Alabama and Georgia recently passed some of the most restrictive abortion legislation in the country.
But even before that, reproductive rights supporters say a web of laws and logistics already made it hard to get an abortion in those states.
When most people think of abortion rights, they think of Roe v. Wade. But when it comes to abortion access, the case to look at is Planned Parenthood v. Casey, which challenged changes to Pennsylvania’s abortion law in the late 1980s.
The 1992 Supreme Court decision reaffirmed the right to abortion while allowing restrictions in Pennsylvania’s law, such as waiting periods, parental consent, and the disclosure of information by a physician before a woman can seek an abortion.
The 5-4 opinion also introduced the undue burden test for determining if a law creates a substantial obstacle in the path of a woman seeking an abortion of a fetus that is not viable.
Using the standard, the court struck down the spousal notification provision of Pennsylvania’s law. It also led the Supreme Court in 2016 to strike down two key provisions of a Texas law that required abortion providers to have admitting privileges at local hospitals and clinics upgrade their facilities to hospital-like standards. And that test could become part of legal challenges to Alabama and Georgia’s new laws.
Georgia’s law would ban abortions after a fetal heartbeat is detected, which can be as early as six weeks into a pregnancy. The Alabama measure virtually bans abortions, even cases of rape and incest.
But laws are only part of the calculus in a woman’s ability to seek an abortion. And while the gestational limits have yet to take effect, the following considerations will continue to impact women seeking abortions in Alabama, Georgia and other states.
Facility access
Most clinics that perform abortions in Georgia and Alabama are in and around the metropolitan areas, creating financial and logistical hardships for women who live outside those areas and must travel to reach centers.
Alabama has five clinics spread across 52,419 square miles: one in Birmingham, Huntsville, Tuscaloosa, Mobile and Montgomery.
In 2014, 59% of women lived in Alabama counties without a clinic, compared with 39% in the rest of the United States, said Elizabeth Nash, senior state issues manager for the reproductive rights think-tank, Guttmacher Institute.
Only one clinic in Alabama is open on weekends, which means a woman may have to take off work, arrange child care and potentially plan an overnight stay because of mandatory counseling and wait periods.
CNN reached out to Georgia for the number of clinics statewide. According to Guttmacher, 58% of women in 2014 lived in counties without one.
Gestational limits – such as the ones passed in Georgia and Alabama – make access an even greater hurdle. They can force women to travel to other states if they pass the limit where they live, which can increase their costs and delay care.
State-mandated counseling and waiting periods
All 50 states require the consent of a patient before medical treatment to ensure the decision is voluntary and informed.
On top of counseling requirements, Alabama and Georgia require that patients wait at least 24 hours between the session and abortion.
The waiting period can create additional financial and logistical hardships for some women, Nash said. And a US Government Accountability study found that mandatory counseling can include information that tries to dissuade women from having an abortion.
In Alabama, the waiting period requires two appointments and two trips to a health care provider. A women must undergo an ultrasound during her visit and the provider must offer her the chance to see the image.
In Georgia, the counseling requirement is waived in cases of medical emergency, and a patient can receive the information over the phone or through a website.
Counseling booklets in Alabama and Georgia include descriptions of developmental characteristics, abortion methods and risks, and other resources, such as adoption.
Out of pocket costs and insurance restrictions
Some women put off the procedure until they have the time or means to proceed. The delay can increase travel costs if a woman exceeds the gestational limit in her states, and could mean she has to get a surgical abortion instead of a medical one.
Insurance would help defray costs, especially for low-income families. But several states, including Georgia and Alabama, impose restrictions on private insurance coverage of abortion and plans sold on the marketplace under the Affordable Care Act.
In Georgia, plans on the state exchange can only cover abortion in cases where the woman’s life or health is in danger. In Alabama, health plans on the state exchange can only cover abortion in cases of life endangerment, rape or incest.
Similar federal restrictions have existed since 1977, when the Hyde Amendment took effect.
Hyde forbids the use of federal funds for abortions except in cases of life endangerment, rape or incest through federal-state Medicaid programs for low-income women.
Some states choose to use their own funds to cover abortions in other circumstances, but not Alabama or Georgia.