Handing reproductive rights advocates a major win that will have impacts beyond Texas, the U.S. Supreme Court ruled 5-3 on Monday to overturn a controversial abortion law in that state.
The decision voids a Fifth Circuit court ruling that upheld a 2013 law, signed by then-Gov. Rick Perry, that required abortion clinics to meet hospital-like standards for surgical centers and also required doctors who perform abortions to have admitting privileges at a hospital within 30 miles.
The admitting privileges requirement is what reproductive health experts say caused more than half of the abortion clinics in Texas to close. Obtaining admitting privileges is onerous -- especially in Texas -- because hospitals are sparse in rural areas, and some hospitals, especially religious ones, refuse to grant them to abortion doctors.
Plaintiffs in the lawsuit argued that such regulations are medically unnecessary and violate women's right to have abortions -- an argument with which the majority of the court sided.
"Both the admitting-privileges and the surgical-center requirements place a substantial obstacle in the path of women seeking a previability abortion, constitute an undue burden on abortion access, and thus violate the Constitution," the court ruled in its majority opinion.
Currently 24 states, most of which are led by Republicans, regulate abortion clinics beyond what the federal government deems necessary -- five of which require abortion providers to have hospital admitting privileges. Twenty-two states have laws on the books that require clinics to meet licensing standards for ambulatory surgical centers.
Health organizations largely praised the court’s ruling, with the American Public Health Association saying the decision means “safe, local reproductive health care cannot be denied based on out-of-touch medical practices that serve no benefit to public health.”
But the ruling is a blow to anti-abortion advocates, who have had increased success in recent years passing restrictions in conservative states. In a statement, the National Right to Life Committee criticized the court's decision.
“How shabby are these abortion clinics that they cannot meet the minimum standards other outpatient surgical centers are required to meet, and just how bad are these abortionists that they can’t get admitting privileges at a local hospital?” said Carol Tobias, president of National Right to Life.
The ruling only immediately applies to the two other states in the Fifth Circuit: Louisiana and Mississippi. Still, it's likely that the decision will spur other states to challenge abortion restrictions.
"It’s going to have serious ramifications throughout the states,” said Elizabeth Nash, senior state issues associate at Guttmacher Institute, an abortion rights think tank. “Neither side is giving up, and there are plenty of abortion cases still sitting in federal courts. This also isn’t the end of the story."
Here’s a look at five states worth watching in the months to come.
In 2005, Missouri became the first state in the country to require abortion doctors to have admitting privileges at a nearby hospital -- setting off a domino effect of legislation across the country. The state is one of five that has only one abortion clinic. A woman seeking an abortion in Missouri must also wait 72 hours after her initial appointment before she can undergo the procedure.
According to Planned Parenthood, women in Missouri travel 100 miles roundtrip, on average, to get an abortion. Because of this, many women in the state seek reproductive health care elsewhere: 3,324 residents traveled to neighboring states to get an abortion in 2013, according to the state health department.
Like Missouri, North Dakota has only one clinic, and it requires its doctors to have admitting privileges at a nearby hospital. The state has emerged in recent years as perhaps the most hostile toward abortion rights.
The state passed a law in 2013 -- considered the strictest in the country -- that banned abortions after the first detection of a heartbeat. That law has since been overturned, but the ruling didn't slow attempts to restrict abortion.
Abortions after 20 weeks -- except in cases when the woman’s health is compromised -- are illegal, and a woman must wait 24 hours after her initial appointment before getting the procedure.
Oklahoma has both laws on the books that are nearly identical to the struck-down regulations in Texas. Clinics are required to have admitting privileges and are required to meet surgical center standards. The state also imposes a 24-hour waiting period and requires women to receive counseling that discourages abortion.
Earlier this year, lawmakers passed one of the most extreme abortion bills ever that would have essentially banned the procedure. Republican Gov. Mary Fallin, however, vetoed it.
Tennessee’s abortion laws, which are similar to those struck down in Texas, are already being challenged in federal court.
In 2012, it became one of the five states that requires abortion doctors to have admitting privileges to a nearby hospital. Two years later, the state passed a law requiring clinics performing more than 50 abortions a year to meet surgical center standards.
Pro-abortion rights groups cheered the ruling there.
“We are thrilled that the Supreme Court knew these restrictions were an undue burden on women, and did nothing in regards to health and safety,” said Allison Glass, state director of Healthy and Free Tennessee, a reproductive rights advocacy group.“We’re really optimistic that this will be a turning point not only in regards to future litigation in Tennessee but any future legislation.”
The state also has a 48-hour waiting period for abortions, which is not facing litigation.
Utah passed one of the nation’s most controversial abortion laws this year. Any woman seeking an abortion after 20 weeks must be given painkillers intended for the baby, not her. While anti-abortion groups praised the legislation as humane, abortion rights advocates called the law scientifically unsound.
Similar to Texas, the state also requires abortion providers to be 15 minutes from the nearest hospital, the doctors must have hospital admitting privileges and the clinics must meet surgical center regulations.