictions dominated the legislative scene during 2013: abortion bans, restrictions on abortion providers, limitations on the provision of medication abortion and restrictions on coverage of abortion in private health plans. Together, legislation in these four categories accounted for 56% of all restrictions enacted over the year.

States also adopted a wide range of other major abortion restrictions in 2013, including those on parental involvement, public funding for abortion, waiting periods and counseling, and ultrasound. (See the full analysis for more details.)

Family Planning, Emergency Contraception, Sex Education and Other Issues

Twenty states enacted measures relating to access to family planning services in 2013. Of the 17 states that passed budgets with line items for family planning funding, only Maine cut funding drastically. In addition, Ohio and Oklahoma instituted new restrictions on family planning providers' eligibility for state and federal funding. At year's end, 10 states had abortion-related restrictions on family planning providers (see State Family Planning Funding Restrictions).

Also, Hawaii became the 18th state to provide protections to women who have been sexually assaulted by enacting a new law requiring that a woman who has been sexually assaulted receive medically accurate and unbiased information on emergency contraception from the hospital treating her injuries. However, Oklahoma and Missouri moved to restrict access to emergency contraception (see Emergency Contraception).

Colorado and Illinois enacted measures to expand access to sex education in 2013. Colorado now effectively prohibits abstinence-only instruction by requiring sex education in the state to be scientifically proven to delay sexual debut, reduce adolescents' number of sexual partners, reduce the frequency of sex, and increase their contraceptive use. Illinois enacted three separate laws related to sex education, including a requirement that any sex education that is taught in the state be medically accurate and age-appropriate and include instruction on contraception and abstinence. These new laws bring to nine the number of states requiring that the sex education provided in the state be medically accurate and include information on contraception (see State Policies in Brief: Sex and HIV Education.) However, new laws in North Carolina and Kansas could limit access to comprehensive and medically accurate sex education.

See the full analysis for more details and for changes in state-level policies on partner treatment of STIs, fetal issues and substance abuse during pregnancy.





For more information:

Full analysis of 2013 state legislative trends



Guttmacher Institute State Center



State Policies in Brief



Medication Abortion Restrictions Burden Women and Providers—and Threaten U.S. Trend Toward Very Early Abortion



TRAP Laws Gain Political Traction While Abortion Clinics—and the Women They Serve—Pay the Price



Insurance Coverage of Abortion: Beyond the Exceptions for Life Endangerment, Rape and Incest



Besieged Family Planning Network Plays Pivotal Role