Sec. 2. Findings
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/bill/118/hr/4303/ih/section-2·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
Congress finds the following: Abortion care is essential health care that should be affordable, available, and supported for everyone who needs it. On June 24, 2022, the Supreme Court overturned Roe v. Wade and 50 years of legal precedent, and Roe v. Wade was never enough. Without the ability to access abortion, the legal right did not help many people working to make ends meet, who are Black, Indigenous, Asian, Pacific Islander, Latinx, young people, LGBTQ+ people, immigrants, disabled people and gender nonconforming people.
Almost one-third (29 percent) of the total United States population of women of reproductive age are currently living in States where abortion is either unavailable or severely restricted and a dozen other States are certain or likely to ban abortion in the future. Systemic racism, economic insecurity, abelism, and a dehumanizing immigration system exacerbate the already-massive barriers to abortion care. While abortion bans and other legal restrictions harm all people who are or may become pregnant, they cause even greater harm to those already subject to systemic racism and economic injustice.
Pregnancy is less safe for some than others because of historic and ongoing racism and discrimination in health care settings, and Black and Indigenous individuals face two to three times the risk of dying from pregnancy-related causes. Individuals in States banning or severely restricting access to abortion care also have worse maternal health outcomes. Forced pregnancy is always unconscionable, and particularly so for individuals facing heightened risk of maternal mortality and morbidity, where pregnancy is less safe for some than others because of historic and ongoing racism and discrimination in health care settings.
Maternal deaths in 2020 were 62 percent higher in States where abortion is heavily restricted than in States where abortion was available, and a Federal ban on abortion would increase maternal mortality by an estimated 24 percent. Congress has the authority to act pursuant to the commerce clause, the necessary and proper clause, and section 5 of the 14th Amendment. Attacks on bodily autonomy are not limited to threats on abortion care. This year alone, more than 120 bills have been introduced attacking gender-affirming care.
States have attempted to outlaw many forms of birth control, and 15 States have near total abortion bans. Several State courts have found that abortion restrictions violate the right to bodily autonomy. The criminalization of abortion care forces people to travel hundreds of miles out of their community to try to get care. As in other forms of criminalization, the people targeted for pregnancy loss and self-managed abortion prosecution are disproportionately people of color, immigrants, and people experiencing economic insecurity.
Throughout the more than 20 years that it has been used in the United States, medication abortion has been proven to be overwhelmingly safe and effective, and has expanded the way people choose to self manage their abortion. All Food and Drug Administration-approved drugs must be available in all States and territories. Research shows that with access to safe, effective methods and accurate information, people may safely self-manage an abortion on their own. Anyone who decides to end a pregnancy should be able to choose to self-manage an abortion at home with medical guidance and the support they want.
Abortion needs to be accessible where people live and where they access health care. For young adults on college campuses, student health centers are often where they access the full range of care they need, and medication abortion must be accessible and available to young adults who get their health insurance through their State colleges and universities, and three States (Massachusetts, New York, and California) have passed laws ensuring access to medication abortion on college campuses.
States have continually crafted legal restrictions to ensure that abortion care is burdensome or impossible to obtain. This strategy has led to more than 1,300 abortion restrictions enacted since Roe v. Wade was originally decided in 1973. These attacks are rooted in racism and compound the failures of the health care and economic systems to provide communities living with low incomes access to high-quality, affordable health care, and safe and sustainable communities. A lack of investment in both telehealth and reproductive health care is a significant barrier to an equitable experience of telehealth for medication abortion care.
Actualizing the promise of telehealth and technology requires centering equity by investing in broadband, cultural competency, health literacy, and digital and physical infrastructure development. Bans on insurance coverage of abortion compound barriers to health care access for immigrant and migrant communities, which can also include logistical barriers like travel costs and distance to clinics, lodging needs and costs, childcare costs and availability, limited access to translation services, culturally competent care inclusive of low-literacy services, lost wages, and lack of paid time off for health care appointments can all delay or prohibit abortion care.
Nearly two out of three people live within the 100-mile border zone that allows for interior Customs and Border Protection checkpoints where immigration officers have increased discretion to detain and question individuals. Immigrants of all statuses and people who are undocumented or in mixed-status families are deprived of the freedom to travel because of in-State immigration checkpoints that put them at even greater risk of criminalization, all of which contribute to a chilling effect for abortion access due to heightened threats of family separation, detention, and deportation.
In 2019, noncitizen immigrants aged 15 to 49 had three times the uninsured rate of naturalized citizens or people born in the United States (36 percent vs. 12 percent), and immigrants with low incomes fared worse, where in 2019 50 percent of noncitizen immigrants aged 15 to 49 with a family income below the Federal poverty level (earning less than $21,330 for a family of three) were uninsured. People held in immigration detention centers who are separated from their children and families face additional barriers to abortion care because of financial barriers due to the abortion coverage bans and other restrictions.
On November 10, 2022, the Office of Refugee Resettlement
(ORR)issued new guidance to ensure that unaccompanied immigrant minors have access to abortion while in ORR custody awaiting reunification with family in the United States. The Federal Government should implement policies regarding the detention of pregnant, postpartum, and nursing people, to ensure that no pregnant person is detained and if such detention occurs, that there is no barrier to abortion while detained regardless of the detaining agency. More than 40 percent of youth and children under age 19 and 12 percent of young people age 19 to 25 have health insurance through government programs. Pregnant people younger than 18 face additional barriers to accessing abortion care. Young people face parental involvement laws in 22 States where abortion is still available, or the exercise of a judicial bypass which requires minors to receive court approval to access abortion care when they do not have their parents’ knowledge or consent. Judicial bypass is not a meaningful alternative but instead another hurdle faced by young people. Many minors do not know judicial bypass is available or do not know how to get it, do not have access to transportation to travel to the necessary courts, or simply are denied bypass by resistant or biased judges. Abortion is one of the safest medical procedures in the country and leading public health organizations such as the American College of Obstetricians and Gynecologists, the American Medical Association, and the American Academy of Family Physicians strongly oppose efforts to impede access to abortion care or interfere in the relationship between a person and health care provider. The 2022 Violence and Disruption Report of the National Abortion Federation found an alarming escalation in incidents of obstruction, vandalism, and trespassing at abortion clinics, with abortion providers reporting an alarming rate of death threats and threats of harm, and documented 218 incidents in 2022, a 20-percent increase in death threats and threats of harm over 2021. Black, Indigenous, and other providers and patients of color face heightened levels of threats, harassment, and violence as compared to their White counterparts. In the face of multifaceted attacks on their work, abortion providers remain an essential and valued part of their communities, providing high-quality, compassionate, and necessary health care. There is a critical shortage of health care providers, including abortion care providers, and it is estimated that 28 percent of OB/GYN residency programs are based in States or territories that are currently enforcing abortion bans. Residents desiring abortion care training living in hostile States are forced to travel to States without abortion restrictions. Abortion care training residents face barriers to training including obtaining licensure and liability insurance, making it difficult for the next generation of abortion providers to provide comprehensive sexual and reproductive health care in their communities. In the face of the fear and stigma following the Dobbs decision, health care facilities have denied patients lawful emergency care because of the similarities in abortion care and miscarriage management. 91 facilities that provide abortion care have closed since the Supreme Court’s decision in Dobbs v. Jackson Women’s Health Organization. Of these, 62 facilities closed as a direct consequence of Dobbs and enforced or anticipated abortion bans. The ability to meaningfully access abortion gives meaning to the right to abortion. In the United States there is an existing support network, including abortion funds, providers, doulas, and many more, to help abortion seekers access care and navigate restrictions with expertise in providing patient-centered care. Investments to improve telehealth would improve care for people with barriers to accessing in-person care, people with disabilities, and rural communities, by providing expanded autonomy and decreased barriers to access. Creating more opportunities for telehealth services should not substitute building much needed capacity for high-quality, in-person care, particularly in underserved rural, low-income, and Black, Indigenous, and people of color communities. Removing Federal restrictions to abortion training and investing in clinic infrastructure, including clinic security, will allow more people to provide and more people to access abortion in a safe and healthy environment and help to alleviate the drastic shortage in abortion providers. Critical investments in evidence-based, patient-centered research and innovation is needed to ensure abortion care continues to meet the needs of patients across the country and will help to improve access and quality of care.