Abortion opponents have a new strategy aimed at reducing the number of pregnancies that are terminated, and it will probably be a lot more effective than the tactics used in the past.

So writes Theodore Joyce, a health care economist at Baruch College in New York, in Thursday’s edition of the New England Journal of Medicine.

The largely ineffective efforts to which Joyce refers are ones aimed at reducing demand for abortions by targeting the women who are considering them. Picketing outside of clinics, requiring a 24-hour waiting period, forcing minors to get permission from their parents and limiting funding from Medicaid were all designed to make abortion a less attractive option.

But such measures have hardly made a dent in the number of abortions performed in the U.S. each year, Joyce writes. So instead of trying to influence demand, they are now focusing on supply – by passing laws that effectively forbid most clinics from performing the controversial procedure.


At first glance, the laws look like simple revisions to licensing standards, with detailed requirements about the facilities where abortions take place. Individually, the requirements seem relatively benign. But when you add them all up, they place an extreme financial and logistical burden on clinics.

In Kansas, for example, a new law imposes these requirements on abortion clinics:

Each procedure room must be at least 150 square feet large, with an additional 50 square feet devoted to janitorial space.

The dressing rooms used by patients must have a toilet, a sink and a closet for storing clothing.

Dressing rooms for patients cannot be shared with clinical staff.

So far, two doctors who offer abortions in their practice have sued to block the law because they say the rules have no bearing on patient safety, yet they would prevent them from providing abortions. This summer, a federal judge agreed and issued a temporary injuction against the law, Joyce writes.

But what if it had been allowed to stand? To answer this question, Joyce turns to Texas. In 2004, a law went into effect that required abortions after 16 weeks of gestation to be performed in hospitals or ambulatory surgical centers. That effectively required freestanding abortion clinics to have more staff, more space and more regulations.


It turned out that not a single clinic could meet the higher threshhold. As a result, the number of later-term abortions performed in the Lone Star State plunged from 3,624 in 2003 to 446 in 2004 – a decline of 88%, according to Joyce’s research. (Meanwhile, the new law’s restrictions aimed at reducing demand for abortions had no effect.)

In Arizona, a new law requires all abortions – including medical abortions that involve swallowing drugs and no surgery – to be performed by physicians. Three clinics that used to rely on nurse practitioners to dispense the drugs for medical abortions were forced out of the market, Joyce writes.

Joyce does not hide his pro-choice stance. Here’s how he sums up his report:

“History suggests that there will always be abortions. The goal should be to reduce the abortion rate by reducing unintended pregnancies, while providing safe, legal services for women who need them. Making access to abortion unnecessarily costly will probably result in clandestine abortions and unintended childbearing among families with the least resources and the fewest options.”