One-third of the Margaret Sanger Center’s patients rely on Medicaid for their health care. In New York, Medicaid treats abortion no differently than any other health issue. But in 29 states, the program is barred from funding abortions in most cases except rape, incest, or to save a woman’s life. The prohibition is the most effective of all state laws in preventing abortions. “One-third of women who are covered by Medicaid and would have Medicaid abortions continue their pregnancies when Medicaid funding isn’t available,” says Stanley Henshaw of the Alan Guttmacher Institute. In 2003, Medicaid paid for 43 percent of abortions in New York City. Every year, pro-life legislators try to ban it, and every year they fail. “That’s one of the reasons we have one of the highest abortion rates in the country,” says Christina Fadden Fitch, the legislative director of the New York State Right to Life Committee. “It’s really sad. It’s like throwing abortion at the poor.”
Over the last year, Dr. Paul has noticed a singular trend: “We are providing more out-of-state abortions.” The number of women coming to Planned Parenthood’s New York City clinics has risen 21 percent.
The few existing studies on states that have passed abortion restrictions confirm the obvious: Women who want abortions leave the state to have them. Mandatory-delay laws, now on the books in 24 states, require a woman to wait usually 24 hours before getting an abortion. The versions that are the most effective in stopping abortions require women to make two trips to the provider, an obstacle for some who have to travel long distances, take days off work, or arrange day care. The most comprehensive study of these two-trip laws, a 1997 Journal of the American Medical Association paper on Mississippi’s experience, showed that three things happened in the state after the law went into effect. Total abortions went down by 12 percent. The percentage of late abortions (after twelve weeks) went up by 40 percent. And the percentage of Mississippians going out of state for abortions also went up by 40 percent. “For an economist, those are really strong behavioral responses to the law,” says Ted Joyce, the paper’s lead author.
The most common state restrictions have been the parental-consent or notification laws. Along with the delay laws, these cause women to travel out of state. Thirty-five states have a version of the law on the books. Nine other states have had their versions enjoined by a court, including New Hampshire, the state that is the subject of the Ayotte case. But as long as abortion is available somewhere, these laws have limited effect. “When Massachusetts imposed a consent statute, abortion rates fell a lot, 43 percent among minors,” says Joyce. “Yet if you measured abortion rates by state of residence, there was no change. Kids just poured across the border.”
Regulating abortion in the United States is like playing whack-a-mole. Every time a state tightens its laws, abortions rise somewhere else. If Roe is overturned, Cristina Page, author of the forthcoming How the Pro-Choice Movement Saved America, estimates that as many as 30 states would likely move toward criminalization, vastly increasing the traffic of abortion seekers into New York, just like in the early 1970s.
But then what? The lesson from the 1870s and the 1970s is that the more the city becomes a place of last resort for abortion, the more uncomfortable New Yorkers become with the procedure. Restellism produced bans nationwide. After the 1970 law was passed, several abortion-rights legislators in New York were drummed out of politics, including the tearful George M. Michaels. Later, the Assembly actually repealed the new abortion law, though it was vetoed by Rockefeller. When Roe was decided in 1973, it was like a giant release valve. The city was no longer inundated with planeloads of women dropping into town for the procedure. The end of New York’s monopoly brought the end of the more unsavory operators and practices that marred the early seventies.
Despite their overwhelming support for abortion rights, New Yorkers, like Americans generally, start to get queasy when confronted with the best weapons in the pro-life arsenal.
Despite the state’s overwhelming support for legalization, New Yorkers, like Americans generally, start to get queasy when confronted with the best weapons in the pro-life movement’s arsenal: graphic descriptions of rarely used late-term-abortion methods, and the fact that thousands of New York women return each year to clinics for a third or fourth abortion. When we nod our heads at Bill Clinton’s famous formulation that abortion should be “safe, legal, and rare” or Hillary Clinton’s more recent proclamation that abortion is “a sad, even tragic choice,” we admit some discomfort with the procedure.
Among New York’s pro-choice leaders, reaction to this message is divided. Political groups like NARAL say they understand the need for conceding to public opinion. But to providers, the Clintonian reframing of the issue capitulates to pro-lifers. “Hillary can say anything she wants about whether an abortion is a tragedy,” says Dr. Paul. “What I know when I perform an abortion for a patient is that the overwhelming feeling is one of relief. Because the abortion has solved a huge problem in her life, whether it’s because she couldn’t afford another child, couldn’t afford to be a good mother to another child, or doesn’t have the money to raise a child.” She becomes increasingly passionate as she speaks. “Every time I do an abortion I save a woman’s life. If you want to call that a tragedy”—she pauses and exhales a sharp sigh—“I don’t consider it a tragedy, I’m sorry.” Dr. Anne Davis of Columbia Presbyterian Medical Center thinks that even as New York retains its status as a restrictionless oasis, the larger war over normalizing abortion is being lost. “We would like to keep abortion part of regular medical care,” she says. “Our view is, abortion is nothing special. Abortion is right up there with having a baby or getting the care for whatever other medical needs you have.”